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					THIS LETTER WAS WRITTEN BY SALLY MORRIS, A MISSIONARY TO SIERRA LEONE It is
being sent by Sally to a wide variety of persons across the US. I will be using part if not all of it in an
Operation Doctor Newsletter.

„FAKE‟
ARTICLE‟S PURPOSE
INTERNATIONAL DISPENSARY ASSOCIATION (IDA) FOUNDATION, based in Holland, The
Netherlands, was set up in 1972. It is a not-for-profit organization supporting health care in over 100
developing countries on a non-commercial basis. IDA supplies high quality medicines & medical supplies
at the lowest prices possible. It‟s drug supplies follow the World Health Organization‟s (WHO) List of
Essential Drugs. The UMC Health & Maternity Center (commonly known as “Kissy Clinic”) has been
ordering its medications from IDA for years. The order is placed with IDA through the CHRISTIAN
HEALTH ASSOCIATION of SIERRA LEONE (CHASL) in Freetown, Sierra Leone. OPERATION
DOCTOR pays IDA directly via bank transfer, & after that the order is shipped directly to Freetown
through CHASL.

In 1996, we initially placed one order per year in the amount of $4,000 USD. We usually ran out in
approximately six (6) months, thus forced to buy from various pharmacies locally, in Freetown. Our patient
caseload has grown significantly over the years, & our services also expanded to include a laboratory
department. This has correspondingly amplified our need for a larger volume of prescription medication.
OPERATION DOCTOR, an Indiana Area Foundation, has now supported the Kissy Clinic for seven years.
In 1994 OD sent Dr. Tom & Kate Foy, from Fort Wayne, IN, to resuscitate the clinic in Freetown - Kissy,
Sierra Leone. Dr. Foy & his wife Kate, a Registered Nurse, stayed approximately 4 months. Services
declined once again when they returned to the US, because Kissy Clinic was left without a doctor to
manage it.
In 1995, Dr. Dennis Marke, an outstanding young Sierra Leonean doctor,
volunteered for a year after rebels invaded & took over the rural hospital he had been serving for the United
     Brethren Church. In 1996,
OPERATION DOCTOR formally employed Dr. Marke & since then, OD has fully
supported the clinic in the following ways:
1. Provides salary for Dr. Dennis Marke.
2. Pays for IDA drug orders.
3. Ships donated medication/medical equipment/supplies from Indiana, USA.
4. Sends short-term medical & nursing personal.
Prescription Medications from Nigeria

To raise awareness of an urgent need for financial support to cover the escalating need for prescription
medications from INTERNATIONAL DISPENSARY ASSOCIATION (IDA) through OPERATION
DOCTOR (OD), an Indiana Area Foundation.

SELF-SUSTAINING ABILITY OF KISSY CLINIC
Kissy Clinic runs & operates on a cost recovery basis. From the proceeds of the IDA medication order paid
for by OD, & the donated medications from Indiana, the clinic pays staff salaries, utility bills, & covers
general maintenance. With an increase in its IDA order, the Kissy Clinic will increase the salaries &
allowances of its staff, further expand its services, & take increasing responsibility for its maintenance. Our
10 - 50% mark up on IDA products accrues enough profit from its quality meds to cover the costs listed &
keep some savings, but still charges much less than any local pharmacy.

IDA SHIPMENT
It takes at least six months to receive IDA shipments. This is a result of the rebel war, which led to the
closure of the bulk of mission hospitals that operated upcountry. For cost effective reasons, IDA must wait
until the few operating Christian Mission hospital & clinics order & fill a 20-foot container before they can
ship.
In the interim, we run out of our IDA stock & are forced to purchase substandard, sometimes absolutely
„fake‟ medications at prohibitive prices from the local pharmacy. For example:
1. The antibiotic Amoxycillin, 250 mg (1,000 tabs) costs 15,50 Euros ($13.36 USD) at IDA, but at the local
pharmacies in Freetown, the cost is 70,000 Leones ($32.18 USD).
2. The antibiotic Doxycycline, 100 mg (1,000 tabs) costs 8,50 Euros ($7.33 USD) at IDA but 70,000
Leones ($32.18 USD) when purchased locally. 3. The antimalarial, Quinine 300 mg (1,000 tabs) costs
29,70 Euros ($25.60 USD) at IDA, & 140,000 Leones ($63.63 USD) for 1,000 tablets here in Freetown,
SL.
The astronomical cost of the locally procured medications & the poor patient response to them often results
    in diminished health care. This sheds a negative light on our well-established image as efficient &
    capable affordable health care providers. The cost of our services increases whilst our efficiency
    becomes unpredictable because of the type of meds we use. One case in point is that of Mrs. Cecilia
    Karimu, wife of the UMC Conference Council Director. The average admission period for moderate to
    severe malaria (a basis for admission) is five days. In her case, she spent 18 days, only to realize later
    that the Chloroquine, Quinine & Artesunate, were all fake. The drug has been brought in by
    unscrupulous pharmacy businesses from Nigeria. Several such cases have embarrassed our practice in
    recent times.

PHARMACIST, MOSES BATEMA
Mr. Batema was trained at the University of Sierra Leone, College of Medicine. When asked if the fake
prescription medications from Nigeria resemble the authentic drugs in size, color, & packaging he stated,
“imitations are suspect when the manufacturers do not write their names & addresses anywhere on the
packages”. Also many brand names are very similar to the established drug, for instance “STOP ACHE” is
misrepresented as “SPOT ACHE”& the everyday consumer does not realize there is a difference.
Seventy percent of the suspect drugs that the Pharmaceutical Quality Control Laboratory checks are
completely fake or substandard. Like in most developing countries, this counterfeit practice has been going
on for a long time. Unfortunately, due to the rebel war over the last 10 years, the practice has intensified.
Importing drugs from the United Kingdom or United States of America are too expensive for patients to
purchase. They are very happy to buy them, but they do not know that these drugs, even though they appear
cheap, are quite expensive because they are simply placebos at best.

CUSTOMS REGULATIONS
Established customs regulations are in place & enforced by the Pharmaceutical Board Inspectors at the two
official ports of entry, Queen Elizabeth Quay & Lungi International Airport. No imported medication is to
be released without being inspected by the Pharmaceutical Board. Unfortunately, the PB is the only
regulator board for imported medicines in Sierra Leone, & it is under financed & under-staffed. Many
substandard pharmacies order their drugs to be delivered to unregulated ports. PBI only have presence at
these unofficial ports when (& if) they are called. This makes thorough monitoring all Sierra Leone‟s
incoming pharmaceuticals virtually impossible to monitor.

SUBSTANDARD MEDICATIONS
The substandard medications are sold to the local pharmacies just as if they had been inspected. By the time
they reach the pharmacies, they are basically unrecognizable as fakes without individual testing by the
PQCL. A few area pharmacies refuse to stock the unauthentic drugs, but often times they have no other
option. This is especially true when they run out of stock & the Pharmacy Board has only one approved
importer to supply the genuine drug. For instance, Artesunate, a commonly used antimalarial drug, is
ordered from a Chinese pharmaceutical dealer directly from the Chinese company. Some time ago the
Chinese importer ran out of stock & Artesunate was scarce on the market. The imitation drugs were
brought through the unsanctioned ports & all of Sierra Leones prescription market was stocked with fake
alternatives. Over 50% of the prescription medications ordered in this country are ordered from Nigeria.
Another common example of failed treatment is Ciprofluoxacillin, the first choice in treatment for typhoid
fever.
Because of the increased need for this particular Rx all sorts of dishonest pharmaceutical companies in
Nigeria are taking advantage of this lucrative opportunity.

IDA SHIPMENT NEEDED
As a result of the imitation medications, we have thought it good stewardship to put in a larger than normal
IDA order for all the following reasons:
    1.   Save & protect the reputation of efficiency our UMC Kissy Maternity and Health Center practice
         has strived so long to earn.
    2.    2. Encourage our hardworking staff by affecting an extremely long overdue salary increase.
         SPECIAL NOTE: The Government hospital is due to effect a salary increase in January 2002. As
         a mission clinic, we traditionally pay more because our services are more efficient & reliable.
    3.   Assume increasing responsibility for general maintenance.
    4.   Expand our services to include mobile clinics to the surrounding poorer communities, including
         the many internal displaced camps.
    5.   SAVE for more “rainy” days.



DONATION INFORMATION
None of us single handedly can put even a dent in this enormous problem of counterfeit medications, but if
we all join together as the body of Christ, mountains can be moved. If you are interested in providing
financial support to assure our Brothers & Sisters in Christ in Sierra Leone receive quality medications,
please note the following:
MAKE CHECKS PAYABLE TO: Operation Doctor* SPECIFY ON MEMO LINE: IDA order MAIL TO:

OPERATION DOCTOR
c/o Joe & Carolyn Wagner
P.O. Box 277
Colfax, IN 46035
USA

				
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