Providing humane health care

Not for the first time in Guyana, a large quantity of medical drugs has had to be discarded due to spoilage. This time, it was vaccines and the area was Region Two (Pomeroon-Supenaam), but this has also occurred elsewhere and is likely to continue for some time. In a report carried in this newspaper on Monday, Chairman of the Region Two Health and Sanitation Committee Arnold Adams said that an investigation has been launched into why the vaccines sent to health centres and health posts, and which cost hundreds of thousands of dollars, spoiled and had to be tossed out.

When drugs such as vaccines go to waste, one has to consider not just the financial cost, but the human factor. Since the vaccines would have been requisitioned by the health clinics and sent there to be used, then one has to assume that children, and maybe some adults, would not be able to access the necessary dosage at the desired time. Vaccines are used for immunisation against certain diseases and, therefore, whoever was unable to receive one because of the spoilage would be at risk of contracting a disease ‒ that is unless efforts were made to quickly replace them. Unfortunately, one does not get this impression based on the gist of Mr Adams’s interview with this newspaper.

Although Mr Adams said that the enquiry into the reason for the spoilage was ongoing, he was able to reveal, based on initial investigations, that vaccines might have been left at health posts where there was either no electricity or an unreliable supply of it. And this he blamed on health workers not doing “their jobs right”. Apart from having to treat sick people and administer vaccines, health workers are expected to fetch vaccines to and from clinics which have no electricity. This does not form part of the job description of those health workers’ counterparts in the city or established towns where there is, or should be, a reliable electricity supply.

However, Mr Adams, who also noted that in some instances the health workers had to travel long distances to store vaccines and used their own funds to do so, decried the lengthy period it takes for them to be reimbursed.

Mr Adams’s explanation raised a few red flags, a major one being how the vaccines are transported from hospitals and clinics where refrigeration is available, to the ones where they are to be administered. One wonders where the health workers are provided with proper cold boxes and carriers to ensure that the vaccines they are carrying remain at their optimum temperature and therefore viable.

It is worth noting here that not all vaccines can be stored at the same temperature. For example, the vaccines for polio (oral poliovirus or OPV) chickenpox (varicella) and measles, mumps and rubella (MMR) have to be frozen and must be kept at temperatures of between -50 degrees and -15 degrees Celsius prior to being used. This is according to guidelines set by both the World Health Organisation (WHO) and the US Centers for Disease Control (CDC).

In fact, the WHO warns: “Vaccines are sensitive biological products. Some vaccines are sensitive to freezing, some to heat and others to light. Vaccine potency, meaning its ability to adequately protect the vaccinated patient, can diminish when the vaccine is exposed to inappropriate temperatures. Once lost, vaccine potency cannot be regained. To maintain quality, vaccines must be protected from temperature extremes. Vaccine quality is maintained using a cold chain that meets specific temperature requirements…”

Obviously, this means that vaccines must remain at the required temperature during transport from one location to the next. To do otherwise would be to render it less than potent and when this happens it can no longer provide the disease protection it should. Furthermore, it is also recommended by the CDC that vaccines be stored in sole-purpose refrigerators and freezers, meaning, they should not be stored with or near food or beverages.

But vaccines are not the only medical products that need to be kept at certain temperatures. Proper storage of all medicines is crucial to ensure their effectiveness and potency. Most medicines come with instructions that they must be kept in a cool, dry place, away from sunlight and moisture and some indicate that they must be kept in the refrigerator. This is because they may become toxic, or less effective or expire quickly if kept at room temperature. Medicines that require refrigeration include most antibiotic suspensions, some forms of insulin (used to treat diabetes), Xalatan (used to treat glaucoma), some antidiuretic medications and even some arthritis medicines. Failure to follow storage recommendations of pharmaceutical products can result in contaminated products and loss of a lot of money.

The question which arises here is whether any health posts or clinics, which do not have electricity, carry some of these fairly common medications. One hopes not, but it is unlikely that health posts and clinics in remote areas where there are no hospitals only cater for immunizations. One must also take into consideration patients who do not have electricity and who are prescribed these medicines at hospitals and sent home with them.

There are many factors that have to be considered in the provision of proper and humane health care and these go beyond practitioners having a caring bedside manner, which all too often is also lacking.

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