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Quality pharmaceutical care is a right

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In Lesotho, there are undeniable disparities in the access to quality healthcare services between rural and urban populations. Populations in the rural areas have been subjected to poor healthcare services, especially the pharmacy services, for decades.
In most rural clinics, pharmacies are run by a nurse, a nursing assistant, a high school graduate, a cleaner, a gardener or a “trained” patient. Patients in such areas are continuously exposed to an immeasurable danger that unfortunately always goes unnoticed and unrecorded.

Why should these populations be excluded in efforts to address challenges facing patient care? I was shocked that even with the support of NGOs in the healthcare services provision, all primary healthcare facilities in districts like Butha-Buthe as well as many other rural communities countrywide have never enjoyed any support in terms of qualified pharmaceutical practitioners.

This puts such communities in great danger of unsafe use of medicines than the communities who have access to qualified pharmacy professionals (Pharmacists and Pharmacy Technicians). The lack of equity in the access of quality healthcare services is truly a public health threat and a clear violation of human rights. Health is a right and the entire nation has a right to quality healthcare, not only urban residents.

For years, Basotho have been exposed to harm associated with inappropriate use of medicines and it is unfortunate that this has been going on through the entire health system (public and private sector). One would have thought that the Ministry of Health would, as a custodian of public health, provide leadership in promoting quality health care, including the pharmaceutical care in public clinics and hospitals.

I would have thought that they would also demand compliance from the private sector. But no! Not in Lesotho. It is indeed worrying and scary at the same time that the Ministry of Health, supposedly knowing the importance of putting the community’s lives in right hands (doctors & clinical associates, pharmacists & technicians, nurses & assistants, dentists, medical lab technicians, physiotherapists etc.), could decide to instead expose the people to the harm that threatens their lives by not enforcing the procurement of qualified personnel in their clinic facilities.

I would like to point out that the access to quality pharmaceutical care is a right and the Lesotho Medical, Dental, Pharmacy Order of 1970 clearly states that. No communities should be deprived of this right, because medicines in the wrong hands is a threat to this right and patient safety!
Why is the Ministry of Health failing to comply with the provisions of this law? Some 15 years ago, the health system was faced with a scarcity of pharmacists since local pharmacists were trained outside the country and the Ministry of Health trained informal practitioners to dispense medicines in the clinics to try and respond to the public health needs during those days.

Although the Ministry of Health was still obliged by law to ensure that medicines were in the custodianship of pharmacists, which would necessitate them to employ expatriate pharmacy professionals at that time, the issues of financial constraints were cited, and contingency plans as described above were put in place.

Lesotho then resorted to training pharmacists locally in a quest to respond to public health needs. I am surprised that despite the availability of locally-trained pharmacists, and notwithstanding the provisions of the law (Lesotho Medical, Dental, Pharmacy Order 1970), the government of Lesotho through the Ministry of Health has always failed to ensure appropriate custodianship of medicines by pharmacists.

Why were pharmacists trained through the public coffers when they are not given a chance to care for the nation? Why do we still have cleaners giving out medicines to patients? Why are nurses and nursing assistants still in the pharmacy? Isn’t the Lesotho Medical Dental and Pharmacy Council (LMDPC) the custodian of Medical Dental Pharmacy Order 1970?
Why are they quiet? Who is responsible for ensuring public safety with regards to medicines? What will it take for the Ministry of Health to comply with the provisions of the law concerning the pharmaceutical sector?

It is shocking that the government of Lesotho wants to make issues of quality pharmaceutical care optional. Why do they want the pharmaceutical services to be provided by people who are not qualified in the field despite the availability of qualified personnel?
Has anyone thought of taking their child to a school where teaching is done by unqualified “teachers”? Why is this nation deprived of a chance to receive care by qualified pharmacy professionals? What will it take for those responsible to do what is right?

When are we going to start regulating the private sector to ensure public safety issues related to medicines use, when they experience same dangers in public sector?
Pharmacists and pharmacy technicians are the only members of the healthcare team who have a training in “Pharmaceutical Sciences“, and are the only group that has skills in determining the quality and ensuring safety of medicines.

Pharmacists as “experts in medicines”, are a backbone of “curative medicine” and should not in anyway be treated as an optional cadre in the provision of healthcare. This is a cry for help; our communities are in so much danger inflicted by medicines, talk of antimicrobial resistance and substance abuse!

Tebello Sarele is a Pharmacist with a Bachelor of Pharmacy (Honors) from NUL, Master of Health Sciences_Antibiotics Stewardship and Conservation from UKZN.

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Insight

Shining Like Stars: Part One

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Last week, in a piece titled “Hope Springs Eternal”, I wrote about the relative values of (leftist) political commitment and Christian faith in a world that is beset with violence, poverty and oppression. Now I’m offering a review of a book by Lindsay Brown titled Shining Like Stars: The power of the gospel in the world’s universities, which explores the work of evangelical students in propagating the Christian faith in some of the world’s most dangerous countries, such as Columbia, China, Russia, Sudan and the DRC. Countries where despair seems to be a pretty rational response to the lives that huge numbers of people are forced to lead. I shall concentrate on cases where that effort to spread the Christian faith is allied to a commitment to agitate for better political and social conditions.

As an aside, I begin by quoting Will Shoki, editor of the invaluable online opinion journal Africa is a Country. I know I’ve mentioned him at least once in previous weeks, but that is because they are so good. In a piece Shoki wrote for the edition of March 4th this year, he records the Marxist philosopher Slavoj Zizek’s reference to “the courage of hopelessness”, whereby “it is only when we despair and don’t know anymore what to do that change can be enacted.” Shoki adds: “I have never been quite sure what this means — in fact, I have never been quite sure what Zizek means about anything.” Which is to say, Zizek is a pretty difficult read, but his work is a nut it’s well worth cracking.

Be that as it may. Let us turn again to the question how, in a harsh world largely run by greedy, selfish, murderous brutes, a dedication to the message of the gospels and a commitment to political and social transformation can be a joint life-saver.

Lindsay Brown, the author of the book I’m reviewing, was for many years General Secretary of the International Fellowship of Evangelical Students (IFES). Towards the end of his book there is an Appendix in which he lists around 150 student organisations worldwide that are affiliated to IFES. Many countries where IFES-allied groups have a strong presence are only nominally Christian, many others (for example, China and the Gulf States) are hostile to the gospel. In Lesotho — where neither of these impediments holds — the relevant body is called the Scripture Union of Lesotho, Tertiary Ministry (SULTM); as Brown’s book doesn’t touch on Lesotho, I’d be very interested to hear from my readers about the activities of SULTM.

The first chapter of Shining Like Stars is titled “Never Underestimate What Students Can Do.” This begins by recounting the story of Daniel and his three fellow captives in Babylon under the tyrant Nebuchadnezzar, the story that ends with three of the young Jews being saved by their faith when they are cast into the burning fiery furnace. Then there are reminders of the long history of evangelism in western Europe, followed by the observation: “world mission is less and less about westerners going elsewhere to serve Christ, but about believers from everywhere going everywhere . . . for example, during the twenty years of civil war in Chad its displaced students, sent by the government to study in other countries, founded IFES movements in Niger, Mali, Côte d’Ivoire, Senegal and Burkina Faso.”

One of the first of many testimonies the book contains is, however, from a female British student of Russian, identified simply as Elizabeth, who travelled as an evangelist to one of the -stan countries, former Soviet republics of Central Asia (which of the former -stans this was isn’t specified). It was a perilous but highly successful mission. Elizabeth records: “My birthday was fun. I had five cakes and three parties. They really know how to make cakes here!” Not much peril involved in that, you might say. But then Lindsay Brown notes that many sensitive words in Elizabeth’s testimony have the letter “x” inserted in them and explains that this was to escape electronic surveillance.

And so it seems being an IFES evangelist can be a bit like being James Bond, except more graceful. The second chapter in Brown’s book is titled “Our Sovereign God and Human Courage” and that’s where I’ll pick up the story next week, as well as detailing the activities IFES evangelists organize to attract students to the gospel. And then — after all, the chief focus of this piece — how they strategise evangelical work in relation to the advocacy of political and social transformation.

To be concluded

Chris Dunton

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Insight

Hope springs eternal

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Given the abysmal state of the world today, what is it that keeps one going? I mean, just look at the mess we’re in. The cowardice of world leaders faced with the challenge of climate change —world leaders most of whom are, of course, in thrall to capitalism (for when it comes to our mismanagement, that’s what really rules the roost). The appalling violence in Ukraine and the Middle East. The apparently endless misgovernance of countries as diverse as Lesotho and Nigeria. How does one not give into despair?

Me, I have an interim resource and a vastly more profound one. The former is my commitment to left-wing socialism, a conviction that life on earth can be vastly improved by following the principles of Marxist-Leninism (not — an important qualification — the corrupt form of those principles that moulded dictatorships such as the Soviet Union). The second resource is faith in the message of the Gospels, the embracing of our Lord Jesus Christ. For with this, the ills of the world pale into insignificance. Which is not — I absolutely insist — to refuse the responsibility of political commitment to ease the suffering of millions on earth, a duty we have while we’re still stuck on the bloody place.

Of those two resources, one allows a limited, constrained kind of hope, the other a hope that is boundless.

To expand on the notion of hope, recently in these pages Bishop David Ramela quoted the great Czech author and political leader Vaclav Havel, who became President of his country after resisting Soviet oppression in acts of dissidence for which he was imprisoned. Havel, as quoted by Bishop Ramela, wrote: “I am not an optimist, because I am not sure that everything ends well. Nor am I a pessimist, because I am not sure that everything ends badly. I just carry hope in my heart . . . I am thankful to God for this gift. It is as big as life itself.”

Hope as distinct from optimism? Well, a couple of references here. First, the great Italian Marxist Antonio Gramsci (like Havel, imprisoned for his beliefs, in his case by Mussolini’s Fascists) wrote of the need to maintain “pessimism of the intellect, optimism of the will.” In other words, any reasonably intelligent person knows that things are going to screw up, but must act as if this were not the case. And another Marxist, the British critical theorist Terry Eagleton (the mentor of your columnist, incidentally, when he was an undergraduate — and ever since) has written a fine book, Hope Without Optimism. I shan’t go into that here, but shall review it in this column in a few weeks’ time.

Turning to the relationship between political commitment and the Christian faith, the evangelist preacher Robert Sheehan once commented: “Many Christians put more weight on political programmes and economic packages than on the power of the gospel in the nation. Do you?” The answer, I would hope, is “no”, but “quite a lot of weight all the same.” And I’m going to sign off this week with a lengthy quotation from the New Testament—namely, Ephesians 2: 14-22—which has to do with the relationship, in the time of Paul’s evangelism, between Jews and Gentiles. It is a passage — to refer to my piece some weeks ago on the Gaza crisis — that one would like to read to the Hamas leaders in Palestine and to Israeli leader Binyamin Netanyahu before banging their heads together.

“For He Himself is our peace, who has made both one, and has broken down the middle wall of separation, having abolished in his flesh the enmity, that is, the law of commandments contained in ordnances, so as to create in Himself one new man from the two, thus making peace. And that he might reconcile them both to God in one body, through the cross, thereby putting to death the enmity. And He came and preached peace to you who were afar off and to those who were near. For through Him we both have access by one Spirit to the Father. Now, therefore, you are no longer strangers and foreigners, but fellow citizens with the saints and members of the household of God, having been built on the foundation of the apostles and prophets, Jesus Christ Himself being the chief cornerstone, in whom the whole building, being fitted together, grows into a holy temple in the Lord, in whom you are also being built together for a dwelling place in God in the Spirit.”

Joining, harmony, hope.

Chris Dunton

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Insight

Reading and emotion

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What does a good piece of writing do? How does a piece of writing evoke emotions in you? Well, reading is a good art that can stimulate and sharpen our sensibilities. In this instalment we focus on the emotional journey triggered and enabled by good literature. While other books may educate us and sharpen our cognitive abilities, that is the abilities to think and solve problems, reading literature of fiction does more; it stirs our emotions and sharpens our affective capacities.

By affective capabilities, we refer to the abilities to feel and tune in to our emotions and sensibilities. Life, after all, is not only about heart facts and reason. Life is about feeling and experiencing and the ability to put ourselves into other people’s shoes. Reading literature is so liberating and humanistic! Reading art in all its many genres grounds us in the varieties of human experiences and engenders in us tolerance, understanding and empathy.


Stories have a way of taking us on journeys real and imagined which stories transform us from the inside. These stories allow us to visit far-flung places and meet new people and feel their environment. Art has a way of mending bridges because through stories we come to understand people who may seem different from us. And at times we may have felt hatred and dislike for them and their way of doing things. But through reading about them, we hear their stories. We experience that which they are experiencing. We begin to see them from the inside out, and we get to know what lies underneath their skin, so to speak. That’s why they say that we can only begin to make sense of the world once we have reduced the whole world to stories. Let’s write a small story together and ascertain how it would move us. Let’s go.


“He trudged on thinking how he would approach Mwandionesa. Her warm and coy smile flashed before his eye.


Slowly mustering up a morsel of self-belief, Themba trudged along the battered, winding road in the heart of a thicket of musasa trees in the Musirizwi enclaves in Chipinge, south-eastern Zimbabwe. Like a heavy burden, a gnawing sense of failure nibbled at his conscience and a sense of uselessness clung on the air with unrelenting defiance. The stain of failure, the feeling that his people and he were inconsequential had taken lodging in his entire being. That is why he found a sense of solace only from isolating himself in his flimsy cocoon of loneliness like the proverbial ostrich which buried its head in the sand. He would have an occasional home-brewed beer called chikeke and thereafter lock himself within the labyrinth and sordid visceral being.


A gaunt bird flew overhead and he heard its flapping feathers amidst the thickening doom and darkness. “Bird”, he retorted to its presence, “what would you do if you were ever crushed by the label of failure.” A soft, warm tear tricked down the rugged terrain of his face. “Makauyo went to Egoli and returned without a name to himself, Khuyumani, too, lies buried in the bowels of the soil with nothing to show” he said as if he were speaking to the bird.


As he touched the cold handle of the door to his heart clutching a small, whimpering puppy in a cardboard box, he could hear the breathing of Mwandionesa and her stabbing, moist eyes asking him without a word where he has been for the last three days. He stood for a moment which seemed like an eternity. With false bravado, he mustered a not-so-convincing, frail knock. Mwandionesa, heavy with child, slowly made for the door and slid it open. Themba did not know what to do. He loved her but he did not know how to express it, like a person bereft of a language. Mwandionesa rummaged her pots on the dying embers of a hearth and gave him respectfully a plate with sadza and a small portion of chicken. A tear escaped-one, two, and another! She broke down, a downpour of tears streaming down her lips. “Themba, ngendaa yei weidaro mwamuna wangu? Indaa yei ndiripe Dube? Indaa yei weiita mukuba wekunzerereka kungaitei imbudzi irikumakaba isina unousha?” (Themba, why do you treat me in a manner? Why do you behave as if you are a stray goat without a shepherd? If I have wronged you I am prepared to appease you”).


“Look at me, Themba,” she demanded as a visibly pregnant and swollen stomach bulged through her threadbare blouse. The puppy whimpered plaintively. With hesitation Themba went to where Mwandionesa stood. With his furrowed labour-weary hands he touched her waist and led her to their mat of reeds made of “umhlanga” as she was fond of referring to reeds. She did not protest. A glow, a faint glow burnt in her eyes as she eased comfortably on his lanky chest. She fumbled for his hand and shepherded it to the lower regions of her belly and said, “He was kicking all these days you were away.” Themba was engulfed in a flurry of emotions; guilt as well as pride. With deliberateness, Mwandionesa said, “this boy will be called Thando. Yes Thando. He will build this homestead and more should you feel that you don’t have a home.” Themba nodded in agreement.
Themba began to feel the warmth of her presence as her succulent breasts pressed against his lanky chest and slowly closed his eyes…”

What a gripping tapestry which evokes a lot of emotions! It’s a story that stirs a lot of emotions; from empathy, sadness and an inner glow in the heart at the end. As the story begins, we feel Temba’s struggles, fear and hopelessness. He seems to be carrying a huge emotional burden and a crushing sense of defeat. I hope you have also seen Temba’s bid to reassert his sense of being and purpose through his desire of caring for a puppy – we could actually feel it whimpering. And the new hope ignited at the end of the story and affirmations of hope and new beginnings! The birth of a child always brings with it new beginnings – hope springs eternal!
So here we are! Stories are so humanising. Learning to read art in all its genres evokes emotions in us. It sharpens our affective side and warms our hearts.

Vuso Mhlanga teaches at the University of Zimbabwe. For almost a decade and half he taught English language and Literature in English at high school. Send your comments and questions to: mhlangavuso85@gmail.com

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