Kazakstan: Lethal Trade in Fake Medicine

The recent deaths of two children from a poisonous ointment rubbed onto their backs to cure rashes have alerted the Kazak public to the peril of buying quack potions from street market vendors.

Two-year-old Margulan, from the village of Karajan, in the south of the country, was rushed to hospital on January 29 and died a day later. Doctors diagnosed the cause of death as poison. The following day his brother Nurlan, aged four, died from the same causes. Four other family members needed hospital treatment as a result of the lethal grey ointment, which the children's mother had purchased a few days earlier at a market in Shymkent, the regional capital, on the border with Uzbekistan.

The Baltabekov family had suffered from a variety of skin problems, but instead of heading to the local doctor's surgery for advice, they followed up their relatives' suggestion and bought ointment at the local market - with disastrous consequences.

Jumabek Jyrauov, of the Kazygurt region's internal affairs department, said a sample of the lethal ointment had been sent for chemical and forensic examination, which will establish the precise cause of the children's deaths.

A pharmacologist, Sergei Viktorenko, confirmed that this type of ointment was in great demand, and is often smuggled into the region from Russia, Uzbekistan and Kyrgyzstan. Where this particular bottle came from cannot be determined, as the packaging on the drugs is invariably forged.

The content of fake drugs sold in markets is frequently diluted, or is subsituted with other substances. In the case of illegally produced tablets and powders, for example, the original contents are often replaced with chalk or clay.

One reported case last year involved a patient, who thought he was being administered a medicinal liquid to boost the immune system. In fact, the bottle contained ordinary tap water, coloured with tea.

"There is a considerable amount of counterfeit medicine at markets, most of which is smuggled in from Uzbekistan," said Nurlybek Asylbek, head of the regional administration for pharmaceutical control. "Only a specialist can detect a counterfeit by its appearance."

Asylbek said government specialists were regularly checking on the medicines sold in registered chemists, and warned that chemists violating the law would lose their licenses.

Last year, the pharmaceutical control administration detected violations at 60 chemists in the region, and shut down four of them. The administration has only been working for a year, before which no one had monitored Kazak chemists for a decade. Typical violations included sales of smuggled medicines and medicaments that were not on the state register, and incorrect storage.

The authorities in south Kazakstan have also set up a commission for licensing and post-licensing control, under the auspices of the health ministry. Last year, the commission investigated 105 medical and pharmaceutical outlets in Shymkent, and recommended that 45 of them be closed.

The problem is that neither the pharmaceutical control department nor the other official medical bodies have any means of putting pressure on the market traders. All they can do is check the network of licensed chemists.

Asylbek said his officials had sent letters to Shymkent city's sanitary and epidemological station, which is supposed to check the quality of goods sold at the street markets.

But a sanitary doctor at the station, Jumagali Muzafar, told IWPR that this was not, in fact, their business and that his colleagues were authorised only to monitor sanitary and hygiene violations there.

It is a vicious circle. No one can put pressure on the market traders, in spite of a government decree in 1999, which categorically forbids the sale of any medication outside official chemist organisations.

The pharmaceutical control department can consult the prosecutor's office, and can write letters of complaint to various authorities, but cannot close down the sales points. It is not even authorised to institute checks on them, as the government has imposed a nine-month moratorium on checking procedures by official inspection bodies on small and medium-sized businesses. As a result, people with no medical education whatever can continue to sell medicines of unknown origin and quality at markets.

Toxicologist Bakhytjan Akhmetov says medical poisoning as a result of these drugs is not uncommon.

Cardiologist Chokan Baimukhamedov said counterfeit antibiotics, medicine to reduce blood pressure, and heart drugs remained widely available in the region.

"There is no guarantee that you will buy good medicine even at chemists," said Baimukhamedov. "Patients with heart disease suffer particularly from poor quality medicine. Most counterfeit medicine is harmless, but lacks the required effect. Patients suffer from this, as do doctors, as if there is no improvement, patients doubt the doctor's competence."

At the moment, officials are unable to deal with the sale of medicines at markets, whose authorities simply ignore the law: stalls laden with pharmaceuticals standing side by side with those selling groceries and industrial goods.

Olga Dosybieva is an Interfax correspondent in South Kazakstan