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Yaguina Nesly waits outside a hut whose walls of corrugated steel are daubed in green and white paint.
It is one of a large number of unlicensed pharmacies in Bangui, the capital of the Central African Republic (CAR), outlets for cheap medication for the city’s many poor.
The informal pharmacists known as “doctas” flourish despite worries that they dispense counterfeit drugs, offer flawed medical advice and foster antibiotic resistance.
“I always buy my drugs here because you can only get an appointment in hospital if you’re lucky,” says Nesly, 23, with her nine-month-old baby swathed on her back.
“I prefer to come to my neighbourhood docta. It’s faster and cheaper,” she added.
A patient buys medicine from Stephen Hyppolite Liosso Pivara Bembe, a former medical student who was never able to finish his studies, in the small street pharmacy he owns in Bangui on February 21, 2022. PHOTO | BARBARA DEBOUT | AFP
Inside the makeshift structure, 33-year-old Stephen Liosso-Pivara-Bembe hands someone pills for stomach pains.
Wearing a white coat and with a stethoscope slung around his neck, Liosso-Pivara-Bembe says he started medical school but never finished because he ran out of money.
He works seven days per week in the store which is decorated with pictures of yellow pills and a sign in white letters reading: ‘Health First’.
People from wealthier economies may sneer or be shocked that illicit pharmacies openly trade like this.
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But in the impoverished CAR, doctas are widely appreciated for providing a rough-and-ready safety net for health.
The landlocked country is struggling with a decade-long civil conflict and ranks the second poorest country in the world in the UN’s 189-nation Human Development Index.
It has just 0.1 doctors per 1,000 people — 30 or 40 times fewer than countries in Western Europe, according to World Bank statistics.
Stephen Hyppolite Liosso Pivara Bembe, a former medical student who was unable to finish his studies, takes the temperature of a child at his small street pharmacy in Bangui on February 21, 2022. PHOTO | BARBARA DEBOUT | AFP
No official figures for doctas
Around 70 percent of medical care is provided by humanitarian organisations and 2.7 million people which is around half the population need health assistance, according to the UN’s Office for the Coordination of Humanitarian Affairs (Ocha).
There are no official figures for the number of doctas. But as an anecdotal guide, AFP counted 10 of the illegal pharmacies just in one major street in a rundown district.
Long lines of people form here, especially in the evening.
In Bangui’s fifth district, a 39-year-old student nurse Antoine Bissa, was hard at work in a store named Biba Pharma.
He said he treated around 100 people per day for injections and drugs, working until 11 pm. He also said the business was the sole source of revenue to support his four children.
“Most of my clients come with symptoms of malaria or a fever or in need of anti-parasite treatment and first aid,” Bissa said.
He said he offered free consultation and cheaper drugs compared with conventional outlets.
“But if they are seriously ill, we tell them to go to hospital for extensive treatment,” Bissa said.
Among the customers waiting for a docta was a 35-year-old civil servant Gilles Doui, who had muscular pains.
“I have three children and I don’t earn enough to go to a regular pharmacy. I prefer buying just a few pills rather than shell out for the whole package,” he said.
“We sell drugs in line with what people can afford,” Liosso-Pivara-Bembe said.
He said purchasing drugs in neighbouring Cameroon and Congo as well as in France, meant he could keep costs down.
“For example, a box of Vogalene (an anti-nausea medication) costs 7,000 CFA francs ($11) but you can get it here for 5,000 CFA francs,” he said.
Patients wait to see Antoine Bissa, a nurse and the owner of a street pharmacy in Bangui, on February 21, 2022. PHOTO | BARBARA DEBOUT | AFP
Dawili supports crackdown
The CAR’s pharmaceutical regulators are struggling against a phenomenon that for all its faults, meets a desperate social need.
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“We don’t work with the mini pharmacies,” said Romuald Ouefio, head of the department of pharmaceutics and traditional medicine at the CAR Health Ministry.
“They are in the informal sector and encourage the spread of drugs of poorer quality, or counterfeit ones,” he said.
There have already been cases of antibiotic resistance through the incorrect use of drugs.
“In a few months’ time, we are going to have a meeting with owners so that they are prepared for switching to other lines of work,” he said, describing this as a prior step before a “very firm crackdown.”
Jules Dawili who runs a medical lab in Bangui, agreed that antibiotic resistance had become a concern because of misuse of drugs or over-the-counter sales.
He pointed especially to amoxicillin used for treating bacterial infections, and doxycycline used for preventive treatment of malaria.
Even so, Dawili said, he did not feel “100 percent” supportive of the crackdown.
“Some of them (the unlicensed pharmacists) are competent,” he said. “The government could select these ones, give them training and make them pass tests so that they can help health professionals.”
“If the government closes the mini pharmacies, it will be doing nothing for people who can’t afford” drugs in registered outlets, said Nesly, the young mother. “A lot of people are going to die.”
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