Drug shortages killing patients

In April, Dorcas Thokoane, 46, could walk to the 12 Apostles Church, in Moroka North, Soweto, 10 minutes from her home.

She felt good, even though she had terminal colon cancer.

Thokoane was prescribed Irinotecan, a life-prolonging cancer drug in July last year - and it was working.

She picked up weight and, despite being given only six months to live, was alive a year later.

But when she went for her treatment at Charlotte Maxeke Johannesburg Academic Hospital, in April, the drug was "out of stock".

It would remain so until her death on Saturday.

Campaigning for Cancer CEO Lauren Pretorius knows of five patients for whom Irinotecan was prescribed at the hospital but who could not be given it after April.

Pretorius does not know what happened to two of the patients because efforts to contact them last week were unsuccessful. One patient's colon cancer has now spread to his liver and lungs and he is not expected to live much longer.

The fifth patient has managed to get hold of the drug privately.

Pretorius said she was told that the hospital's pharmacy and therapeutics committee had decided not to continue providing the drug because of "budgetary constraints".

But it is not only Irinotecan that has been out of stock.

According to Campaigning for Cancer, drug shortages across the country are common.

Since January, the Stop Stock Outs Project has received 200 reports of shortages of medicine, including, on Wednesday, shortages of HIV drugs at Leratong Hospital, west of Johannesburg.

"People die every day because of stock-outs," said project spokesman Bella Huang.

She said a lack of accountability, financial mismanagement, and a paper-based clerical system were to blame.

According to the project's records, there have been about 100 reports of HIV medications being out of stock across the country since the beginning of the year.

When patients' treatment is interrupted, they face the likelihood of developing drug resistance.

The Stop Stock Outs Project records show:

• A shortage of quinine tablets at Hillbrow Clinic, Johannesburg, in February. Quinine is used to treat malaria;
• Refengkotso Clinic, in the Free State, experienced a shortage of HIV antiretrovirals in February. This was resolved in five days; and
• On July 18 there was a shortage of adrenaline at Tshiombo Clinic, in Limpopo.

In Mthatha, Eastern Cape, clinics had not received their May, June and July orders of medications.

The organisation's manager, Monique Lines, said shortages of medicines in certain provinces "must be declared an emergency".

Sometimes the suppliers were to blame, said SA Medical Association Trade Union spokesman Phophi Ramathuba.

She said orders were placed but drugs did not arrive.

"It's painful to tell a patient we don't have drugs. It's not a good thing. It's stressful for us [doctors]," Ramathuba said.

In Thokoane's case, her family contacted Campaigning for Cancer and it was only then that they were given "a proper explanation" of the circumstances surrounding her treatment.

Pretorius was told that the drug had been made available "off tender", which was usually resorted to if a head of department motivated for the drug to be obtained in this way because certain patients needed it.

Although the provincial and national H ealth departments have failed to respond to repeated requests for comment since Friday, an informal response was sent to Campaigning for Cancer last month.

The organisation was told that Irinotecan was not on Charlotte Maxeke hospital's list of essential drugs.

"We appreciate the difficulty that Mrs Thokoane must be facing and the hospital will continue to support her as best as possible," the e-mail read.

On Friday, Thokoane was in a hospital bed, unconscious, with just the whites of her eyes showing. "She can't walk and she can't speak," said her niece, Tumi Thokoane.

When visiting hours ended her relatives sat in silence, their faces blank.

"There is absolutely nothing to say," said Tumi.

On Saturday morning Thokoane died.