GIVE me pandadol for one hundred shillings and quinine for three hundred shillings.” This is not unusual in Uganda where virtually any medicine can be bought over the counter from shops ranging from pharmacies to drug stores and kiosks. Self-medication is a growing phenomenon and is being furthered by the availability of all sorts of literature telling the public what medicine to take for any condition. In the past, medicine was strictly taken on direct orders from doctors and purchased only from chemists, who made the medicines.

However, today everyone – from your charcoal seller in the market to the news reporter – all can volunteer you purported ‘expert’ advice on what medicine to take for any complaint that you have.

Self-medication is when one buys or consumes medicine without consulting a health worker about the symptoms that they are experiencing. It is also when you decide to take your medicine in a way different from what your health worker told.

Further, it is when one shares medicine with another, or when the person receives a certain medication with the prescription of a health worker, got cured at one moment, but later use the same medication when that person or someone else develops symptoms similar to the disease, which the medicine treated that time. This is done without going back to the health worker.

Today, the medicines most used for self medication are painkillers like aspirins, paracetamols (hedex, action, rapid etc); brufen, indocid… the list is endless; anti-bacterial medicines like amoxyl, ampiclox, flagyl and several others; as well as anti-malarial medicines. It is also becoming fancy
to take food supplements, vitamins and herbal remedies without consulting healthcare providers.

The Dangers
A doctor in the 1500s concluded, “all medicines are poisons!” In most medical schools worldwide, this is usually the opening statement on the day students are introduced to pharmacology (study of medicines).

This statement means all medicines have the ability to kill and kill they will if they are used wrongly. The greatest danger of self-medication is that a layperson does not know that medicine is not a one-size-fits-all kind of thing and that drug doses are usually given according to body weight. Nonmedical persons also don’t know that people with certain diseases would react gravely to some medicines or that the dose could be changed to fit the person.

Laypeople may not know that drugs interact with other drugs and with other substances that we eat and drink so that taking a drug that is usually harmless may cause harm if the person is on a another medication or eats or drinks a certain substance. Medicine interacts with the different systems of the human body.

When a doctor is prescribing medication, he or she is actually thinking about all this. That is why he or she will give you pandadol for your headache and the next patient he sees with a headache may receive diclofenac.

One of the dangers of self-medication is the development of drug resistance. Because the main purpose of self-medication is to get rid of a certain pain or discomfort, people usually take the medicine and stop as soon as the discomfort goes away. This has been the main cause of what is known as drug resistance and has contributed to how expensive newer drugs are.

Drug resistance is when an organism that causes a certain infection can no longer be killed by medicine that used to be able to kill it in the past. The most common example in Uganda, is malaria.

Malaria used to be treated with chloroquine. But, over a long time, people were missing some doses of it or taking it for less than the three days that they were meant to take it. As a result, the malaria parasite became resistant to chloroquine.

The ministry of health then advised that malaria be treated with chloroquine and fansidar. But, even then, people would take a few tablets and stop as soon as they felt better, the malaria parasite also took advantage of this and became resistant to the combination.

Then, treatment of malaria was changed to artemether / artenam, which was abused in the same way until about a year ago, when the treatment of malaria was changed to coartem and duo-cotexin. It should be observed that each time the medication was changed, it became a more expensive type and the malaria parasite would become resistant even to this new medicine for as long as people failed to take it as the doctors or health workers advised.

Resistance
This develops because people do not take their medicines at the exact time that their doctors
tell them to and for the number of days that they have been instructed. Medicines are meant to kill
organisms that cause infection. But, for this to happen, there must be a certain concentration of
the medicine in blood and that is why medicine should be taken a certain number of times in a
day and for a certain number of days.

If, for instance, one got diarrhoea and the doctor told the person to take medicine every after eight hours for five days, but the persons decides to take it only once or twice a day for only three days and stops because the person feels better, when he or she starts on the medicine, it kills some bacteria. But, because it is for fewer times than prescribed, the bacteria receive only small amounts of it and instead of killing them off, affords them chance to change and become too strong for the medicine. In other words, they become resistant to the medicine so that next time you get that infection you will not respond to the medicine that worked the first time.

Self-medication has often been the reason why some dangerous illnesses have been missed until very late. For example someone may treat a wound for months and by the time he decides to come to hospital may be discovered that the wound was not healing because the patient has diabetes and by then the wound may be so festered that the affected leg may require amputation (cutting it off).

Sometimes a headache is treated for days and yet the person has high blood pressure or meningitis, which can kill if not managed by a doctor. Self-medication has also been found to be the start of many addictions.

Popular musicians from the past, like Elvis Presley, are said to have died as a result of addiction to normal medicines (not illegal drugs). A lot of teenagers these days are getting addicted to cough syrups because they have a substance in them that makes them feel good and so since it is very easy to buy the syrups without a prescription, more teenagers are buying and getting addicted to them.

Benefits To Self-medication
Some of these reduce on the workload of health workers. Without the availability of medicines that people can buy without prescriptions, there would constantly be long queues in health units, of people seeking prescriptions for things as minor as headaches or muscle pain after exercise.

It is also important for illnesses, which may occur at a time when one cannot immediately access a health worker. For instance in an accident or if one is far away from a health unit, selfmedication
could be applied as an emergency

First Aid Kit
In my primary three, our science teacher would often say, “first aid saves life.” How correct his word was. First aid is the immediate treatment someone in need of medical care receives before he or she is taken to a hospital.

It is important for every household and every car owner to have a first aid kit (commonly called a first aid box). It does not have to be a special box, although preferably it should be a box or cupboard that can be locked to keep children from opening it.

However, you can get any box and label it with a ‘red’ cross so that anyone can tell what it is. If it is a box without a lock, make sure it is placed where children cannot access it even when they climb on a chair or table.

The contents of a first aid box should be basic medical equipment and medicine including gauze,
both sterile and non-sterile, plasters of different sizes, cotton wool, bandage, gloves sterile and
non-sterile, disinfectant and antiseptic like dettol, basic pain and fever medication like aspirin and
panadol. Other contents will depend on what other illnesses are in the family, for instance if there are people with allergies in the family, there should be an antihistamine like piriton, cetrizine or loridine.

If there is an asthmatic in the family, there should be an inhaler; if someone with high blood
pressure, epilepsy or diabetes, then back up of their medicine should be in the first aid box too, in
case what they have runs out.

All the medicines should either be in their original factory packaging or put in airtight plastic pill envelops (these are available in pharmacies and drug shops). Label the packaging and include instructions on how they should be used.

If the medicine is not in its original package, the date on which it was purchased should be written on the envelope so that family members will know how long the medicine has been in the box. However, I must caution here that the box should be checked at least once every month and expired medicines rightly disposed of. I encourage people to take classes in first aid, that they can know how to handle emergencies.

Finally although self-medication may be beneficial, it has several dangers. One of the first duties of the physician is to educate the masses when not to take medicines. The layperson must be made aware of the dangers of uncontrolled use of medicines and doctors should encourage their patients to only purchase medicines from qualified pharmacist or dispensers.

Dr. Miriam Laker Opwonya-Oketta
Coordinator ARV-Kaposi’s Sarcoma Study
Infectious Diseases Institute, Makerere University
drmiriaml@yahoo.co.uk