Antimicrobial resistance, according to WHO definition, is a broad term encompassing resistance to drugs for treatment of infections caused by viruses, parasites, fungi and not merely resistance to antibiotics.
Resistant microorganisms are on a war path and have acquired an edge over our most important tool in the fight against disease causing microbes-antimicrobials. It is one of the greatest threats to our health systems globally as it narrows down the therapeutic options for infections, prolongs hospital stay, increases cost of treatment and raises the rate of mortality/morbidity. It is real and it is happening now. It is not a thing for the future as many believed in the past. Some are saying we are at the door of the post antimicrobial era and expect by 2050 antibiotic resistance could lead to the death of 4.73 million people in Asia and 4.15 million in Africa.
While lack of doctor’s prescription, informal sector drug dispensers, poor infection control procedures in hospitals and antibiotic use in the farming industry are among the established factors fuelling antimicrobial resistance globally and in Africa, Somaliland together with the broader Somalia has her unique challenges when it comes to the matter in discussion! Sometimes I get panic attack when I look at the way people are doing reckless activities which are putting the public health at the greatest risk.
Human resource problem in the health sector in Somaliland/Somalia is in crisis proportions leading to poor, inadequate and wrong treatment for common infections by unqualified medical personnel. The safety, quality, and efficacy of drugs in the market are not controlled paving the way for substandard and counterfeit drugs circulating in the country. These and the following are among the factors unique to Somaliland’s challenges when it comes to antibiotic resistance.
Moreover, after the collapse of the Somali republic in 1991, following the fall of Hargeisa and the subsequent declaration of independent Somaliland, there were no law enforcement bodies regarding health care service delivery and drug dispensing procedures. In Somaliland no laws were passed controlling the use, selling and prescription of drugs. In the south there was no central government until recently and health care institutions are merely in the rehabilitation phase. Therefore, absence of government bodies to put rules and regulations controlling pharmaceutical companies and drug prescriptions has been the biggest challenge in curbing the danger posed by antimicrobial resistance in the Somali health care.
Another public health problem concerning antimicrobial resistance, unique to Somali health care , is the presence of multidrug resistant TB. The type of MDRTB present in Somaliland is among the deadliest types seen in the world. This is partly due to the fact that anti TB drugs are not strictly regulated by the departments concerned with their distribution and control. It is unfortunate that private clinics order anti TB drugs from China and sell to patients on demand! Actually, it is the patients that order them like common items in the market. You will be surprised to find that a patient demands the anti TB drugs from the clinician on the basis that S/he is suffering from TB or was diagnosed TB 10 years ago and symptoms recurred! The clinician generously helps the patients with the antiTBs and cashes in his money.
Personally, the greatest of all the challenges, and the one single factor which can encampus all the others, is the lack of public health education among the Somali masses. Most of the Somali people are not formally schooled and therefore are ignorant of the dangers of taking drugs over the counter. There are no efforts to educate the people on how to seek medical attention if sick. Most of them revert to symptomatic treatment from over the counter drugs. For example if they have fever they go to the nearest drug shop and ask if they can have the medicines for fever and they conveniently buy whatever their money can purchase. There are no government campaigns to educate the people on public health. This is very dangerous and is at a level I have not seen in other developing countries facing the same Challenge.
In conclusion, with ceftriaxone resistance (one of the most efficacious broad spectrum antibiotics) being more than 21% in some regions in Somalia and the enormous work that needs to be done to tackle the crisis of antimicrobial resistance globally, in Somaliland it will be a good start to establish an efficient Food and Drug administration agency to enforce the rule of law, to have a well organized public health campaigns educating the masses on the risks of taking drugs without a doctor’s prescription. We also need to have our own national medical guide land, Somaliland Medical Guideline to establish a common ground for treating common infections in our country.
The rest, we may catch up with the rest of our fellow Sub Saharan Countries in the near future!
Dr. Mohamed Bobe,
#NomadicHealthCare #252HealthCare
Hingalool District, Sanaag.
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