A customer at the pharmacy says, “Instead of going to family doctors, the smallest part of the hospital in Ulaanbaatar, it is better to go to an animal hospital’s doctor – at least one who has experience.”
One man laughs loudly and another guy continues, “The last time I went to a family doctor, I felt like I was participating in an experiment, because the young doctor wrote me prescriptions for eight kinds of medicine. Then, if one didn’t work, I could change my medicine several times.”
Another woman laughs and says, “All of the family doctors have recently graduated from their universities and don’t have practice and life experience. It is hard to face their lost and frustrated eyes. Of course, I went several times but just received some paper health tests for cough symptoms. Actually, it is better to just buy some new medicines promoted on television than to go to the hospital several times. It is a time saving process.” Generally, drug promotion on television is very active from September to March. The new session of high school and universities also starts on the first day of September.
Nationwide, ten percent of household income, or 100 thousand MNT, is spent on purchasing medicine, of which 60 percent is used for treatment and nearly 40 percent is a wasted expense. The wasted expense is caused by the irrational use of medicine in Ulaanbaatar households. The high season is winter and spending is twice as high as it is in summer. This is related to self-treatment without a doctor’s consultation, the purchase of medicines without a prescription, patients who stop taking medicine before its prescribed period, and the use of medicine based on advice from family, relatives and friends without a doctor’s consultation.
According to the Law on Health, a doctor who graduates from university must work as a family doctor for several years before transferring to another specialization at a hospital. A pediatrician who graduates from university may not find a job for a long time, and during their training session they will only practice on dolls not children.
People buy medicine like food at a food court or a restaurant. Most of the drug sellers agree that painkillers are the most requested product at the pharmacy. Buyanaa is a 26-year-old woman who majored in journalism but is now a drug seller. Furthermore, her sister is the owner of a medicine import company. She says that she can sell 30 to 40 doses of painkillers a day. She also notices that people over 35 who live around her pharmacy are the most likely to be dependent on painkillers. Seniors always buy painkillers from her, and she makes approximately 200 to 300 thousand MNT a day. A small food market makes 100 to 200 thousand MNT a day. It is plain to see that a pharmacy can be a booming business.
According to statistics, 75 companies that run pharmaceutical businesses are owned by non-professionals in Mongolia, and it is estimated that there are over 500 pharmacies in Ulaanbaatar according to a 2012 study by the Ministry of Health. The study also revealed that 60 percent of the pharmacies are not operated by professional pharmacists. But drug sellers don’t agree with the findings of the study, because every year state inspectors check the licenses of pharmacists and very few non-professionals are reported.
Over 97 percent of the 2,400 drugs that are sold on the Mongolian market are imported and only three percent are made in the country. Mongolia’s drug consumption increased by 28.5 percent in 2012 compared to 2000. However, the price of drugs has remained relatively stable, except for a 2.5 percent increase in the prices of drugs imported from Germany. It is believed that a big network of drug businesses exist in Mongolia, including 160 registered companies such as Monos, Emimpex, Eurofarm, and Asiafarm. These companies import drugs and pills mostly from Russia, Hungary and Germany. Lately, pills have also come from France, Indonesia and England. Mongolians who once used traditional drugs now also take numerous drugs and pills imported in containers from all corners of the world.
Monos provides 65 percent of the country’s imported drugs and pills. The company has special interests in 54 percent of the pharmacies in Mongolia. But it is not only companies that have been granted an official license to import drugs, individuals also import drugs and pills in large quantities. The imported drugs and pills are believed to be sold through 535 pharmacies. But local reports say that there is already a thriving black market for the drug business in Mongolia. There is no control of the black market or of the illegal drug business.
An older regulation said that the Ministry of Health needed to certify imported drugs, but this has been changed so importers are now responsible for drug guarantees. It is believed that the boom in the drug business is the result of Mongolia’s free consumption of drugs without the need for prescriptions. In the city, 198 pharmacies are graded as first class and 337 as second class. Only 95 of these pharmacies grant drugs and pills through state health insurance.
Seniors can’t lift their bags when they leave the pharmacy
Seniors and women form a line ten people deep at the sales counter of a pharmacy. Three of them have brought big paper bags to take their medicine home in. No one buys just one medication. Some seniors can’t even lift their bags full of medicine because of the weight. “Seniors who live near the pharmacy buy painkillers from our us,” says a drug seller who works in 100 Ail, three kilometers from Sukhbaatar Square.
One of her customers says they are addicted to prescription pain medication. They first started taking prescription painkillers some years ago when their doctor prescribed them to treat post-surgical pain following spinal surgery. Over the past several years the customer tried to break their dependence on pain pills and, in fact, checked into medical facilities twice in an attempt to do so.
Painkillers produce a short-lived euphoria and are highly addictive. The long-term use of painkillers can lead to physical dependence. The body adapts to the presence of the substance and if one stops taking the drug abruptly, withdrawal symptoms occur. The body can also build up a tolerance to the drug, meaning that higher doses have to be taken to achieve the same effects.
Like all drugs, painkillers simply mask the pain for which they are taken. They don’t “cure” anything. Someone continuously trying to dull the pain may find himself taking higher and higher doses—only to discover that he cannot make it through the day without the drug.
Symptoms of withdrawal can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps known as cold turkey, and involuntary leg movements.
Surviving in the business world is harsh, and it’s a problem pharmacy owners face, but if they remain in charge nothing will change. The seniors struggle to live on pensions that are wasted on medicine that doesn’t help them. Seniors who are addicted to painkillers can go to the national narcotics treatment center’s door, but hospitals don’t have the capacity to treat all addicts. It is easier to change the old regulations of family hospitals or change practices with our young doctors.
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