Following the death of 14-year-old Amina Ibrahim, after reacting to a combination of drugs that she took,MOTUNRAYO JOEL writes about the dangers of self-prescription and Stevens-Johnson syndrome, the rare but dangerous medical condition that it can trigger
Amina Ibrahim’s mother, Maryam, rushed to her daughter’s bedside, knelt down and began to pray loudly in Hausa, hot tears running down her face soaking her black hijab. Her wailing rang out loud and clear filling the air within Mohammed Abdullahi Wase Specialist Hospital in Kano State.
“I hoped that my baby will survive. She cannot die; she will be healed. You cannot die; we will all go home together,” she cried. But her prayer was futile. Her daughter didn’t rise up to pacify her. Fourteen-year-old Amina was dead.
“Your death could have been avoided. What did I do wrong, why did my daughter have to die. My Amina, I refuse to believe you are gone,” she cried. As she cried, her husband, Bala Ibrahim, looked on. His vacant eyes staring into space. Bala held his daughter’s hand. He could not touch her face or hug her in death. Stevens-Johnson syndrome, the medical condition that Amina succumbed to, had left her face and body terribly disfigured.
As tears rolled down Maryam’s eyes and her hijab got even more wet, the doctors and other hospital workers who struggled to save the fourteen-year-old’s life moved in to console her.
Shortly after she started wailing, the Accident and Emergency ward of the hospital began to fill up with people who heard her and came to console her. Within a short while, the entire ward was a cacophony of noise and screams.
Stevens-Johnson syndrome is a life-threatening skin condition that disfigures the body before finishing off its victim.
Mayoclinic.org, the website of foremost US medical group, Mayo Clinic, describes Stevens-Johnson syndrome as a “rare, serious disorder of skin and mucous membranes” that is usually “a reaction to a medication or an infection.”
It says, “Often, Stevens-Johnson syndrome begins with flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters. Then the top layer of the affected skin dies and sheds.”
Maryam told our correspondent that her daughter’s health problems started when she started reacting to the drugs she bought from a local drug dispenser in their neighbourhood. These drug dispensers are called ‘chemists’ across Nigeria.
SUNDAY PUNCH learnt that Amina, who resided with her parents in Dala Local Government Area of Kano State, developed body pains after taking the drugs.
Maryam said, “I wish I had told Amina not to go to that particular chemist. But how could I have known that she embarked on a trip to her death? My children and I usually patronise the chemist. We do not have money. I am a housewife while my husband is an electrician. We feed on the little money my husband makes on a daily basis. I have five children; we cannot afford to be visiting a hospital every time we are ill. My daughter complained of cold and cough which made her visit the chemist to get some medications.
“On May 26, Amina and her younger brother went to the chemist near where we live in Dala council area. She told the chemist what was wrong with her. I later learned that it was the chemist’s son who was on duty that day. The boy is about 19 years old.”
Mrs. Ibrahim, who spoke through a female interpreter, added that the boy prescribed an antibiotic, Septrin, to Amina, claiming that it would relieve her of her discomfort.
According to her, later in the evening of that day, Amina took the drug (septrin) and within an hour, her lips and tongue got swollen and her eyes became red.
“The pain was unbearable for her. We did not know what to do. I had to check the expiry date on the drug sachet to be sure it had not expired. But I could not find any date, ’’ she stated wiping tears with her palms.
She further said Amina returned to the chemist the next day to complain of her reaction to the drug.
‘‘I followed her to the chemist and we met him in his shop. He said Amina was developing symptoms of chicken pox and that she would need to be placed on injection and other drugs to fight the ailment. We heeded his advice, believing he was an expert in health matters,” her mother said.
She told our correspondent that the chemist gave her daughter a combination of drugs which included paracetamol, ciproxin, puriton, ciprotob and blood tonic to treat the chicken pox which he claimed Amina had.
“Immediately she completed her injection doses, things got out of hand. My beautiful daughter changed into someone I could not recognise. Her face turned black as if she got burnt. Her health also deteriorated daily,” she said.
Throughout his narration, Amina’s father, was lost in thought. Once in a while, a solitary teardrop would travel from one of his eyes, down his face and on to his cheeks. He did not wipe these tears. He just stared into space.
“I do not know what to say, I do not even know what to think. I cannot believe my baby is gone. What pains me most is that her death could have been avoided. Every day, throughout the period Amina was being treated, we hoped she would be fine and we would all go home together someday. I just did not know if my family would be able to recover from this,” he said softly.
When asked if they had reported the chemist to the police, he said, “We can’t find him again.”
Research done by clinical pharmacists has shown that self-prescription is one of the commonest forms of drug abuse in the country.
A Chief Pharmacist at the Food and Drug Information unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Abiodun Adigun, warned that the condition was on the increase in Nigeria. He also said the condition affected all age groups, races but was more common in females than males.
He said, ‘‘Being a member of the pharmacovigilance committee, I have been opportune to fill and submit the yellow form (adverse drug reaction form) to the National Agency for Food Drug Administration and Control zonal centres emanating from drug use at normal therapeutic dose.
“Recently, the Minister of Health, Prof. Isaac Adewole, alerted the public on the need to increase awareness and knowledge of this disease with the aim of preventing it. People with a weakened immune system either as a result of an organ transplant, HIV/AIDs and autoimmune diseases such as lupus are at increased risk.”
Twenty-year-old Temitope Adegunle (not real name) is one of the many Nigerians who self-prescribed. Temitope, who lives in Agege, a Lagos surburb, does not go to the hospital when ill.
“Whenever I have malaria, I take Quatem, cough mix, antibiotics, blood tonic and another drug which I cannot readily remember now. I rarely visit hospitals. Why should I when I can receive treatment at a nearby chemist?” he said.
A clothier, Mr. Taiwo Idris, said he takes paracetamol, amalar, amoxil and vitamin C whenever he is ill.
The habit of using drugs without prescriptions is not limited to artisans as some educated persons also indulge in it.
An undergraduate, who simply identified himself as Ajuba, said going to hospitals for diagnosis and prescription is a waste of time.
“I personally consider it a waste of time, when I can walk into a chemist and purchase the drugs I need. I’m not saying it is wrong going to hospitals, but if you know your ailment and the drugs you need, walk into a chemist and purchase the drugs, simple,” he said.
A businessman, Mr. Tolu Olagunju, also said he uses drugs without prescription except when it is a major health case.
“For cases such as malaria, typhoid, buying drugs without prescription is not bad. These are not serious, life-threatening cases. I only go to my family hospital when I have a major health challenge that I can’t handle. With the current state of the economy, going to hospitals and paying consultation fee and all other fees just to see a doctor is difficult, let me be honest with you,” he said.
Similarly, Mrs. Lola Olanrewaju, a mother of three and a businesswoman also acknowledged buying drugs without prescription.
“I don’t take my children to a hospital every time they have a health challenge. There are some drugs I am conversant with which I know work for them. It is abroad that people always visit hospitals if they have any little health challenge,” she said.
A deadly disease
In 2012, a medical doctor, Adeyosola Adedayo, also died of SJS, at the young age of 27.
According to his brother, Fadesola, the late Adeyosola contracted the condition after an allergic reaction to a precautionary medication he took while helping the less-privileged in Lagos, Nigeria.
He said, “Since his death, I wished that no one should feel the pain that my family and I felt. I have since made it my life’s mission to raise money and awareness for Stevens-Johnson syndrome among other deadly skin diseases.
“We were so close; I still remember our last conversation. I didn’t know that it would be our last conversation. His departure has left a huge void in my heart. He was a lovable person; his death came as a shock to many.”
Also, in 2011, Marian Adejokun, a young lady based in the United Kingdom, was left scarred for life after she developed an allergic reaction to a medication.
Adekojun spent more than three weeks in intensive care at the Royal London Hospital where doctors diagnosed her with Stevens-Johnson syndrome.
Her ordeal began five years ago when she developed an itchy eye. Her doctor asked her to get some eye drops from the pharmacy which she used before going to bed.
“The next morning, I was horrified to wake up with lumps all over my body. As my condition began to deteriorate, I was rushed to the hospital. As my skin began to shed, I was put into a medically induced coma — and doctors warned my mother I may not survive. I am indeed lucky to be alive and healthy,” she said in London.
Experts’ mixed perspectives
Commenting on the condition, a clinical pharmacist at the University of Nigeria Teaching Hospital, Enugu, Mrs. Ogochukwu Onwujekwe, noted that Amina’s situation must have been triggered off by a combination of the different drugs she took.
She said, “Drugs can kill and heal. There are some certain drugs that trigger SJS, however the syndrome is a rare disease condition. It is a pity that when the drug reaction started, the chemist thought it was chicken pox. If Amina had reported the reaction at its early state to a proper doctor in a hospital, it would not have escalated.
“It is a sad tale. Nigerians who patronise quack chemists and drug hawkers must realise that they are endangering their health.”
Onwujekwe said it was possible the drug responsible was not withdrawn and so caused more harm.
‘‘If a qualified health care professional was sought, the problem would have been nipped at an early stage. The patient may be resuscitated with a treatment similar to that meted out on severe burn patients. It may however leave the patient with long term conditions like blindness, scarring, arthritis, nerve damage and other limitations and disabilities for example permanent skin damage,” she added.
Onwujekwe added that the condition could be triggered by sulphur-based drugs such as tylenol, non-steroidal anti-inflammatory drugs like ibuprofen and naproxen , and anti-psychotic and anti-epileptic drugs, especially carbamazepine.
She said, ‘‘Unfortunately, these are the drugs that are usually “mixed” in chemists’ shops by the unqualified drug sellers to unsuspecting buyers to cure ailments.”
Onwujekwe called on the Federal Government to move against the prevalence of self-prescription among Nigerians.
She said, “These strategies should be at different levels: health system, governance level, level of health care providers, medical doctors, pharmacists, patent medicine vendors and level of consumers. Some of the interventions for the different levels that the government can implement include embarking on awareness and sensitisation campaigns on the need to seek medical care in reputable facilities with trained personnel.’’
She also advocated that clear warnings should be on the labels of drugs that have the potential to cause adverse drug reactions.
The health practitioner advised those who use drugs to report adverse reactions to the nearest health facility for appropriate medical attention.
The President, Pharmaceutical Society of Nigeria, Ahmed Ibrahim Yakasai, in a telephone call with our correspondent, said that the body just had a meeting on the issue of quack chemists. According to him, the trend has become worrisome and needs to be tackled urgently.
“We just had a meeting on the issue of quack chemists springing up, and we are doing everything possible to curb this problem,” he said.
Last year, in Cross River State alone, 148 chemists were closed for unauthorised sale of drugs.
The PSN had lamented that the shortage of qualified pharmacists was responsible for quacks.
Welcome to ‘pharmasy’
It is common to find local drug dispensers popularly called ‘chemists’ prescribing drugs for Nigerians in different parts of the country.
To get first-hand account of how they operate, I went to four chemists to complain about non-existing ailments.
The first place I visited was a one located at Ile-Ogbo Street, New Oko-Oba, Agege, Lagos. At the entrance of the store was an elderly man with white beards, probably in his 60s seated on a wooden stool, and dressed in a blue and white shirt with stripes.
Before I could walk into the store, he stopped me and asked what I wanted. I told him I needed some drugs for body pain and stomach upset.
Without standing, he directed his wife, who was overseeing her dry fish and other food products displayed at the entrance of the patent store, to attend to me.
He said in pidgin language, “She dey complain of body pains, stomach upset and weakness. Na malaria deydo her. Give her acetaminophen and amalar.”
Both drugs cost me less than N200. He instructed me to use them, claiming that they both work extremely fast.
At the second chemist, I was not prepared for what I encountered.
The owner of the store located Abule Egba, Lagos, attended to me through the mobile phone. She was at home while her daughter, who was about 17 years old, was the one in charge of the store.
I told the young lady that I had body pains, constipation and that I also needed drugs to boost my energy level.
She quickly dialled her mother’s phone line and the mother instructed her to give me Ibuprofen and paracetamol tablets, for the body pains, mist.mag trisilicate for constipation together with hyoscine butyibromide.
As I was about to step out of the store, I noticed the daughter look at the remaining naira notes in my hand. Then she called me back and said I should also buy hydrolyte oral rehydration salt to boost my energy level.
The third patent medicine store which was located at Agege, Lagos, has a signboard that read ‘pharmasy.’ The error in spelling of the word ‘pharmacy’ did not prevent people from patronising them.
This time, a more mature lady attended to me. She wore a sleeveless top with a pair of jeans.
I told her I needed drugs for pain and constipation. She gave me bisacodyl tablets (laxative), mist.mag, metronidazole tablets, and finally diclofenac potassium tablets with the inscription, ‘the best for arthritis.’
The last chemist I visited in Agege prescribed magnesium trisilicate, amoxil, sulfadoxine+pyrimethamine and another drug that had no core ingredient written on it but only the name of the company. I told the attendant that I needed to excrete properly. None of the attendants at the patent stores I visited gave me an instruction on how to take the drugs.
Most of the drugs I bought in the chemists had no NAFDAC number. This number is put on only drugs approved by the Federal Government for consumption.
Speaking on the drugs I was given at the chemists, a clinical pharmacist at the University of Nigeria Teaching Hospital, Nsukka, Mrs. Ogochukwu Onwujekwe, said the salespersons were not authorised or qualified to prescribe drugs.
She added that some of the drug combinations I was given were strange and called on Nigerians to shun quack chemists.