Mental health patients battling 'cheap' drugs side effects

Mental health patients in Uganda are suffering from unwanted side effects resulting from cheap administered drugs in Ugandan hospitals.

Martin Mugonyi, 36, who suffers from mania, bipolar and depression is one such victim. Mugonyi has been a patient at Butabika National Mental Referral hospital for more than ten years.

"I was first diagnosed with mania in 2002 as I was joining university. I was taken to Butabika and put on treatment. I was on that medication for a year," he said.

According to Mugonyi, when he joined university he stopped his medication because it could cause drowsiness.

"I used to take my drugs in the night but waking up in the morning was difficult. I used to wake up at midday and tried to go to campus but it was too hard. I wanted to sleep all the time”, he said.

Mugonyi says that due to the side effects of the drugs, he decided to leave campus and stay home.
 
"I wanted to be an electrical engineer and work for telecommunication companies like MTN. That was my dream but I failed to achieve it because I failed to attend classes due to feeling sleepy all the time," he told URN.

Mugonyi is not the only patient at Butabika to complain about the side effects of the medication. The problem is attributed to the use of cheap drugs.

According to the Butabika hospital administration, they have been dispensing cheap drugs that present side effects and alter the physical ability of patients to function when they take them. One such drug is Largactil.

It is one of the drugs the hospital relies on mostly to treat mental illnesses for more than 50 per cent of its patient population. Despite its side effects, the hospital procures the drug because of the limited resource envelop from government to benefit all patients.

Dr David Basangwa, the executive director Butabika hospital, says the hospital operates on a budget of 600 patients yet it has 1,000 patients at the moment.

"What happens with a limited budget is that you go and shop where you can get the cheapest medicines with the cheapest option possible. With the advancement in science and technology there is now newer formulations that are used in psychiatry which have minimal defects.

Currently, we use the very cheap medicines that sometimes have side effects that patients don’t like - causing them a bit of drowsiness, feeling sleepy, they can’t pay attention. Whereas if we had adequate funding, what the rest of the world is using are newer medicines that are given with minimal side effects", said Dr Basangwa.

He explains that due to the funding gap, they are forced to prioritise on what conditions to treat and which drugs to use. The hospital prioritises the procurement of drugs like Largactil, which can treat a number of mental illnesses. 700 of the 1,000 mental patients currently at the hospital are treated using Largactil.

100 patients are being treated for schizophrenia, 300 for mood swings, 100 for paranoia and another 200 for alcohol & drug abuse.

Dr Basangwa says that while cheap drugs like Largactil are effective in treating mental illnesses that they are prescribed to treat, they present a number of side effects that affect the quality of life of the patients.

"The cheap drugs are able to do the job as well as the expensive drugs. They treat our patients very well, they manage the symptoms very well. Science has only created modifications in these medicines on the area of side effects. So what our patients unfortunately suffer even when they’ve been cured well, is that they suffer from certain side effects. One of them these side effects is the sedation, that a patient after taking the medicine will get the side effects cleared but will feel a little lazy, sleepy and sometimes unable to perform good work", he added.
 
"When a student takes these drugs they cannot go to school and study or a person cannot even work when they are on these drugs. They are slow," Dr Basangwa said.

Alternative drugs that present less or no side effects in patients are available on the market. Olanzapine can be used to treat the same illnesses that Largactil treats. However, due to the lack of money, procuring drugs like Olanzapine is impossible, according to Dr Basangwa.

"On the open market, a one month dose of Largactil for one patient costs Shs 5,000. Olanzapine on the other hand costs Shs 200,000. With our funds, we cannot afford that," he said.

According to Dr Basangwa, they have been buying cheap drugs since 2012 when they started experiencing an increase in the number of mental ill patients.

"Before we used to get a budget of Shs 1.2 billion that was enough to cater for 600 patients. Five years later, we still get the same money for 850 in-patients. So we have had to cut corners to make sure that all Ugandans get the care," he said.

Dr Basnagwa says ideally in situations when they face drug shortages, they would expect family members to step in but the case is different at Butabika.

"Our biggest challenge is that most of our patients do not have relatives who attend to them. They are brought in by police and there is no way you can ask someone like that to buy drugs for themselves due to a shortage," he said.
 
The mental health focal person at ministry of Health, Dr Hafsa Luswata says the shortage of funds at the facility is an issue beyond the ministry's reach.

"As far as the funding is concerned, it is not the ministry of Health. Of course, we advocate for all our facilities to be well facilitated but it is ministry of Finance that releases the finances to the different ministries. That is beyond us for sure", she said.
 
According to Dr Basangwa, Butabika hospital needs twice its current annual budget allocation of Shs 1.2 billion to be able to procure drugs like Olanzapine. Butabika was founded in 1955. It has a capacity of 900 beds. Currently, the hospital has 200 out patients and 850 in-patients.