What? You don't have Idraparinux?

What kinds of medications are available at an African mission hospital, and from whom do you procure them?  These are questions that we get asked a lot.  Here are two lists.  Five things we have, and five things we don’t!  Most of our medications are imported from Europe and Asia.  A few are made locally in Ethiopia.  One thing we can’t use is expired meds – it’s prohibited by law – so even though we’d like to take these off your hands, please don’t send them to us!

Five medications we have:

1.  Most antibiotics!   We have penicillins, 3rd generation cephalosporins, macrolides, aminoglycosides, fluoroquinolones.  We even have vancomycin most of the time.
2. Pain meds:  For mild pain, we carry ibuprofen and tylenol. We also have stronger IV pain meds for our surgical patients, and fractures.
3. Blood pressure and diabetes medications.  We have oral calcium channel blockers, ACE inhibitors, diuretics, and some beta-blockers.  We use metformin and glibencamide for diabetes control, and we also have insulin.
4. Albuterol multi-dose inhalers.  These are key for our chronic asthma patients, and COPD patients.  We don’t have nebulized albuterol (which we’d like to have), but we can substitute these MDIs, and they work quite well.
5. GI problems?  We’ve got proton pump inhibitors (Prilosec for example), and we even have Zofran for nausea and vomiting.

Five medications we don’t have.  We are hoping that in time, our access to some of these meds will improve:

1. Fancy antibiotics.  Anti-pseudomonal penicillins like Timentin and Zosyn.  These are great for severe infections.  Also, we still lack a good IV first generation cephalosporin.
2. Artesunate.  This is the WHO-recommended standard for IV treatment of severe malaria.  It is difficult to find however, and we rarely have it.  Instead, we use Quinine which is an acceptable but less desirable medication.
3. Newer blood pressure and heart failure medications like Carvedilol.   Also, newer diabetes meds like long-acting insulins.
4. Low-molecular weight heparin.  Ever heard of Lovenox?  It makes treating deep venous thrombosis and pulmonary embolism so much easier.  But alas, it is rarely available on the African market.
5. IV calcium and sodium bicarbonate – rarely we will have these.  It does create problems managing a hyperkalemic patient or profoundly hypocalcemic patient.  We have other therapies that we can use though.

Others you are wondering about?  Ask in the comments and we’ll respond!