Tuesday, 10 December 2013

Medication ordering

Really boring title for this entry, but to be quite honest it’s difficult to dream up a witty title for a process that is slightly – vast understatement – very frustrating!  To be honest this post is probably only going to be vaguely interesting for those working in the pharmacy/medical world back home but I did promise a post on this subject in my last blog, so here it is! 

There’s an agreement that we will endeavour to source medication for the hospital within country, rather than import from abroad.  The latter would be more reliable in terms of knowing when we’d get the order and not much more expensive.  However, we live and work on the outskirts of the capital of Chad and so have easy access to the main wholesaler for the country.  Also in the capital is a slightly smaller wholesaler and numerous ‘depot pharmacies’ (even smaller wholesalers) and then retail pharmacies.  So we have access to a wide range of potential medication wholesalers and as such are in a far better position than those working in other towns around the country.
That’s probably where my positivity ends!!  I am in Chad and I must remember that. 
All of the above wholesalers only mainly stock generic medication which is good as they are more affordable for our patient population.  The retail pharmacies only stock branded medication and as such charge a premium for them.
Within the pharmacy here at Hopital de Guinebor II, all of our stock records are on paper in a big red file – the ‘classeur rouge’ is referred to and multiple times a day.  The regular use and dust in the atmosphere means this file looks rather tired and the pages within slightly brown!  Keeping on top of what medication or sundries have left the pharmacy is a challenge but we now have a good system that only falls down when one of us forgets to write in the notebook what we’ve issued.  There’s always going to be small element of human error when everything is done manually!!
Paper stock records
We aim to use the main wholesaler for the bulk of our ordering as it’s by far the cheapest.  However we’re obviously not the only hospital ordering from them as they are basically the main wholesaler for the whole country.  As with all things in Chad, the order is done on paper – no internet connection to the wholesaler with same-day delivery here!!  I wish, it would make life much simpler!  I usually place an order that will last us about a month, based on consumption in the preceding few months.  Most tablets come in boxes of 1000 and injectables in boxes of 50.  So making exact orders can be tricky with these pack-sizes!  Even if you hardly use a certain tablet you have to buy 1000 of them!  We just try and ensure they’ve got a long expiry date!  Once I’ve figured out what to order, this gets printed twice, once for us and once to take to the wholesaler.  Once dropped off we have to go back a week later to pick up the ‘proforma’ – which is our order, plugged into their computer by hand and then printed out.  I then have to check the proforma against my original order and make any corrections (there’s always at least one).  It also gives me chance to see what they’ve not got in stock and make other arrangements to get those products from another wholesaler (more expensive).  We then take the proforma back to the wholesaler and wait....and wait.....and wait....and make numerous phone calls to check on progress....and wait a bit more and then in about a month after we dropped off the original order we can go and pick up the order.  The length of time from start to finish varies – the shortest has been 3 weeks and the longest 2 months!  Meanwhile, I am having to figure out orders on a weekly basis at the second largest wholesaler in town.  The big advantage of this place is that you get products the same day but they sell the exact same products as the main wholesaler but 20% more expensive.  So we’re not keen on making orders with them although they’re really convenient and when the main wholesaler is taken a-g-e-s to get our order ready and/or they’ve run out of something, we have to. 
These two wholesalers are where we get most of our products but we can’t get everything from them all the time as they often have stock-outs.  An example was two weeks ago – we received our large monthly order from the main wholesaler but with only 4000 paracetamol – this is enough to last us 2 days!  I’d ordered 40000 tablets but they’d run out, meaning we had to get the remaining 36000 from the more expensive wholesaler.  Slightly annoying!
There are numerous other smaller ‘depots’, one of which will deliver out to the hospital.  Given that it’s a good 30 minute drive into town, this is a great help.  Although he obviously sells at a slightly higher price.  I have been known to haggle with him over his prices!  As he’s a smaller private business, this is easier to do.  That was a weird experience at first, bartering over buying ampoules of ampicillin but it’s become strangely ‘normal’ now!!
So keeping on top of drug ordering here is a fairly busy task and a crazy juggling act – trying to get the most we can from the most cost-effective place, but having to deal with long lead times and frequent stock-outs of important drugs.  There’s usually a way around it though, we end up being fairly resourceful out here out of necessity!

Part of a monthly order waiting to be unpacked in pharmacy

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