A Medicine Run

Once a month, we pile into our 4-wheel drive Toyota Land Cruiser and embark on an unpleasant, muddy, dusty, bumpy 4-hour drive to a city called Jimma. We make this trip for one reason only—to purchase the necessary medicines to run our clinic. Our destination is PFSA, the government wholesale drug distributor. The process of purchasing drugs at PFSA is an enlightening look into the frustrations of doing business in this country, so we thought we’d tell you all about it… and you can share in our pain. Here’s a summary in list form:

1 Fax and email our request for about 100 medicines and supplies to PFSA one week before our med run in the hopes they will start the following process ahead of time (this has never happened, but we remain eternal optimists).

2 Call PFSA a few days before our departure in case they have randomly decided to close operations (which they have done before, forcing us to travel 10 hours to Addis for medicines).
3 Wake up early and drive to PFSA so we can hopefully start the request process before a long lunch “hour” is taken.

4 Arrive at PFSA and give a hard copy of our medicine request to the manager who [slowly] copies our printed list into his own handwritten version leaving out the medicines currently out of stock (which changes drastically each month). The manager doesn’t consult a computer or list – the stock apparently memorized.

5 Or so we think, until we walk the 20 steps to the store room, where staff correct the manager and cancel a few items off the list that they don’t actually have.

6 Next stop is my personal favorite—the “invoice writers”; AKA the bottleneck; AKA the guys whose jobs would be obsolete if PFSA used computers. It is their job to handwrite our med order once again, the same med order that has already gone from our printed document into the manager’s handwritten copy and through the storeroom’s alterations. And let me tell you, these guys take their sweet time. And they love coffee breaks. Depending on how many other health centers are trying to get meds, this process can take hours and sometimes days.

7 Finally, we receive our “invoices” and we know how much our med order will cost. Let me point out that we must order our medicines before we have any idea how much they cost. Where else do you buy something before you know the cost? If we notice something with an absurdly high price we must have the invoice writers remove it and re-write the invoice.

8 We also look for mistakes in the invoice. There are always mistakes. At this point, our level of frustration will determine whether we even try to correct the mistakes (which may require an extra hour or two).

9 Back to the store room where they start collecting the medicines. There are about 4 store room managers, and believe it or not, they also like coffee breaks. And long lunch breaks too.

10 As the store room collects the medicines, they often realize that they are out of things they said they had. So, to reconcile these possible errors in the invoice, there are two guys in a back room known to us as “the checkers.”

11 Ah, the checkers. Their job is to recalculate the prices on our invoices to ensure that they are correct. Using calculators, errors are often made, and this process can take another half hour or even an hour.

12 The manager then needs to glance over and sign the checked invoices, in essence checking the checkers.

13 Finally, our last window – the cashier. Unfortunately, it is also the cashier’s job to go to the bank, and we’ve gotten this far and had to wait 2 hours just for someone to count our cash.

The process usually takes us 1-2 full days, and that’s only because we are persistent and pushy. Pharmacists from other health centers sometimes wait a week. No wonder it’s so hard for people in the countryside to get the medicines they need. As a comparison, Lalmba’s clinic in Kenya gets their medicines from a company in France that ships medicines at cost to NGOs in developing countries…and they deliver. Unfortunately, Ethiopia doesn’t allow this. And so, in another few weeks, we’ll set out for Jimma and continue to practice our deep breathing relaxation techniques.