No.02 - 01/2006
04 January 2005

Health/Human Rights

Wrong medications sold at Shan festivals

Tawngtai

Lack of medical knowledge and subsequent improper use of medications can have serious health consequences amongst Shan migrants.

There was a festive mood in the air, as thousands of individuals, many dressed in Shan national dress, celebrated new year at Wat Pa Pao, one of the few Shan temples in Chiang Mai.  Here, they are able to eat Shan food, enjoy Shan music, and purchase all manner of goods from their homes.  Many stalls had been set up on the temple grounds, with tables piled high with all manner of goods: sauces, powders, various beautifying powders and creams, mixes, cheroots, and almost ubiquitously, various medications.

At one stall, colorful packets of aspirin were for sale, the packet showing pictures of fat, healthy babies and the instructions indicating the correct dosage for children.  The problem is that it should not be used in children.  Noted Dr. Withaya Huanok, a Thai physician.

“It [aspirin] actually should never be given to children under 12 for a cold or other viral infection because of the risk of Reye Syndrome. Children with Reye Syndrome can develop confusion or other changes in their thinking, along with inflammation of the liver. Many die as a result. If children need a medication to help with fever or other symptoms during a cold or other infection, they should use paracetamol (Tylenol) instead.”

At another stall, near a plastic basket full of beautifying creams, including containers of thanaka paste and bark, was a pile of small light green boxes containing fluocinonide ointment.

A shopkeeper noted that it is one of the best selling items here; most of the customers who buy this ointment are young girls.  “If you put it on your face, it will make your face clear up," she added.

A 21 year-old Shan migrant, who was advised by her friends to use it to help clear up acne and has been using the ointment since 2002, noted, “When I stop using it [the fluocinonide ointment], my face itches and I have to keep using it.”

For many skin problems, it will likely help temporarily, noted Dr. Huanok.  However, fluocinonide is also a very potent steroid and, like other agents in its class, should not be used on the face.  "The problem is that if used for a long time, they can cause the skin to become thin and wrinkled. Veins under the skin can become more visible. And these changes usually don't go away once the medication is stopped, so it is very important that people know not to use this on the face, where the skin is already very thin compared to elsewhere."

Like most of the other medications for sale here, the fluocinonide ointment is made in China and is sold cheaply, at 8 baht per 10gm tube.

Elsewhere on the table were unknown powders in used vaccine containers and boxes of antibiotics for sale.  Several vials containing tiny white pills were in a tray in the back.  Dexamethasone, read the label.

“This is used for seizures,” said the young shopkeeper.  When asked about type of seizures or other indications, she sheepishly responded, “I don’t know any more.”

Dexamethasone is a powerful corticosteroid which, given longterm, can result in serious health consequences including diabetes, high blood pressure, brittle bones, thinning of the skin, cataracts, high cholesterol, and increased risk for infections.  In children, these can result in stunted growth.  Many of these side-effects do not resolve with stopping the drug.

The sale of these medications underscores the fact that in the homelands where many of the customers and vendors fled from, there is no healthcare infrastructure.  The Burmese government devotes only 0.19% of its GDP or 2.7% of the state budget for public health, and most healthcare services remain concentrated in urban areas, away from the frontiers dominated by ethnic minorities.  Further, in many areas, Burmese army soldiers are documented to be involved in blocking supplies of medications and medical services to ethnic minority areas as part of their counter-insurgency strategy.  And, where medications can be bought in Burma, many are fake or adulterated, another consequence of lack of rule of law.  In one study published in the British medical journal Lancet, 53% of artesunate, a key agent used to treat malaria, did not contain any active ingredient, which can have fatal consequences. 

Despite the fact that over 200,000 Shan are thought to have fled to Thailand, they continue to lack access to medical care and services, a fact also underscored in the popularity of these festival pharmacies.  Such barriers include language, culture, legal, and economic factors, allowing a large, unregulated trade in medications to continue, fueling their improper use and further adverse health consequences in an already vulnerable population.