14ymedio, Madrid, 15 October 2021 — Cuban authorities are unable to stop the diversion of medications. Despite having a strict chain of control in place from the factory to the line at the pharmacy, the illegal sale of stolen drugs is not only evident in the courts, but also in conversations on any Cuban street.
The government website Cubadebate published an extensive and documented report today entitled Theft and illegal sale of medicines: The pains of the soul, in which it seeks answers to the failures that allow the scarce nationally produced medicines to be stolen for resale, mostly at exorbitant prices. The text investigates the specific situation of the province of Villa Clara, although it can be extended to the rest of the country. At the time the article was written, the province’s pharmacies stocked only 51% of the medicines in the basic table and were missing 132 products. In the case of controlled drugs, 85 in total, one-in-four, were missing.
The report is based on the idea that the country lacks drugs, a phenomenon fundamentally attributed, they emphasize, to the US embargo. Drugs, sometimes, must be imported from India or China, which slows down the transfer, they say, despite the fact that the majority of the international pharmaceutical industry acquires its products from these countries, the United States included.
But although it blames the empire, Cubadebate wonders why those that can be manufactured are stolen and someone is allowed to profit from that lack. On paper, it seems impossible that diversions can occur. One just has to see how the process of moving the products from the marketing and distribution company works. There, the protocol indicates that each night there is an inventory. “All the lots are signed by the person who dispatched them and if there is a missing one, it is very easy to detect who handled the packages,” reveals one of the workers.
In addition, the drugs are also counted and weighed. Thus it was discovered, for example, the diversion of one hundred blister-packs of azithromycin that apparently arrived without problems but turned out to be empty. The newspaper has also spoken with an inspector who insists that his function is “to guarantee that the quantities assigned to each entity come out of the warehouses.”
Could the problem be a diversion along the highway? If the theory is strictly followed, this does not seem possible. The provincial director of the Medicines Marketing and Distribution Company (Emcomed) says that of some 20,000 monthly operations only 20 or 30 are questioned, and he also maintains that the drivers do not know their destination until the very moment they must start the route. Subsequently, customers have three days to report incidents and a report is sent with which to analyze and debug responsibilities.
“Here we have a digitized, but not automated, system that guarantees the control of the drugs to the final destination, because it offers traceability by batches and products. At the end of the day, the submajor inventory must coincide with the physical count. However We are aware that no process is infallible,” he says.
From here, the report points to pharmacies. Customers suspect that something is ‘leaking’ there too. They speculate on information boards with less than the real amount or shipments, below what is noted on the sales voucher.
According to an investigation carried out in Matanzas this summer, there are “deficiencies” in filling in the information of the prescriptions, the quantities sold are omitted or too many drugs are dispensed for a treatment. The director of the provincial company of Pharmacies and Optics of Villa Clara admits this situation, but argues that it is not common in 174 pharmaceutical establishments in the province. “Not even in good times have we managed to eradicate one hundred percent,” he accepts. And for him, the reason is clear: the lack of drugs is “the main incentive for most crimes.”
In mid-September, the Villa Clara Prosecutor’s Office accumulated 33 criminal proceedings related to the theft and diversion of medicines and other medical supplies, all of which are punishable by up to one year of deprivation of liberty or fines of up to 300 ‘shares’* or both. Also, two of these investigations are related to the sale of medicinal oxygen. One of those interviewed for the report, in fact, even paid 20,000 pesos for a cylinder for her father, sick with covid-19.
The authorities urge citizens who have news of these situations to complain because, although they claim to monitor the queues of pharmacies, they cannot easily demonstrate that an illegal operation is taking place. “Until the criminal act is proven, we adopt a prophylactic work with these people to prevent them from continuing with behaviors that may lead to a breach of the law. The objective is that whoever reaches the line is the one who needs the medicine and will receive it in the amount indicated,” it says.
The report details cases of thefts in the middle of the red zone, such as the case that led the agents to a vendor who offered more than 25 types of drugs that a nurse stole from an isolation center. Another example is that of an investigation in which 124,000 pesos were found linked to these illegal sales.
Professionals attribute these cases to the violation of the control mechanisms, the lack of demand and the absence or misrepresentation of data in store cards, pharmacies, medical prescriptions and medical records. But, once again, the lack of stocks, which leads patients to move to the black market. “I have seen doctors who have no choice but to suggest the black market. And that hurts a lot, both them and me!” one of the buyers tells Cubadebate, recognizing that social networks have become a good place to make these acquisitions, sometimes abusing necessity, but other times as a pure exchange.
“I sell medicines simply because people need them,” says another of the interviewees, a salesman. “Sometimes I have and I propose the medicines that come my way, although almost always in Internet groups I find advertisements looking for something. I write to those people and if it suits them we agree on the price, or if I deliver or not. Other times they contact me because they see what I have. Here they don’t ask many questions.”
In the extensive report, which covers multiple factors, there is only one question missing that Cubadebate does not investigate. If all the measures are so strict and “on paper the protocol looks almost invulnerable,” aren’t there too many people looking the other way to a situation that is vox populi? And, more importantly, why?
*Translator’s note: Cuba’s Criminal Code sets fines as a number of ‘shares’ (or ‘quotas’). Thus, the value of one share can be changed in one place in the code, modifying all the fines in the code.
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