Sylvia's Journal

Getting medicines to Afghans follows a logical process, at least for us, but other forces are undermining what we are trying to do. In order to comply with Afghan law all pharmaceuticals that enter the country (legally) have to submit to quality testing. So far we have received a waiver because the medicines we bring in are in compliance with very stringent international quality standards. But the waiver has expired and so we have to comply with Afghan law; this means leaving containers in customs and letting government officials take out samples and test these.

I’d like to think this is the right thing to so. The problem is that we also adhere to our own stringent ethical standards which mean we don’t pay bribes to get things out of customs. Others do, we know that. In fact, of all the containers that are stuck, and will soon be stuck, two were released within a day by a company we hire that does things their own way. Slush funds help. These containers are full of contraceptives which follow a different process than all the other medicines we bring in.

Two containers full of boxes with antibiotics and other life saving drugs are now stuck in customs until the contents are tested for quality. These two containers were first stuck in Karachi customs with thousands of others and were finally freed to find themselves stuck in Kabul. We have another container sitting forlornly at the wrong border crossing from Pakistan into Afghanistan. I suspect that by the time we get that one pried loose the contents will be gone or gone bad as a result of the high temperatures.

The truck drivers who transported these containers from India are also stuck because the containers are sitting on their trucks in a part of the airport from which they are banned. And so they cannot sleep in their cabs which is what they are expected to do; they have no money for hotels. We’d like to send them home (they call us every day) but we cannot offload the drugs from the containers. If we did, millions of dollars of pharmaceuticals with a high street value would be lying around loose in boxes in a space that is open 24 hours and to which we have no access. It is practically an invitation to underpaid airport staff to help themselves to some stuff that gets a good price in the bazaar.

Although we can rent containers here we cannot bring them into the quarantine area to transfer the contents because of restricted access. That would be the simple solution.

I don’t know if practices have changed (most people say not) but several years ago quality control officers insisted on taking samples from each batch – not just one but 40 or even 60 samples. Since each container has many batches in it the extracted number of (highly valued and valuable) vials and pills added up to hundreds if not thousands. People tell me that all these products ended up in the bazaar. Somewhere there is a handsome profit.

And so, in trying to follow official procedures and not participate in the national pastime of petty corruption we may end up encouraging another sort of more perverse kind of corruption. I can see how companies resort to payments under the table. In fact, the few hundred dollars that are being paid to extract containers from customs maybe a lot less than the loss of expensive medicine to either damage caused by improper storage or pilfering.

And in the meantime health facilities are reporting stock outs and ordinary Afghans cannot get the drugs that were supposed to be given to them for free, with the compliments of us, American taxpayers. Instead they have to go to the bazaar and buy them. Whether these are pilfered or not we don’t know since for security reasons there is no indication that these drugs were donated by us. It all seems so intractable. How to untangle this mess? Living wages, ethical banks? stewardship of mineral resources?