Ha Linh Thu has had a cough and fever for nearly a week, but she has not gone to a hospital. The 28-year-old accountant from Hanoi’s Dong Da District has turned doctor instead and prescribed her own medicines.
She has bought some antibiotics and anti-inflammation drugs.
“I possibly have a sore throat. I have had the condition several times, so I know its symptoms as well as the drugs I should take,” she said.
Worries about the likelihood of spending hours waiting to be examined at crowded state-owned hospitals and high costs at private ones mean Thu often self-medicates in case of symptoms like fever and pain.
In Vietnam, many people do this or use drugs suggested by pharmacists, friends and relatives.
Nguyen Thi Luong, a retired worker living in Hanoi’s Hai Ba Trung District who was buying cough medicine from a small pharmacy in an alley, said: “I seldom go to see a doctor. When I am sick, I tell the symptoms to pharmacists. They would suggest me some medicines.
“I often recover after a few days of using the drugs.”
In Vietnam, people find it very easy to buy drugs, whether antibiotics or cough medicines, from drugstores without a doctor’s prescription. Many pharmacies ignore the regulation that they should not sell prescription drugs without prescriptions.
The owner of a pharmacy on Minh Khai street said while he does not want to violate the law, his shop cannot compete with others if it insists on prescriptions.
“Almost no drugstore asks buyers for prescriptions.”
This is because of the mild penalties for violations, Luong Ngoc Khue, head of the ministry’s examination and treatment department, said.
No prescription was involved in 88 percent of antibiotics sales in cities and 91 percent in rural areas, according to the ministry.
Nguyen Van Kinh, director of the National Tropical Diseases Hospital, said: “It is no exaggeration to say that drugs, especially antibiotics, are bought and sold … as easily as vegetables.
“Vietnamese use antibiotics like eating rice. They go to the pharmacy to pick up antibiotics anytime they feel sick.”
Kinh said a majority of Vietnam's pharmacists lack proper medical training and routinely disregard regulations that make prescriptions mandatory for antibiotics.
The reason for self-medication, Minister of Health Nguyen Thi Kim Tien recently told reporters, is that people do not want to go to hospitals with the primary healthcare system not covering all residents.
State-owned hospitals with their reasonable fees are overloaded, while private clinics often charge exorbitantly and lack quality doctors.
At public facilities like Bach Mai Hospital in Hanoi, or Tu Du Hospital in Ho Chi Minh City, it is normal to see long queues waiting to see doctors. They also often see chronic bed shortages and overworked doctors.
According to the Ministry of Health, this situation is common at major public hospitals where the waiting time averages four to seven hours and bed occupancy can be 170 percent.
'Irrational use of antibiotics'
The habit of self-medicating has caused drug resistance, Tien said.
The World Health Organization (WHO) has listed Vietnam among countries with the highest antibiotic-resistant infections.
A doctor examines a baby at a hospital in Hanoi. Photo credit:VnExpress
“In recent years Vietnam has witnessed a growing threat of antimicrobial resistance brought about by the excessive and irrational use of antibiotics at all levels of the healthcare system and the public as a whole,” it said in a recent report.
Dr Lokky Wai, WHO’s Vietnam representative, said: “The inappropriate use of antimicrobial drugs threatens the capacity of the health system to prevent, control and treat common infectious diseases, resulting in higher mortality, prolonged treatments and catastrophic expenditures for the patients.
“Antimicrobial resistance is multidimensional and imperils human and economic survival.”
Most antibiotics are now no longer effective in treating bacterial infections, health officials said at a recent conference on fighting drug resistance through 2020.
They blamed pharmaceutical retailers and members of the public for using antibiotics unnecessarily.
“The Ministry of Health should take drastic measures to deal with the issue before it is too late,” Pham Manh Hung, chairman of the Vietnam Medical Association, said.
“Because of the antimicrobial resistance, we have to use third or fourth generation antibiotics for treatment of some diseases, while other countries still use first generation.”
Tien said his ministry would strengthen enforcement of regulations related to drug sales by pharmacies, and raise people’s awareness of using prescribed drugs.
Dependent on imports
With the limited capacity of domestic companies, Vietnam’s pharmaceutical market heavily depends on imports. Local producers can meet only 50 percent of the country’s demand for medicines, and the rest has to be imported, according to the Ministry of Health.
Most local companies are small to medium-sized. Hau Giang and Traphaco, who account for most of the market share, turn out mostly low-cost generics and not sophisticated drugs.
Vietnamese drugs are not very popular, with doctors and patients preferring imported ones, believing them to be of better quality.
Due to low sales and profit due to heavy reliance on imported raw materials, many drug firms have stopped production to focus on trading drugs. Vietnam imports 90 percent of raw materials needed for pharmaceutical production.
Each Vietnamese spent around $31 on drugs last year, and half of it went toward imported medicines.
Drugs imports cost over $2 billion last year, up 8.3 percent from 2013, according to the Ministry of Health. The imports were mostly from France, Germany, the US, and India.