Emmy Fitri

A woman with filariasis sitting in Tangerang. The tropical disease, caused by mosquito-transmitted filaria worms, is endemic in Indonesia with almost 12,000 people diagnosed with the condition. (SP Photo)

Did Disease-Fighting Drugs Do More Harm Than Good?

A Bandung blogger recalled the morning he saw people enthusiastically thronging to a football field in his hometown to get free drugs meant to fight a debilitating disease endemic in Indonesia.

In the days following, that enthusiasm turned to fear as those treated by the drugs started to die or fall ill by the hundreds.

“It’s shocking that people died following the distribution of the medicines because I can still remember everyone looking so happy and carefree,” the blogger, known by the name Hakimtea, posted on his Web site.

“My friend’s wife and children took the drugs and fell ill,” Hakimtea said. “Luckily, they weren’t bad enough to go to hospital and after a few days in bed they recuperated.”

Within four days of free drug distribution, nine people were dead last week and nearly 1,000 had fallen ill with symptoms such as nausea, dizziness, muscle soreness and vomiting. Hundreds were hospitalized.

The distribution was part of a push by the Health Ministry to fight a disease known as filariasis, which is caused by microscopic worms transmitted by mosquitoes. If left untreated, it can lead to blindness and elephantiasis, a condition which can permanently deforms the legs, hands and genitals.

The drug victims were concentrated in the West Java district of Majalaya and surrounding areas, such as Cimaung, Manggahang, Banjaran and Soreang. Ministry records show there were almost 12,000 diagnosed cases existing in 386 of the country’s 471 districts.

However, the tragic deaths have yet stirred up a national reaction despite the suspicions of several groups that mistakes may have been made in the distribution of the drugs.

Health Minister Endang Rahayu Sedyaningsih was quick to deny the deaths were caused by the drugs, saying only that some underlying diseases were the probable cause.

Endang said teams from the local health agency and the World Health Organization had investigated the drugs involved and declared them to be safe.

However, Marius Widjajarta, chairman of the Indonesian Health Consumers Empowerment Foundation, said medical teams should check the health and history of the residents before handing out the drugs.

“There must be screening process before (the drugs are distributed). Moreover, the medics must know that those receiving the medicines don’t have certain ailments that may be negatively affected by taking the drugs. Such a practice, however, is hardly seen here,” said Marius, who is also a general practitioner at Saint Carolus Hospital in Central Jakarta.

In Bekasi, where he lived, the local heath agency also distributed the same drugs as part of the national antifilariasis campaign. “There’s no control because the drugs were not consumed on the spot but taken home.”

The drugs used were diethylcarbamazine citrate and albendazole — the WHO’s most recommended drugs against filariasis — but were not strong enough to induce vital organ damage and deaths, Marius said. “They’re just like over-the-counter drugs for the treatment of hookworm.”

However, pregnant women, those with cardiac problems and the undernourished should not follow an antifilariasis regiment.

“The drugs could have passed their expiry date but this needs to be checked. The ministry uses drugs from different pharmaceutical companies and I don’t think the ministry is willing to publicly share much about the origin of the drugs,” he said, adding that drugs for health programs usually have a short shelf life.

Filariasis, as with many other tropical diseases, is closely related to poor sanitation and unhealthy environments.

Tjandra Yoga Aditama, the ministry’s director general of disease control and environmental health, said earlier that it was “normal” for people consuming the antifilariasis drugs suffer side-effects such as nausea, vomiting and dizziness. So far, other than the deaths in Majalaya, there had been no fatalities during the national campaign, which kicked off in 2002.

The antifilariasis program was part of a global drive to eliminate lymphatic filariasis by 2020.

“The drug distribution aims to cut off the chain of infection,” Tjandra said in an e-mailed statement.

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