The Shay Rebellion | Christopher Shay

With a fever, an upset stomach and a splitting headache, Chheth Sokha, 52, did what she always did when she felt sick — she went to the grocery store and bought some cheap medicine.

“Whenever I am sick, I always buy medicine at grocery stores, because it is cheaper than at big pharmacies,” she said.

She bought the same medicine she had purchased the last time she was sick, but this time instead of making her feel better, the medicine landed her at the Russian Hospital.

“The doctor told me that I was poisoned by the medicine. I thought by buying cheap medicines I could save money, but it was the opposite. Fake medicine cost me even more when I got worse and had to go to the hospital,” she said.

The medicine that Chheth Sokha bought was almost certainly counterfeit. The problem of fake medicine in Cambodia is a long-standing one, and despite efforts from the World Health Organisation (WHO), Interpol and the Cambodian government, it is not a problem that is easily cured.

A week ago, Interpol seized US$6.65 million of counterfeit drugs in Cambodia, China, Laos, Myanmar, Singapore, Thailand and Vietnam, but even this impressive haul will not significantly impact the global counterfeit drug market, experts say.

“It is a huge illegal business, and single events in and of themselves will be unlikely to make a dent in the world market of counterfeit drugs,” Thomas Kubic, the president of US-based Pharmaceutical Security Institute, said.

Kubic pointed to a recent seizure in Belgium to illustrate the scope of the global problem. In September, over 2,146,000 counterfeit anti-malaria and pain medications from India en route to Togo were seized. Inquiries disclosed that this was just one of four other similar weighted shipments — with an estimated total of over 10,000,000 dosages.”

Specific statistics for Cambodia are unavailable, but a 2007 WHO estimate revealed that about 200,000 people in Asia die every year as a direct result of counterfeit pharmaceuticals.

With porous borders, an impoverished population and a drug distribution system that still relies on over a thousand unregistered pharmacies, Cambodia is particularly vulnerable to counterfeits streaming in from other countries, but increased efforts by international organisations and the government have made a noticeable impact in recent years.

A Cambodian Health Ministry survey conducted in 2002 revealed that about 13 percent of drugs in the Kingdom were counterfeit, and now estimates put the percentage at around ten percent. In contrast, only about one percent of drugs in developed countries are counterfeit.

“The prevalence of counterfeit drugs has decreased. We have done a lot of education to people about counterfeited items, and the items have started to disappear in the markets,” Chroeng Sokhan, the vice director of the department of drug and food said.

But Chroeng Sokhan admitted that due to the global nature of the problem, there is only so much that can be done locally.

“Counterfeiters have a lot of money, so they can do many things. They can adapt. It’s a difficult problem to solve locally. We need Interpol support for cross-border help,” he said.

The government says it is working with its neighbours to decrease the number of fake drugs smuggled across borders of southeast Asia.

“We are taking measures to crackdown on the illegal trafficking of fake medicine. This is being done with the cooperation of authorities in neighbouring countries by increasing the exchange of information,” Sar Kheng, the deputy prime minister, said in a meeting last week.

“Even though China, Thailand and Laos refuse to admit some of their citizens produce fake drugs, what is important is that we cooperate to strengthen the border checks,” Yim Yann said.

The other key part of Cambodia’s war against counterfeits is to educate Cambodians about the dangers of fake pharmaceuticals. The government as well as drug producers have focused on educating pharmacists, hoping to create a frontline against the distribution of counterfeits in the Kingdom.

Has Aun, a pharmacist who sells medicine near Central Market, said, “It is difficult for us to know whether a drug is fake or good because they really look the same. But we have been trained on how to detect fake drugs by the drug producers and the Ministry of Health.”

Sok Serey, another pharmacist said, “The ministry’s agents examine our pharmacy at least two or three times a year. They train us how to check for expired drugs and how to check the brand names of drugs.”

The sophistication of some of the counterfeit drugs have made it nearly impossibly to tell if a drug is authentic or not. For the last five years, counterfeit malaria medicine with holograms nearly indistinguishable from the real drug have been found in the Kingdom, according to a report authored by sixteen top malaria researchers.

Tey Sovannarith, the deputy director of the technology office in the drug quality experimentation and examination department, said that when a visual inspection is inconclusive, he even needs to resort to checking the melting time of the pills in order to know for sure if a drug is counterfeit.

The counterfeit drug market has hurt the reputation of overseas drug companies in Cambodia, especially ones from China. Sok Serey said that her pharmacy did not carry any medicine made in China, because of the danger of counterfeits.

“I don’t like Chinese medicine. Sometimes it works; sometimes it doesn’t,” she said.

Chroeng Sokhan mentioned that two of the three counterfeit drug “ghost manufacturers” — fake companies that produce fake drugs — that currently produce the majority of the counterfeits in Cambodia are located in China.

What can Cambodian consumers do? According to William Mfuko, the officer responsible for essential medicines at WHO in Cambodia, because of public education efforts, all Cambodians need to is “watch TV, listen to their radio and look out for posters that warn against counterfeit drugs.”

“Most of all,” he said, “they should develop habits of consulting medical professionals for their drug needs. Self-medication is often the driving force behind counterfeit drug markets.”

Through continued education and better enforcement, the government hopes that Cambodians will become more discerning drug consumers and will learn what Chheth Sokha had to figure out the hard way.

“From now on, I’ll remember the doctor’s advice not to use medicines which do not have clear or proper brand names. Moreover, I will be really careful taking medicine, because they are double-edged swords. They are good for us only if we use them properly. But if we do not use them properly, they could kill us,” she said.

Also written by Khoun Leahkana