Elizabeth had learnt to accept the fact that she had contracted HIV, the virus that causes Aids. She saw no point in continuing to deny the fact.
With counselling and advice from her doctor, she started taking antiretroviral drugs (ARVs). But after a while the cost took the toll on her expenditure - she was spending about Sh100,000 a year on the medication.
The thought of stopping the treatment and die had crossed her mind many times. After all, she was soon going to die, she thought. The branded or "original" ARVs were not readily available either.
But all was not lost. Her doctor took her through a series of counselling sessions and offered her the alternative of generic drugs.
"Initially I started using generic ARVs because I could no longer afford the branded ones," Elizabeth, who now looks stronger and determined to live on, told Saturday Nation in an interview this week.
"Originally I felt dejected and thought the generics would not go down well with me. Pharmacists and my personal doctor had to reassure me that they work."
It is two years since she started using the generics and, in her own words, she has not had any side-effects and supply problems. Besides, she says, she hardly spends Sh50,000 annually.
Little difference
"In fact, I cannot see any difference between them and the branded drugs," she says. "Initially I used Combivor, but today I'm using its generic form which is a combination of Zidovudine and Lemurduvine. Most people, just like I initially thought, confuse generics with counterfeited drugs. Generics have kept me going."
Industry players who spoke to the Saturday Nation accused drugs regulator Pharmacy and Poisons Board of laxity, arguing that ineffective medicines are circulating in Kenya. It is drugs that do not work which people confuse with generics, they said.
The board regulates pharmacy practice and the manufacture of and trade in drugs and poisons.
It is also charged with the responsibility of implementing the regulations to achieve the highest standards of safety, efficacy and quality of all drugs, chemical substances and medical devices locally manufactured, imported, exported, distributed, sold or used, to ensure the protection of the consumer according to the law.
However, the organisation is said to be understaffed, with only a handful of inspectors to monitor nearly 3,000 outlets in the form of chemists, pharmacies, kiosks and general shops.
Although the inspectors are tasked to not only combat counterfeit drugs, but also ensure drugs in the market are duly registered, some doctors argue that the board is ill-equipped to police the market. Dr Ronald Inyangala, the board's head of trade affairs and post-market surveillance, says the problem of counterfeits and substandard drugs is a worldwide affair. "We have the will and capacity to fight on to minimise the problem," he says. "It is not that serious. It is definitely under control. The level of counterfeits and substandard products is less than 10 per cent."
A survey reveals that most users cannot differentiate between generics and substandard and counterfeit drugs. But while they dismiss the efficacy of some, they inadvertently use them. And it is after some time that it dawns on them that the drug they are using is actually generic.
What is for sure is that the dumping of inefficacious drugs in the market is an issue the board is yet to deal with conclusively to ensure there are only "brand-named" and quality generics.
What most Kenyans do not know is that Paracetamol, for example, is the generic form of standard Panadol or Tylenol. But the basic active ingredient in both drugs is Paracetamol. The chief executive officer of Amini Management (EA), Dr Amit Thakker, says that if the generics are of the recommended quality, they have the same level of efficacy as the branded ones.
His counterpart at Metropolitan Hospital in Nairobi, Dr Karangaita Gakombe, explains: "Brands evoke a certain perception in consumers. Indeed, this is the age of branding where same products, even from one manufacturer, bear different brands and may even be sold through different outlets. Indeed, quality generics work."
Dr Thakker says generics save hundreds of lives that could have otherwise been lost due to expenses involved in healthcare. But Dr Gakombe discerns a danger in relying on generics, saying that failing to respect patent rights will discourage research and development. In the end, he says, this will be detrimental to healthcare delivery
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