KAMPALA, Uganda — In the bustling slums of Kampala, amid dilapidated shacks constructed alongside open sewers, Muwangula Misambwa’s business is booming.
Misambwa is one of Uganda’s traditional healers — witch doctors — who ply a trade in promising to solve problems through herbal potions and ancient spells passed down through generations.
Officials and international aid agencies have long encouraged the sick to place their trust in modern medicine. But fake pharmaceuticals believed to have come from Asia have flooded Uganda and other African nations, including Tanzania, Nigeria and Congo, pushing patients back to traditional healers such as Misambwa.
“You find people who have taken bad tablets, several different types of malaria tablets, for example, and all of them have been fake. So many people have come to me like that,” said Misambwa, who is involved in reporting fake and substandard drugs to the government and proudly showed off his certification as an officially licensed healer.
Kampala’s poorest residents are particularly vulnerable. Waiting in long lines at clinics takes up valuable time, and top-end malaria cures are expensive. So when a malarial fever strikes, many search for cures in neighborhood drugstores, where the fakes are frequently found.
Jobbill Adonijh, 25, who works as a waiter at an upscale Indian restaurant and grew up in the poor neighborhood where Misambwa practices, said fake drugs are a basic fact of life here. Two years ago, when he was barely getting by in a different job, he was struck with malaria and bought cheap pills, as he had at least once before.
“When you take the pills and it does nothing, it doesn’t treat anything, it comes out so badly, you get so sick,” Adonijh said. “After like two days, I was feeling jaw pain, pain everywhere, so I went to a doctor and needed to get different medication.”
The cheap pills “made me not get better, but get sicker and sicker,” he recalled.
A growing body of academic research shows that fake pharmaceuticals are a serious problem in sub-Saharan Africa and that bogus drugs can kill. Studies undertaken by infectious disease researchers, including one published in the Lancet medical journal, say that up to one-third of malaria drugs worldwide are fake or substandard.
Government officials and residents suspect China as a prime source for the fake drugs, but hard evidence is difficult to find amid a web of deeply entrenched interests among governments, aid groups and pharmaceutical companies.
China, concerned about its image in Africa — where it has invested billions in infrastructure and is now deeply engaged in both business and diplomatic efforts — has denied the accusations.
“This allegation is groundless,” a Foreign Ministry spokeswoman, Hua Chunying, said at a news conference last month. “In fact, the Chinese government has conducted active cooperation with African countries in the field of medical and health care, playing an important role in improving African people’s health and raising the health-care level in Africa.”
Watchdog groups and aid agencies fault widespread corruption in Uganda and in other East African countries for porous borders that have allowed the problem to grow. Even Ugandan officials acknowledge that border control is a problem.
The deluge of fake drugs across Uganda and other parts of the Lake Victoria basin — the world’s deadliest malaria zone — has brought patients back to traditional healers.
As Ugandans become more aware that a large portion of drugs may be fake, they have returned to their trust in the old ways.
Across the border in Tanzania, health officials say thousands of doses of lifesaving antiretrovirals given for free to people with HIV and AIDS last fall turned out to be fake.
The Tanzanian government estimates that 1.4 million of its citizens are living with HIV or AIDS, and its free drug program has been a major success in extending lives. But with the fake medications came a loss of trust in the program.
“It’s a huge problem,” said Rodgers Stephan, an AIDS activist who is HIV-positive.
Rodgers said many people have given up on the drugs for fear they might do harm and have returned to herbalists, whose potions have no proven benefits.
“Even now it’s a major challenge. People have stopped taking their drugs and they don’t know what to do, who to trust or which place to go,” he said. “It has become a major problem in our community.”
McLaughlin reported with a grant from the Pulitzer Center on Crisis Reporting.