Unlike the chain pharmacies that dominate the U.S., most of Senegal's are privately owned. They come in all different shapes and sizes. Some stand out, with old-fashioned signs painted in bright blue and green. A cheerful cardboard teddy bear sits in front of one, telling customers the pharmacy is open for business.
Inside, the shelves resemble those in an American drugstore:filled with cosmetics, baby items, toothbrushes and other toiletries. Boxes of medicine neatly line the shelves behind the counter, where a pharmacist can be seen diagnosing a patient or mixing medicinal syrups by hand.
Patterson credits the rise of Senegal's pharmaceutical industry partly to French colonizers in the early 20th century. Senegal was then suffering from outbreaks of yellow fever, bubonic plague, flu and smallpox. That put pressure on the French to build a better health infrastructure.
The first school of medicine was established in 1918, training the Senegalese to become pharmacists, nurse, veterinarians and midwives. The locals were first trained as assistants, but over time "[the colonizers] decided to professionalize Africans in these biomedical health [care] not just use them in terms of auxiliary support," Patterson says.
Fast forward a few decades. Today there are more than 1,000 pharmacies serving a country of 14 million. Many Senegalese prefer to visit a pharmacy to get diagnosed and treated for minor injuries, infections and illnesses. It's both cheaper and more convenient than visiting the doctor, says Patterson.
Why are pharmacies are at the forefront of health care?
The primary reasons are proximity and cost. [People] don't have to pay a fee to visit the pharmacy [as they do] at a hospital. In terms of proximity, pharmacies are everywhere. You can find multiple pharmacies in many neighborhoods, particularly in cities and increasingly in smaller towns. Whereas doctors are congregated primarily in the urban centers and neighborhoods that have high socioeconomic status.
And in some circles, pharmaceuticals are considered a status symbol?
Being able to take pharmaceuticals can be seen as a sign of affluence — someone can have a cold and take five different things that they were able to go to a pharmacy and buy these things — [even] if they only need one.
How do pharmacists regard Senegal's traditional healers?
Traditional healing is so pervasive. It's been a major part of [Senegalese] life and we just can't scalp that. What often happens is that many people will go to the traditional healer first. And if it's not working, they'll go to the pharmacist. And the pharmacists know this. [They will ask] if someone is taking some sort of herbal remedy [because] there could be drug interactions. Some of the pharmacists are absolutely opposed [to traditional healers]. Others say, "we should have more collaboration."
In your book you write that women own 48 percent of pharmacies in Senegal. How did women become such big players?
We first see a handful of African women getting into the School of Medicine and Pharmacy in the 1940s. The literacy rates for women are lower than they are for men — they've always have been — [and] most women weren't going that far in [primary and secondary] school so that made it difficult. There was also discrimination so qualified women were often not admitted to keep more spots for men. What happened in the 1960s and '70s is that women started [attending university] in much higher numbers. They tended to stick with it and were more tenacious in their studies, and men dropped out at higher rates.
More [women] were able to own pharmacies. Madame N'deye Dieynaba Mbodj Fall, who ran the National Order of Pharmacist [Senegal's major pharmacist association] from the late 1970s to the late 1990s, became the most powerful pharmacist in the country. And [she and other women pharmacists] were able to open up this sphere for women after them.
How has that affected gender roles?
These women have a very lucrative pharmacy [business], and money speaks. They're able to contribute to the welfare of their immediate and extended family — if someone is getting married or needs school fees. With this kind of economic contribution comes power. The [women] can influence decisions, like what their family member should study.
For some husbands, it's very difficult to deal with a woman with this much economic clout so some of the [women] get divorced. They only remarry if they want to because they can support themselves and their children.
You write about Keur Serigne Bi, an underground market for illegal drug sales. How does that play into Senegal's health care?
In many countries in the global south, there are parallel drug trades. Keur Serigne Bi is this [marketplace] where the focus is [selling] pharmaceuticals that have been acquired through [illegal] means. Things are often perceived to be slightly less expensive. And some people of lower social economic strata who have the perception that pharmacies are judging them feel more accepted [at these markets]. There are problems though because most of those who are selling are illiterate. Some things that should be refrigerated aren't. Some things are expired and where a pharmacist would throw that away, they would keep it until they sell it.
Why hasn't the government or pharmacist associations shut them down?
It's tricky. The Mourides [a branch of Sufi Islam] is one of the largest investors in Keur Serigne Bi [which means "the house of religious leaders"]. They are very powerful in terms of religion or influencing elections. So one can understand why the government would be reticent to go up against a religious brotherhood.
What's the outlook for the new generation of pharmacists?
The only way they can really own pharmacies is to move outside of congested urban areas, where there are too many [pharmacies], and into rural areas. There is money to be made. Maybe [the government] needs to give the graduates incentive to open pharmacies in the rural areas.