Patient referral should begin with community pharmacists – Pharm. Olanrewaju
(By Adebayo Oladejo)
In this interview with Pharmanews, Pharm. Madehin Abdulgafar Olanrewaju, the national financial secretary, Association of Community Pharmacists of Nigeria (ACPN) and zonal coordinator, ACPN, Ipaja, Dopemu, Egbeda and Akowonjo Zone, explains why he thinks community pharmacists are not being recognised and rewarded enough in the country and what can be done to improve the situation .Excerpts:
Tell us about yourself and how you became a community pharmacist.
I am a community pharmacist and I graduated from the University of Ife, now Obafemi Awolowo University, Ile-Ife. I had my MBA degree from the University of Maiduguri in 1997.
I had developed interest in community practice before I gained admission into the university and it was the community pharmacists in my area in Ibadan, especially Mol Chemist, that influenced my decision to study Pharmacy, even though most of my loved ones wanted me to study Medicine.
By the time I gained admission and started studying Pharmacy in 1983, my interest in community pharmacy was already awakened. So, right from school, I had begun considering some names for the pharmacy I would operate after graduation. The only hospital experience I had was during my youth service, after my internship. But immediately after my youth service, I entered into community practice, and it was not just a community practice where I would go and register somebody – I was fully involved.
I joined Namu Pharmacy Limited, Bornu State, in December 1999, in form of a partnership. I was in that partnership for 15 years, until I decided to relocate to Lagos. I did this for two reasons:one was the challenge of political instability, which usually led to crisis and chaos then, and I was not comfortable with the thought of raising my children in that place; the other reason involved the typical challenges associated with partnership. I realised that my expectations were not being met.Though I still have good relationship with them till today,I had to leave then.
When I left Namu Pharmacy in December 2003, I relocated to Lagos and started working towards having my own premises, but it was not really easy getting a good location.So,along the line, the opportunity of working with Emzor Chemist came. At that time, the Chemist wasn’t doing very fine and they were looking for somebody to revive it.So,I was given employment, as the superintendent pharmacist there.
I joined Emzor in January 2004, and by the time I left in 2008, we were already making sales of about three million naira monthly –the records are there for anybody to verify. Meanwhile, I had to leave because the initial reason I joined was to learn a few things about retail pharmacy and to understand the terrain very well. My experience with Emzor made me to know all that, and to understand the distribution system.So,by the time I was leaving, I had garnered enough experience.
I resigned from Emzor and started my own pharmacy, Epsilon Pharmacy Limited. It was incorporated in 2008 and the premises were registered in 2009.Since then, I have been doing what I love best because, to me, community practice was just like a calling and I have answered the call.
How would you assess community pharmacy in this part of the country?
Community pharmacists have a lot of potentials because, as community pharmacists, we render services to people.It is however unfortunate that Nigerians have not realised the full potentials of the community pharmacist and therefore not tapping into it.
The knowledge that pharmacists have is enormous; yet Nigerians don’t see them as people who have anything special to offer, rather than mere drug sellers. This is a mistaken perception because there is so much information that pharmacists have and are willing to share with the public. Components of this information provide the key to effective therapy.
Many Nigerians have not realised that, while drugs can be helpful, they can also be harmful. They don’t know that the only person that is trained to guide people on proper usage of drugs is the pharmacist. Meanwhile, other developed countries have realised this and this is why every prescription must go through the pharmacists before it gets to the final consumer.
Aside from that, we have a deregulated environment where people do things the way they like – they buy drugs and start selling, as they wish. And, due to ignorance,the consumers may not know that there is a need for them to see a qualified pharmacist before purchasing or consuming a drug. If the consumers are aware of this, charlatans would have been put out of business.
What are the challenges that come with community practice and how can they be surmounted?
The major challenge we have in community practice is empowerment. I mean empowerment in the area of knowledge and finance. A community pharmacist needs finance to undergo financial training, management training and others. Let me say here that it is the masters programme that I did that actually exposed me to the fact that those traders who have made success out of the drug distribution trade understand some rules of the thumb which wetrained pharmacists do not know.The only way we can learn all these rules is to go for trainings.
Still on finance, the community pharmacy profession is attached to the article of trade, even though it is not purely trading.For example, if one owns a pharmacy outlet and the person is very sound in the knowledge of pharmacology, pharmaceutical care, etc. – if people come to his pharmacy and find his shelf empty, they will lose confidence in him because they would have been disappointed with what they see in his pharmacy.
The state of your pharmacy determines the first impression people have of you. And by the time the first impression has been defeated, even though you are talking sense, they may not listen to you. But if they enter your premises and the place is neat, well-stocked and you are looking good, you have already broken the barrier of lack of confidence, and they will be willing to listen to you. This is where finance comes in.
If the government really appreciates the role of pharmacists as the interface between the drug and the consumer, they will develop deliberate policy in two areas: one is how they can increase the number of pharmacists being produced by pharmacy schools by funding those schools and establishing new ones; the second is to financially empower practising community pharmacists because, whether we like it or not, community pharmacies are like primary health centres, where majority of people visit first when they have a health challenge. By the time the government increases their capacity, they will be able to deliver effectively and, when necessary, they will also be able to refer patients to the appropriate professionals. In the real sense, the referral system should begin with the community pharmacy because that is where the patient goes first, and the community pharmacist should then refer to other professionals.
How lucrative is community pharmacy?
As it is now, there are lots of potentials in community practice and that is why everybody wants to sell drugs. Even professionals outside the healthcare system like lawyers, bankers, engineers and so on, are all interested in selling drugs.The reason is that they all see it as a very lucrative business. What determines whether a business is lucrative or not is the rate at which people demand for it. No one can do without drugs; drugs are consumed from the cradle to the grave. This is why everybody wants to go into the business of drug-selling.
Yet, it is not everybody that is trained to handle drugs because they are special products. It is now left for the government to deliberately prevent the profession from being hijacked by those who are not formally trained.
In a nutshell, community pharmacy practice is a lucrative business but the problem is that many pharmacists are not psychologically and technically positioned to tap the potentials of community pharmacy in their environment.
What are the major health conditions that bring patients in this area to the pharmacy and why is this so?
I will say it is malaria that often brings people to the pharmacy because by the time they come and complain and we give them a malaria drug, within the next two to three days, they will be okay. This is why I think we should be able to empower community pharmacists to take care of malaria and other minor illnesses, while the serious ones can be referred to the hospital.
How do you see the war on fake drugs?What strategies can be adopted to effectively tackle the menace?
The challenge of fake drugs is a global problem but other societies have identified the challenge and developed strategies to take care of it. In Nigeria, we have also developed strategies but we are not doing enough.The reason is that we are losing focus.For example, there is the task force on fake and counterfeit medicine set up by the federal government and is managed in all the states of the federation, but the members are not empowered to work. They should be able to go to any place where medicines are sold and be able to deal with anybody that stocks fake products. They should be able to trace those who are behind the pushing of fake drugs into the markets because they are all human beings and not ghosts. The regulatory bodies should also be empowered to do monitoring constantly, in order to ensure that people are doing the right thing always in the distribution system.
Another major area we have failed to look at is that in the process of moving a drug from the manufacturer to the consumer, the drug could become adulterated, due to poor storage. Many people do not know that poor storage can make the active ingredients in a drug to reduce, thereby making the drug substandard. So, the regulatory agencies have to start investigating whether those that are in the system have the proper capacity for storage. Monitoring is essential.The manufacturer, the importer and, finally, the retailer should be properly monitored.