Private hospitals without qualified pharmacists should be sanctioned – Pharm. Debo Tade
In this interview with Adebayo Folorunsho-Francis, Chairman of Mastoofy Supermarket & Electronics Ltd, Pharm. (Deacon) Adebowale Robert Tade, expresses weighty views on the different areas of pharmacy practice in Nigeria and why he thinks pharmacists in the country are not respected or appreciated enough.Exerpts:
Tell us a little about yourself
For someone who believes in both paternal and maternal sides, I always claim to hail from two states in Nigeria – Ijagbo community in Kwara and Ikogosi in Ekiti.
I was born on 16 February and presently nosing 70 years. I went to Baptist Boys’ High School, Abeokuta (a school whose motto is “nulli secondus” – second to none – and has produced a head of state, top academicians, erudite jurists, business moguls, top company executives for this nation and myself). I graduated from the School of Pharmacy, Ahmadu Bello University (ABU), Zaria, where I attended from 1965 to1970.
I have travelled extensively across the globe for general and senior management studies, courses in financial management/accounting studies and strategic planning skills. I had my internship in one of the busiest children hospitals in Africa, Massey Street Hospital, Lagos. After working there for a while, I made up my mind to quit hospital pharmacy because there was no respect for the pharmacy profession in hospital pharmacy practice.
Why did you say that?
I will come to that later. It is not something I want say at the beginning of this interview.
Tell us about your work experience then
I first worked with Burroughs Wellcome. I was one of those who first launched Septrin, Actifed, Neosporins and some others. I later moved up north and worked with Beecham. At a point, I wasn’t satisfied with the state of things at the company because I was the only sales representative covering the most of the then northern states up to Lake Chad. I was always busy travelling from one end to the other. Eventually I got fed up. One day, I was forced to ask myself what I was doing in the Chad area. I left the company and returned to the south where I got an appointment with Pfizer in 1973 as medical representative.
I got promoted as the ethical product manager in 1975, after some very competitive on-the-job tests and interviews. Thanks to Pharm. Douglas Egbuonu for his forthrightness and the Late Pharm. Dr Fred Adenika for his thoroughness and leadership. Detribalised Nigerians they were.
How did you feel about your promotion?
I can only thank God for His grace because, shortly after that, I moved in quick succession from product manager in 1976 to marketing manager in1978 and head of the pharmaceutical division as division manager in 1981.
By dint of hard work, I worked my way up to becoming Pfizer’s deputy managing director in 1985, the first Nigerian pharmacist to be so appointed and also elected to the Board of Directors of the company. It was a long wait but I enjoyed it anyway to the glory of God. Pfizer businesses registered astronomical growth in income and competitive edge in the short and medium term after my historic elevations.
Again, because of politics in the workplace, coupled with subterranean manoeuvres, I was moved to the then ailing Animal Health division of Pfizer to grow the business under the notion that I was an excellent turnaround management expert. I was named the country manager of Pfizer’s Animal Health Business, which included Livestock Feeds Plc.and veterinary pharmaceutical business. Pfizer divested its businesses in Nigeria later between1996 and 1997 and I became the chairman and managing director of Livestock Feeds Plc.
Following the divestment, Pfizer needed a seasoned manager for its 100 per cent-owned Pfizer Specialties Ltd., a company which operates in Nigeria, Ghana, Liberia, Sierra Leone and The Gambia. I was recalled by Pfizer New York headquarters and was named country manager, chairman and managing director. I was very active in all the regions. I launched some new Pfizer ethical products, including Viagra and Norvasc, and also posted unprecedented profits in all of the regions. I was at the helm of affairs for seven years and retired thereafter in 2005 in excellent health. Glory to God Almighty.
I thank God that I am still standing, long after my retirement. Now, I have dedicated my full time to doing God’s work and assisting in the running of Mastoofy Limited, a company my wife established after her earlier retirement in 1998.
In retrospect, can you confidently say studying Pharmacy was a good decision?
I will say that it was a good decision. After all, I achieved my set objectives of becoming a pharmacist and made my mark in the industry. I was also fortunate to have led the biggest pharmaceutical company in the world in terms of research and development, high volume sales and relatively high bottom-line figures over years.
What was the profession like in your day compared to today’s practice?
Depending on where you place yourself. In my day, the respect was really not there. But today, it is even worse, which is why I mentioned earlier that it depends on where you place yourself, your personal profile and the angle you are looking at it from. Do you respect yourself? Fine. The public will respect you likewise.
Tell us more about controversies surrounding the practice during your time
(Laughs) This also depends on the arm of pharmacy practice you are referring to. If it is industrial pharmacy, respect was there; it is still there and will still be there. In the industry, people like me competed with other professionals. It is a multi-disciplinary sector. Even as a pharmacist and deputy managing director also in charge of Pfizer Animal Health, I was privileged to head the animal feed section. In spite of my not being a veterinary doctor or an animal health specialist, I had veterinary surgeons who reported to me daily. That was born out of the profound respect they had for me. In me, they saw an innovative management guru, and an informed leader.
As general manager of Pfizer and, later, as chairman/managing director, I had finance directors, veterinarians, medical doctors, human resources directors and manufacturing plant directors who actively reported to me over the years. All of these people are candidates for the top job in the pharmaceutical industry and the best is usually given the top job. So, it is a competitive arena and you just must be proven to be ahead of them in all parameters of business and management of people and financial resources.
I thank God that Pfizer exposed me to relevant postgraduate general management and financial courses, some of which were done at Columbia University and Turfs University in the USA. I also thank God that I was trainable and progressively justified the rationale for my wide exposures to worldwide seminars and interaction.
Does that mean you never had any controversial issue at the industrial pharmacy level?
I cannot really say the challenges I encountered can be called controversy per se. But you have to prove your mettle still, especially when you have diverse people reporting to you all the time.
To me, Pfizer remains the biggest pharmaceutical giant to date. Whoever works in the company must be adequately equipped to do the job well. If, in the process of training, you don’t perform well, they will drop you. Unlike some pharmaceutical companies where you could present unproven reports, in Pfizer, operating results emanating from you must be robust and in line with the company’s short to medium business plan.
For our annual budget, I was in charge and, honestly, an annual budget document was about 200 pages,A4, single space, in narratives and data, all supported by research and encompassing secondary/desk research and primary/in-depth interviews. New products launch plans were rooted in so many surveys, requisite research work, collating etc. All of these ordinarily were veritable documents/thesis which qualified for PhD awards (laughs). Many of our budget documents, new products lunch plans were references for future managers to develop their skills and excel in our competitive business operations environment.
What about controversies at hospital, academic and community pharmacy levels?
Yes, I agree there were problems in hospital pharmacy. Now we have the directorate of pharmacy which wasn’t there before. But before this could be achieved, it was “battle royale”. Quite some intrigues there.
In the area of academic pharmacy, there were some things missing in the past that have now been addressed. At least, we now have deans heading various pharmacy faculties. This was missing in the past. We thank God for the elders and forerunners who fought gallantly to have them in place. That was another battle.
But when it comes to hospital pharmacy, the kind of intrigues going on there is quite disturbing.
Maybe you can tell us why you had to quit hospital practice
I told you I would come back to that. Well, when it comes to health institutions, especially at the Massey Street Hospital where I worked, we resumed as early as 8.00am, counted tablets at the counter, prepared mixtures, made some emulsions and read/interpreted prescriptions and dispensed as necessary.
I remember I once queried the hospital specialist’s prescription. He was furious but I stood my ground because my training was instructive that he was wrong. Thank God, my superintendent pharmacist had to agree with me, albeit reluctantly.
We rarely prepared emulsions. You see, when I left pharmacy school, I was of the opinion that we would have a small production unit to work from. Definitely not what I encountered! There was no desired respect for us (pharmacists) because our scope of operation was limited. Patients’ counselling on use of medicines, ward-round checks on prescriptions were not allowed or readily tolerated in the system. That was why I made up my mind to quit. I was wasting away at the hospital.
Do you mean the general public don’t accord pharmacist due respect too?
They don’t even have an idea of what we do. Doctors, surprisingly, also pretend not to understand what pharmacists could do, or are trained to do. That is why you hear them at times asking, “What do pharmacists do?”
Do you know that there are times we are compelled to query some of these doctors’ controversial prescriptions? But the public wouldn’t know this. Their concern is just to pick up whatever is prescribed for them. In truth, the average pharmacist is not putting up to 10 per cent of what he/she studied in pharmacy school into practice. In a serious society, the government would have addressed such issues. But here in Nigeria, our government is not encouraging pharmacists at all.
Are you aware that in Europe and in the USA, some drug labels and adverts carry inscriptions that patients should contact pharmacists or doctors for consultations as necessary? The understanding of roles of pharmacists and doctors is clear and well-understood in the civilised countries
What about pharmacists working in private hospitals?
Those ones are worse. The kind of scandals that go on in private hospitals are more serious. How many private hospitals have a standard pharmacy in place, with pharmacists in charge? Only a few. In some cases, what you see are bunch of untrained nurses and illiterate salespersons placed behind a counter to dish out drugs. It is an insult to the profession. It is a serious issue that I think the government should look into.
I don’t want to make it look like the PSN is not doing enough. But I believe most [erring] private hospitals in Nigeria should have been brought to book. Any private hospital without a pharmacist should be sanctioned. Just imagine all the professional charges they collect! In most cases the private hospitals inflate the prices of drugs. The content of hospital bills in private hospitals is lopsided, cost of medicines is about 50 per cent of total hospital bills, and no pharmacist is in the employment of the private hospital. What a shame!
You didn’t say anything about community pharmacists. Are you impressed with them?
(Laughs). If we have to address community pharmacy practice in detail, I will say it is quite enormous. But I will just mention a few. In our days, our headache used to be patent medicine dealers. But today, I have observed that the problems associated with community pharmacy are worse than before.
Tell me, how many pharmacists who retired from hospital, academic or industrial pharmacy practice can wholeheartedly say they are interested in setting up a community pharmacy? Not many. This is because they are aware of the problems with running such practice now. Too many quacks have taken over the profession.
Additionally, community pharmacy is a key service arm of pharmacy practice which many pharmacists desire to be involved in. But community pharmacy has currently been dominated and changed into family business in locations with relatively high economic activities. Other locations available are yet to open up for minimal sustainability. Many are just crawling and slowly growing into sustainable economic levels that could make a pharmacist break even in the practice.
Establishing pharmacies in village-type streets in urban areas will not support the basic living conditions of young pharmacists or even some elderly ones, who were not favoured to open up community pharmacies on lucrative streets and are edged out by a cartel of powerful pharmacists who influenced “regulations” to become everlasting “lords” on commercial roads with high human traffic, even dominating hospital zones.
The truth is that some older and very influential pharmacists have cornered community pharmacy practice without qualms, a selfish and domineering behaviour, forgetting that the whole earth is for the Lord God and we all are mortals who will pass away someday.
What are the challenges facing pharmacy practice in Nigeria and how can they be surmounted?
Several challenges have evolved over the years, and the culture, attitude and environment have constituted the main problems for Pharmacy and every other profession and, indeed, the individual Nigerian.
Until justice and fairness become our watchword, there can never be peace in the professional arena. The challenge of practising any profession morally and ethically would always be a distraction and any gain by one would be viewed as a loss for the other. There are certainly enough laws guiding the profession, but respect for the law is often applied subjectively.
How best do you think the issue of fake drugs and counterfeit medicines can be curbed?
The problem of fake drugs started several years back. When I was the marketing manager of Pfizer, I tried my best to curb it, as majority of Pfizer products were also being counterfeited.
I recall a time when we took some offenders to court, the subject matter is described in legal parlance as ‘passing off’. We had about 35 varieties of counterfeited Pfizer’s TERRAMYCIN in the market ranging from names like Termicin, Tercin, Tamycin and about 30 others. We managed to win some cases, but we lost others.
Personally, I think the government is not doing enough to help us in this regard. There should be punitive laws for culprits. While I will not support death sentences for culprits, I think long term imprisonment will serve to deter several others
How do you mean?
It is simple. Why allowing open drug markets in Nigeria when, actually, in China, if the government catches you doing this, they will kill you immediately? But Nigeria has been treating the issue with kid’s gloves because of vested interests. We need an enabling law. I remember how my life was at risk during the raid we carried out on Onitsha market back then. Open drug markets are now everywhere, in Lagos, Kano and others.
What is your view concerning growing fears among young community pharmacists that the old ones are not accommodating?
This is why I said earlier that community pharmacy has been messed up. My grouse is that patent medicine stores and even pharmacies not owned by pharmacists are sited within the 200-meter gap and without sanctions. This “rule” must be abrogated or systematically reviewed to be devoid of selfishness of elders in the profession.
Also, some elders are lording their appetite for domination over current and upcoming generation of pharmacists. Some elders in the profession should rescind abuse of their previous exalted positions and privileges previously enjoyed which influenced the 200 meters “rule” to their advantage. This unpopular “rule” is not an Act of parliament and the implication is clear. The examples often cited of some countries and elsewhere are in error as there are lots of enabling incentives for young and upcoming pharmacists I those places. The draconian 200-meter gap rule should be significantly reduced to about 20 meters in hospital areas.
My view is that in hospital areas of about one kilometre radius, ideally, pharmacies could cluster as close as 10 meters apart. Competition should be allowed to play itself not domination and perpetuity of family practice, as it is today. In areas distant from hospital catchment, not more than 25 meters should be allowed. To ask pharmacists to open premises in untapped streets and villages, places without access roads, infrastructure and economic viability are non-existent, is outright invitation to militant resistance and litigations against PSN/PCN in no distant future. The time is now for review.
Is the rule not an attempt to make more pharmacists move into rural areas instead of the over-saturated urban areas?
So I was told. But where is the potential in that? Where is the economic activity? Now you expect the pharmacist to make N100 all day, not even N1,000. The proponents of this policy or call it selfish elders are not realistic. It is not a law of parliament but a policy put together by some selfish elders. It is an outright infringement of the fundamental human rights of pharmacists, yes it is. Very unaccommodating, I must say!
How active were you in PSN-related activities?
I, together with the likes of Pharm. Ogundibo, Pharm. Bob Manuel of Glaxo and some few others pioneered the establishment of the Industrial Pharmacists group, an arm of the PSN in the early ‘80s. From my time as marketing manager to general manager, deputy managing director, to chairman/managing director, I strived to cause Pfizer to support the PSN at local and national levels in meetings, debates, and in resolving topical issues, including policy of engaging pharmacists by companies as pharmaceutical representatives, pricing guidelines to companies, ethical practices by companies etc.
Every year at the PSN annual national conference from 1977 to 1988 and, particularly, in the era of Nigeria’s SAP(Structural Adjustment Programme), as a pharmacist at the helm of affairs in Pfizer, I made sure Pfizer solely sponsored all key PSN conference opening buffet lunch. Pfizer painted the PSN conference programme red with products adverts to inform and educate all on Pfizer research -based products.
Pfizer partnered well with the PSN. It was a win-win deal as Pfizer successfully launched many of its key research -based products at the time. Several other companies are today on the queue to support the PSN with programme adverts and buffet lunch at the annual PSN meetings.
Let me seize this opportunity to commend the literary ingenuity of Elder Pharm. Atueyi for his pioneering efforts on the Pharmanews journal. Pfizer, under my leadership partnered with him through innovative centre-spread adverts, which commenced with FELDENE centre-spread advert from 1980/1981 and beyond. It is now well emulated by other companies. It was Atueyi then and I in action.
From my exposure to Pfizer veterinary pharmaceutical business from 1987 to 1998, I knew that veterinary business, if well managed, is more profitable than human pharmaceutical business but many pharmacists are unaware. Some level of understanding is required by pharmacists to also be involved in veterinary pharmaceutical practice. Therefore, in 1992, I got together the deans of the faculties of Pharmacy in three of our universities, dean of a veterinary institution and the then registrar of the Pharmacists Council of Nigeria to deliberate, decide and agree on curriculum/courses on veterinary medicine in Pharmacy degree programme. The blueprint from the two-day meeting, which was held at the Sheraton Hotel, Lagos, seems moribund but I pray it will be revived soon.
I am a Merit Award winner, Courtesy of PSN, Lagos State Branch; a Fellow of the Pharmaceutical Society of Nigeria (FPSN);and a Fellow of theWest African Postgraduate College of Pharmacists (FPCPharm.).
How do you see the annual PSN national conferences?
The jamboree aspect is about 60 per cent, while the scientific aspect which is educational, sort of continuing education in Pharmacy, is about 30 per cent. The balance of 10 percent is for politics. I enjoy it though. But it is advisable to shift the priorities when we have policy decisions – we should know who is to do what and strive to report back by next conference.
If you were not to be a pharmacist, what other profession would you have opted for?
When I was in secondary school, there was this dog we had with yellow eyelids. One day, the dog misbehaved, became a threat to people and my father shot it. Being a biology enthusiast, I took it upon myself to bury it. I exhumed it after some weeks and skilfully put every skeletal bone in their proper place. As brilliant as I was, I identified all the bones, the vertebral column as I was thought in school (including the skull) correctly. Perhaps I could have become a surgeon or doctor. Against all expectations, I turned out to be a pharmacist. I think it was partly because I saw some pharmacists compounding medicines at the Ilorin General Hospital when I was on the queue to collect a cough medicine. I was really impressed! I also saw a pharmacist at a time searching for herbs and also sorting out some leaves, combining and grinding them to make some concoctions. You know that pharmacognosy is also a vital part of Pharmacy.
As an elder in the profession, what is your advice to young pharmacists?
They need to be definitive and decide early enough which arm of pharmacy practice they desire to be involved in. They need not beat about the bush. It doesn’t matter whether you are in hospital, industrial, community or academic pharmacy practice– the sky is your limit. They must work hard, adequately equip themselves and, above all, allow the fear of God and the direction of the Holy Spirit to guide and direct them. That’s the key to success.
I think they can also take a cue from Pharmanews. Atueyi is someone I know is quite principled. He knew what he wanted to do from day one. At one point, he was editor of the PSN journal. He wasn’t well equipped for the job because the PSN wasn’t taking the publication as serious as he and, indeed, some of us desired. But his flair for hardwork and focus saw him succeed. This is why I said people should work toward their goals.