Why pharmacists can no longer hide behind counter – Pharm. Lawal
In this recent interview with Pharmanews, Managing Director and Superintendent Pharmacist of Victory Drugs, Festac Town, Lagos ,Pharm. Folasade Olufunke Lawal bares her mind on the happenings in the pharmaceutical industry and why she thinks pharmacy practice has progressed over the years. Excerpts:
How long have you been in the practice and how did it all begin?
Victory Drugs was established on 6 May, 1989 out of passion for a practice that would please God and be maximally beneficial to mankind, a patient-focused healthcare delivery. I graduated from the University of Ife (now Obafemi Awolowo University) in 1985 with a Bachelor of Pharmacy degree. I later got a master’s degree in Clinical Pharmacy in 2006 from the University of Lagos.
While in secondary school, my strength was in the sciences, with Mathematics being my best subject. I was caught between studying Mathematics and a medical sciencescourse. My closeness to my maternal grandfather, a herbal medicine practitioner, drew me closer to the medical sciences than to Mathematics. However, the thought of working in a hospital as a medical doctor was unappealing. In our day, pharmacy profession was very unpopular -so little was heard or known of pharmacists. However, I got to know more about Pharmacy through my secondary school classmate and close friend, Remi Oladeji.
I had my internship training at a community pharmacy and did my National Youth Service programme at a government hospital. Thereafter, I worked in a private hospital for one year. In none of these places was I able to express my passion the way I wanted to. So I took the bull by the horn and started my own retail pharmacy with about N7,500, for furniture and stock, and by God’s grace, we have evolved, over the years, to a standard retail pharmacy. The journey was tough but the Lord was, and is still on our side.
Tell us about some of the challenges you have faced in your practice and how they were tackled
Having practised as a community pharmacist in Victory Drugs for over25 years, challenges faced by me and my teamhave been enormous, but I will briefly enumerate the major ones.
Lack of adequate and regular supply of electricity is number one and, to overcome this, we have had to get generator sets and inverters. This, of course, results in very high running costs which cannot be passed on to clients.
Insecurity is another challenge that is limiting ouractivities and time of operation. What we have done is to employ the services of security companies. Of course, that is also additional cost. We have also had our fair share of the inter-professional rivalries rampant in our practice setting, but God has helped us to surmount this by teaching us to put ourselves in the shoes of others, see things more objectively and carefully pursuing peaceful ways of resolving conflicts whenever they arise. We have high regards for other healthcare professionals and see them as partners-in-progress; so we go out of our way to make friends with them in the best interest of our clients. We obey the biblical injunction that, as much as it lies within us, we should live peaceably with all men.
Another professional challenge borders on poor differentiation of roles by the various healthcare professionals. It is easier for a camel to pass through the eye of a needle than to get prescriptions from private hospitals, while it is also common that prescription drugs are dispensed without appropriate prescription or any prescription at all in community pharmacies. We all have our share of the blame for this unethical practice, with the government probably having the largest share.
Moreover, ours is a peculiar country where healthcare is often paid for, out-of-pocket, by people who would rather pay for “product” than “service”. Most services rendered in community pharmacies are not remunerated, and most patients are also not willing to pay reasonable hospital bills without accompanying medications. This has contributed in no small measure to the sub-optimal healthcare service being rendered in the country, making ethical practice rather difficult. It is a big and difficult challenge.
What we have done is to build a healthcare team around healthcare professionals who share our “Health for all”vision, using the principles of pharmaceutical care. When we pick up health challenges that need input of other healthcare professionals, we refer appropriately and politely ask for feedback which, more often than not, we get. By this, there is continuum of care, communication gap is avoided and the patient gets the best at minimal cost.
There is also the challenge of poor access of patients to information on their health and medication, thereby limiting or compromising our input into their care or management. For instance, patient Xmight have seen a healthcare professional who diagnosed malaria and gave him drugs without disclosing to him the name of the drugs. The patient could then visit us a few days later with same complaint, with test results still showing malaria but patient can’t tell what drug he took. It becomes herculean to choose the right medication because, apart from the risk of overtreatment, we also stand the risk of failure to treat in the event that we give him the same drug he just took that failed to cure the malaria. This is a case too many. We have tried to solve this by coming up with Medical Diary,which empowers patients, through documentation, to track their medical records and benefit from continuum of care or intervention from various healthcare professionals instead of the disjointed healthcare which exposes them to mismanagement.
How do you see pharmacy profession today compared to when you started?
Pharmacy profession, when I started, was more drug-focused than patient-focused. It was very unpopular to have pharmacists intervene in disease-prevention or the likes. Pharmacists hid behind counters and were not to be seen. Most people did not know what Pharmacy was. There were very few pharmacists and the few were hidden, not accessible. Perhaps, then, only the academic pharmacists were recognised in terms of their contribution to national development. I think there were only about five schools of Pharmacy in the country then.
Thank God,Pharmacy today has metamorphosed from drug-focused to patient/client-focused, with pharmaceutical care getting more entrenched in the country. Pharmacists now play leading roles in preventive healthcare, which is the strength of any healthy society. Today, the pharmacist is very visible and easily accessible. In fact, the community pharmacy today is the first port of call by the public and is thus an indispensable resource for preventive health.
What do you think government can do to improve the standard of pharmacy profession in Nigeria?
Government’s role in improving the standard of pharmacy profession in Nigeria is critical to national development. The higher the standard of pharmacy practice, the lesser the morbidity and mortality indices of the country and the healthier the nation. And the healthier the nation, the wealthier it gets.
The Nigerian government can improve the standard of pharmacy profession by sanitising the chaotic drug distribution which, as I mentioned earlier, has already been embraced by the government. Also, they should be empowering pharmacists to optimise their potentials by reviewing the statutory hindrances mentioned above with a view to promoting access to healthcare.
There should also be adoption of national guidelines on disease prevention and management, with the roles of each healthcare professional group clearly defined and measures put in place to enforce compliance.
Other suggestions include ensuring that national prescription and dispensing policy is adhered to; strengthening the health insurance scheme and allowing equal opportunities for all healthcare professionals to practise through adequate remuneration and adoption of pay-for-service; empowering community pharmacies through provision of easy-to-access loans with very low interest rates and provision of basic amenities like uninterrupted supply of electricity; making it attractive for community pharmacies to be set-up in rural areas; compelling all private establishments where drugs are handled to have pharmacists in their employ, either full-time or part-time as the case may be; and upholding the law that states that only pharmacists can own retail pharmacy outlets in Nigeria.
What are the most common health conditions that bring patients in this area to your pharmacy, and why is this so?
They are largely preventable diseases like malaria, typhoid fever and infections generally. Also gaining grounds are non-communicable diseases like hypertension, which accounts for the highest visits, diabetes and dyslipidemia.
These are pointers to not-good-enough health prevention strategies in the community and the country at large. For cases like malaria, apart from the mosquito-breeding environment, it seems like malaria is generally over-treated.Many people are not willing to be tested before treatment largely because of the cost to them. They have to pay to be treated and if, positive, will now pay for their medication.So they prefer to just buy antimalarial drugs. This is another area we need the government to invest in or cover with functional health insurance. To be effective, community pharmacists should be remunerated to carry out rapid malaria tests on people who ask to buy antimalarial drugs off prescription or who come with symptoms suggestive of malaria.
We need, as a country, to focus or expend more energy on effective preventive health strategies, thereby optimising pharmacists’ intervention.
Many people have canvassed for stiffer penalties to be meted out to drug counterfeiters. Do you support the motion?
If it will act as deterrent, why not?But I think the government needs to empower indigenous manufacturers to produce safe effective medicines at affordable costs. This will deter drug counterfeiters. With the current move by the government to sanitise drug distribution, I believe the population of counterfeiters will naturally reduce.
Finally, what’s your advice to pharmacists in Nigeria?
Dearly beloved pharmacist, the train of pharmacy best practices is moving.If you are not yet on board, please come on board and let us continue to fight the good fight of pharmacy best practices, armed with the biblical injunction that “godliness with contentment is great gain”.
The dividends of pharmacy best practices are great and should not be seen in terms of money alone. We shall all have our share if we do not get weary in doing good. The God who has called us to this noble profession is more than able to uphold us and make us fulfilled in Him. As men of honour, we join hands for pharmacy best practices – no compromise!