Saturday, October 25, 2008
Vacation
timkopus blogs take a two weeks break. The blogger deeply regrets for the inconvenience this has caused to his ardent readers. The blogger promises even more relevant, practical, well researched and informative content for readers consumption and discussion in the subsequent posts. The blogger also wishes to inform the readers that there are four blogs running concurrently and they can all be accessed by viewing the blogger's profile. All blogs posts will resume on monday, November 3 2008. Finally, the blogger wishes to thank the readers for the invaluable comments that have proved once more the relevance of the blogs.
Tuesday, October 14, 2008
Pharmacy solutions
Check out a new series of posts under the name "pharmacy solutions".
Trust me. There is no single person who can come up with solutions to our well known but difficult to solve problems.
Check out every few days or weeks for new ideas in this interactive blog for home made solutions. Ideas straight from Kenyan pharmacists or those that have had first hand working experience in Kenya.
Regular readers will receive automatic notifications whenever there is a new comment.
So do you want to make the big move. Visit http://timkopussolutions.blogspot.com/ and make you ideas known to Kenya and the world.
Trust me. There is no single person who can come up with solutions to our well known but difficult to solve problems.
Check out every few days or weeks for new ideas in this interactive blog for home made solutions. Ideas straight from Kenyan pharmacists or those that have had first hand working experience in Kenya.
Regular readers will receive automatic notifications whenever there is a new comment.
So do you want to make the big move. Visit http://timkopussolutions.blogspot.com/ and make you ideas known to Kenya and the world.
Friday, October 10, 2008
Your comments on our Pharmacy and Poisons Board!
This is one institution that we cannot ignore. It controls all the facets of a pharmacist's professional life. Here is your chance to give your honest comment if it was not exactly close to the standard ones that are part of today's poll.
You can even take advantage of this to speak your mind about this institution we loathe so much, yet we still need just as much.
You can even take advantage of this to speak your mind about this institution we loathe so much, yet we still need just as much.
Sunday, October 5, 2008
Stormy PSK meeting on PPB nominations
Back in August 20 at around 7pm, there was a meeting that I’m sure many pharmacists were aware of but probably did not consider it very important. It was PSK election meeting of the nominees to the Pharmacy and Poisons Board (PPB). Well, I’m sure those who did not attend might want to know what became of it, and for those who attended, they may find out that the official minutes of the meeting may give an inadequate account of the happenings on that floor. The first two or the only two candidates according to the law were to be nominated and be presented to the minister for appointment. The minister then picks one of the two nominees for each of the four different practice areas of pharmacy and that decision will be gazetted. The minister’s decision will then be final.
Armed with this information, I headed for KICC, was it Aberdares Hall, to vote and follow the proceedings. I was there not so much as a PSK member but as a person who was really trying to know what it was all about. My ballot paper didn’t have much to show for growth if any in the right direction. The same old folks with a mix of new blood here and there were fighting for positions for or for not a little more than the perks and priviledges that come with it. There was a sprinkling of one or two youngsters, who apart from being young(er) pretty had the same generic visions for pharmacy in Kenya for the next three years. In total there were 13 contestants for the four board positions allowed for PSK members. This was one full house and I could sense mixed feelings in the room; those ones of hope, anticipation, resentment as well as curiosity.
One man called Wanjala was not particularly happy today. No one, I noticed, allows him to speak so he forces his words through when he wants to rather allow the chairman to give him to go ahead. He rightfully knows that the chairman will never allowed him to talk, just as he would not have allowed him to write him the letter he wrote him and informed the other PSK members of the letter’s contents via email, if he had the power to. Wanjala definitely knows something but he was obviously outnumbered by the old folks who seemed to have ganged against him, and successfully so. One even alleged that he was attending the meeting illegally because he was not a paid up PSK member at that time. The plot worked because man Wanjala was being forced to defend himself rather than explain more to us why he thinks that the elections were flawed and should be declared by the returning officer null and void. He wanted to produce PSK payment receipt as evidence of him paying his subscription, but then the returning officer himself disowned him. The returning officer added in that he received a memorandum that was not signed, for ownership purposes and so his objection was the only thing that was null and void that evening. The only way that election would have been halted seemed to be by this Wanjala man hiring an independent lawyer, and not the society lawyer who gets some pocket change for running PSK elections, an activity that does not require much of his input, but just his rubber stamp.
But before that there was a small talk from some hirelings of PSK, oops GSK, targeted at marketing a human papilloma virus (HPV) vaccine. GSK, PSK, what a rhyme? Some city gynaecologist who claims to charge 2000KSh for Pap smear took us through the 200 strains of HPV, a DNA virus, where 15 are known to be high risk. But then the vaccine is available for only two strains, type 16 and 18, the ones that are thought to be the most common, most virulent and most etc. You know most is a very non committal term, a very good thing for anything that is medical school. He had been preceded by a gentleman who I suspect sponsored whatever was to be sponsored in the meeting; the process of the elections may be. I’m informed that elections are nowadays very expensive affairs, not with the printing of secure ballot papers, hiring and paying a returning officer who would rather make his money in commissions of inquiry, and domestic observations of the (il)legality of the process with a view to make some objectionable comments that may require the re-reading of the constitution.
Anyway, I was talking about the ‘CPD’ that was being offered to half or fully asleep audience, most of whom are in their fifty’s or may be older. The rule seems to be the young do not need or want these CPDs while the old sleep through the ‘CPDs’ they really need to renew their annual practice licenses for their businesses. I really doubt a Dominic needs it because I do not think he even has time to practice in his private pharmacy, and the CPDs were not designed for the spouses of pharmacists who seem to be really interested in the workings of a pharmacy. Well, this PSK, no GSK guy managed to add into the very long list of product names in my head a Cervarix®, this 200 bob , no, 1200 bob, no, 4500 bob, no, 7000 bob vaccine. Some wazees were momentarily awoken from their sleep by that part of the talk with some questions related to the mark up. Our marketer today was interested in rubbing this name into our heads more than its price, or may be the price depended on the client pharmacy they will sell their vaccines to. So this was brushed off, and one or two or slightly more pharmacists tried to revisit where sun did not shine during the presentations. A Dr Menge was more interested in the vaccine as a potential toxin, reinforcing the idea that what one thinks is what they are. He also was involved in a PCR brawl where both the presenter and he were struggling to say it is an antigen test using different words. Well, that was resolved, one of them decided to surrender.
Well the presentations were over, and people had earned their CPDs for their practice licenses (not themselves) but the vote counting was still going on. Dr Wanyanga took us through screensaver questions that were more of ‘just for the laughs’ than they were for the topic of discussion. Issues like possible mass male vaccination to prevent the spread of HPV to women and cause cervical cancers were discussed. More relevant issues like the vaccines potential to be used for prophylactic or therapeutic purposes during the early stages of the infection were also discussed. Anyway there were many volunteers (or casuals) who did the ballot papers separation and counting. The room rapidly became empty during Dr Wanyanga’s comical exploits of the topic, which made me conclude that all these people were either here for the CPD points or they were genuinely not interested in the outcome of the elections. Our Dominic aka Ngugi decided to withdraw anyway from the race as a community pharmacy representative but allowed his votes to be counted anyway.
With one down and 13 left, lawyer Mwenesi; our returning officer finally announced the polling results, amidst loud objections by Wanjala and quiet objections by Wanjala’s fans, and it was as follows:
Community Pharmacy
• Anthony Walela 146 (Nominee)
• Muhu Kahiga 24 (Nominee)
• Dominic Karanja (veteran) 54 (withdrew)
• Kijana Baya (veteran) 24
Public Sector Pharmacy
• Wanjau Mbuthia 88 (Nominee)
• Micah Anyona 77 (Nominee)
• Jennifer Orwa 73
This was one close race, too bad there was no female nominee in this category just like in the first.
Industrial Pharmacy
• Ann Maina 97 (Nominee)
• W. Kimatu 86 (Nominee)
• Anastacia Nyalita (veteran) 70
• Larry M. Kimani 43
Hospital Pharmacy
• D. B. Menge 282 (Nominee)
• Bildah Kiama Murage 62 (Nominee)
Bildah was voted for in the wrong category (public sector) giving Menge much more votes than he needed to win the election. The error was corrected during the announcing of the results.
Now the minister of medical services is allowed to pick any of the two nominees to the board. The nominees names will be passed on to him, without the vote tally of course as that will be considered by him to be forcing him to pick predetermined people. The meeting was hurriedly adjourned, lest someone will raise a point of order that may not be readily welcomed by the officials.
Armed with this information, I headed for KICC, was it Aberdares Hall, to vote and follow the proceedings. I was there not so much as a PSK member but as a person who was really trying to know what it was all about. My ballot paper didn’t have much to show for growth if any in the right direction. The same old folks with a mix of new blood here and there were fighting for positions for or for not a little more than the perks and priviledges that come with it. There was a sprinkling of one or two youngsters, who apart from being young(er) pretty had the same generic visions for pharmacy in Kenya for the next three years. In total there were 13 contestants for the four board positions allowed for PSK members. This was one full house and I could sense mixed feelings in the room; those ones of hope, anticipation, resentment as well as curiosity.
One man called Wanjala was not particularly happy today. No one, I noticed, allows him to speak so he forces his words through when he wants to rather allow the chairman to give him to go ahead. He rightfully knows that the chairman will never allowed him to talk, just as he would not have allowed him to write him the letter he wrote him and informed the other PSK members of the letter’s contents via email, if he had the power to. Wanjala definitely knows something but he was obviously outnumbered by the old folks who seemed to have ganged against him, and successfully so. One even alleged that he was attending the meeting illegally because he was not a paid up PSK member at that time. The plot worked because man Wanjala was being forced to defend himself rather than explain more to us why he thinks that the elections were flawed and should be declared by the returning officer null and void. He wanted to produce PSK payment receipt as evidence of him paying his subscription, but then the returning officer himself disowned him. The returning officer added in that he received a memorandum that was not signed, for ownership purposes and so his objection was the only thing that was null and void that evening. The only way that election would have been halted seemed to be by this Wanjala man hiring an independent lawyer, and not the society lawyer who gets some pocket change for running PSK elections, an activity that does not require much of his input, but just his rubber stamp.
But before that there was a small talk from some hirelings of PSK, oops GSK, targeted at marketing a human papilloma virus (HPV) vaccine. GSK, PSK, what a rhyme? Some city gynaecologist who claims to charge 2000KSh for Pap smear took us through the 200 strains of HPV, a DNA virus, where 15 are known to be high risk. But then the vaccine is available for only two strains, type 16 and 18, the ones that are thought to be the most common, most virulent and most etc. You know most is a very non committal term, a very good thing for anything that is medical school. He had been preceded by a gentleman who I suspect sponsored whatever was to be sponsored in the meeting; the process of the elections may be. I’m informed that elections are nowadays very expensive affairs, not with the printing of secure ballot papers, hiring and paying a returning officer who would rather make his money in commissions of inquiry, and domestic observations of the (il)legality of the process with a view to make some objectionable comments that may require the re-reading of the constitution.
Anyway, I was talking about the ‘CPD’ that was being offered to half or fully asleep audience, most of whom are in their fifty’s or may be older. The rule seems to be the young do not need or want these CPDs while the old sleep through the ‘CPDs’ they really need to renew their annual practice licenses for their businesses. I really doubt a Dominic needs it because I do not think he even has time to practice in his private pharmacy, and the CPDs were not designed for the spouses of pharmacists who seem to be really interested in the workings of a pharmacy. Well, this PSK, no GSK guy managed to add into the very long list of product names in my head a Cervarix®, this 200 bob , no, 1200 bob, no, 4500 bob, no, 7000 bob vaccine. Some wazees were momentarily awoken from their sleep by that part of the talk with some questions related to the mark up. Our marketer today was interested in rubbing this name into our heads more than its price, or may be the price depended on the client pharmacy they will sell their vaccines to. So this was brushed off, and one or two or slightly more pharmacists tried to revisit where sun did not shine during the presentations. A Dr Menge was more interested in the vaccine as a potential toxin, reinforcing the idea that what one thinks is what they are. He also was involved in a PCR brawl where both the presenter and he were struggling to say it is an antigen test using different words. Well, that was resolved, one of them decided to surrender.
Well the presentations were over, and people had earned their CPDs for their practice licenses (not themselves) but the vote counting was still going on. Dr Wanyanga took us through screensaver questions that were more of ‘just for the laughs’ than they were for the topic of discussion. Issues like possible mass male vaccination to prevent the spread of HPV to women and cause cervical cancers were discussed. More relevant issues like the vaccines potential to be used for prophylactic or therapeutic purposes during the early stages of the infection were also discussed. Anyway there were many volunteers (or casuals) who did the ballot papers separation and counting. The room rapidly became empty during Dr Wanyanga’s comical exploits of the topic, which made me conclude that all these people were either here for the CPD points or they were genuinely not interested in the outcome of the elections. Our Dominic aka Ngugi decided to withdraw anyway from the race as a community pharmacy representative but allowed his votes to be counted anyway.
With one down and 13 left, lawyer Mwenesi; our returning officer finally announced the polling results, amidst loud objections by Wanjala and quiet objections by Wanjala’s fans, and it was as follows:
Community Pharmacy
• Anthony Walela 146 (Nominee)
• Muhu Kahiga 24 (Nominee)
• Dominic Karanja (veteran) 54 (withdrew)
• Kijana Baya (veteran) 24
Public Sector Pharmacy
• Wanjau Mbuthia 88 (Nominee)
• Micah Anyona 77 (Nominee)
• Jennifer Orwa 73
This was one close race, too bad there was no female nominee in this category just like in the first.
Industrial Pharmacy
• Ann Maina 97 (Nominee)
• W. Kimatu 86 (Nominee)
• Anastacia Nyalita (veteran) 70
• Larry M. Kimani 43
Hospital Pharmacy
• D. B. Menge 282 (Nominee)
• Bildah Kiama Murage 62 (Nominee)
Bildah was voted for in the wrong category (public sector) giving Menge much more votes than he needed to win the election. The error was corrected during the announcing of the results.
Now the minister of medical services is allowed to pick any of the two nominees to the board. The nominees names will be passed on to him, without the vote tally of course as that will be considered by him to be forcing him to pick predetermined people. The meeting was hurriedly adjourned, lest someone will raise a point of order that may not be readily welcomed by the officials.
Thursday, October 2, 2008
Your comments on our Pharmacy and Poisons Board!
This is one institution that we cannot ignore. It controls all the facets of a pharmacist's professional life. Here is your chance to give your honest comment if it was not exactly close to the standard ones that are part of today's poll.
You can even take advantage of this to speak your mind about this institution we loathe so much, yet we still need just as much.
You can even take advantage of this to speak your mind about this institution we loathe so much, yet we still need just as much.
Monday, September 29, 2008
When nothing seems to be close to straight forward
The Ministry of Health, now Ministries of Medical Services (MoMS) and Public Health and Sanitation (MoPHS) offices are some of those places you will find yourself frequenting more frequently than you ever thought. It does not matter whether you are in public service or in the private sector; once in a while you need services at the ministry headquarters as well as the board. If you are a civil servant, then those are some of the places you are condemned to, and you will still need the people there to sort your issues whether you like them or not. So what are these things that make a visit to Afya house and related offices, a harrowing experience?
First of all, there are no clear directions given to a person who is new to the system. And even with that hurdle done away with, the biggest headache you will still have, and a potential time waster if not a real one, is getting the service you need. Let us not hide behind words here; getting service here means finding the person who provides the service. Even before this gentleman serves you, he would have to do the impossible, to convince himself that he is actually supposed to serve you. You will realize that making your approach formally doesn’t take you nowhere, just find out where he hangs out 'baada ya kazi'. That will take you somewhere, because his service is at his discretion; it is not, I repeat, it is not your right.
The most ideal situation for a pharmacist is when you need nothing from them, or even better still when they need something from you. In that case they will come to you, and depending on your side of the law and fortune, you can arm-twist them to meet your demands or cajole them out of your tight situation and fund better future ‘linkages’ with them. The second strategy is an art that you can only learn in your ownbest way over time, depending on your personal experiences; and that is not for rookies.
Woe unto you if you are demanding to be paid something, whether it is your salary or your company provided a service or delivered goods and you’re waiting for your cheque. That is when you will realize how many people we have in our midsts who like to reap where they have not sown. I think I will just leave it at that because this is a common knowledge issue, unless you are uninitiated. That is when those lazy fellows, who not only look hopeless, but actually are, suddenly wake up from their deep slumber. God, if only this 'innovativeness' could take them somewhere! The only sad end to this is they will remain hopeless to the last hour to their retirement, and then retire in wretchedness.
You go to the Board (Pharmacy and Poisons Board) and you will think what seriousness! That is when you are seeking to licence your private pharmacy practice. Then walk down the streets of the Kenyan towns, and see for yourself the fruits of the ‘hard work’ of your Board, and you will think what a waste! And that is, if you are very conservative, unlike me. Then you realise that all that drama they created when you were registering your own pharmacy was just mere posturing and that hard cash from the corrupt suddenly changes the rules. That is not about to change soon so long as people want to earn big for minuscule input. We have so many unproductive pharmacists who sit in that Board and in many other areas in the ministry where pharmacists are allowed to have a bed space. All these people will have lost all their childhood dreams to make an impact to the world by the time they book themselves accommodation in these ‘resorts’, with an exception of one dream, to be rich and successful. Now that is where the spanner works are thrown in, and the poor pharmacist wants to be rich, if not wealthy, by whichever means. The same story is repeated almost to the last man in many of the government agencies we have.
There is not better motivation than to have a massive benefit for little or no input; that is what we used to call 'efficiency', yes! It would have been manageable if only a few of us were seeking these shortcuts, but this is an epidemic because I really have to look hard to find those who don’t fancy the shortcuts. Isn’t this a dangerous trend, where your income is not supported by fundamentals? What if everybody chooses this path? Are the prospects here limitless?
Why is it that no one wants to pioneer a change that actually begins to reward working hard and/or working smart with success? Why are we tapping on a ‘resource’ which is rapidly diminishing? What happened to the brains that we used to have?
Everybody wants to be very successful and very wealthy, but if you do not create wealth on your way to becoming wealthy, then this strategy could turn out to be one big bubble. No one will need to break that bubble, it will burst itself. And those who reeled in it will be ruined.
First of all, there are no clear directions given to a person who is new to the system. And even with that hurdle done away with, the biggest headache you will still have, and a potential time waster if not a real one, is getting the service you need. Let us not hide behind words here; getting service here means finding the person who provides the service. Even before this gentleman serves you, he would have to do the impossible, to convince himself that he is actually supposed to serve you. You will realize that making your approach formally doesn’t take you nowhere, just find out where he hangs out 'baada ya kazi'. That will take you somewhere, because his service is at his discretion; it is not, I repeat, it is not your right.
The most ideal situation for a pharmacist is when you need nothing from them, or even better still when they need something from you. In that case they will come to you, and depending on your side of the law and fortune, you can arm-twist them to meet your demands or cajole them out of your tight situation and fund better future ‘linkages’ with them. The second strategy is an art that you can only learn in your ownbest way over time, depending on your personal experiences; and that is not for rookies.
Woe unto you if you are demanding to be paid something, whether it is your salary or your company provided a service or delivered goods and you’re waiting for your cheque. That is when you will realize how many people we have in our midsts who like to reap where they have not sown. I think I will just leave it at that because this is a common knowledge issue, unless you are uninitiated. That is when those lazy fellows, who not only look hopeless, but actually are, suddenly wake up from their deep slumber. God, if only this 'innovativeness' could take them somewhere! The only sad end to this is they will remain hopeless to the last hour to their retirement, and then retire in wretchedness.
You go to the Board (Pharmacy and Poisons Board) and you will think what seriousness! That is when you are seeking to licence your private pharmacy practice. Then walk down the streets of the Kenyan towns, and see for yourself the fruits of the ‘hard work’ of your Board, and you will think what a waste! And that is, if you are very conservative, unlike me. Then you realise that all that drama they created when you were registering your own pharmacy was just mere posturing and that hard cash from the corrupt suddenly changes the rules. That is not about to change soon so long as people want to earn big for minuscule input. We have so many unproductive pharmacists who sit in that Board and in many other areas in the ministry where pharmacists are allowed to have a bed space. All these people will have lost all their childhood dreams to make an impact to the world by the time they book themselves accommodation in these ‘resorts’, with an exception of one dream, to be rich and successful. Now that is where the spanner works are thrown in, and the poor pharmacist wants to be rich, if not wealthy, by whichever means. The same story is repeated almost to the last man in many of the government agencies we have.
There is not better motivation than to have a massive benefit for little or no input; that is what we used to call 'efficiency', yes! It would have been manageable if only a few of us were seeking these shortcuts, but this is an epidemic because I really have to look hard to find those who don’t fancy the shortcuts. Isn’t this a dangerous trend, where your income is not supported by fundamentals? What if everybody chooses this path? Are the prospects here limitless?
Why is it that no one wants to pioneer a change that actually begins to reward working hard and/or working smart with success? Why are we tapping on a ‘resource’ which is rapidly diminishing? What happened to the brains that we used to have?
Everybody wants to be very successful and very wealthy, but if you do not create wealth on your way to becoming wealthy, then this strategy could turn out to be one big bubble. No one will need to break that bubble, it will burst itself. And those who reeled in it will be ruined.
Monday, September 22, 2008
When a pharmacist is overpaid?
Is there such a thing as an overpaid pharmacist? In the world of today when everyone is agitating for higher pay commensurate with the sacrifices made to train and continues practicing? But what about those of us who not only hate their work, but do not work at all? What about those of us who find a reason not to do what they were trained to do every hour of every day of every week of every month of every year until retirement do we part? What about whose only source of continuous medical education (or is it continuous professional development) are our local dailies? What about those who make technical appearances, go for trainings that do not benefit them or their institutions? What about those who can not only not carry out any reforms, but do not have the vaguest idea of what could constitute reforms in pharmacy?
It does not matter to me how little you earn, so long as you do not deserve it, you are overpaid. There are those pharmacist who want to be seen doing something, and there are those who actually do something, yet there are those who don’t care about doing anything at all. It is the last category who I think are grossly overpaid, while the first two are underpaid. It is only that the very first will have much more difficulties, justifying for more pay.
I have a few things I want to suggest that may help you spot, and eventually weed out these overpaid pharmacists. They have no clear gender predisposition for these breed of pharmacists, they just seem to be just as randomly distributed, as it is statistically possible. It is only that you just spot one as soon as you meet them. All you need is a five-minute chat, and you will know if a loser or somebody who can take our profession places has joined you.
So here are the red flags that could help signal the presence of the overpaid pharmacist:
• They always look for something to divert their attention from their main activity.
One such a big distraction is the newspaper, one thing many workers especially civil servants are paid to read.
• Need to carry out a ‘bank transaction’ just minutes after reporting to work
• The Sudoku, Crossword and Codeword geek
• Monday afternoon text messages to explain a Monday morning problem
• Locum is your first topic of their discussion on his(her) first arrival
• It takes two months or longer to 'look for a house'
• Still not conversant with the systems after more than one year in employment
• Non-committal on more opportunities to prove worth as a pharmacist
• All the workmates that he knows can be counted with the fingers of one hand
• Highly theoretical but very lethargic when it comes to putting the theory into practice
• He wants to be the Chief Pharmacist because ‘this dispensing can take me nowhere’ making you wonder why he wants to supervise something that take people nowhere
• Loves off-site training but not the service opportunities that come after it
• Wants to retire in civil service, if a public servant
Remember that in most cases, the pharmacist must show at least 5 of above tendencies to be firmly in the overpaid bracket. I'm saying that because I know of a few 'underpaid pharmacists' who would like to exercise their brain power (wordpower) with one or two crosswords a day. They may even take it further to a game of scrabble just to prove a point that they are indeed still much smarter than a 5th grader!
It does not matter to me how little you earn, so long as you do not deserve it, you are overpaid. There are those pharmacist who want to be seen doing something, and there are those who actually do something, yet there are those who don’t care about doing anything at all. It is the last category who I think are grossly overpaid, while the first two are underpaid. It is only that the very first will have much more difficulties, justifying for more pay.
I have a few things I want to suggest that may help you spot, and eventually weed out these overpaid pharmacists. They have no clear gender predisposition for these breed of pharmacists, they just seem to be just as randomly distributed, as it is statistically possible. It is only that you just spot one as soon as you meet them. All you need is a five-minute chat, and you will know if a loser or somebody who can take our profession places has joined you.
So here are the red flags that could help signal the presence of the overpaid pharmacist:
• They always look for something to divert their attention from their main activity.
One such a big distraction is the newspaper, one thing many workers especially civil servants are paid to read.
• Need to carry out a ‘bank transaction’ just minutes after reporting to work
• The Sudoku, Crossword and Codeword geek
• Monday afternoon text messages to explain a Monday morning problem
• Locum is your first topic of their discussion on his(her) first arrival
• It takes two months or longer to 'look for a house'
• Still not conversant with the systems after more than one year in employment
• Non-committal on more opportunities to prove worth as a pharmacist
• All the workmates that he knows can be counted with the fingers of one hand
• Highly theoretical but very lethargic when it comes to putting the theory into practice
• He wants to be the Chief Pharmacist because ‘this dispensing can take me nowhere’ making you wonder why he wants to supervise something that take people nowhere
• Loves off-site training but not the service opportunities that come after it
• Wants to retire in civil service, if a public servant
Remember that in most cases, the pharmacist must show at least 5 of above tendencies to be firmly in the overpaid bracket. I'm saying that because I know of a few 'underpaid pharmacists' who would like to exercise their brain power (wordpower) with one or two crosswords a day. They may even take it further to a game of scrabble just to prove a point that they are indeed still much smarter than a 5th grader!
Sunday, September 14, 2008
Cute Dentists
Allow me to digress a bit for today if only it can help you relate better to my ideas about how we can be pharmacists that are more effective. And my focus today is on dentists, and how they have managed to remain afloat in this turbulent times. We have to give them that, our dentists really make up for their scary job by being some of the prettiest people in the medical and dental, and let me add pharmaceutical field. So I thought what a paradox-sweet pain for the patient. And now for the record, the beautiful girls seem to have pleasure holding the sharpest things on earth, (made of the toughest steel, I guess) on the faces of horrified patients. Well, at least the beautiful can also inflict pain with gusto but why did they all go to dental school. I must admit, however, that I never visit a dentist until it is too late, and I keep wondering when I’ll ever learn. I don’t think you will be surprised if I tell you I never look forward to visiting a dentist, neither do I enjoy the sounds that patients make as they are worked on as I nervously wait for my turn.
Dentists are more closely knit than pharmacists, who are even more closely knit than doctors are. And for doctors, it is a man-eat-man world, where ugly differences and needles shoving eclipse all that they have in common. If they were half as close as dentists were, KMA would have been one of the most powerful unity of purpose institutions, with an extraordinary potential for utter ruthlessness. Well, that can be a blessing or a curse, depending on what side of their possible negative energies you were going to be.
Well, as I seem to say, I don’t mind dating a dentist; they are one fly crop anyway. I highly recommend you hook up with one of them if you are not hitched yet. Did I hear somebody laugh? My reasons, as you can guess are very sketchy, and border much more on the elitist way in which the carry themselves. On top of wielding some of the scariest and sharpest metallic objects, they always have designer cookbooks in their purses. And they don’t carry around those books for nothing, they do what it says and to perfection. They like very tasty foods, some being sugary and some being vey sugary. And another one that blows me off is that they do not carry over their work to social meetings like many so-called professionals. I will be curtly surprised if one sickens me with the tales the different kinds of mouths they experience (let me not say see) everyday over dinner. Be prepared though for a flossing session after the last pieces of cutlery have been cleared off the table. But that is one little inconvenience when compared to our other colleagues idea of a date. I’m talking about those who talk about fine needle aspiration, spinal anesthesia, liver tissue biopsy or a patient with some interesting presentation that needed ‘consul’s’ or ‘senior registrar’s’ clever but unconventional intervention, but at a cultural night or in some very important date in some up market restaurant. I’m talking about that kind of talk that will prompt him to remove a notebook jacket and start making notes. That is one gross way to impress a man on a date, but as one close friend confides in me, it works as wicked as it is. The gentleman will find a reason to go through the books after the date, just in time for his call and ultimately impress the big man during the ward rounds, who himself comes to the ward with almost a sole intention of impressing the young ones. The mutual satisfaction that comes out of this all is enough aphrodisiac for all and everyone wins. What a happy ending!
One other thing that you probably didn't know about dentists is, the boys are so into physical fitness and good grooming; they actually go to the salon, not the ordinary barbershops. They love their wrist massages, and wear well manicured nails as they do for all the appendages that a skin can have (name four such). Girls listen, those boys cook, they wax, they spend, but they also earn big. They make their money, from working in at least two different towns, one of them being Nairobi, almost every day of every week of every month before fatigue sets in forcing them to slow down. They also like cars with feminine looks; those guys are so in touch with their feminine side! In the dentist circles, you are almost a loser if you stick in the public service for more than three years, for the pharmacists five, and for the doctors something much more.
So what do I really admire about dentists, that I think we can learn from them?
One is that they so mind their business. Their work does not come in the way of resources that bring so much friction for those who are involved, the reformists and the conformists. They do not ask to many questions about the hands that are found stuck in the till if they ever see, but just choose to look the other way. They prefer being on the blind spot of the administrators field of vision, and can disappear for days, and even weeks on end without being noticed.
Two, they do not engage in fights that are not worth fighting probably because they know the kind of tools they have at their disposal should the provocation become too much and the need to use them arises.
Three, they know their intrinsic value, and do not need to explain to anybody anything. They do not spend too much energy proving their relevance, they know their relevance and that counts. If you shout to them, they do not shout back, so you are left with two options: continue shouting alone indefinitely or forever hold your peace.
Four, they know that their job is not for the faint hearted. Who else injects their patients so many times before they can work on them?
Five, they are so elite and guarded to keep their four main secrets secret.
I want to be a dentist, or at least, have the dentists’ attitude towards life, for a change. I guess there is be something you might have learnt from me today, or at least from the dentists.
Have you?
Dentists are more closely knit than pharmacists, who are even more closely knit than doctors are. And for doctors, it is a man-eat-man world, where ugly differences and needles shoving eclipse all that they have in common. If they were half as close as dentists were, KMA would have been one of the most powerful unity of purpose institutions, with an extraordinary potential for utter ruthlessness. Well, that can be a blessing or a curse, depending on what side of their possible negative energies you were going to be.
Well, as I seem to say, I don’t mind dating a dentist; they are one fly crop anyway. I highly recommend you hook up with one of them if you are not hitched yet. Did I hear somebody laugh? My reasons, as you can guess are very sketchy, and border much more on the elitist way in which the carry themselves. On top of wielding some of the scariest and sharpest metallic objects, they always have designer cookbooks in their purses. And they don’t carry around those books for nothing, they do what it says and to perfection. They like very tasty foods, some being sugary and some being vey sugary. And another one that blows me off is that they do not carry over their work to social meetings like many so-called professionals. I will be curtly surprised if one sickens me with the tales the different kinds of mouths they experience (let me not say see) everyday over dinner. Be prepared though for a flossing session after the last pieces of cutlery have been cleared off the table. But that is one little inconvenience when compared to our other colleagues idea of a date. I’m talking about those who talk about fine needle aspiration, spinal anesthesia, liver tissue biopsy or a patient with some interesting presentation that needed ‘consul’s’ or ‘senior registrar’s’ clever but unconventional intervention, but at a cultural night or in some very important date in some up market restaurant. I’m talking about that kind of talk that will prompt him to remove a notebook jacket and start making notes. That is one gross way to impress a man on a date, but as one close friend confides in me, it works as wicked as it is. The gentleman will find a reason to go through the books after the date, just in time for his call and ultimately impress the big man during the ward rounds, who himself comes to the ward with almost a sole intention of impressing the young ones. The mutual satisfaction that comes out of this all is enough aphrodisiac for all and everyone wins. What a happy ending!
One other thing that you probably didn't know about dentists is, the boys are so into physical fitness and good grooming; they actually go to the salon, not the ordinary barbershops. They love their wrist massages, and wear well manicured nails as they do for all the appendages that a skin can have (name four such). Girls listen, those boys cook, they wax, they spend, but they also earn big. They make their money, from working in at least two different towns, one of them being Nairobi, almost every day of every week of every month before fatigue sets in forcing them to slow down. They also like cars with feminine looks; those guys are so in touch with their feminine side! In the dentist circles, you are almost a loser if you stick in the public service for more than three years, for the pharmacists five, and for the doctors something much more.
So what do I really admire about dentists, that I think we can learn from them?
One is that they so mind their business. Their work does not come in the way of resources that bring so much friction for those who are involved, the reformists and the conformists. They do not ask to many questions about the hands that are found stuck in the till if they ever see, but just choose to look the other way. They prefer being on the blind spot of the administrators field of vision, and can disappear for days, and even weeks on end without being noticed.
Two, they do not engage in fights that are not worth fighting probably because they know the kind of tools they have at their disposal should the provocation become too much and the need to use them arises.
Three, they know their intrinsic value, and do not need to explain to anybody anything. They do not spend too much energy proving their relevance, they know their relevance and that counts. If you shout to them, they do not shout back, so you are left with two options: continue shouting alone indefinitely or forever hold your peace.
Four, they know that their job is not for the faint hearted. Who else injects their patients so many times before they can work on them?
Five, they are so elite and guarded to keep their four main secrets secret.
I want to be a dentist, or at least, have the dentists’ attitude towards life, for a change. I guess there is be something you might have learnt from me today, or at least from the dentists.
Have you?
Monday, September 8, 2008
Is non-practice allowance a compensation enough?
We were having this social talk with a fellow pharmacist, and we were discussing about issues that any ordinary, young and ambitious pharmacist will be pondering on a day-to-day basis. We agreed on one thing without any reservation; that we were ‘grossly underpriced’ along with many other ‘wrong collared’ workers, and especially for us when it comes to the awarding of non-practice allowance. I have lost count of the different collars workers might be wearing to work: blue, white, pink or no collar. But whatever colour it may be, white for the white lab coat or white for the white shirt, we are not compensated enough for eschewing private practice. Anyway, we got talking, and among many other issues we discussed was how nonsensical the public sector has become. It is fast becoming a dustbin of ineffective souls, who are of no value anywhere else-their safe haven. What will all these people have done without the government foster?
The seemingly healthy competition between the two brand new ministries of health has degenerated into an unhealthy crisis. The new doctor to patients’ ratio is almost hitting an all time low (or high if you see it the other way round) because of the artificial shortages. Reason being more of your medical officers are being turned into ‘administrators’, something so many are so willing to do. Thankfully, administrative indicators, or whatever it may be called are yet to be crafted for this new crop of ‘administrators’. Their original work is just added on to those who are still ‘unfortunate’ to remain in the service delivery. The new one health centre and three dispensary districts (yes there are some like that) will have 3-4 absentee doctors, who do nothing but just sit in their offices, if they have one yet. One such ‘district’ does not have a single clinician seeing patients, because they are all managers. It makes me think these are the people the permanent remuneration board had in mind when they were crafting the non-practice allowance, because, they do not practice, literally.
If only someone can help me on this, much touted doctor-patients ratio thing. Does it still count to the ratio if all you do is sit in an office playing solitaire and waiting for the monthly reports from overworked nurses in hospitals and rural health facilities, if any, to come in and making yourself busy with staff files in the in-betwen period. Or bless that lucky month, when you are out for most of the time for trainings, meetings, seminars, and many other humdrum activities to keep you busy. It doesn’t matter if you are talking about the same thing, month in month out. What is important is that you are going out for free accommodation, free food, and free pocket money (or out of pocket-same thing) from USAID funded operatives. I have never seen a more generous international development government organization, as USAID, to a point that the many bogus organizations play around with the generosity American people with ingenious but sham data. Anyway, I did not intend to discuss this today; it is just that I hate empty pretence, if there is anything like that.
So what will happen if those in public sector decided to decline the non-practicing allowance in unanimity? Will they be allowed to engage in private practice? That will seem to be the logical thing to do, and if pharmacists take that unprecedented step, the situation could actually turn chaotic. Well, that is definitely one thing our policy makers have not thought so much about, and I cant wait to see how they will handle such a situation. Well, it won’t make so much difference for many doctors, especially the seniour ones, because they do practice anyway, to an extent that they even clock more hours than those in private practice. For them, it will be money thrown to the wind, but for pharmacists, it will be an ecstatic moment. Pharmacists in the public sector are the only ones who, are not only not allowed to practice privately, but actually do not practice because of strict enforcement of the policy by the regulators. And if they do, they carry out their illegal duties very subtly with a lot of insider dealings with the agents of the regulators, at a cost.
What we know is that if an individual pharmacist who has not resigned from public service attempts to run a private pharmacy, he will be stopped on his tracks by PPB, unless he is connected. Physicians, however, proudly display all their licences from MP&DB, along with other academic certificates on a conspicuous place in their office. They get away with both non-practice allowance and private practice fees, and they do not have to keep it in the hush-hush just as they do not have to declare to the taxman anything other their regular government salary.
Now what if, what if pharmacists decide, this allowance is not worth its name and said no thanks. Will it just be like, ok, if you don’t need it you can’t have it or will it result in an unprecedented situation with a new set of rules for engagement. Will we start negotiating hours of regular work, to give us room for our other work? Will we be told, no, no, please take it back and we will add you more, we need you.
Whatever is bound to happen thereafter, that is a step worth making. It is so much a better move than going on strike to demand for better pay, and make fool of yourself in the process.
Any other thoughts on this?
The seemingly healthy competition between the two brand new ministries of health has degenerated into an unhealthy crisis. The new doctor to patients’ ratio is almost hitting an all time low (or high if you see it the other way round) because of the artificial shortages. Reason being more of your medical officers are being turned into ‘administrators’, something so many are so willing to do. Thankfully, administrative indicators, or whatever it may be called are yet to be crafted for this new crop of ‘administrators’. Their original work is just added on to those who are still ‘unfortunate’ to remain in the service delivery. The new one health centre and three dispensary districts (yes there are some like that) will have 3-4 absentee doctors, who do nothing but just sit in their offices, if they have one yet. One such ‘district’ does not have a single clinician seeing patients, because they are all managers. It makes me think these are the people the permanent remuneration board had in mind when they were crafting the non-practice allowance, because, they do not practice, literally.
If only someone can help me on this, much touted doctor-patients ratio thing. Does it still count to the ratio if all you do is sit in an office playing solitaire and waiting for the monthly reports from overworked nurses in hospitals and rural health facilities, if any, to come in and making yourself busy with staff files in the in-betwen period. Or bless that lucky month, when you are out for most of the time for trainings, meetings, seminars, and many other humdrum activities to keep you busy. It doesn’t matter if you are talking about the same thing, month in month out. What is important is that you are going out for free accommodation, free food, and free pocket money (or out of pocket-same thing) from USAID funded operatives. I have never seen a more generous international development government organization, as USAID, to a point that the many bogus organizations play around with the generosity American people with ingenious but sham data. Anyway, I did not intend to discuss this today; it is just that I hate empty pretence, if there is anything like that.
So what will happen if those in public sector decided to decline the non-practicing allowance in unanimity? Will they be allowed to engage in private practice? That will seem to be the logical thing to do, and if pharmacists take that unprecedented step, the situation could actually turn chaotic. Well, that is definitely one thing our policy makers have not thought so much about, and I cant wait to see how they will handle such a situation. Well, it won’t make so much difference for many doctors, especially the seniour ones, because they do practice anyway, to an extent that they even clock more hours than those in private practice. For them, it will be money thrown to the wind, but for pharmacists, it will be an ecstatic moment. Pharmacists in the public sector are the only ones who, are not only not allowed to practice privately, but actually do not practice because of strict enforcement of the policy by the regulators. And if they do, they carry out their illegal duties very subtly with a lot of insider dealings with the agents of the regulators, at a cost.
What we know is that if an individual pharmacist who has not resigned from public service attempts to run a private pharmacy, he will be stopped on his tracks by PPB, unless he is connected. Physicians, however, proudly display all their licences from MP&DB, along with other academic certificates on a conspicuous place in their office. They get away with both non-practice allowance and private practice fees, and they do not have to keep it in the hush-hush just as they do not have to declare to the taxman anything other their regular government salary.
Now what if, what if pharmacists decide, this allowance is not worth its name and said no thanks. Will it just be like, ok, if you don’t need it you can’t have it or will it result in an unprecedented situation with a new set of rules for engagement. Will we start negotiating hours of regular work, to give us room for our other work? Will we be told, no, no, please take it back and we will add you more, we need you.
Whatever is bound to happen thereafter, that is a step worth making. It is so much a better move than going on strike to demand for better pay, and make fool of yourself in the process.
Any other thoughts on this?
Monday, September 1, 2008
Why cant we just own it…if we cannot take it anymore?
For sometimes now, I have been reading through profiles of some of the most outstanding pharmacists of the world. One striking thing about all of them is that they own a piece of this lucrative industry. Many pharmacists and doctors seem to like to be employees more than anything else.
Visit anywhere, in the society meetings, and their websites and in many other forums where people of common interest discuss, and chances are pay or salary issues will be on top of the list. People will shout themselves hoarse, demanding that it is demeaning to be paid this or that. Of course, that is true, and for our case, I really support better pay befitting the sacrifices one makes to train to be and continue practising as a pharmacist. But who are the real money-spinners of the pharmaceutical sector? Who are the real owners of the institutions we are proud to work in? Who own these hospitals (and therefore are entitled to hire administrators who can put pharmacist’s interests first) that we are desire to work in?
It disheartens me when I see a pharmacist who is 20 years plus in the profession, still struggling in employment like a pharmacist intern. Well, some of these circumstances may not be of the individual pharmacist’s making, but surely, with the more than 1900 registered pharmacist in Kenya, a good number of us should be standing out as the real forces in the sector. We were not made just to draw a salary, but also to write the cheque.
I do not know about you, but I think your value as a professional can only be as much as your stake in the profession.
We will not be discussing about poor remuneration (a topic I will like to discuss further in the future) if the people who largely drive the process were pharmacists. It is only bankers, industrialists, agriculturalists, politicians, accountants, or real estate businesspersons, the main investors either directly or by proxies, in the pharmaceutical industry who have the guts to pay pharmacists and other professionals what they want-and whether their employees are happy with it (or not) is immaterial. It is their investment anyway, and in the grand scheme of things, your input forms a very small-almost insignificant-part of the return on their investments. A more ‘compassionate’ one will probably listen to your minuscule cry for a salary increase but then vanquish you with longer working hours or higher targets to gain on the lost ground.
I do not think I have enough influence to start talking big, like Donald Trump or his antonym, Ombega(this may be an inappropriate example) does, but I think I can at least say the bolt of reality has stricken me at a relatively young age, professionally. This thought has probably come out of frustration on my part, for the lack of a pharmacist that I can really identify with. Prof Kokwaro is definitely high on my respect list, but he alone cannot settle my simmering uneasiness. He is probably the only pharmacist I know who can be on the interview panel for a pharmacy related job by his own right, and not by delegation. But I am crying for more who I can look up to. I have read about a pharmacist (not in this country) who specializes in pharmaceutical packaging materials as well as patients’ dispensing bottles. All our local manufacturers (or to be specific large-scale compounders) buy their packaging materials from manufacturers of generic packaging materials. We know that pharmaceuticals packaging manufacturers require specialist packaging, which can be ribbed for the visually impaired or have the right degree of opacity for the right drug. Even the secondary or the tertiary packaging need to be appealing, both to the patient or the one who does the dispensing, but only a pharmacist knows best what can be appealing. We are seriously in need of people who lead the profession from the front, to guide us venture into the so many fields that are available for us.
The industry is probably our best bet, as much as the community pharmacy is. The community pharmacy obviously has an impact on an individual pharmacist and a few people around that individual. It is also one place pharmacists have ruled, but not without the irrepressible quackery that they have learnt to live with. But the impact is not sufficient enough to secure pharmacists interests in the larger pharmaceutical industry. I like both the spirit and the drive of the Sphinx Pharmaceuticals guys. They are really trying to live the dream of local pharmacists dominating their own industries. The Cosmoses, Laboratories & Allied, and to some extent the Elyses of this country do not really strike me as pharmacists friendly industries. Cosmos, like many firms run by some people with an exaggerated sense of self importance, is a major showcase of the caste system where you will always be the untouchable, and I prefer to be out of the touch by avoiding there and similar environments altogether.
Caste system, or any culture that comes out of it, is so asinine, if you ask me-the bottom line is we are all equal. Why work with or for somebody who does not stand taking a meal with you at the same table? Why participate in creating more wealth for the protagonists of such a rigid and disgusting social system? The truth is these are just crude businessmen using whatever crude means at their disposal, including distastefully exploiting the pharmacists’ professional skills and knowledge of the systems, to make money. The compensation to the pharmacist can make you cry, not just because of its meagre amounts involved (especially for the kind of input and dependability of most processes on the pharmacist) but because the pharmacist actually accepts to be subjected to such embarrassment. Who really cares about these so-called ‘laws of Manu’? Beta Healthcare and to some extent Dawa, however, seem to be doing something much more than just making money. I have a lot of respect for GSK as a multinational and the impact they have on the humanity. But GSK, the Kenyan chapter, does not impress me as a pharmacist, both in terms of its workings and as a centre of training of pharmacists. They are even reluctant to take intern pharmacists for training because they are just a little more than a distribution branch and do not manufacture much as such. And it is easy to know why; it under the siege of non-pharmacists who will do anything that is self-perpetuating. GSK is so dominated by commercial interests of its rich owners, yes, but the more worrying are their equally if not more appalling managers, who their only remote association with pharmacy is the products they know little about. Of course, they will defend their ignorance to death. That is what happens when strangers are in charge in your industry. You cannot blame them-they are just playing the game.
What must we do, and now?
Now we need to be in control of every sector that employs us, so that we can improve the terms of service for our younger colleagues. With pay issues out of the way, at least the only thing that they will have to do, as individuals, is to perform. We can then be able to do audits of all aspects of our practice that will be our performance benchmarks. This can happen even at the PSK level, just as RPSGB is attempting to do amongst its members, who happen to be all the pharmacists practising in that country, without exception. But first things first, let’s begin the race for the ownership of this industry, before we can successfully indoctrinate the new way of practising pharmacy into all pharmacists.
This thing of sucking up to others has to end. We can be entrepreneurs just like anybody else. So go out there and look for money from wherever you can, like agriculture, horticulture, sugar industry, dealerships, goat business, supply of goods and provision of services, publishing etc. Then bring back your fortune and invest in the pharmaceutical sector, from the packaging materials, manufacturing, research and drug development, clinical trials, (the infamous) marketing, distribution, wholesale and retail pharmacy, institutional patient care, private patient care, consultancies, education, the list is endless. You will be surprised with the results, just as much as you will be pleased with it.
Just take it from me, the many good things we want to do will be a mirage if we are not in control of our sector. Nobody else cares about pharmacy practice, other than the money involved. Let us deny them the money, and other good things will follow.
Visit anywhere, in the society meetings, and their websites and in many other forums where people of common interest discuss, and chances are pay or salary issues will be on top of the list. People will shout themselves hoarse, demanding that it is demeaning to be paid this or that. Of course, that is true, and for our case, I really support better pay befitting the sacrifices one makes to train to be and continue practising as a pharmacist. But who are the real money-spinners of the pharmaceutical sector? Who are the real owners of the institutions we are proud to work in? Who own these hospitals (and therefore are entitled to hire administrators who can put pharmacist’s interests first) that we are desire to work in?
It disheartens me when I see a pharmacist who is 20 years plus in the profession, still struggling in employment like a pharmacist intern. Well, some of these circumstances may not be of the individual pharmacist’s making, but surely, with the more than 1900 registered pharmacist in Kenya, a good number of us should be standing out as the real forces in the sector. We were not made just to draw a salary, but also to write the cheque.
I do not know about you, but I think your value as a professional can only be as much as your stake in the profession.
We will not be discussing about poor remuneration (a topic I will like to discuss further in the future) if the people who largely drive the process were pharmacists. It is only bankers, industrialists, agriculturalists, politicians, accountants, or real estate businesspersons, the main investors either directly or by proxies, in the pharmaceutical industry who have the guts to pay pharmacists and other professionals what they want-and whether their employees are happy with it (or not) is immaterial. It is their investment anyway, and in the grand scheme of things, your input forms a very small-almost insignificant-part of the return on their investments. A more ‘compassionate’ one will probably listen to your minuscule cry for a salary increase but then vanquish you with longer working hours or higher targets to gain on the lost ground.
I do not think I have enough influence to start talking big, like Donald Trump or his antonym, Ombega(this may be an inappropriate example) does, but I think I can at least say the bolt of reality has stricken me at a relatively young age, professionally. This thought has probably come out of frustration on my part, for the lack of a pharmacist that I can really identify with. Prof Kokwaro is definitely high on my respect list, but he alone cannot settle my simmering uneasiness. He is probably the only pharmacist I know who can be on the interview panel for a pharmacy related job by his own right, and not by delegation. But I am crying for more who I can look up to. I have read about a pharmacist (not in this country) who specializes in pharmaceutical packaging materials as well as patients’ dispensing bottles. All our local manufacturers (or to be specific large-scale compounders) buy their packaging materials from manufacturers of generic packaging materials. We know that pharmaceuticals packaging manufacturers require specialist packaging, which can be ribbed for the visually impaired or have the right degree of opacity for the right drug. Even the secondary or the tertiary packaging need to be appealing, both to the patient or the one who does the dispensing, but only a pharmacist knows best what can be appealing. We are seriously in need of people who lead the profession from the front, to guide us venture into the so many fields that are available for us.
The industry is probably our best bet, as much as the community pharmacy is. The community pharmacy obviously has an impact on an individual pharmacist and a few people around that individual. It is also one place pharmacists have ruled, but not without the irrepressible quackery that they have learnt to live with. But the impact is not sufficient enough to secure pharmacists interests in the larger pharmaceutical industry. I like both the spirit and the drive of the Sphinx Pharmaceuticals guys. They are really trying to live the dream of local pharmacists dominating their own industries. The Cosmoses, Laboratories & Allied, and to some extent the Elyses of this country do not really strike me as pharmacists friendly industries. Cosmos, like many firms run by some people with an exaggerated sense of self importance, is a major showcase of the caste system where you will always be the untouchable, and I prefer to be out of the touch by avoiding there and similar environments altogether.
Caste system, or any culture that comes out of it, is so asinine, if you ask me-the bottom line is we are all equal. Why work with or for somebody who does not stand taking a meal with you at the same table? Why participate in creating more wealth for the protagonists of such a rigid and disgusting social system? The truth is these are just crude businessmen using whatever crude means at their disposal, including distastefully exploiting the pharmacists’ professional skills and knowledge of the systems, to make money. The compensation to the pharmacist can make you cry, not just because of its meagre amounts involved (especially for the kind of input and dependability of most processes on the pharmacist) but because the pharmacist actually accepts to be subjected to such embarrassment. Who really cares about these so-called ‘laws of Manu’? Beta Healthcare and to some extent Dawa, however, seem to be doing something much more than just making money. I have a lot of respect for GSK as a multinational and the impact they have on the humanity. But GSK, the Kenyan chapter, does not impress me as a pharmacist, both in terms of its workings and as a centre of training of pharmacists. They are even reluctant to take intern pharmacists for training because they are just a little more than a distribution branch and do not manufacture much as such. And it is easy to know why; it under the siege of non-pharmacists who will do anything that is self-perpetuating. GSK is so dominated by commercial interests of its rich owners, yes, but the more worrying are their equally if not more appalling managers, who their only remote association with pharmacy is the products they know little about. Of course, they will defend their ignorance to death. That is what happens when strangers are in charge in your industry. You cannot blame them-they are just playing the game.
What must we do, and now?
Now we need to be in control of every sector that employs us, so that we can improve the terms of service for our younger colleagues. With pay issues out of the way, at least the only thing that they will have to do, as individuals, is to perform. We can then be able to do audits of all aspects of our practice that will be our performance benchmarks. This can happen even at the PSK level, just as RPSGB is attempting to do amongst its members, who happen to be all the pharmacists practising in that country, without exception. But first things first, let’s begin the race for the ownership of this industry, before we can successfully indoctrinate the new way of practising pharmacy into all pharmacists.
This thing of sucking up to others has to end. We can be entrepreneurs just like anybody else. So go out there and look for money from wherever you can, like agriculture, horticulture, sugar industry, dealerships, goat business, supply of goods and provision of services, publishing etc. Then bring back your fortune and invest in the pharmaceutical sector, from the packaging materials, manufacturing, research and drug development, clinical trials, (the infamous) marketing, distribution, wholesale and retail pharmacy, institutional patient care, private patient care, consultancies, education, the list is endless. You will be surprised with the results, just as much as you will be pleased with it.
Just take it from me, the many good things we want to do will be a mirage if we are not in control of our sector. Nobody else cares about pharmacy practice, other than the money involved. Let us deny them the money, and other good things will follow.
Monday, August 25, 2008
My case for proper health managers
How times have changed! Gone are the days when acute of shortage of doctors meant that the only doctor in the lucky district that had a doctor hat to fit many hats. We now even have the luxury of one or more doctors being exempted from clinical duties to a as the district health managers. We even have others who are attached to the provincial medical officer’s office as RRI (Rapid Response Initiative) Coordinators and other roles that I have not been able to grasp. And it is not because we have achieved the desired (and the elusive) patients to doctors ratio yet. If anything, more doctors (and pharmacists) are concentrating on what I will call ‘dead space’ jobs where they merely play supportive and advisory roles to a razor thin workforce. They will (or will be helped by a statistician to) set targets that are only realistic if all the health workers in the public service were doing the actual service delivery.
While this is a positive development, it should now give way to the final stage for proper management of health services and systems support. We now need to go the whole hog and have a new brand of health managers in Kenya.
The DMoH of the yesteryears was the resident doctor at the public hospital, as well as the head of a team of health workers involved in community health. This managerial post was essentially a compromise and consolation for the demoralized doctor, as it was an extra burden for them, for lack of alternative options by the policy makers. Things have now changed.
The DMoHs of today are under a lot of pressure to perform just like other managers of today. They are not only involved in community health activities, but they are the accounting officers charged with the management of health care financing as well as participating in the annual tendering for the provision of supplies and services in the district along with other departmental heads of the district. They DMoHs can draw up proposals for health projects that can be as grand and as beneficial as their individuals abilities to manage one. They draw up and defend district strategic health sector plans (usually for 5 year periods) as well as the annual operation plans for its implenmetation.
A few motivated ones actually manage to make some headway in this area they were ill prepared for in the first place, but the unfortunate majority fail miserably in their duties. But can you really blame them with only a lean resume in management, if at all? And can you equally put to chance the management of health services just because one odd medical officer is able to perform in a sea of non-performers? No, this will not be fair to the majority rural poor who depend on the public health system for their survival-not in this era where there plenty of capable and more realiable individuals with graduate degrees in public health.
The only loosely associated background these officers, as currently constituted, can lay a claim on is that of community health, a common course and a limited module learnt in passing and barely examined in the medical school or not at all, depending on the university where one was trained. Even if it were comprehensive, the community health program is too inadequate anyway, for the new roles faced by health care managers. Public health officers and nursing schools curricula even delve into this module more deeply at a diploma level and that is why they are seen to be performing better for their level.
************************************************************************************
Now that is as much as I can say about the need for the right kind of people for the right kind of jobs. The era of anything goes just because one is a medical officer is no more, just as the pharmacist cannot get away with the non-performance that had been the hallmark of those in the public service. Now I have beef with people who go back to school for the wrong reasons.
Why do we go to school, most of the time at the government expense, to specialize in clinical pharmacy, surgery, obstetrics and gynaecology, paediatrics, pharmaceutical analysis etc , and etc, yet we know that all we want to do thereafter is sit behind a desk in a public office doing nothing? If you are a trained garduate analyst, and you are not doing analysis or your are not reviewing analysis protocols then to me you went for the wrong training. Why didn’t these people just specialize in the public health and policy or something else that is relevant?
Where did we get this notion that the only way you can be recognised is by pulling you out of your real calling (when you are just gaining the relevant experience) and send you to an office in Afya house or the other offices that clutter the capital, in the name of ‘promotion’? Why don’t they just promote you, reward you generously from where you are, and allow you to be the voice of your specialty from your private offices and your work station(s).
Is it cost effective to have tens of doctors in a division of let’s say reproductive health, if no one is providing their level of care at the districts? In the reproductive health division, we do not need OB/GYNs sitting there doing what they were not trained to do. We need them to roll up their sleeves, give the best possible care to their patients and be allowed to regularly offer advisory services to the division to guide policy. It is a pity that one goes for an advanced degree only to start collecting statistics on what junior doctors who have less training do, instead of doing the work themselves. This is the crisis that we are in; we are not leading from the front and we specialize so that we can be exempted from the work we pledged to the humanity under oath that we will do .
While this is a positive development, it should now give way to the final stage for proper management of health services and systems support. We now need to go the whole hog and have a new brand of health managers in Kenya.
The DMoH of the yesteryears was the resident doctor at the public hospital, as well as the head of a team of health workers involved in community health. This managerial post was essentially a compromise and consolation for the demoralized doctor, as it was an extra burden for them, for lack of alternative options by the policy makers. Things have now changed.
The DMoHs of today are under a lot of pressure to perform just like other managers of today. They are not only involved in community health activities, but they are the accounting officers charged with the management of health care financing as well as participating in the annual tendering for the provision of supplies and services in the district along with other departmental heads of the district. They DMoHs can draw up proposals for health projects that can be as grand and as beneficial as their individuals abilities to manage one. They draw up and defend district strategic health sector plans (usually for 5 year periods) as well as the annual operation plans for its implenmetation.
A few motivated ones actually manage to make some headway in this area they were ill prepared for in the first place, but the unfortunate majority fail miserably in their duties. But can you really blame them with only a lean resume in management, if at all? And can you equally put to chance the management of health services just because one odd medical officer is able to perform in a sea of non-performers? No, this will not be fair to the majority rural poor who depend on the public health system for their survival-not in this era where there plenty of capable and more realiable individuals with graduate degrees in public health.
The only loosely associated background these officers, as currently constituted, can lay a claim on is that of community health, a common course and a limited module learnt in passing and barely examined in the medical school or not at all, depending on the university where one was trained. Even if it were comprehensive, the community health program is too inadequate anyway, for the new roles faced by health care managers. Public health officers and nursing schools curricula even delve into this module more deeply at a diploma level and that is why they are seen to be performing better for their level.
************************************************************************************
Now that is as much as I can say about the need for the right kind of people for the right kind of jobs. The era of anything goes just because one is a medical officer is no more, just as the pharmacist cannot get away with the non-performance that had been the hallmark of those in the public service. Now I have beef with people who go back to school for the wrong reasons.
Why do we go to school, most of the time at the government expense, to specialize in clinical pharmacy, surgery, obstetrics and gynaecology, paediatrics, pharmaceutical analysis etc , and etc, yet we know that all we want to do thereafter is sit behind a desk in a public office doing nothing? If you are a trained garduate analyst, and you are not doing analysis or your are not reviewing analysis protocols then to me you went for the wrong training. Why didn’t these people just specialize in the public health and policy or something else that is relevant?
Where did we get this notion that the only way you can be recognised is by pulling you out of your real calling (when you are just gaining the relevant experience) and send you to an office in Afya house or the other offices that clutter the capital, in the name of ‘promotion’? Why don’t they just promote you, reward you generously from where you are, and allow you to be the voice of your specialty from your private offices and your work station(s).
Is it cost effective to have tens of doctors in a division of let’s say reproductive health, if no one is providing their level of care at the districts? In the reproductive health division, we do not need OB/GYNs sitting there doing what they were not trained to do. We need them to roll up their sleeves, give the best possible care to their patients and be allowed to regularly offer advisory services to the division to guide policy. It is a pity that one goes for an advanced degree only to start collecting statistics on what junior doctors who have less training do, instead of doing the work themselves. This is the crisis that we are in; we are not leading from the front and we specialize so that we can be exempted from the work we pledged to the humanity under oath that we will do .
Monday, August 18, 2008
Practical tips for the pharmacists in the public hospitals
The pharmacists in the public hospitals are probably the best face of pharmacists as professionals to the general public. If we want to have a leverage, then we must start reforms here.
You are a pharmacist, and in the public sector having just completed your internship, and in very high spirits that your 12 months of wait has finally ended. You have just been employed, and once again you have applied for job as a pharmacist confirming among other things that your grandparents were a Kenyans, and you went through some primary school with an odd name like, Amaiya Primary School. You get an appointment letter within minutes of your application, signed on the behalf of PS by a guy who can write but cannot talk. You accept the appointment in yet another letter and the whole choreographed process is completed within 30 minutes. You start celebrating the 'efficiency' in which your application was processed. Your celebration is however cut short by the posting order that catapults you to Isiolo District Hospital. And as you will soon discover, you, indeed, were very lucky to be taken there and were a decision away from being deported to Marsabit. Not that Marsabit does not deserve a good person, but there seems to be no mechanism to compensate the extra costs that such a person incurs, as well as the hardships experienced. At least for Isiolo, that is the where tarmac ends and gives way to lorry-buses for those going beyond. There really must be a dark lining for every silver cloud! Did I say silver?
Well, you arrive to Isiolo within a fortnight with your posting letter to beat the deadline for reporting because you really need that salary-it is not much as far as your bills are concerned-but it keeps you going as you are waiting for better options to come your way. You check around the town, and discover that this is not a place for you. The hospital buildings are far much more nicely finished that any building you can see around, and look very new. Surely, CDF must have transformed this country or is it the so many NGOs that clutter the region. You brush off the thought and settle for the more weighty matters at hand. Some Mbuva guy has condemned you to this place, and he is not about to change his mind soon, or he might and think there is service need in Marsabit. This must be the wrong province to be in, you think, that it is easy to be in Machakos as it is easy to be in Kagundo, Meru or Marsabit.
You grudgingly accept to work here, and console yourself that it is not busy after all, and you can always create time for yourself to do other things. You also discover that all your medical superintendant is interested in, is your physical presence in the hospital for sufficiently long time for his hospital management team meetings and for his regular hospital staff returns to higher levels of the bureaucracy. There are no tangible targets set for you by the man behind the desk who deported you to Isiolo. He does not even give you management support thereafter for whatever reason. No amount of communication and good work you do will move him. The only communication you will probably get from him thereafter, is through another posting order, or in some odd mistake-finding mission by the people who have a ‘chief’ as part of their titles. The very person who does not come to your side when you need them most in the field, will come breathing fire on your neck, in a clear show of deep seated and long standing frustration (I wonder how one can be in both situations at the same time!) than genuine interest for efficiency. Surely, somebody must be making the hell out of their lives in Afya house, that I’m almost tempted in my child self not to hope to be in that house when I grow up, unless all I want is to unleash terror that has been building up inside me on others. As I had hinted, they may never visit you. Probably, the big bosses up there do not provide adequate funds for 'supportive supervision' as the small bosses do down here. So, it is actually lose-lose situation for us all, and for that we at least have something in common in this system. If they actually visit, then count yourself lucky, and chances are this might never happen to you again for the time you will be in civil service, unless you are in Tigoni or Kiambu that are a stone-throw away from Nairobi.
************************************************************************************
We all know that a civil service job is not your dream job, but there must be something you can do in the when you are still there. One of the best legacies you can leave behind is to put the pharmacy profession a step ahead so that younger pharmacists can find a better environment. You know that you had a million ideas on how you can transform pharmacy, and yourself, on the day that your pharmacy school dean recommended that you should be awarded a pharmacy degree by your university. So what can you do to make your while worthwhile?
You can start by first learning the systems, in your new workplace. You were probably in a referral hospital for your internship, or you just did not take your hospital internship seriously. It is understandable; interns can be absolved for reeling in their newfound status, and be allowed to party while it lasts. But now things are more serious, and the profession depends on the decisive steps that you take. You realise, that as much as the private sector pharmacy practice is completely different from the public sector, the private sector terms of service is actually pegged on that of the public sector.
After learning the systems (for your efficiency), you start the hard work that you know clearly will impact on your future, whether in the public or private sector. What do you do next? Here are some tips for you.
• Change the rules for the access of medicines in the hospital by the patients.
The truth here is, actually, you are not changing things but you are just doing what was supposed to be done in the first place. They are actually very basic rules, that make huge impact on the image pharmacists project to others. The rules include, but are not restricted to the following:
No one should be dispensed a medication for speculative purposes, but only on what it is indicated for.
Observe the rule of the right drug for the right patient in the right dose for the right duration.
No one, not even the hospital staff who will prove to be your biggest headache of all time, should be exempted from this rule.
Keep your eye on the fast moving commodities, and especially those that are of high market value.
Analyse all the data you generate and make useful conclusions on them. Like, do not just fill the mandatory antibiotic registers, for drug accountability purposes only. That is what was expected of a pharm tech or a data clerk, but not a pharmacist. A pharmacist should be able to process information they generate to guide policy making. Predict antibiotic resistance patterns from them by matching, the indication with drug choice, dose and the duration of treatment. And when you find a problem, present it in your hospital CMEs.
Finally, and please, for goodness sake, don’t steal drugs. Pharmacists simply don’t do it. It is very petty. Period. I suggest any suspected essential medicines thief should be up for disciplinary committee with a view to permanently deregister them. Please, if you must steal, steal government’s time and not its commodities.
• Be pro-active to a extend of being branded a ‘busybody’ by your detractors
Can you believe this? You can actually be a pain in the *** to an extent that everybody wishes you were on leave, or better still transferred to a faraway place, especially if you are tough on money and budgetary issues. Read all the regulations on prudent use of hospital funds, those that are collected locally as well as those that are provided for centrally. Your main supplier of essential medicines and medical supplies (KEMSA) will probably not provide for all your basic pharmaceutical needs. That is where hospital funds come in. You probably don’t know that you should be allowed to spend 75% of your collections on your pharmacy. You also probably do not know that you can only get your pharmaceuticals from those suppliers who tendered for them and were given tenders at the district level.
What may even be more shocking, is money allocated to pay your pharmacy debts not reaching the supplier if you don’t follow them actively. Civil servants were made to be pushed, and they are always looking for sources of dirty money, searching for one loophole after another, so start closing loopholes that are touching on your work lest it might be difficult for an outside eye to separate the wheat from the chaff. You are too fresh, too proud and in another league to allow yourself to be enrolled into such dirty games; so push them aside and do what you know is good. There are a million clean ways for a pharmacist to make monumental amounts of money. Ask around, and you may discover your store man or whoever clerk is assigned to process payments to the suppliers, is sitting on the payment vouchers, because a bribe has not been paid. Shame such people in front of everyone, if they consistently frustrate those that you need to function well; your suppliers.
• Do constant research
One classical situation is that of the paediatric wards constantly complaining that a specific brand of broad-spectrum antibiotic injection like Ceftriaxone in the right peadiatric doses is not working at all. The department in such cases may specify that the Rocephin brand be ordered for the patient. While such claims may be correct, wouldn’t it be prudent that you carry out a small study to confirm or rubbish such claims?
You can take the following steps in your small research:
Take one vial of the powder for reconstitution, reconstitute the injection yourself in the pharmacy, and note any unusual observation for injections.
Go through the patients file in the ward and check for the provisional diagnosis and steps taken so far by the primary doctor.
Note the dose prescribed for the diagnosis and the duration of treatment ordered
Observe as the drug is administered during ward treatment sessions to see if the right dose is administered in the right way
For high treatment failure rates, document the antibiotic sensitivity tests (if they are done). Consider misdiagnosis or too little amount of drug if the suspected bacteria are even mildly sensitive to the drug. If resistant, then consider wrong drug choice or poor drug quality.
Note if more than one clinician on more than one occasion complain about the product. Be very certain that the complaint is credible.
A credible complaint is always due to a first-hand experience and not from hearsay or unverifiable ward gossip. Make sure the complaint is not an unjustified push for branded products that are costly to the hospital in the long run and are unsustainable. I know of a situation where erroneous information spreads like wild fire and nobody takes time to validate the information. A fallacy in that situation can end up being taken as the truth.
In your desperate attempt in defence of your faulty product, (it really has to be a product that you believe in or so you thought) you could issue another batch of the same product (if you have) and note if there is difference. Sometimes the defect could be restricted to just one batch of the product.
Now try another brand and rest your case. Either way, you will have already done your research if you had not figured out that yet if you go through all these steps. And with your findings, you will be able to intervene authoritatively.
Compile your evidence and present them a hospital forum for continuous education.
Send your samples to a national quality control laboratory (for a nominal fee to the hospital) to ascertain if the percentage of the drug to the label claim. If the percentage ends up being above 100%, then you have more nuts to crack; it had better be much less than 100% to fit your theory. Thankfully, the NQCL should be able to do for you some qualitative analyses that may go a long way to quench your thirst for excellence.
Someone else with more suggestions can add in the comments.
You are a pharmacist, and in the public sector having just completed your internship, and in very high spirits that your 12 months of wait has finally ended. You have just been employed, and once again you have applied for job as a pharmacist confirming among other things that your grandparents were a Kenyans, and you went through some primary school with an odd name like, Amaiya Primary School. You get an appointment letter within minutes of your application, signed on the behalf of PS by a guy who can write but cannot talk. You accept the appointment in yet another letter and the whole choreographed process is completed within 30 minutes. You start celebrating the 'efficiency' in which your application was processed. Your celebration is however cut short by the posting order that catapults you to Isiolo District Hospital. And as you will soon discover, you, indeed, were very lucky to be taken there and were a decision away from being deported to Marsabit. Not that Marsabit does not deserve a good person, but there seems to be no mechanism to compensate the extra costs that such a person incurs, as well as the hardships experienced. At least for Isiolo, that is the where tarmac ends and gives way to lorry-buses for those going beyond. There really must be a dark lining for every silver cloud! Did I say silver?
Well, you arrive to Isiolo within a fortnight with your posting letter to beat the deadline for reporting because you really need that salary-it is not much as far as your bills are concerned-but it keeps you going as you are waiting for better options to come your way. You check around the town, and discover that this is not a place for you. The hospital buildings are far much more nicely finished that any building you can see around, and look very new. Surely, CDF must have transformed this country or is it the so many NGOs that clutter the region. You brush off the thought and settle for the more weighty matters at hand. Some Mbuva guy has condemned you to this place, and he is not about to change his mind soon, or he might and think there is service need in Marsabit. This must be the wrong province to be in, you think, that it is easy to be in Machakos as it is easy to be in Kagundo, Meru or Marsabit.
You grudgingly accept to work here, and console yourself that it is not busy after all, and you can always create time for yourself to do other things. You also discover that all your medical superintendant is interested in, is your physical presence in the hospital for sufficiently long time for his hospital management team meetings and for his regular hospital staff returns to higher levels of the bureaucracy. There are no tangible targets set for you by the man behind the desk who deported you to Isiolo. He does not even give you management support thereafter for whatever reason. No amount of communication and good work you do will move him. The only communication you will probably get from him thereafter, is through another posting order, or in some odd mistake-finding mission by the people who have a ‘chief’ as part of their titles. The very person who does not come to your side when you need them most in the field, will come breathing fire on your neck, in a clear show of deep seated and long standing frustration (I wonder how one can be in both situations at the same time!) than genuine interest for efficiency. Surely, somebody must be making the hell out of their lives in Afya house, that I’m almost tempted in my child self not to hope to be in that house when I grow up, unless all I want is to unleash terror that has been building up inside me on others. As I had hinted, they may never visit you. Probably, the big bosses up there do not provide adequate funds for 'supportive supervision' as the small bosses do down here. So, it is actually lose-lose situation for us all, and for that we at least have something in common in this system. If they actually visit, then count yourself lucky, and chances are this might never happen to you again for the time you will be in civil service, unless you are in Tigoni or Kiambu that are a stone-throw away from Nairobi.
************************************************************************************
We all know that a civil service job is not your dream job, but there must be something you can do in the when you are still there. One of the best legacies you can leave behind is to put the pharmacy profession a step ahead so that younger pharmacists can find a better environment. You know that you had a million ideas on how you can transform pharmacy, and yourself, on the day that your pharmacy school dean recommended that you should be awarded a pharmacy degree by your university. So what can you do to make your while worthwhile?
You can start by first learning the systems, in your new workplace. You were probably in a referral hospital for your internship, or you just did not take your hospital internship seriously. It is understandable; interns can be absolved for reeling in their newfound status, and be allowed to party while it lasts. But now things are more serious, and the profession depends on the decisive steps that you take. You realise, that as much as the private sector pharmacy practice is completely different from the public sector, the private sector terms of service is actually pegged on that of the public sector.
After learning the systems (for your efficiency), you start the hard work that you know clearly will impact on your future, whether in the public or private sector. What do you do next? Here are some tips for you.
• Change the rules for the access of medicines in the hospital by the patients.
The truth here is, actually, you are not changing things but you are just doing what was supposed to be done in the first place. They are actually very basic rules, that make huge impact on the image pharmacists project to others. The rules include, but are not restricted to the following:
No one should be dispensed a medication for speculative purposes, but only on what it is indicated for.
Observe the rule of the right drug for the right patient in the right dose for the right duration.
No one, not even the hospital staff who will prove to be your biggest headache of all time, should be exempted from this rule.
Keep your eye on the fast moving commodities, and especially those that are of high market value.
Analyse all the data you generate and make useful conclusions on them. Like, do not just fill the mandatory antibiotic registers, for drug accountability purposes only. That is what was expected of a pharm tech or a data clerk, but not a pharmacist. A pharmacist should be able to process information they generate to guide policy making. Predict antibiotic resistance patterns from them by matching, the indication with drug choice, dose and the duration of treatment. And when you find a problem, present it in your hospital CMEs.
Finally, and please, for goodness sake, don’t steal drugs. Pharmacists simply don’t do it. It is very petty. Period. I suggest any suspected essential medicines thief should be up for disciplinary committee with a view to permanently deregister them. Please, if you must steal, steal government’s time and not its commodities.
• Be pro-active to a extend of being branded a ‘busybody’ by your detractors
Can you believe this? You can actually be a pain in the *** to an extent that everybody wishes you were on leave, or better still transferred to a faraway place, especially if you are tough on money and budgetary issues. Read all the regulations on prudent use of hospital funds, those that are collected locally as well as those that are provided for centrally. Your main supplier of essential medicines and medical supplies (KEMSA) will probably not provide for all your basic pharmaceutical needs. That is where hospital funds come in. You probably don’t know that you should be allowed to spend 75% of your collections on your pharmacy. You also probably do not know that you can only get your pharmaceuticals from those suppliers who tendered for them and were given tenders at the district level.
What may even be more shocking, is money allocated to pay your pharmacy debts not reaching the supplier if you don’t follow them actively. Civil servants were made to be pushed, and they are always looking for sources of dirty money, searching for one loophole after another, so start closing loopholes that are touching on your work lest it might be difficult for an outside eye to separate the wheat from the chaff. You are too fresh, too proud and in another league to allow yourself to be enrolled into such dirty games; so push them aside and do what you know is good. There are a million clean ways for a pharmacist to make monumental amounts of money. Ask around, and you may discover your store man or whoever clerk is assigned to process payments to the suppliers, is sitting on the payment vouchers, because a bribe has not been paid. Shame such people in front of everyone, if they consistently frustrate those that you need to function well; your suppliers.
• Do constant research
One classical situation is that of the paediatric wards constantly complaining that a specific brand of broad-spectrum antibiotic injection like Ceftriaxone in the right peadiatric doses is not working at all. The department in such cases may specify that the Rocephin brand be ordered for the patient. While such claims may be correct, wouldn’t it be prudent that you carry out a small study to confirm or rubbish such claims?
You can take the following steps in your small research:
Take one vial of the powder for reconstitution, reconstitute the injection yourself in the pharmacy, and note any unusual observation for injections.
Go through the patients file in the ward and check for the provisional diagnosis and steps taken so far by the primary doctor.
Note the dose prescribed for the diagnosis and the duration of treatment ordered
Observe as the drug is administered during ward treatment sessions to see if the right dose is administered in the right way
For high treatment failure rates, document the antibiotic sensitivity tests (if they are done). Consider misdiagnosis or too little amount of drug if the suspected bacteria are even mildly sensitive to the drug. If resistant, then consider wrong drug choice or poor drug quality.
Note if more than one clinician on more than one occasion complain about the product. Be very certain that the complaint is credible.
A credible complaint is always due to a first-hand experience and not from hearsay or unverifiable ward gossip. Make sure the complaint is not an unjustified push for branded products that are costly to the hospital in the long run and are unsustainable. I know of a situation where erroneous information spreads like wild fire and nobody takes time to validate the information. A fallacy in that situation can end up being taken as the truth.
In your desperate attempt in defence of your faulty product, (it really has to be a product that you believe in or so you thought) you could issue another batch of the same product (if you have) and note if there is difference. Sometimes the defect could be restricted to just one batch of the product.
Now try another brand and rest your case. Either way, you will have already done your research if you had not figured out that yet if you go through all these steps. And with your findings, you will be able to intervene authoritatively.
Compile your evidence and present them a hospital forum for continuous education.
Send your samples to a national quality control laboratory (for a nominal fee to the hospital) to ascertain if the percentage of the drug to the label claim. If the percentage ends up being above 100%, then you have more nuts to crack; it had better be much less than 100% to fit your theory. Thankfully, the NQCL should be able to do for you some qualitative analyses that may go a long way to quench your thirst for excellence.
Someone else with more suggestions can add in the comments.
Monday, August 11, 2008
Are the pharmacists this subservient?
Are we meek and drawn-out? Sadly, I think so.
While it is easy to whine about effects, many people do not dwell much on the causes. I do not know about you, but I cannot remember a situation where someone other than me solved my problems. Pharmacists for a long time had taken for granted their professional status. In Kenya, this profession has been standing on a shaky ground and no one who had the opportunity bothered to lay a good and firm foundation for it. And so predictably, the value of a pharmacist continued to plummet faster than that of a run-down African country economy. This will continue to happen if we do not do something that is far-reaching now and now. Our sense of self-importance will be dealt a big blow because no one else will recognise us by our own terms. We want to be recognised yet we are doing nothing about it; that really disturbs me. May be someone somewhere is trying, but his or her individual efforts are not powerful enough to turn around the profession. May be it is about time we lowered our expectations for a major transformation and concentrate on the few who have a combination of knowledge (it is so needed), attitude and drive that can take us to the next level. Certainly, a diminutive transformation is better than no transformation at all.
Many pharmacists, both in public and private sectors do not lead by example. They delegate their professional obligations to lesser ‘professionals’, and make themselves invisible to those who really need their services. They do not want to dig out and touch the dirt themselves lest they soil their well-pressed garb. They seem not to have an idea where the jewel of their profession is. This is even made worse by the now more alarming knowledge depreciation that, as one pharmacist once joked about, can give you a clue on the ‘pharmacist’s’ year of graduation. I am talking about those oldies, the types who pretend to be subordinates when a new nurse calls on them, desperate for their professional intervention for a poisoned patient or one who has some other drug related problem. And because they have not been practicing enough to build up their confidence and improve their problem solving skills, they do not gain experience, that they should have, with time.
The main problem is that we pharmacists care less about adding value to our practices to remain competitive, and by extension earn respect. We all want exponential increase in earning power, for no value added. Value addition starts from the kind of knowledge you have and are able to retain to be of use to you, what more you can do with your hands and what you are confident it cannot be done (or done well) without you. Value addition develops to what you were not able to do yesterday, but you can do today because of your deliberately thought out efforts. Value addition is about a bunch of you or more considering each of your individual ideas for improving your practice, debating on it in your own conference, whether scientific or not and lobbying for it to be part of your regulators policy and demanding to be paid for it. Value addition of your services will enable you to attract and earn much more from the premium clients. Such clients in our economy are still few, but their numbers can only go up with a growing economy. It is only wise to be ready for higher-end clients, than to lose the priviledge to better-placed competing professions in the era of overlapping roles when the time is ripe.
Those in public sector who seem not to have any job description other than drug supply management can take advantage of that gap to curve their own niche. You can guide infection control committees by going for newer and more technical information on sterility control. From the information, you can develop protocols on what minimum concentration is inhibitory, bactericidal, or sporicidal against a given microbial load. Then ensure that the dilutions of disinfectants or sterilants are as a routine done well to achieve the required disinfection or sterilisation respectively, for all the re-usable sterile instruments without corroding them as they are costly to replace. Remember, those WHO manuals are just hand-me-down guides of do this or do that prepared by someone like you for those who want ready-made information in brains-resource limited settings. You can then compare your own protocols with the standard protocols found in the manuals or guidelines. Believe you me; no one will be more authoritative on such than you will because you took your time to think like the experts. You can also carry out on job studies and be ready to present them in your hospitals continuing education meetings. You can even lead in these meetings and make useful comments to other people’s presentations by reading ahead for a pharmacist’s point of view on the topic. It also insures you against those questions that may catch you off guard.
For those in private practice, create for yourself your own customized patient information leaflets. Do not depend solely on the manufacturers/distributers leaflets, as they are mostly inadequate and have an element of bias. They may even be unavailable for the line of medications you are so passionate about or it could simply be because you can do better. Anything that convinces your clients that you are genuinely interested in their welfare as you are in their money is worth doing. You can even create a special day where you provide health education forums to your patients, especially those on long-term treatment. Such actions will certainly lift you up, and make you enjoy your work more. You could even improve your clinical skills more tastefully than those in hospitals could (since you do not have the benefit of a clinician seeing the patients before you see them at all time) by advancing your education so as to handle the walk-in patients’ problems more competently. The possibilities are endless in this sector for a pharmacist who wants to engage his mental faculties’ full throttle. And please I will always say, love your work or close shop and quit the profession-do not hang in there.
These little things that seem insignificant from far are stifling the dominance we so need in managed health care. Be assured that when a surgeon or any other does not find you useful, or sends a prescription you only to be filled by a dubious character you delegated your responsibility to; it won’t be long before that same surgeon employs such a dubious character to dispense from his office. The surgeon will argue that it does not make a difference anyway, in terms of quality of care to the patient, and for that, the surgeon has a point. Before you know it, all these characters will have fully fledged illegal pharmacies in their clinics, which of course, are not run under the watch of Pharmacy and Poisons Board. This has already happened and many of the medical practitioners are embracing the practice in their private clinics in a reckless abandon. It will happen again, and again, and again.
The question is; what can you do to reverse this trend? I do not think you really want to do nothing. I do not think it is in your interest to carry on as if nothing has happened. I really do not think you will allow yourself to have worked that hard to qualify and let somebody else revel in your turf, not without a fight.
Is that too much to ask?
While it is easy to whine about effects, many people do not dwell much on the causes. I do not know about you, but I cannot remember a situation where someone other than me solved my problems. Pharmacists for a long time had taken for granted their professional status. In Kenya, this profession has been standing on a shaky ground and no one who had the opportunity bothered to lay a good and firm foundation for it. And so predictably, the value of a pharmacist continued to plummet faster than that of a run-down African country economy. This will continue to happen if we do not do something that is far-reaching now and now. Our sense of self-importance will be dealt a big blow because no one else will recognise us by our own terms. We want to be recognised yet we are doing nothing about it; that really disturbs me. May be someone somewhere is trying, but his or her individual efforts are not powerful enough to turn around the profession. May be it is about time we lowered our expectations for a major transformation and concentrate on the few who have a combination of knowledge (it is so needed), attitude and drive that can take us to the next level. Certainly, a diminutive transformation is better than no transformation at all.
Many pharmacists, both in public and private sectors do not lead by example. They delegate their professional obligations to lesser ‘professionals’, and make themselves invisible to those who really need their services. They do not want to dig out and touch the dirt themselves lest they soil their well-pressed garb. They seem not to have an idea where the jewel of their profession is. This is even made worse by the now more alarming knowledge depreciation that, as one pharmacist once joked about, can give you a clue on the ‘pharmacist’s’ year of graduation. I am talking about those oldies, the types who pretend to be subordinates when a new nurse calls on them, desperate for their professional intervention for a poisoned patient or one who has some other drug related problem. And because they have not been practicing enough to build up their confidence and improve their problem solving skills, they do not gain experience, that they should have, with time.
The main problem is that we pharmacists care less about adding value to our practices to remain competitive, and by extension earn respect. We all want exponential increase in earning power, for no value added. Value addition starts from the kind of knowledge you have and are able to retain to be of use to you, what more you can do with your hands and what you are confident it cannot be done (or done well) without you. Value addition develops to what you were not able to do yesterday, but you can do today because of your deliberately thought out efforts. Value addition is about a bunch of you or more considering each of your individual ideas for improving your practice, debating on it in your own conference, whether scientific or not and lobbying for it to be part of your regulators policy and demanding to be paid for it. Value addition of your services will enable you to attract and earn much more from the premium clients. Such clients in our economy are still few, but their numbers can only go up with a growing economy. It is only wise to be ready for higher-end clients, than to lose the priviledge to better-placed competing professions in the era of overlapping roles when the time is ripe.
Those in public sector who seem not to have any job description other than drug supply management can take advantage of that gap to curve their own niche. You can guide infection control committees by going for newer and more technical information on sterility control. From the information, you can develop protocols on what minimum concentration is inhibitory, bactericidal, or sporicidal against a given microbial load. Then ensure that the dilutions of disinfectants or sterilants are as a routine done well to achieve the required disinfection or sterilisation respectively, for all the re-usable sterile instruments without corroding them as they are costly to replace. Remember, those WHO manuals are just hand-me-down guides of do this or do that prepared by someone like you for those who want ready-made information in brains-resource limited settings. You can then compare your own protocols with the standard protocols found in the manuals or guidelines. Believe you me; no one will be more authoritative on such than you will because you took your time to think like the experts. You can also carry out on job studies and be ready to present them in your hospitals continuing education meetings. You can even lead in these meetings and make useful comments to other people’s presentations by reading ahead for a pharmacist’s point of view on the topic. It also insures you against those questions that may catch you off guard.
For those in private practice, create for yourself your own customized patient information leaflets. Do not depend solely on the manufacturers/distributers leaflets, as they are mostly inadequate and have an element of bias. They may even be unavailable for the line of medications you are so passionate about or it could simply be because you can do better. Anything that convinces your clients that you are genuinely interested in their welfare as you are in their money is worth doing. You can even create a special day where you provide health education forums to your patients, especially those on long-term treatment. Such actions will certainly lift you up, and make you enjoy your work more. You could even improve your clinical skills more tastefully than those in hospitals could (since you do not have the benefit of a clinician seeing the patients before you see them at all time) by advancing your education so as to handle the walk-in patients’ problems more competently. The possibilities are endless in this sector for a pharmacist who wants to engage his mental faculties’ full throttle. And please I will always say, love your work or close shop and quit the profession-do not hang in there.
These little things that seem insignificant from far are stifling the dominance we so need in managed health care. Be assured that when a surgeon or any other does not find you useful, or sends a prescription you only to be filled by a dubious character you delegated your responsibility to; it won’t be long before that same surgeon employs such a dubious character to dispense from his office. The surgeon will argue that it does not make a difference anyway, in terms of quality of care to the patient, and for that, the surgeon has a point. Before you know it, all these characters will have fully fledged illegal pharmacies in their clinics, which of course, are not run under the watch of Pharmacy and Poisons Board. This has already happened and many of the medical practitioners are embracing the practice in their private clinics in a reckless abandon. It will happen again, and again, and again.
The question is; what can you do to reverse this trend? I do not think you really want to do nothing. I do not think it is in your interest to carry on as if nothing has happened. I really do not think you will allow yourself to have worked that hard to qualify and let somebody else revel in your turf, not without a fight.
Is that too much to ask?
Monday, August 4, 2008
With many with the title doctor...why waste your time hanging on to it? I wonder if there aren't other things worth the while
I followed the recent case in court put up by some members of the Kenya Medical Association (KMA) who wanted the court to make a very strange ruling. The complaint was that there were far too many people using the title ‘doctor’for their comfort. The starting point for this campaign was one profession they have had an age-old rivalry with, the pharmacists.
This is not the first time such an offensive was launched by these members of the ‘noble profession ‘against the pharmacists. It happened a few years ago, when some members of this dignified profession close to the policy makers, decided to come up with a well-crafted ‘clinical allowance’ that was primarily meant to lock out the irritants that were pharmacists than it was meant to reward the hardworking doctors who were then grossly underpaid. The pharmacists successfully wrestled this challenge by convincing the policy makers that they talk to, touch and stay in close contact with the patients for sufficiently long enough time to risk their health just like other health workers. This only served to heighten the professional tension to those who chose to go that way, as opposed to better working relationship and even more productivity for those who chose to accept the indispensability of the other.
Over many years, because of their sheer numbers and lack of many options, medical officers have dominated the public service from entry level to the policy level. The policies that sometimes inadvertently affected other health professionals, mostly negatively, could be lobbied through their non-statutory medical association. Better still an overzealous and pragmatic director of medical services who sits in so many boards that I have lost count of them was all that was needed. He is mandated by the law to lord over many concerns, from those that are of little concern to his backbone profession to those that are of no concern at all to him or his foot soldiers.
Now lets assess the damage this chronic infiltration has had on our health system.
All the management structures are based on their professional hierarchy model and all other health professionals are made to play supportive roles. This system inspired the titles like the District Medical Officer of Health (DMoH), the Provincial Medical Officer (PMO) being medical officers. I would not mind these titles if they were only mandated to oversee their fellow medical officers like it is for all other cadres. These individuals are however charged with the management of health services at the district and provincial levels respectively. Unlike other managers in all other sectors, all that one needs to be a DMoH, and theoretically a PMO is to be a post-internship medical officer. The Ministry of Health would then attempt to take these ‘managers’ through countless shuttle trainings that are costly to the taxpayer in an attempt to make them competent.
For a long time I have been made to believe that government funds for Primary Health Care (PHC) activities is actually nothing more a remuneration package for the DMoH. Why don’t they just call it DMoH extraneous allowance or bossing allowance, because that is what it is?
*********************************************************
The new move by a section of KMA is just but the reinforcement that the debates that started at the medical school are not about to go, rather they are getting more dreadful. While at the medical school level these debates were healthy because it was a critical ‘baby steps’ towards professional identity of the different health professionals being trained there, it only serves to inflate personal egos at the working environment level. For instance, at the medical school level, pharmacists were branded ‘shopkeepers’ in unending rhetoric. That concept was suddenly dropped as soon as all stepped out of the gates of medical school and scrambled to be shopkeepers. This is a case of a subject loathed at the medical school being the best alternative for all and sundry.
They want the court to strip this title from the pharmacists for a number of reasons. Let us keep that for another day.
The most puzzling thing about this campaign though, is the amount of negative energy devoted to it. The medical profession is plagued by so many problems, right from mushrooming clinics and quackery, unregulated alternative medicine practitioners, poor remuneration and working environment for those in the public sector among many other factors. These matters in my opinion were more urgent and needed more lobbying among the policy makers. By trying to fight pharmacists, the members of the medical profession are fighting against an insurmountable change in the provision of healthcare worldwide. The new trend in pharmacy training is biased towards training a new breed of pharmacist with wide range of clinical skills. The professional undergraduate degree of Doctor of Pharmacy (PharmD) is being offered each year in more Pharmacy schools around the world.
More pharmacists are enrolling for advanced degrees in general and chemical pathology, anatomy and physiology, clinical pharmacy (a pharmacy equivalent of clinical medicine). Pharmacists are specializing in paediartics, chemotherapy, nuclear pharmacy, diabetology and cardiology. Pharmacists are even now specialising in health policy and public health. I cannot think of any field that was tighly closed to pharmacists a few years back that is not wide open now. Not even clinical trials has been spared!
More are even advancing in their traditional fields, like in pharmaceutical analysis and drug quality control. Everybody now needs them in a liberalized world of medicine where both genuine and counterfeit products and ‘professionals’ are in the market. Does it really matter how good you are in therapeutics if the product you are using is fake?
More pharmacists are becoming more things. It is a herculean task trying to keep up with them, especially if your only motivation is striving to contain them. Good luck though!
This is not the first time such an offensive was launched by these members of the ‘noble profession ‘against the pharmacists. It happened a few years ago, when some members of this dignified profession close to the policy makers, decided to come up with a well-crafted ‘clinical allowance’ that was primarily meant to lock out the irritants that were pharmacists than it was meant to reward the hardworking doctors who were then grossly underpaid. The pharmacists successfully wrestled this challenge by convincing the policy makers that they talk to, touch and stay in close contact with the patients for sufficiently long enough time to risk their health just like other health workers. This only served to heighten the professional tension to those who chose to go that way, as opposed to better working relationship and even more productivity for those who chose to accept the indispensability of the other.
Over many years, because of their sheer numbers and lack of many options, medical officers have dominated the public service from entry level to the policy level. The policies that sometimes inadvertently affected other health professionals, mostly negatively, could be lobbied through their non-statutory medical association. Better still an overzealous and pragmatic director of medical services who sits in so many boards that I have lost count of them was all that was needed. He is mandated by the law to lord over many concerns, from those that are of little concern to his backbone profession to those that are of no concern at all to him or his foot soldiers.
Now lets assess the damage this chronic infiltration has had on our health system.
All the management structures are based on their professional hierarchy model and all other health professionals are made to play supportive roles. This system inspired the titles like the District Medical Officer of Health (DMoH), the Provincial Medical Officer (PMO) being medical officers. I would not mind these titles if they were only mandated to oversee their fellow medical officers like it is for all other cadres. These individuals are however charged with the management of health services at the district and provincial levels respectively. Unlike other managers in all other sectors, all that one needs to be a DMoH, and theoretically a PMO is to be a post-internship medical officer. The Ministry of Health would then attempt to take these ‘managers’ through countless shuttle trainings that are costly to the taxpayer in an attempt to make them competent.
For a long time I have been made to believe that government funds for Primary Health Care (PHC) activities is actually nothing more a remuneration package for the DMoH. Why don’t they just call it DMoH extraneous allowance or bossing allowance, because that is what it is?
*********************************************************
The new move by a section of KMA is just but the reinforcement that the debates that started at the medical school are not about to go, rather they are getting more dreadful. While at the medical school level these debates were healthy because it was a critical ‘baby steps’ towards professional identity of the different health professionals being trained there, it only serves to inflate personal egos at the working environment level. For instance, at the medical school level, pharmacists were branded ‘shopkeepers’ in unending rhetoric. That concept was suddenly dropped as soon as all stepped out of the gates of medical school and scrambled to be shopkeepers. This is a case of a subject loathed at the medical school being the best alternative for all and sundry.
They want the court to strip this title from the pharmacists for a number of reasons. Let us keep that for another day.
The most puzzling thing about this campaign though, is the amount of negative energy devoted to it. The medical profession is plagued by so many problems, right from mushrooming clinics and quackery, unregulated alternative medicine practitioners, poor remuneration and working environment for those in the public sector among many other factors. These matters in my opinion were more urgent and needed more lobbying among the policy makers. By trying to fight pharmacists, the members of the medical profession are fighting against an insurmountable change in the provision of healthcare worldwide. The new trend in pharmacy training is biased towards training a new breed of pharmacist with wide range of clinical skills. The professional undergraduate degree of Doctor of Pharmacy (PharmD) is being offered each year in more Pharmacy schools around the world.
More pharmacists are enrolling for advanced degrees in general and chemical pathology, anatomy and physiology, clinical pharmacy (a pharmacy equivalent of clinical medicine). Pharmacists are specializing in paediartics, chemotherapy, nuclear pharmacy, diabetology and cardiology. Pharmacists are even now specialising in health policy and public health. I cannot think of any field that was tighly closed to pharmacists a few years back that is not wide open now. Not even clinical trials has been spared!
More are even advancing in their traditional fields, like in pharmaceutical analysis and drug quality control. Everybody now needs them in a liberalized world of medicine where both genuine and counterfeit products and ‘professionals’ are in the market. Does it really matter how good you are in therapeutics if the product you are using is fake?
More pharmacists are becoming more things. It is a herculean task trying to keep up with them, especially if your only motivation is striving to contain them. Good luck though!
Saturday, July 26, 2008
The game of numbers
Even the professional associations are a game of numbers
There is a new benchmark that the performance contracting is based on, and that is the numbers, or figures for those in the financial sector for which a target is set. A target is an objective towards which effort is directed, and it could be a certain number, which is a proportion of the total possible. Alternatively, it could be a figure we so desire to reach.
Why are numbers (or figures) this critical even in the seemingly welfare groups that professional societies are?
Medical associations and societies have existed for as long as structured healthcare systems were developed. With time, private home visits by individual doctors reduced to give way to health institutions. This allowed lower costs of medical care per person and wider coverage of healthcare provision. The expanding system meant that there was need for more health workers as there was need for more specialized treatments for wide range of diseases that came with the higher number of patient visits.
The governments got involved when the issues of healthcare became more important tool for those seeking political offices as politics is a game of numbers. At the same time, the increased attention on the welfare of the patient meant that the welfare of the pharmacists, doctors, nurses and other health workers took a back seat. The individual practitioners with little time and resources could do very little to change the situation. Like for everything in the modern beaureucracies, the only option was the trusted game of numbers. The most successful associations and societies were and still are those with the numbers.
A casual look at the medical associations and society’s websites will show how these professional associations take seriously the issues of the day. One association had a very catchy plea for more membership by reminding individual practitioners what they can do if they have the requisite numbers. It goes as follows: “If one doctor can find answers, heal wounds, bring hope... Just imagine… what we can do together. Together we are stronger.”
Given, professional associations and societies are largely welfare groups and voluntary at start. This is the first selling point to its members before it can undertake roles that are more complex. The members are that their plight as individuals are addressed before they can agree to pay the subscription that will enable smooth running of the society. Some of the selling points are negotiation for improved remuneration for members, formation of cooperative societies, profession indemnity schemes and sometimes negotiated financial services for the members.
However, it is always the desire and intention of each professional society to have as much say in the sector they are involved in as much as the law can allow, even if it going beyond boundaries and trampling on ‘competing’ professions. In such situations, the law must be restrictive and clearly separate matters of importance to the larger society from those of selfish and self-preserving traits among individuals under the guise of professional cause. This is the path that has been taken by the medical association in Kenya, as pathetic as it is primitive.
While I am not at liberty to go to details as the matter is in court, I can only laugh at the poor sense of priority for those schemers. Those ones who chose to fight pharmacists at the ministry of health boardrooms, and a poor attempt at that in the courts. I welcome anyone fighting us, but just make sure that you are ‘well oiled’, because it is going to be a long fight.
In such dangerous situations, when professional associations are tempted to use their numbers for negative dominance over other related professional bodies rather than for the welfare of their individual members, then the law must be applied firmly. In addition, such associations must never be allowed have statutory powers, a status that must always come with responsibility.
Any time spent by a professional body fighting other professional or professional bodies is opportunity lost, to improve the welfare of its members, the reason it exists. There are many reasons professional associations are founded, but advocating for lower remuneration, withdrawal of any privileges or propagating any kind of negative energy towards allied professions are not among them.
My final word of advice is this. The most immediate threat to a Kenyan doctor in terms of daily income, is the traditional practitioner ranting the very audible but incomprehensible words just outside his office on top of a rundown vehicle, and with the help of the best loudspeaker that his daily sales can buy.
Who will not go to the person who promises to cure all the maladies that have existed before, the present and the ones to come? I will if I did not know better.
But many are pre-occupied with the pharmacists to recognize this. Why didn’t they just choose to be pharmacists in the first place and solve this problem once and for all?
There is a new benchmark that the performance contracting is based on, and that is the numbers, or figures for those in the financial sector for which a target is set. A target is an objective towards which effort is directed, and it could be a certain number, which is a proportion of the total possible. Alternatively, it could be a figure we so desire to reach.
Why are numbers (or figures) this critical even in the seemingly welfare groups that professional societies are?
Medical associations and societies have existed for as long as structured healthcare systems were developed. With time, private home visits by individual doctors reduced to give way to health institutions. This allowed lower costs of medical care per person and wider coverage of healthcare provision. The expanding system meant that there was need for more health workers as there was need for more specialized treatments for wide range of diseases that came with the higher number of patient visits.
The governments got involved when the issues of healthcare became more important tool for those seeking political offices as politics is a game of numbers. At the same time, the increased attention on the welfare of the patient meant that the welfare of the pharmacists, doctors, nurses and other health workers took a back seat. The individual practitioners with little time and resources could do very little to change the situation. Like for everything in the modern beaureucracies, the only option was the trusted game of numbers. The most successful associations and societies were and still are those with the numbers.
A casual look at the medical associations and society’s websites will show how these professional associations take seriously the issues of the day. One association had a very catchy plea for more membership by reminding individual practitioners what they can do if they have the requisite numbers. It goes as follows: “If one doctor can find answers, heal wounds, bring hope... Just imagine… what we can do together. Together we are stronger.”
Given, professional associations and societies are largely welfare groups and voluntary at start. This is the first selling point to its members before it can undertake roles that are more complex. The members are that their plight as individuals are addressed before they can agree to pay the subscription that will enable smooth running of the society. Some of the selling points are negotiation for improved remuneration for members, formation of cooperative societies, profession indemnity schemes and sometimes negotiated financial services for the members.
However, it is always the desire and intention of each professional society to have as much say in the sector they are involved in as much as the law can allow, even if it going beyond boundaries and trampling on ‘competing’ professions. In such situations, the law must be restrictive and clearly separate matters of importance to the larger society from those of selfish and self-preserving traits among individuals under the guise of professional cause. This is the path that has been taken by the medical association in Kenya, as pathetic as it is primitive.
While I am not at liberty to go to details as the matter is in court, I can only laugh at the poor sense of priority for those schemers. Those ones who chose to fight pharmacists at the ministry of health boardrooms, and a poor attempt at that in the courts. I welcome anyone fighting us, but just make sure that you are ‘well oiled’, because it is going to be a long fight.
In such dangerous situations, when professional associations are tempted to use their numbers for negative dominance over other related professional bodies rather than for the welfare of their individual members, then the law must be applied firmly. In addition, such associations must never be allowed have statutory powers, a status that must always come with responsibility.
Any time spent by a professional body fighting other professional or professional bodies is opportunity lost, to improve the welfare of its members, the reason it exists. There are many reasons professional associations are founded, but advocating for lower remuneration, withdrawal of any privileges or propagating any kind of negative energy towards allied professions are not among them.
My final word of advice is this. The most immediate threat to a Kenyan doctor in terms of daily income, is the traditional practitioner ranting the very audible but incomprehensible words just outside his office on top of a rundown vehicle, and with the help of the best loudspeaker that his daily sales can buy.
Who will not go to the person who promises to cure all the maladies that have existed before, the present and the ones to come? I will if I did not know better.
But many are pre-occupied with the pharmacists to recognize this. Why didn’t they just choose to be pharmacists in the first place and solve this problem once and for all?
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