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.
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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 25, 2008
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.
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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!
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