MY VERSION OF A PHARMACIST CREED

Today I just want to think of my devotion to my profession.

I have to disclose though that I borrowed this heavily from the US Coast Guard.

'I am proud to be a Pharmacist.

I revere that long line of expert APOTHECARIES, COMPOUNDERS and PHARMACISTS who succeeded them as we know today, and who continue to evolve in new roles that I can only imagine now and those that I’m unable to yet; who by their devotion to duty and sacrifice of self have made it possible for me to be a member of a service honoured and respected, throughout the world.

I never, by word or deed, will bring reproach upon the fair name of my service, nor permit others to do so unchallenged.

I will always be on time for all my duties, and shall endeavour to do more, rather than less, than my share.
I shall, so far as I am able, bring to my seniors solutions, not problems.

I shall live joyously, but always with due regard for the rights and privileges of others.
I shall endeavour to be a model citizen in the community in which I live.
I shall sell life dearly to an enemy, but give it freely to rescue those in peril.

With God’s help, I shall endeavour to be one of His noblest Works...
A PROUD PHARMACIST IN KENYA'

James Macharias will always be our Health Secretaries until we put Our House in order

A distinguished banker was recently nominated by the president to be the cabinet secretary in charge of health. There has been uproar amongst us, the healthcare professionals, that 'outsiders' are being appointed to positions that should be the reserve of 'medical professionals'. Kenya Medical Association (KMA) responded almost immediately after the announcement. What was not clear was if KMA would have been happy still if the nominee was, let's say, a pharmacist.

I'm a pharmacist, and I really believe in us (all healthcare professionals). This view is not shared among the different cadres of health and healthcare professionals. Nurses are in support of the new secretary of health, not because they like him, but clearly because he is not the 'domineering self-centred all-important full-of-himself' doctor.

The society at large perception does not help us either. They visit public hospitals and wonder why they are that poorly managed. When they are told the top manager in the hospital is a doctor, they associate any failures with this individual. When hundreds of hospitals are managed in the same way, they conclude that this is just but the way doctors are trained - to care less and mismanage. When they hear billions that are squandered at the policy level, with little to show on the ground they write us off completely. Sooner or later,  our bad reputation flows upwards in the political circles, and end up at the president's desk. The president does not even need to depend on this information flow. Before he became the country's chief executive, he was first a Member of Parliament (M.P.) who gets information first-hand from constituents suffering from the healthcare we or we don't provide. The face of this poor healthcare is a the healthcare provider on the ground and his immediate manager, the Medical Superintendent or the DMoH (is that still their title?). 

So what do we need to do to get out of this?

First, let's dissociate ourselves from the greed, inefficiency and little concern for patients' welfare that has been associated with us. Let's shake off this tag - it begins with me and you today. Just having management degrees beefing up our CVs will not shake that tag. They will look past it and appoint others who they think have better clarity of purpose. We have just allowed ourselves to supervise failure for too long. We know the problem is bigger than us, but outsiders do not know that.

How do we turn this trend around, at least for 2018?

Let's write down indicators expected for change in health attributed to us and our presence before we consider other inputs that make healthcare. Let's be less wasteful. Let the few managers we have be exemplary. It begins with something as simple as this. What if from today we said we will not tolerate the bad septic hospital smells? Private hospitals have hacked it with the same amount of Jik and liquid soap that district hospitals buy. I'm yet to see/hear doctors, nurses or pharmacists saying enough of the pungent rotten smell of our wards and boycotting work until it is sorted. No one disinfects and clears patient vomit immediately it happens. Patient clothes are not disinfected and laundered. Soiled linen is left to culture more colonies of bacteria and putrefy further. Even the fact that the Medical Superintendent is a physician or surgeon doesn't seem to matter. If you condone it, you are part of it. If you tolerate these little avoidable discomforts, your value is revised downwards. It is those guys who fake it until they make it that will take up our jobs.

If you hang in there, in civil service, because of salary and nothing else, you are also in the same category. Opportunities are not for those who can clearly and passionately describe the problem; but for those who have a solution, however simple, in absence of other inputs (resources, equipment, money, medicines etc.) The fact that different health professionals are in constant collision and frustrate team work makes it difficult for the president to appoint one of them.

What do we do at Afya house? 

We are missing in action when it matters. We occupy spaces we do not deserve. Just as an example. The Chief Pharmacist is, in all my perception, absent. Yet he is supposed to be one of the top managers in pharmacy, and even a policy maker of the position equivalent to the immediate former posts of the Treasury and Devolution cabinet nominees at the Ministry of Finance. This means if the Chief Pharmacist knew what he was doing and his achievements could be seen and testified by all, then he could be appointed a health secretary. What’s more? We work in silos and secretly forward bills to the minister to be passed to laws without sharing with colleagues. We then expect other health professionals, affected by the laws we crafted in hush hush behind closed office doors, to obey and follow them without caring for their input. And they always turn out to be bad laws, no, terrible laws! 

We cede our power by accepting mediocrity. The question is, will the mediocrity continue to have an explanation or will we finally learn?

Chief Pharmacist: From my lips to God's Ears

If I became the Chief Pharmacist today, first I will create a crisis by refusing to be a registrar of a Board that is another full time job in itself. I will be happy to be an ex-officio member of the Board, and I must not go there all the time because I have qualified deputies. I will then lobby to my Minister (or is it cabinet secretary?) to go to parliament to reduce my roles, if he ever wants me to deliver.

Then, I will have a national pharmacy strategy that aims to improve health from my department’s perspective. My strategy will and should be feeding to the larger strategy of the ministry responsible for health, and not standalone. I will make sure every person contributing to pharmaceutical services: pharmacists, technologists and other techs, and subordinates know this strategy and they have memorized it in their brains and hearts.

 If there is no strategy in place when I step into office on my first day or if the current strategy is in conflict with national strategy, I'll start addressing by addressing that. I will work through deputies who will have all the power to do what they deem fit for pharmacy; I will only ask them to be accountable and put their money where their mouth is.

I believe in human resource. The pharmacists under me must be the most competent in the world. They must be good public speakers, must be able to educate patients and public on the health, they should be able to engage constructively on general health issues and they must be able to design, test, monitor and improve healthcare programs that work. They must know their patients, and they must address their needs, they must be able to communicate understanding to them, they must love them and they must follow them up longitudinally. I will have to sample reports of such on my desk. No training opportunity that can make them the best in the world as a pharmacist can be swept under the carpet by me, because I will have no carpet. All trainings will be on merit, and on value for investment. If you will not do, don’t be trained. If you promise to do, and you don’t; no mechanism to get the value back from you will I spare.

Then I will focus on the needs of Kenyan public, and what they need a pharmacist for. I will not accept pharmacists to do what the Kenyan public does not need them to. I will happily bring to an end the era of 'boss pharmacists' because that is not what the consumers of health that I'm accountable to need.

I will fight for, protect and give pharmacists a larger slice of training opportunities than was allocated. I will not allow others to steal the show, or let DMS or whoever that will assume the responsibilities of the current DMS know more about pharmacy than me. I will not miss his meetings because he intimidates me, but he may miss my meetings because he fears accountability.

 All I will need of the pharmacists I will do anything for is not to embarrass me with apathy, dishonesty with themselves, stealing, empty heads, divided or no loyalties, inability or painstakingly slow minds, poor decision making skills, poor or no customer care, purposeful stagnation, caggy or caged thinking, being experts of anything else other than pharmacy, lack of accountability and personal responsibility, not being able to take advantage of opportunities given and excelling etc etc.

 I will be quick to enforce sanctions as I do with rewards. Finally, I will be on a fixed non-renewable contract of five years (or even four) to give others with better ideas chance to lead. If people really liked me, and want me to go on, I will only accept an advisory position.

I will whisper to my successor that anyone who spends or plans to spend a quarter century in a position is nothing more than a space occupying lesion.

Response to 26 March 2012 Daily Nation article titled 'Policing the drugs business'

This post is a reply to an article on Daily Nation of 26th of March 2012.

The original article can be accessed via this link: http://www.nation.co.ke/Features/DN2/Policing+the+drugs+business+/-/957860/1373432/-/item/0/-/137y6o7/-/index.html

I have not read the print version of this article, but the author had not declared any potential conflict of interest that we the readers should consider when reading this article. Other than that I think the writer has a valid point, and Pharmacy and Poisons Board (PPB), the beneficiary of the TruScan technology needs to consider this as they go ahead and use this 'donation'. The Board members, who generally represent larger pharmaceutical sector, with heavy representation from the Pharmaceutical Society of Kenya (PSK), should be clear on what this scan technology can do and what it can't. That is why the PPB employs experienced pharmacists who should be able to use intuition, common sense, practice knowledge, well thought out drug policing strategies with a wide reach and finally the TruScan to identify the true counterfeits. I'm a pharmacist, and naturally I'm interested in knowing what technology the TruScan machine uses. Does it use infra red, MRI, UV or rapid chemical tests to identify active ingredients in a drug? If it does that, and that can be validated, then it is able to scan for the presence of the active medicine in any drug, brand or 'generic'. Is the 'analysis' that it does quantitative or qualitative? You need to know both attributes to declare a medicine a 'counterfeit'. In pharmaceutical science, too little of the right medicine is a bad thing and too much of it is still a bad thing.


 If the TruScan is not looking for an active ingredient, then is it scanning the primary and the secondary packages of the medicines to identify 'genuine packs'? And is knowing that just the pack is genuine good enough?


 Does TruScan just 'scan' Pfizer products, all the branded products, or it 'scans' all licenced for use and registered for trading pharmaceutical products? Who is the inventor of this technology? This is the kind of information that I was looking for when I chanced on this article, but did not find.


Remember, there is also competition between branded product manufacturers, and Pfizer here does seem to take up the burden of 'funding' an initiative that benefits all the multinationals whose products get faked. Why is it that it is only Pfizer which is purchasing this TruScan? Why would Pfizer fear generic products more than other manufacturers of branded pharmaceutical products, yet it has a wider range of medicines and still a respectable market share of each, and absolute market share for some? The article should either address Pfizer directly or generalize only when there is involvement of other multinational companies, otherwise the message will be construed to be views that are not necessarily objective.

It is my considered opinion that a counterfeit is that which claims to be what it is not. As a pharmacist, I do not perceive generics as counterfeits. I almost daily have to reassure a nervous client who has a mistaken idea of what generic drugs are, and educate them on the concept at the same time. I also know that it is the branded drugs, that many of us tend to rush to, that are the targets of the counterfeiters and not the generic brands.

I would then understand if the big pharmaceutical companies come together to address the problem that is unique to them. They lose the most to counterfeits, and gain the most if counterfeits are wiped off the pharmacy shelves. If people were to shift en masse and buy generic brands, the counterfeiters will go there. In Kenya now, generic brands, suffer the least when it comes to counterfeiting, and when it comes to fighting these counterfeits, it will make sense to focus on the branded products and get the companies affected on the board because they have everything to gain from such an initiative and so do the public.
A good every day example of counterfeiting are the paper currency notes counterfeiters and their motivation. They do not bother with a fifty shillings note: but they do fake the one thousand note where they are assured of higher returns if not, or before they are detected.

A survey preferably funded with public funds or by companies without their direct involvement in the processes, is welcome as the writer has suggested, identifying the true extent of the influence of counterfeit products in the market, its supply channels and its effect on public health. The survey should not just end there, but also suggest actions required to address the menace once and for all.

Pharmacists also know that just having a genuine product is not good enough. Before it gets to the right patient at the right dose and for the right medical condition, it must also be stored right. If a pharmacy does not store products in a way to preserve chemical integrity, buys from suppliers who don't do so, or worse still, buys from suppliers who they have no idea how they handle and store medicines, then the patients will still suffer, even when presented with a 'genuine product'.



Finally, I feel very uncomfortable with conversations that happen in virtually almost every pharmacy that this one medicine is 'original' that one 'is not'. Who will take up a product that is 'not original' even if the intention was to say this one is 'branded' and the other is a 'generic brand'? It is very unprofessional and not a priority conversation, when there are so many things to talk about that will benefit the patient the more: like the patient's medical condition; how to use the medicine and what to expect from the medicine. The patient is also supposed to be equipped with the knowledge on what to do if an expected positive outcome of the medicine does not occur or an expected negative outcome does occur!

A Challenge to 21st Century Kenyan Pharmacists who are still Sitting on the Fence

Pharmacy of today appears as a collection of disputatious factions and splinter groups still ‘a profession in search of a role’and a profession unable to choose from a bewildering variety of functions and unable to overcome a variety of ‘barriers to clinical practice’.


We will not solve this problem by introspection. It will not help to clarify, list, or debate more functions for pharmacy. The element that is missing as we define our role during this period of transition is our conception of our responsibility to the patient. Some pharmacists have not yet identified patient-care responsibilities commensurate with their extended functions, and the profession as a whole has not made CLEAR SOCIAL COMMITMENT that reflects its clinical functions. Some pharmacists will remain mired in the transitional period of professional adolescence until this step is taken.


Pharmaceutical practice must restore what has been missing for years: a clear emphasis on the patient’s welfare. Professional maturity has much in common with maturity as a person. One attribute common to both is a word view, an expectation that one thrives best by using one’s power t serve something bigger than oneself. Another attribute common to both is acceptance of responsibility for one’s actions.
Drugs do not have doses, patients have doses.



(Charles D. Hepler and Linda M. Strand statement back in March 1990 in an American Journal of Hospital Pharmacy)

LET US TALK PHARMACEUTICAL CARE!

BUILDING YOURSELF AS AN EFFECTIVE PROBLEM SOLVER

Pharmacy is built firmly on the concept of technical rationality. The idea states that practitioners are primarily problem solvers who select rational ways to serve particular purposes.

If I can use two words to describe what pharmaceutical care is, then I will say it is a RESPONSIBLE PROVISION. We provide treatment when we dispense medicines; it does not become pharmaceutical care until when we ensure that our dispensing is done responsibly. I do not want to bore you with the long definition of pharmaceutical care that has been repeated over and over, and has been ringing in the years of all pharmacists who want to understand what pharmaceutical care is; and how it can be implemented in their daily practice so that they can make the difference they have always striven to. It goes like this: Pharmaceutical Care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life.

Pharmaceutical care is essentially a process and is as follows:

Step ONE: Identify any DRUG-RELATED PROBLEM (actual or potential);

Step TWO: Resolve the DRUG-RELATED PROBLEMS that actually develop.

STEP THREE: Prevent all potential DRUG-RELATED PROBLEMS from developing


We usually start out with a lot of energy as rigorous ‘young’ practitioners, who are ready to solve well-formed problems (those that should be straight forward if all other practitioners did their part right) by applying theory and technique from systematic and scientifically derived knowledge. However as we become oriented to the ‘fuzzy” problems of daily practice, we find that the problems we encounter are not that straight-forward but rather “messy indeterminate situations”.

It does not take long for us, novice practitioners, to learn that we really don’t know how to solve many problems we face in practice. We learn quickly that defining the actual problem that needs to be solved is difficult and sometimes results in no clear solution.

Working Groups have been used in medicine (and pharmacy) for a long time to crack very important issues of practice that were not clear-cut from the outset. All of us know that all Cancer Chemotherapy protocols/regimens are product of focused Working Groups (or if you like Study Groups). A Pharmaceutical Care Working Group is an idea that has already taken off, and a handful of dedicated volunteer pharmacists will see to it that it changes the practice of clinical pharmacy in Kenya.

We will start from scratch and build working systems that pharmacists will rely on to practice. The moment we realized that no one but us can build our practice was the moment we decided to bid farewell to ambiguity. If only the vigour shown by these patriotic Kenyans can have a snowballing effect on every Kenyan pharmacist involved in patient care, and shake each and every barrier that has stood on our road to Pharmaceutical care!

The Pharmaceutical Care Working Group will provide a systematic method to collect and assess the clinical information used to determine patient’s problems and health needs. With repetition and practice, you can become proficient at “framing” the patient’s problems, achieving concordance with your own professional viewpoint and the patient. That is why it is called Pharmacy Practice!

HOW I WILL CONTRIBUTE TO ATTAIN THIS VISION FOR PHARMACY IN KENYA (See the vision in the immediate older post of this blog)

How can i contribute as an individual to attain this vision?

Individual level

 Ensure that all chronic care patients who are sent to me have an implementation (pharmaceutical care) plan for their treatment, follow up on them and track their future appointments so that I use that opportunity to evaluate treatment outcomes and set new goals.

 I will keep a register of all the patients I provide chronic care to be available for scrutiny by my peers and colleagues, so as to achieve a sustainable continuity of care.

 I will encourage the people who I will have the privilege to mentor, to embrace pharmaceutical care so that we can be members of a larger team who we can hand over care of our patients between us whenever we are not available to offer the essential service, with the goal of making sure that chronic care of patients is not an intermittent process but a long term continuous commitment.

 I will keep records of my interventions for scrutiny by me and my peers both for accountability and for opportunity for me and my peers to learn and improve our practice.

 I will teach, mentor and grow pharmacists younger than me to reach where I have not reached, to offer services that make more impact than I was able to, with or without compensation or remuneration of any kind.

 When my time comes I will provide leadership to pharmacists that will ensure that they realize their goals and have professional satisfaction.


As a member of team

 I will accept to carry out assignments and responsibilities assigned to me by my peers and professional colleagues that aim to improve the practice of pharmacy.

 I will be part of the process that ensures that there is a lifelong learning process going on for me and my fellow practitioners.

 I will take advantage of all opportunities to generate new knowledge in my area of practice and specialization, and target to carry at least one research or clinical audit each year which can be appraised by my supervisor.

 I will participate actively participate in a society, working group or an association that works to further the interests of the profession.


In the Regulation of Pharmacy Practice

 I will push for creation of working groups to come up with standards of practice for all the different specializations in pharmacy.

 I will call for the hospital pharmacy representative to the Pharmacy and Poisons Board (PPB) to buy the idea that regulation should always promote the provision of pharmaceutical care and ensure that the Board makes advancement of pharmacy practice a priority.

 I will mobilize the pharmacy practitioners and other stakeholders to keep the laws regulating pharmacy practice up to date and make the medicines that were registered after the last revision of Poisons List legal to be prescribed in Kenya.

o I will make my colleagues aware that the Poisons List Confirmation Order-which gave rise to a Poisons List [5] with two parts, (Part 1 and 2), in the Subsidiary Legislation to section 25 (Order under section 25) of the Pharmacy and Poisons Act-is now obsolete and need revision.

o That the revision of the list (addition or removal of medicines) together with its schedules be revised on an annual basis by pharmacists who have significant knowledge base and skills, and spend most of their time providing care directly to patients.

o That the reclassification of medicines from one prescription status to another is done in a structured way and the changes communicated efficiently to all pharmacists and other interested practitioners.


REFERENCES

1. New Statesman, 21 April 1917, article by Sidney Webb and Beatrice Webb quoted with approval at paragraph 123 of a report by the UK Competition Commission, dated 8 November 1977, entitled Architects Services (in Chapter 7).
2. Pharmaceutical Society of Australia: National Competency Standards Framework for Pharmacists in Australia 2010. http://www.psa.org.au/site.php?id=6782
3. Board of Pharmacy Specialties http://www.bpsweb.org/about/vision.cfm
4. Graham Copeland. A Practical Handbook for Clinical Audit. Clinical Audit Support Team, NHS http://www.wales.nhs.uk/sites3/Documents/501/Practical_Clinical_Audit_Handbook_v1_1.pdf
5. Pharmacy and Poisons Act, CAP 244 of the Laws of Kenya

MY VISION FOR THE CLINICAL PHARMACY PROFESSION

A pharmacy professional

A profession [1] is a vocation founded upon specialised educational training, the purpose of which is to supply disinterested counsel and service to others, for a direct and definite compensation, wholly apart from expectation of other business gain (Webb S, 1997).

Pharmacists are professionals who have the abilities and skills which are necessary to achieve outcomes related to:
• Providing pharmaceutical care to patients
• Developing and managing medication distribution and control systems
• Managing the pharmacy
• Promoting public health
• Providing drug information and education

While these outcomes seem easy to achieve, there is still a huge gap between what is expected of pharmacists [2] and what pharmacists actually achieve.

Clinical Pharmacist Training

The clinical component of pharmacist’s work need to improve the most and training for this role must meet the following objectives:
• to develop students' communication skills for effective interaction with patients and with practitioners of other health professions,
• to help students develop a patient awareness in the practice of pharmacy
• to enable students to integrate the knowledge acquired in course work prior to clinical exposure, and to apply it to the solution of real problem
• to develop students' awareness of their responsibility for monitoring the drugs taken by patients and,
• to help students become more aware of the general methods of diagnosis and patient care specifically related to drug therapy


Lifelong learning and professional growth

A good training in clinical pharmacy and the subsequent qualification as a practitioner is just but the beginning of a long journey towards developing competent professionals who will make an impact to the society. My desire is that pharmacists themselves will find it in their interest to develop, implement and sustain an internal mechanism where pharmacists’ knowledge, skills and attitudes are evaluated and improved.


Specialization

My vision for clinical pharmacy and pharmacy profession as a whole is that one day pharmacists will realize that it is not possible for an individual to accumulate enough knowledge in a lifetime to be an authority on all aspects of clinical pharmacy or general pharmacy. Some pharmacists have already realized this and are trying their best to fill the gap in the health care provision. The areas of specializations must however be relevant to the current needs, and must be continually reviewed to go with the times.


Certification

From patient to provider, the value of a certified practitioner registers throughout the health care continuum. This provides a legal basis and right to provide care in any clinical environment. For pharmacy professionals, documentation of specialized experience and skills yields the additional benefits of personal satisfaction, financial rewards and career advancement.


How do we get there?

• The current clinical pharmacy training undergraduates are receiving in the University of Nairobi is much better than a decade ago; this is obvious when one engages a student on a clinical approach discussion. This needs to be sustained and even improved further.

• The undergraduate students in pharmacy should spend an extra year in training to be in line with internationally accepted standards for pharmacy training for students who have spent four years in high school or less than twelve years of pre-university education. This will give the pharmacists in training more time to accumulate knowledge, skills and attitude required to practice top level pharmacy.

• The internship should be done in areas where there is at least one preceptor per intern. The preceptor must have at least three years of experience in pharmacy practice post-registration and must be available at all times for consultation during the entire period of internship. The preceptor must demonstrate to have the knowledge, skills and attitudes required to train a highly motivated intern to have a successful professional life after registration before recertification.

• The pharmacist should be registered only if they pass pre-registration assessment that focuses on competencies expected of an entry level pharmacist. After that, annual practicing licence can be issued to a registered pharmacist without the need to sit for an exam, so long as there is evidence of continuous professional development (CPD) and the required CPD threshold has been achieved or exceeded.

• Only registered pharmacists should be allowed to practice pharmacy. Peer-led professional audits can be done on a regular basis to ensure that minimum standards required of a practice are maintained in all pharmacies.

• The current advanced training in clinical pharmacy needs to take at least 3 years with the pharmacist getting full residency status as their medical colleagues. The classes should be peripheral in term of time allocation, and real work environment practice to take the centre stage.

 The first half of the first year, can be fully academic, where an emphasis is placed on physiology, epidemiology, evidence-based healthcare and biostatistics. The second-half can the concentrate on pathophysiology, biopharmaceutics, pharmacokinetics, drug information and pharmacy management, toxicology, patient assessment, clinical chemistry and introduction to therapeutics and pharmaceutical care.
 The second year can be a year of problem-based learning where students need to build relationship with patients, other health care professionals and more importantly other pharmacists. The emphasis will be on the continuum of care, where there are multiple contacts between a student and an individual patient and student must have a plan for the patient who will be both in patient records and school of pharmacy records. The classes during this time will be mainly therapeutics, with numerous student presentations and faculty moderation. An adjunct class of advanced pharmacokinetics will be useful during this period. Some exposure to research methods can also be useful at this time
 The final year will concentrate on individual research work completion, more exposure to clinical areas of sub-specialization, and some level of participation in teaching more junior members so as to learn more. Communication and presentation skills, together with clinical audit [4] skills need to be enhanced at this stage. There should be evidence that the expected activities were actually carried out. Short-term exposure to other hospitals which are regional centres of excellence should be encouraged during this period.

• The newly qualified clinical pharmacists should practice for one year in the areas of their sub-specialty (residency) before they are awarded a board certification.

• The pharmacists to patient ratio should increase, and there should be presence of clinical pharmacists in all major specialties in major hospitals first, then to all other hospitals. The pharmacy specialist skills should not be spread thin, as there will be little or no overall impact. These specialists should be concentrated where they are needed most and should not be involved in primary care which registered pharmacists can provide with the help of lower cadre pharmaceutical professionals (technologists and technicians).

• The clinical pharmacists can harness their skills and knowledge by sharing information and experiences. They must have forums where they can communicate and influence the growth of the profession. Associations will leverage the growth of the profession by growing the capacity of the profession from within, and also by the lobbying forces outside the profession to further their interests.

• There must be a certification and recertification regulatory board [3] to certify pharmacists who meet the requirements to practice in their specialty areas, and prevent those who do not qualify from practicing.

• The clinical pharmacists should be able to motivate others to advance the practice of pharmacy. They should carry out clinical audits on a regular basis to demonstrate that the practice has improved. A clinical audit [4] is a cyclical process, involving the identification of a process to intervene, setting or adopting already available standards, comparing practice with the standards, implementing changes and monitoring the effect of those changes. Its purpose is to improve the quality of clinical care.

• There must be a standards body to force all healthcare providing institutions to meet certain minimum standards to be allowed to operate. Pharmacy practice can only excel if the pharmacists are well equipped to provide care.

REFERENCES
1. New Statesman, 21 April 1917, article by Sidney Webb and Beatrice Webb quoted with approval at paragraph 123 of a report by the UK Competition Commission, dated 8 November 1977, entitled Architects Services (in Chapter 7).
2. Pharmaceutical Society of Australia: National Competency Standards Framework for Pharmacists in Australia 2010. http://www.psa.org.au/site.php?id=6782
3. Board of Pharmacy Specialties http://www.bpsweb.org/about/vision.cfm
4. Graham Copeland. A Practical Handbook for Clinical Audit. Clinical Audit Support Team, NHS http://www.wales.nhs.uk/sites3/Documents/501/Practical_Clinical_Audit_Handbook_v1_1.pdf
5. Pharmacy and Poisons Act, CAP 244 of the Laws of Kenya

Thoughts for those who embrace March 13th 2010 Public Sector Pharmacists meeting

Pharmacy is about drug delivery/outcomes. When there are no drugs, the clinical pharmacist or any pharmacist for that matter finds no use for his skills. Let the pharmacists take over everything about drugs-including being the main signatories for all funds available for purchase of drugs. A professional is that who can make decisions and/or solve problems. Let the pharmacists solve drugs supply, drug use, drug misuse, drugs abuse, drug underuse and drug overuse problems. You cant put to task a pharmacist for what they he (sorry for the use of one gender) is not responsible for in his performance appraisal-he is not responsible for the perennial stock outs! In the same breath you cant squeeze the juice out of somebody's profession, curtail his job satisfaction and and go ahead and expect him to deliver. It consummately baffles me when the system lets someone who is not a pharmacist take over the most pleasant, most innovative, most outstanding and most progressive part of my job, and leaves me to do the most mechanical and repetitive (read boring) part of the job; a part that does not give me the chance to grow and take more responsibility before my retirement.
This meeting is very timely and the record needs to be set straight. The 'local arrangement' management of the public sector where one person is everything has to stop. Everything we do from now henceforth has to be supported by the law. If the law as it is has in any way derailed or has attempted to derail and threatened the survival of the pharmacy profession, then we must act and fast. We must not engage without putting conditions. We have to tell them what needs to be done, or ask them to stop training pharmacists altogether. No office must curtail and abruptly bring to an end to the dreams of any Kenyan child. Even more importantly, no individual should ever be allowed to have such powers.

On that score, this is the most irresponsible, most corrupted and and the most confused health system that has ever been in the world.
Everyone wants to play your role, qualifications notwithstanding, when there is money and blame you for their mess when the money runs out or where there is no money.

Please allow those pharmacists who are still in public sector to have something to do and be happy about, or the average age for those who can still stomach those issues will always be below 30. Need I say that pharmacists in public sector are all young and 'inexperienced', and that this will go on for as long as there is nothing to do 'for pharmacy' there? Who wants to grow old in such a system?

That meeting, I will attend; not for me, but for others who need me. I would want to return to the public sector as a 'Director' or as a PS, not as a spineless 'Chief' who cannot even be allowed to manage his own secretary by a guy who makes up for his lack of eloquence with hate and tyranny.

If the way forward of that meeting does not tackle the autonomy and clear career progression of pharmacists; one that will make an individual pharmacist plan his career life by saying 'I will go back to school, to do this so that I become this...et cetera et cetera'..., then we are doing nothing. We must say if we are not able to achieve to this end over a certain time-frame, then lets all resign from this job with false sense of security, we venture out there together and take over the pharmaceutical economy, because even that we have let others to. Then we start managing all drug issues, in all pharmacy specialties and sub-specialties that we will define, and in our own terms. Who said pharmacists can only achieve the health ministry goals by remaining as their employees? So long as we keep a few in the critical areas and pray to God; and pray really hard that they stop being part of the problem that is already undermining them anyway, then we are set. I hope they see that point and realize that the day pharmacists are empowered, they too will gain but ten-fold, and PPB might just become the most powerful institution in the health or even the larger social sector. Somebody needs to open their eyes, and take them back to the day they decided as a high school graduates to pursue pharmacy. That nostalgic feeling has to come back. They should be allowed to take their minds through on wild journey of the reason they were born.

So what is this thing that pharmacists can do in their own right without reference to anybody else? Everything. Did you know that the only way you can shape legislative process is by being a strong and visible lobby group and with money to boot? Our lawmakers can only debate on your issues when they are pampered and taken for some luxurious retreat somewhere, at your cost

A new post on Pharmacy solutions blog

The excerpts are...

....Now Kenya usually has two rules-the one on paper and the one that carries the day. Pharmacists are the only health professionals who zealously protect what is on paper; the 8-5pm working hours rule, and as it goes, it takes a pharmacist to enforce this work ethic among the other pharmacists.....

....I do not know if there is a pharmacy version of open professional ‘rebellion’ that is only good to the pharmacists and is protected to death by our bosses. In short, our work is quantitative and not qualitative. We are not allowed to make ‘extra money’ on the side lest we lose focus on the ‘very important job’ we were employed for. This is a very good rule, but look where it has taken us?
No wonder everyone is going public health.

Check it out on http://timkopussolutions.blogspot.com/ and send in your comments