Role of Pharmacists in institutionalisation of health system: Challenge of the moment
Dr Mohammad Didare Alam Muhsin :
One of the basic needs of people in the world is to get proper treatment and care for their diseases. Human beings are faced with various ailments, and therefore necessarily need treatment, right from their birth. Thus, since the prehistoric era, doctors have had a special status in every society, and so also those who make medicines to be used in medical work.
There was a time when the treatment of diseases and the manufacture of medicines were done by the same person. This is true even today of many traditional and old-fashioned medical practices. But with the development and expansion of the health system over time, the treatment of diseases and the manufacture, distribution and overall management of drugs took the form of two distinct branches. In today’s world, the countries in which the health system is on a strong foundation or moving towards it, there is an independent group of professionals and experts called pharmacists who are continuously working together with doctors for the holistic management of these two streams of the health system.
The department of pharmacy or pharmaceutical science in the universities is the factory for the creation of this specialist group called pharmacists. Modern medicine prepares a future doctor as an expert in diagnosing the patient and prescribing medicines accordingly, but it is not the job of medicine to learn or teach the vast and versatile technical knowledge required for manufacturing, quality control, storage and distribution of medicines. A doctor must know about medicine, but he learns it only from the perspective of treating the patient. Activities such as manufacturing, quality control, storage or distribution of drugs are not his areas of expertise. In today’s world, it is the pharmacy or pharmaceutical science departments in universities that are working to produce such experts.
Now, suppose a doctor diagnosed a patient correctly and prescribed him the right medicine, but the quality of the medicine given to the patient from the pharmacy is off the mark. Will it cure the disease? Consider another aspect – the medicine has been made properly by the manufacturer, but it has not been stored properly in the pharmacy (drug store), and as a result the medicine got spoiled. If such a medicine is given to the patient, will it work? When prescribing to the patient, a physician may err on the side of dosages, may prescribe two drugs that have adverse interactions with each other, or may unnecessarily burden the patient with too many drugs without enough ground – not only financially crushing the patient, but also at the same time prompting him to take so many drugs together that may even lead to liver damage and/or kidney failure. If the doctor wilfully or unwillingly makes such a mistake, who will catch it? Behold, you are making a wave of satisfaction by entrusting all those experts, who have just somehow passed SSC, with the responsibility of dispensing medicine. When dispensing the medicine to the patient, it is necessary to explain many things like when and how to take the medicine – in the morning or evening, before or after meal, where to keep it, what to do if there are any unwanted side effects and so on. If these things are not adequately explained to the patient and he fails to handle the medicine correctly, it may either not work properly, or the patient may suffer from various complications after taking the medicine. Do you think it is possible to perform this huge task of giving such important advices for a person who does not possess expert knowledge of medicine?
Reader! By this time you understand that not only drug manufacturing or quality control, but also drug storage and distribution is not a child’s play. If it were possible for an SSC passer, or someone who undertook a six-month certificate course, to carry out this huge responsibility, then in Europe and America it was not considered essential to employ such highly specialised personnel as pharmacists, who studied pharmacy for four to six years at the university level to earn a Bachelor of Pharmacy (B. Pharm) or Doctor of Pharmacy (Pharm.D) degree, to perform this task. Not only in these countries, but even in the Arab states of the Middle East, which are not more advanced than us in education, you cannot imagine running a pharmacy (drug store) or managing drugs in a hospital without the direct supervision of graduate pharmacists.
So, why or how are we doing the same job without engaging experts like pharmacists? Ours is a very densely populated country with a huge population. As we have more people here, naturally we suffer from more diseases and ailments. So, is not it logical that we will need to be more cautious in managing drugs than in Europe, America or the Middle East? The fact is that perhaps we consider dispensing medicine against a doctor’s prescription as a simple task and we simply cannot understand why such a very simple task should require expert knowledge of medicine. We think that It should be enough if you can just read the prescriptions and know the names of medicines. Children are not aware of the combustion power of fire. So, a child can easily reach into the fire without hesitation. When we don’t even understand that medication management is a very sophisticated job, how can we understand the need of a graduate pharmacist in a pharmacy (drug store) or hospital?
As per the Bangladesh Pharmacy Council website, there are currently 13 public and 28 private universities offering pharmacy education at the undergraduate level in the country. If an average of 50 graduate pharmacists is produced every year from one of these universities, then we are producing more than 2000 graduate pharmacists per year. While in the developed countries of the world 80-85 per cent of graduate pharmacists perform their professional duties in retail pharmacies (drug stores) or hospitals, in our country about 90-95 per cent of graduate pharmacists are employed in pharmaceutical companies. Undoubtedly the pharmaceutical industry has grown tremendously with the participation of graduate pharmacists in the country, but the jobs in this sector have already become somewhat saturated now. So, where will the large number of graduate pharmacists being produced every year go? As of now, a large part of them migrate to Europe, America or the Middle East. But by involving them in hospitals and retail pharmacies (drug stores) in this country, we could have institutionalised the health system of the country. What a waste of skilled manpower of a country?
Actually, we Bengalis consider ourselves as an extraordinary talented nation. Many call it satirically as the land of all possibilities. Maybe we think that we all can do everything. So, while I am not sure if we think it is possible to do a surgeon with a barber, we see no problem running a pharmacy (drug store) with a technician with little academic knowledge of drugs. We consider it sufficient to have at best a diploma pharmacist in the hospital. Even in some cases we may consider it, too, redundant. We feel more comfortable seeing a physician, rather than a pharmacist, at the top of drug administration of the country. Do all these not bear the signature of our extraordinary talent and immense scholarship? Now, you should not get surprised if things continue like this and we happily keep expecting that the quality of the country’s health services will hastily increase day by day. How ridiculous!
(The writer is Professor and Chairman, Department of Pharmacy,
Jahangirnagar University).