Dr Charles N Nwako
In the Nigerian Pharmacy space or Drug World , it is becoming almost impossible to differentiate between some supermarkets, provision shops, patent medicine stores , unregistered pharmacies and the properly registered & licensed pharmacies.
In all these, you find almost apparently same types of drugs and related products. All appear to offer same services of drug provision, but many are without the provision of the required & accompanying professional Drug Information.
This is because these Drug Outlets aside the properly registered and licensed pharmacies, are not manned by Pharmacists. It is only in properly Registered and Licensed Pharmacies manned by Superintendent Pharmacists that one can receive professional pharmaceutical services or care like Drug Information through Effective Medication Education & Counseling. Even licensed Patent Medicine Dealers are not knowledgeable to counsel Patients on ethical drugs.
The populace are even more confused as a good number of them tend to rush to the non pharmacies as they claim they spend less time, less amount of money etc in these so-called Drug Stores.
It has been observed that an appreciable number of Nigerians tend to shy away from patronizing the registered and properly licensed pharmacies that are manned by pharmacists, on the account and alleged belief that services in the Pharmacies are costlier, more time consuming etc.
What most Nigerian Clients or Patients do not know is that, it is not just about drugs being given out but also about the associated dispensed drug Information that accompany such medications .
It is also important to emphasize here that , it is not the size of a Church building that makes it a Cathedral, but the presence of a Bishop.
Every drug has a set of specific & accompanying Drug Information that rightly guide its proper usage, otherwise such use could turn out to be harzadous.
Some of the deleterious effects may not manifest immediately but years later. Those who rush to these Unlicensed Drug Outlets to obtain their drugs without the correct & associated information are like someone who rushes or attends a church or mosque service without actually hearing & receiving the main sermon. It is not by visiting or occupying space in church or mosque ,but by how one utilizes & applies the sermon in his life. What changes one is the message or sermon preached . Without the Sermon or Gospel, attending a Church or Mosque service is grossly incomplete. So also is getting the right and sufficient information when you visit a Pharmacy Establishment.
Currently, there is an upcoming report from some recent studies & findings that Drug Related Deaths are now ranking third place after Cancer & heart disease globally. If such findings are seen in advanced societies where drugs are strictly utilized under the supervision of Pharmacists or other highly qualified medical personnel & are mainly obtained through legal means such as Prescription or Pharmacy Only Medicines ( Pharmacy Initiated Medicines), how much worse will the case be in a country like Nigeria with chaotic drug distribution ?
In Nigeria, almost everyone is misusing or abusing drugs , irresponsibly self-medicating with drugs as well as being non adherent to their medications' guidelines for usage. Suffice it to say that the incidence & prevalence of Drug- Related complications or deaths are expected to be unimaginably high & unreported in Nigeria.
One keeps wondering at the negative impacts & Drug-Related complications that could have been created & caused by the unchecked activities of quacks & traders who have infiltrated & hijacked the pharmacy Practice in Nigeria.
Effective Drug Education, Medication Review & Counseling are therefore the only ways out of this menace . Such could only be accurately provided by Pharmacists who are the healthcare Professionals globally known and trained to excel on the knowledge and actions of all types of drugs.
Since Pharmacists are the highest trained healthcare Professionals on drug knowledge and matters, any other person who assumes the post or duty of a pharmacist & involved in drug refilling, dispensing or handling as an occupation with respect to Patients or clients care, is best described as an Impersonator or an Usurper. Such a person's action could pose a great danger to the health of the citizenry and must be discouraged. Even when other trained healthcare professionals are involved in medications handling, it should be done under the direct supervision of Pharmacists. That is the position of science and the proper or healthy practice too.
Many of our people are much more concerned in some cases about cheap cost of their medications & less time spent in non pharmacies or other non properly registered drug outlets , but are oblivious of the fact that majority of such drugs obtained in these non pharmacies could be either substandard, fake or subject to misuse due to absence of professional guidance. This partly explains why many Nigerians suffer from treatment failure, drug resistance, adverse drug reactions, drug induced diseases & even untimely death.
Many people in the society think that every person who handles drugs in a drug outlet is qualified to do so & that one does not need to spend some time with the pharmacist. Some don't even know who is a Pharmacist , and think he is just anyone in a drug store. Many are not even aware or do not care to know that any Pharmacist they see in Nigeria must have graduated from the University and licensed, after spending about six or seven years (depending whether it a doctor of pharmacy or Bachelor of Pharmacy Programme) plus an additional one year NYSC programme.
Some Pharmacists also have advanced degrees in Clinical Pharmacy or Patient Oriented Pharmacy Practice.
Of importance too , is the fact that many of the fake drug outlets do not have signposts clearly indicating their names. That is dangerous as it makes them unidentifiable.
An establishment dealing in drug matters should have a proper signage to show if it is a Pharmacie, Patent Medicine Shop, or Supermarket.
All Drugs are potential Poisons.
Before drugs can be assured to be safely and appropriately used, they will be accompanied by some professional information & Education from the pharmacists who are the medications experts. It is the pharmacist that designs and manufactures all orthodox medicines & really understands the workings of the drugs. For instance, in developed world, their citizenry are familiar and deeply understand the sign; " Pharmacist on Duty" or " Pharmacist not on Duty". These patients or clients are never in a hurry while in the pharmacies as they patiently wait for their pharmacist's Medication Education & Counseling.
o wonder did USA passed a Bill called , "OMINIBUS BUDGET DRUG RECONCILIATION ACT". This ACT makes it mandatory that the pharmacist owes the patient the duty of providing Drug Information & must educate & counsel the patient on the proper use of drugs. Some other countries have theirs too.
It is very unfortunate in Nigeria, that non pharmacists & quacks have invaded pharmacy Practice , a Practice that is supposed and meant to safeguard the health of people.
Almost all our streets are occupied with drug stores that are in many cases operated by illiterates, semi literates, school dropouts, & non pharmacists. What a madness !
Almost every Tom, Dick & Harry in Nigeria wants to invest in pharmacy Practice without being aware of the dangers such action can pose on the health of the unsuspecting public.
People see drugs as ordinary articles of commerce. But In other countries citizens are jailed if caught with drugs or medicines when they are not a licenced pharmacist, or not a patient with a valid Prescription (or other recognized means of medicines possession).
Dispensing, Effective Medication Education & Counselling are even more important than the actual provision of the drug itself , as the wrong use of any drug could kill or harm rather than cure the patient or client.
Drug Dispensing is a course in the Pharmacy Curriculum which students must pass with a "B - grade". It is therefore very risky for a non pharmacist to dispense drugs. If a non pharmacist is to dispense drugs, then it should be done under the direct supervision of a Pharmacist. Else many people can be silently harmed. No wonder the life expectancy for Nigerian is about 54 compared to the US and the UK with 98 and 97 respectively. Also the Nigeria health index according to a recent WHO ranking is 189 out of 191 countries surveyed. What a tragedy !
What then is this EFFECTIVE MEDICATION EDUCATION & COUNSELING ?
In a nutshell, it is simply the Responsible Provision of Drug & Disease Related Information which aims at improving the Patient's knowledge about the proper use of his drugs to prevent Drug-Related errors as well as elicit some behavioural changes that will result in expected positive lifestyles, Wellness & Wellbeing of the patient (Oparah AC , 2020). It also talks about how the patient could be actively involved in co-managing his disease state, how to identify failure or effectiveness of medication therapy, all about drug interactions, Adverse Drug Reactions, refilling , untreated indications, medications reconcilation, disposal of drugs etc. It must also be stated that this is patients' right & a duty every pharmacist owes the patient.
Your pharmacist by virtue of his training on drugs, is fully equipped to provide the salient drug information to you through Effective Medication Education & Counselling. That is why you have no other option than to submit your prescription (and other self selected medications) to your pharmacist for proper evaluation, rationalization & appropriateness.
The pharmacist then provides the basic information vis a vis your disease condition.
For instance, contrary to the apparent general or erroneous belief that every drug should be taken with food, Ampicillin should be taken on an empty stomach. Anti ulcer drugs like our popular OMEPRAZOLE & its family members could only work at optimum level if taken 30-60minutes before meals especially in the morning. Also many patients who use such type of drugs are not aware that concurrent intake with Antacids will destroy the beneficial effects of such anti ulcer drugs.
The pharmacist will also educate & counsel patients that there are aggravators of stomach Ulcer like taking unripe oranges, spices, peppery food, high calcium products, misuse of pain relievers like Ibuprofen.
It will also amaze you that those who take their anticholesterol drugs like Rosuvastatin & its family members outside bedtime periods may not get the best out of such drugs.
Those who use their Antihypertensive Diuretics Drugs(Water Pills) like Hydrochlorothiazide at night time could be wasting their drugs as it will push up their Blood Pressure as a result of sleep disturbances, and waking up to urinate at night, rather than bringing down the blood pressure. Furthermore, Water Pills (diuretics) when concurrently used with pain killers (NSAIDs) such as diclofenac can completely damage the kidneys.
Many hypertensive Patients who use much table salt or eat fried food are indirectly worsening their Blood Pressure.
Also those who take blood builders (Iron preparations) with milk are wasting their drugs & may even become more anaemic.
Most patients using the antidiabetic Insulin, who do not consult with their pharmacist or who prefer to patronize quacks may never be counseled or educated that it should be stored in a functioning refrigerator & used within a specified period of time.
The bitter truth is that many Nigerian patients end up wasting their time, energy & wealth after visiting their prescribers, if they fail to complete the chain or cycle of care by not visiting & directly interacting with their pharmacists about their prescriptions. Some patients or clients send their wards,relatives, spouse or children to refill their drug Prescriptions. This is called "Dispensing by Proxy" & is a big error. There is no " Reported speech" in Effective Medication Education & Counseling.
As you start the chain of care in your health-seeking behaviour by visiting your prescribers, you should complete the same cycle by passing through your pharmacist & demanding for the provision of Effective Medication Education & Counseling. Your pharmacist is the ultimate drug expert who is most equipped with the mandates, skills & trainings to provide you with the Authentic & Effective Medication Education & Counseling & any other Drug -Related Services.
Do not allow anybody to deceive you as Information & Knowledge are Power!
Dr Charles N Nwako PharmD, MCPAN.
Chairman National Publicity Committee of the CLINICAL PHARMACISTS ASSOCIATION OF NIGERIAN(CPAN)