Pharmacy Practice – What They May Not Teach You In The University Uniport 8th Induction Ceremony

Mr. Chairman Sir, the Vice Chancellor, Dean, Faculty of Pharmacy, other Deans present, distinguished academic and non-academic staff, colleagues in the profession of Pharmacy, Pharmacy inductees, dear students, ladies and gentlemen, I am thankful to God for this invitation to deliver this Lecture at the induction of New Pharmacists produced by the Faculty of Pharmacy of this great University. 

Though the invitation came rather late, I could not miss the opportunity to return to Port Harcourt, my second home. I still remember with nostalgia the great hospitality I received when I came to deliver the convocation lecture a few years ago, nor can I forget the warm reception I received last year when I visited the faculty on my campaign trail. At some time I was a regular visitor to the Faculty when Prof Udeala invited me to chair a committee that tried to establish a working and collaborative relationship between the faculty and the Private sector. I hope that someday, that committee will be resuscitated.

Indeed, I always wish to seize every opportunity that I can find to interact and counsel young people. I missed that privilege as a young person and I have decided to offer myself to support young people as they navigate their way in a challenging World.

THEORY vs PRACTICE

I have chosen to address you today on the topic – “Pharmacy Practice: What They May Not Teach You in the University”. The motivation for this choice is a personal experience. 43 years ago when I was stepping out of the greatest school of Pharmacy in Africa (I am sure you know the school – Great Ife!), I was cast in a mold full of expectations, eager to put to immediate practice, all that I have been taught. I do not know exactly what your curriculum and schedules are in the faculty today but since I know that some members of the teaching staff in the faculty are chips of the old block, I can imagine that you run a hectic schedule in the faculty.

The Pharmacy curriculum is to my mind the most rigorous schedule in the university system in this country. With many hours of practicals every day for five days in the week, and the laboratory reports have to be ready the next day. With several hours of lectures interspersed with rigorous testing on a wide spectrum of subjects. With as much emphasis on organic chemistry as on inorganic chemistry; with as much emphasis on physiology as on pharmacology, the drilling was quasi-military in form and content; I was fully packaged and poised to go. But I must confess that what I met on the outside was not exactly what I thought. I met a hostile Pharmacy and drug environment outside the confines of the university. And I was not quite prepared for that kind of environment 

WHAT THEY DO NOT TEACH YOU

All the science, even the theories and practicals taught at school are very important for you to practice Pharmacy. They are the basic building blocks on which the practice must be anchored. Without them, you really cannot practice except of course in the special context where everything is possible. But I wish to submit to you here today, that the key success factors in Pharmacy practice are not taught in the schools of Pharmacy yet.  

HOSPITAL PHARMACY

How much of compounding still goes on in our hospitals today? Except for some of the teaching hospitals and a few of the really large General/Specialist Hospitals, no kind of compounding goes on in most of our health institutions today. It is certain that more than 50% of the graduating and undergraduate population seated here today may never have an opportunity to compound anything throughout their stay in the hospital practice. And for the other 50% or so who may have the opportunity, only an insignificant portion of their time will be spent in this activity. And yet so much time is devoted in teaching compounding in Pharmaceutics, at least in our time.

What about the new fad called Clinical Pharmacy? Except in one or two Teaching Hospitals, most of you will fight to be allowed to join a team of doctors on a ward round and even when you discover some incompatibilities or potential adverse drug interactions, and return the prescription to the doctor, How many of the doctors will be willing to amend their prescriptions? And the focus is now on Pharmaceutical care with emphasis on  patient counselling. Where will you stay and counsel the patients – across the windows or in an office? Many hospital pharmacies still lack space to allow for confidential counseling but you must nevertheless counsel. Because today, we insist that no patient should get any drug without counseling. But the reality is that many of you may just end up in the Hospital Pharmacy practice either just handing pills to patients across the counters (sometimes only returning the prescription with comments- o/s) or sit on a table filling out forms – indents, stock ledgers, stock requisition etc. and many may never really interact with patients on the much emphasized Pharmacist-Patient relationship. You may never have the chance to really explain to the patient what “take two capsules four times a day” really means. But when that happens, do not be shocked or discouraged. 

For our graduating Students and undergraduates, I am drawing your attention to these so that you are not taken aback when they confront you as they surely will. I was indeed taken aback myself. The key to success in the Hospital Practice is to be determined and deliberate to practice what you think is the right thing to do. For most young Pharmacists, unprepared for the realities of the outside world, they are easily broken down and they are forced to conform. My point is that you must be prepared to confront the problem, be prepared to overcome them and then must work really hard to overcome them. The Bible says that we should not be overcome by evil. If the present state of hospital practice must continue to change – it is the Pharmacists who must do so and the young Pharmacists are in the best position to do so. The older ones may have been compromised or may have become stuck with their old ways, including indulging in corruptive procurement practices.

The successful hospital Pharmacist of today must indeed be a real specialist in drug therapy and Pharmacology. He must understand disease states and the role drugs play in their diagnosis and prognosis. He must have on his fingertips the information on old and new drugs. Nobody will teach him all these in the university. Like the lawyer, the real learning for the Hospital Pharmacist begins after graduation. He must learn to read and read and read. He must know how to access and arrange information. To be successful, he must earn the respect of his colleagues in the Health team, not because he has a degree in Pharmacy or has a PharmD but because he has and readily uses the dynamic knowledge on drugs to advise doctors, nurses and patients on why and how drugs must be used. And he must be prepared to volunteer this information. Some of his colleagues who think they know too much about drugs may not care to ask and therefore may take steps which may undermine the rational use of drug products. It is the professional job of the Hospital Pharmacists to pre-empt such situation and step in boldly to correct any anomalies. Again, I must emphasize that it is only the Pharmacist who is constantly reading – books, journals, literature reviews, clinical reprints and who attends scientific symposia and seminars on a continuous basis that can be equipped to perform this professional role. Anyone who depends only on what he was taught in the university will certainly not make a success in the Hospital practice, today and tomorrow.

COMMUNITY PHARMACY PRACTICE

Did you learn how to confront the patients who ask for sub-optimal doses? especially when if you refuse to sell,  the Patent Medicine Vendor or “Chemist” next door will gleefully sell? In the university, have they taught you how to cope with the menace of Patent Medicine Stores and the myriads of illegal/quack Chemist shops? Have you been taught how to identify fake/adulterated drugs (not just of powders in Pharmacognosy) and how to stay clear of them? What of this problem of Pharmacists abandoning their shops to store boys and girls and taking off to other pursuits? At this point, what is the distinguishing character between such a shop and the one owned by a non-pharmacist? The “Register and Go” syndrome you may have heard of. But did anybody teach you about the pressures that lead young Pharmacists to “selling off” to illiterates and allowing crimes to be committed under their names and protection? What are the strategies for overcoming these? Are we prepared to confront the problems? Are you familiar with the distribution chain and the existing confusion?

It is important that we learn that the possession of a degree in Pharmacy does not really guarantee us success in the professional realm of General Practice or community Pharmacy? The mere appellation as is commonly seen on sign boards – Retailers, Wholesalers, Compounding and Dispensing Chemists, does not indicate success. Success will come from choosing what aspect of the General Practice one is most suited for or prepared to practice. SPECIALIZATION of functions is the key. If you have the financial resources or access to them and wish to play in the big league, then you may consider setting up a wholesale business and of course you must be prepared to face the traders and the open market merchants, scattered all over Nigeria. You must take courses in Business Management and understand Basic Financial and Accounting Principles. If you prefer the more professionally fulfilling retailing Pharmacy Practice then you must learn how to elevate your practice clearly above the quacks and pretenders. You must have the temperament to work long hours because like other professionals – medicine, dentistry, law and even barbing or hairdressing the personal touch is critical. You must build a bond with your patients or clients and offer them services which are clearly superior to what they can get elsewhere to assure you retain their patronage. Many pharmacists spread themselves too thin trying to be everything at once – wholesaler, retailer, compounder or even manufacturer all at the same time. And in the end they are unable to make a reasonable success of their practice. My experience is that retail or community practice can be both professionally and financially fulfilling if one devotes time to it if you doubt me ask Juli Pharmacy, Edo Welfare Pharmacy, HealthPlus, MedPlus, Nett Pharmacy etc, who have made monumental success of Community Practice Pharmacy.

It is important for every Pharmacist who wishes to go into general practice to realize that he is going into a battle field with very formidable adversaries. He must therefore have the right mental attitude and professional competence and confidence to overcome. He must be prepared to join in the crusade to order our distribution system in Nigeria. It may be helpful to acquire some experience working under seniors before going solo. Alternatively group practice or partnerships are proving to offer better prospects of success than going solo.

INDUSTRIAL PHARMACY

How much training have we got in the act of communicating drug information to doctors and other healthcare professionals? And yet this is what the majority of the Pharmacists who are employed in the industrial sector practice. What of Management Training? I know that a bit is being taught today but is that sufficient to equip a Pharmacist to be a Manager of men and materials? Suppose you wish to establish a small scale Pharmaceutical manufacturing outfit. Do we know how to proceed with feasibility studies, project financing and project implementation? The future of Nigerian Pharmacy practice must be in the industrial sector. We must break our over-dependence on imported finished Pharmaceuticals. There is nothing that stops a young Pharmacist from aspiring “ab initio” to go into drug manufacturing. But he must take immediate steps to seek the information necessary to actualize his hopes and desires.

It may be worth the while to state here that while many young pharmacists will be desirous to go into sales and marketing of drugs with big pharmaceutical companies – not all are so endowed and equipped. You must assess yourself to ensure that you have the basic behavioral attributes. Are you extroverted? What is your English language and communication ability like? Do you love travelling? Are you self-motivated? Do you easily get turned down? Answers to these questions must be honestly provided to ensure a successful career in the industry as a Pharmaceutical Representative. And even when you become a Medical Representative as they are fondly called, your success will depend more on your knowledge of competitive products and medicine than on the knowledge of your products. And therefore you must seek information and improve your knowledge on the diagnosis and management of disease conditions.

Pharmaceutical manufacturing is more than compounding and those who wish to go into that aspect of Industrial Pharmacy must show some familiarity with machines and must also have the temperament to stay in one place. Manufacturing job does not permit truancy. Therefore, there is the need to undertake post graduate training( certificated or not) to truly understand the art of pharmaceutical production.

ACADEMIC PHARMACY

It is true that “every headmaster was once a pupil” but it takes a lot to transform a pupil to a headmaster. It requires more than academic brilliance to be a successful academic Pharmacist. Do we have the urge to seek and explore? Are we patient and long suffering? Do we have or can we learn intrinsic self-discipline? Are we prepared to climb the ladder of wealth and prosperity on a steady and slow basis? Like John the Baptist, those who wear designer suits may not be readily found in the academic world. Do we cut corners unnecessarily? Academia involves the search for the truth and we must be truthful to actually search for it. Many young Pharmacists have actually attained great success in the academic world. Many examples abound in the University of Port Harcourt. They may not be very high in the list of wealthy men. They may not wear designer or silk suits often but today they stand tall in the community of Pharmacists – nationally and internationally. They are well recognized and when they speak, the world listens. Ask what it has taken them to reach these heights – they will not teach you these in the Pharmacy class but you must learn them and be prepared to face up and live up to the realities. It is okay to bemoan lack of funds and facilities in the universities and use that as an excuse to abandon research. The more enterprising academics are finding ingenious ways to obtain assistance from Pharmaceutical and other companies and agencies. Many have become experts in seeking and writing for sponsorships and grants. A few have attracted endowments. 

KERNEL

Ladies and Gentlemen, the summation of the above presentation is that the mere possession of a B.Pharm degree or even PharmD is not adequate guarantee that we shall be successful in the practice or even in the world. There are a lot of variables out there in the world which will determine our success or failure. My objective here has been to draw your attention to a number of them and to set you thinking. The truth is you can be what you wish to be but you must work hard to be what you want to be and with the grace of God you can make it. Look around you and you will find those who have made it in our profession and those also who have not made it – some early and some much later. In all cases you will find some basic and common ingredients which run through their lives. Some of these common attributes include:

*Vision – determine where you want to be. Envision the future.

*Knowledge – seek, search, explore

*Determination – focused hardwork

*Persistence – never say die

*Planning – key to all successes

*Passion- A deep seated internal motivation to achieve

*Entrepreneurship – element of risk. No venture no success

*Adaptability to Technology & Change – Nimble, current & dynamic

*Integrity/Honesty – it is the best policy, character is everything 

*Time Management – self-discipline/being organized

*Inter-professional Relationships – social styles/ partnerships/ networking – open doors! Productive relationships

*Fear & Trust in God – the bedrock

CONCLUSION

Mr. Chairman, ladies and gentlemen, I thank God that I am a Pharmacist. The training may be rigorous, the environment may be uncertain and hostile but it is a profession to be proud of. But it takes hardwork, determination and faith in God to succeed.

Our dear graduates, especially the graduating class and those being inducted today into the profession of Pharmacy, I am certain that you have the basic ingredients for a successful Pharmacy practice impacted into you by your lecturers.  But how to actually achieve success is not always taught in school – I mean the formal school. You have to learn most of that in the “world school”. As you step out from here into the “world school”, you are more or less on your own and how successful you become will depend primarily on whom you are and what you really want to be and the sacrifices you are willing to make( including deferred gratification).I am hoping that you all will be successful. But you must throw away the entitlement mentality. You are entitled to nothing except air and perhaps Salvation if  you are willing to obey God. Nothing else is free. You have to prayerfully work hard for everything else including “pure water”. I look forward to watching, seeing and reading about each of you as you march through the sands of time, leaving your footprints.

Finally, let me thank the Dean and members of the Faculty for finding me suitable for this unique honour as a Guest Lecturer. I wish you all God-driven successes in the years ahead as we all continue the unending learning in the “world school”.

Thank you for your attention and God bless.

PHARM. (MAZI) SAM I. OHUABUNWA OFR, MON, NPOM, FPSN, FNAPharm, FPCPharm

President, Pharmaceutical Society of Nigeria