Dr Ucheoma Nwizu, an experienced clinical pharmacist at the Neighbourhood Health Centre, in Milwaukie, Oregon, USA, has observed that most Nigerian pharmacists have strong entrepreneurial dispositions but need to improve on their clinical skills.
The clinician, who manages various chronic disease conditions through a collaborative practice agreement with physicians in her clinic, said it is imperative for Nigerian pharmacists to harness their entrepreneurial orientation towards improving pharmaceutical care.
Below is the full interview:
Please tell us about yourself, your early years and education.
I am a clinical pharmacist, but I wanted to be a teacher for as long as I can remember. As a young girl, while others played house, I played school and I was the teacher. Being the first child of two schoolteachers, it seemed innate to me, but my parents discouraged my career choice. They did not want me in a career that depended solely on the government for income. I did not need much persuasion, as I had watched my mother work for months without a salary.
I attended various elementary schools as my dad was in the federal civil service; but for secondary school, I attended Federal Government Girls’ College, Owerri. In secondary school, the science subjects made more sense to me, as they were logical and required less memorisation. I thrived in understanding and applying concepts. Subjects like History and English Literature, though interesting, required memorisation and reproducing in the examinations, so I stayed away. I chose to study Pharmacy, following the footsteps of Pharm. Ifeanyi Atueyi, founder and publisher of Pharmanews, who was my dad’s very good friend. He was the only health professional I knew who was not a doctor or a nurse. He carried himself with dignity and I naturally assumed pharmacy was a noble health profession.
I studied Pharmacy at the University of Benin. My “ahaa moment” in pharmacy school came when I sat in my first clinical pharmacy class. Here, everything I had been learning seemed to tie in neatly. I migrated to the United States with a strong desire to pursue a career in clinical pharmacy. I was able to accomplish that after 12 years of practising as community pharmacist. I obtained a PharmD degree from University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Denver, Colorado. This was where I pleasantly discovered that clinical pharmacy and teaching share the same genetic makeup.
Following my PharmD degree, I pursued postgraduate residency trainings in Pharmacy Practice and Ambulatory Care. During this period, I further developed my skills in teaching and education by completing certificate trainings in Instructional Design and later in teaching.
I currently practice at Neighborhood Health Centre, in Milwaukie, Oregon. My roles in the clinic include collaborative management of chronic conditions like diabetes, hypertension, dyslipidemia and smoking cessation; providing comprehensive medication reviews for our patients who are on multiple medications; providing education to our healthcare providers and nurses on medications and guideline changes; and providing drug information responses to all providers and patients at the clinic. Additionally, I precept students on APPE Ambulatory Care rotations.
In my spare time, I teach online classes to pharmacy students. I have a passion for providing education across the globe. The joy is in impacting the pharmacy world in small measures from a little corner in my kitchen office. I love to run and hike. My favourite time of the week is my Saturday run/walk. I can spend hours doing that while my head is plugged into music, or a book or podcast.
As a pharmacist with years of experience in clinical practice, can you share with us some intriguing aspects of the practice?
One of my most profound encounters in pharmacy practice occurred during my experiential learning for my PharmD Degree. During an Ambulatory Care rotation at a Veteran’s Hospital in South Dakota, a poorly controlled diabetic patient was referred to my preceptor for management, and after explaining the therapeutic goals, my preceptor said to him, “Don’t worry, Mr. ‘J’, we will get you there.”
This encounter, though somewhat uneventful, was an epiphany in the expectations of my profession and marked the beginning of my quest for extended clinical experience and direct patient contact. As I learnt to articulate the treatment goals for each patient I encountered, I began to realise that the essence of what we must do as pharmacists is to ensure that our patients “get there” and that they do so in a safe and timely manner.
Over the years, I have learnt to shift the focus. I no longer bear all the responsibility of “getting my patients there”. I have learnt to empower them “to get there”. I make sure they know where “there” is and I strive to push them up in self-management of their chronic condition as I slowly recede to the background. This skill, for me, is a game-changer in a successful therapeutic relationship.
I am also intrigued by how much our patients can learn. When I practised at the Heart to Heart Centre in Jos, Plateau State, Nigeria, I was pleasantly surprised at how much even illiterate patients can learn. I learnt not to equate English speaking with intelligence. I learnt to devote attention to teaching and empowering patients to participate in their healthcare, irrespective of their education level. It is amazing what can be achieved when patients collaborate with their healthcare providers.
I am also intrigued by how our profession has grown. I started practising Pharmacy in the US in the “count, pour, lick and stick era”, in which pharmacist manually typed up the label, counted the pills, licked, and slapped labels on the dispensing bottles. By the time I left retail practice after 12 years, things had advanced – from the ability to scan hard copies of prescriptions to the system, electronic transmission of prescriptions, to visual verification of prescriptions. Things are now automated, and the pharmacist can now spend time in clinical practice.
I have also watched the advancement of Clinical Pharmacy in the United States. We keep expanding the territories. Ambulatory care used to consist of running anticoagulation clinics and drug information services. Now, we have collaborative practice agreements to manage chronic disease conditions. Clinical pharmacists have strongly occupied their place in the United States health system and the system has benefited from it.
The outbreak of coronavirus has led to the death of many diabetics across the globe. As a certified advanced diabetes management consultant, how would you advise healthcare givers to prevent further death of diabetics from COVID-19?
Yes. Patients with diabetes are at higher risk of poor outcomes and even death from COVID. The first recommendations are for prevention, – social distancing, wearing of masks and hand hygiene. In my practice, we found it helpful that we already had a diabetes registry. A diabetes registry is a running list of our diabetic patients, including their A1Cs (The measure of glycaemic control).
With this registry, we were able to schedule phone appointments with patients, placing the highest priority on those patients with poor glucose control. As we sought to understand the pandemic in the initial days, it was important that we ensured that our diabetic patients have no need to go to the emergency room or hospital visits for non COVID reasons. This meant making certain that they can manage their conditions effectively at home.
My task was to closely follow up with patients, and adjust their medications as appropriate to ensure reasonable glycaemic control. As I explained to the students on rotation at the time, the primary goal was to keep them away from the hospital. We did not seek perfect blood sugar numbers; safety was our number one goal. We were to avoid all glycaemic emergencies.
The next target was to avoid unnecessary clinic or pharmacy visits. This sometimes meant, making judgements with limited data. Sometimes, though, we did not have very recent labs; we had to make reasonable clinical decisions, based on previous laboratory results.
Sometimes, certain medications were not prescribed, based on laboratory test requirement or lack thereof. Medications were now prescribed for 90 days at a time and we collaborated with the insurance companies to sync all their medications, so they were only going to the pharmacy once to get all their medications and supplies. The primary goal was to avoid unnecessary risk of exposure to the COVID virus.
We learnt you helped develop a manual for preceptor development for Nigerian pharmacists. Please tell us in summary what the manual was all about.
This was a NAPPSA initiative. The Nigerian Association of Pharmacists and Pharmaceutical Scientists in the Americas (NAPPSA), through its Education Committee, collaborated with some pharmacy educators in the United States to provide a manual for pharmacy preceptors in Nigeria. This was our way of making a tangible contribution to experiential learning in pharmacy education in Nigeria.
The primary objective of the manual is to provide guidance and the necessary tools to pharmacists in Nigeria, who are engaged or seeking to engage in experiential education, to improve precepting skills and help develop quality sites for experiential learning. This manual provides a practice framework for the development of experiential education in various settings and encourages preceptors to create individualised strategies to build a successful learning experience for their students.
In addition, this manual provides tools to help develop a curriculum for experiential learning and for assessment of students and preceptors to ensure they are meeting target goals. The manual is accessible through the NAPPSA website at:
As an ardent practitioner of Clinical Pharmacy, what are the differences in the implementation of Clinical Pharmacy in the United States and Nigeria?
Between 2009 and 2012, I had the privilege of living and practising simultaneously in Nigeria and United States. This gave me the rare opportunity of observing both practices at the same time. The most obvious difference is the extent to which clinical pharmacists are integrated into the health system in the United States, as opposed to Nigeria.
The American-trained and practising clinical pharmacists have made steady strides and advancements into the health system with the mindset to continue expanding their frontiers. Pharmacists in the United States identify care gaps and move in to fill those gaps. As a result, their service is always meaningful and appreciated.
Another difference is the practice culture, which I think stems from the difference in training. The US PharmD training requires over 1600 hours of experiential learning. Pharmacists who practise in clinical settings undergo additional experiential learning (residency training) for a year or more. In fact, more hospitals and health systems now require residency training or more to be qualified for higher level clinical pharmacy practice. The result is that the clinical pharmacists in the US are comfortable in clinical settings, direct patient care and are skilled in interacting with physicians and other members of the healthcare team.
With the Nigerian pharmacist, I have noticed a stronger entrepreneurial disposition. Something in the training or culture pushes them to create business opportunities for themselves. This mindset is not common in the US. In my interaction with clinical pharmacists in Nigeria, what I see lacking is not the knowledge, but it is in the practice. The lack of clinical practice then erodes the knowledge. It becomes a case of the chicken and the egg – which came first. We must find ways to make our knowledge translate to patient care. We must also find ways to bring our entrepreneurial mindset to clinical pharmacy practice.
In what ways can Nigerian pharmacists improve the practice of Clinical Pharmacy?
I think it is important for pharmacists in Nigeria to understand the history of the development of clinical pharmacy in the United States and indeed other parts of the world, so as to successfully build our own models. This model may be tweaked to suit our own practice environment, but it is important that we think through our strategies.
We must realise that frontiers are conquered one at a time. There are multiple areas of care gaps in the Nigerian health system and pharmacists can position themselves to fill those needs. I believe we can focus on the skills needed to identify problems and articulate solutions, bearing in mind the culture we are in. We need more meaningful projects or research supporting the involvement of clinical pharmacists in direct patient care.
Our curriculum also needs to include courses that develop skills needed to expand the frontiers of pharmacy services. These skills include leadership, project management, and process improvement.
Finally, and as mentioned earlier, we must bring our entrepreneurial spirit to the advancement of clinical pharmacy practice.
How would you advise younger pharmacists who are aspiring to practise in the Diaspora?
The pharmacy profession in the United States is now very competitive, due to a saturated market. Obtaining the PharmD is now required to be considered for most jobs. There are opportunities to obtain the PharmD in Nigeria as well as in the US. There are universities in the United States that offer the PharmD degree programme to pharmacists who are still practising in their own countries. This is worth exploring.
It is important that what you do where you are right now counts. Whether you are a student or currently employed, it is important that you seek to improve the practice where you are. Some of these changes do not require a lot and do not have to be huge. Always ask yourself the question, “How can I do what I am currently doing, better?” “How can I improve my service to the patients or doctors or nurses or even my fellow pharmacist?”
Think efficiency, think effectiveness. Do not waste your time. This will come in very handy as you seek employment in the United States. Most employers want pharmacists who have such leadership skills.
Mentorship is very important. Finding the right mentor can be a powerful tool for professional growth. Consider people you already know or ask for referrals when choosing a mentor. Your mentor should be someone who has enough time to dedicate to developing a positive mentorship relationship. As a result, avoid choosing someone solely because of their popularity.
Finally, cultivate the habit of learning. Learning does not stop when you graduate. Pharmacy practice requires lifelong learning. You can do this by participating in planned or deliberate learning activities, such as degree programmes, professional continuing education etc. It can also be in non-pharmacy related education. You will be surprised how this may tie into clinical pharmacy practice and serves you well in as you apply to different opportunities.
