Future of Pharmacy is in specialisation – Sir Echezona

pharmacy

In this in-depth interview with Adebayo Folorunsho-Francis, Pharm. (Sir) Gilbert Umeadi Echezona, Fellow of the Pharmaceutical Society of Nigeria and former director of pharmaceutical services in Anambra State from 1997 to 2007, recalls several significant events in the growth of Pharmacy in Nigeria, as well as offering practical suggestions on advancing the profession and strengthening its umbrella association, the Pharmaceutical Society of Nigeria. Excerpts:

Tell us a little about your background

My early life was shaped by my maternal uncle who was a teacher with the Catholic Mission. I started my early education in 1954 in Sobe, a town about 12 miles from Auchi in present day Edo State (Mid-West Nigeria). For my secondary education, I attended the famous College of Immaculate Conception, Enugu, from 1962 to 1966.

My educational pursuit was disrupted by the civil war (1967-1970). During the war, like most young men at the time, I joined the militia and,later, the Biafra Organisation of Freedom Fighters(BOFF) from 1968-1970. At the end of the war, I was offered admission to the University of Nigeria, Nsukka (UNN), to read Pharmacy. I obtained bachelor’s degree in Pharmacy in 1975.

I started my pharmacy career as an intern pharmacist at the University of Nigeria Teaching Hospital, Enugu (1975-1976). I did my one year mandatory National Youth Service Corps programme in Yelwa Yauri, Sokoto State, from 1976 to 1977. In August 1977, I joined the Anambra State Civil Service as Pharmacist Grade 1. I also served Anambra State in various capacities, holding different positions and retired in 2007,after 30 years of meritorious service.

How would you describe your career in government?

Without exaggerating, my career in government was exciting and fulfilling. As a young pharmacist, I had a lot of exposure in the service, such as attending a store management course in Ghana for three weeks, and appointment as instructor and head of department at the College of Health Technology, Oji-River, an institution that trains middle-level manpower. I will tell you some other major posts I held in the course of our discussion.

Why did you decide to study Pharmacy?

At the end of my secondary education in 1966, I wanted to study Geology. However, my contact with a herbal ‘doctor’ in the course of military assignment during the civil war changed that. At UNN, where I attended, the introductory lectures in Pharmacognosy reassured me that I did not make a mistake. In the university, other students had high regard for pharmacy students.

Three months after graduation, as intern pharmacists, we were granted car loans for cars of our choice. The house officers received more money. We did not understand and were too excited to probe.

Did you eventually discover the reason?

Yes.The reason became clear when I finally took up a permanent appointment with the government. I discovered, to my utter disappointment, that pharmacists were discriminated against in the civil service. The conditions of service for pharmacists were very poor. Pharmacists were not included in policy-making committees in the hospital hierarchy. They were denied promotions and stagnated. Many of my contemporaries became disillusioned and left for the private sector. Those of us who were patient stayed and, by the grace of God, broke through the man-made bottlenecks and made it to the top.

Even in the private sector, it is the same story. Quacksand charlatans have taken over the profession. In spite of all these, I still believe I made the right choice. Today, a lot has changed. We now have pharmacists in top political positions as governors, ministers, legislators, ambassadors, commissioners, etc. I believe the future is still very bright for pharmacists and Pharmacy. I have nothing to regret.

 Tell us about your work experience

I worked first as a hospital pharmacist, then as an administrative pharmacist. As a Grade 1 pharmacist, I served under a senior pharmacist for three years before being postedto head a hospital pharmacy. In those days, one was not allowed to function unsupervised until one had had five years’ post qualification experience, the internship and NYSC periods inclusive.

What was the profession like in your day compared to today’s practice?

As at then, safe and good quality drugs were available in adequate quantities. The out-of-stock syndrome was non-existent. Patients received all the medicines in their prescriptions and at no cost to them.The drug distribution/supply chain was reliable and coordinated. Fake counterfeit medicines did not exist. There was paucity in the number of pharmacists employed to function in government hospitals, arising from discrimination in recruiting pharmacists. Consequently, non-pharmacists (pharmacy technicians and pharmacy assistants) were used to cover pharmaceutical duties in some hospitals.

Job satisfaction was equally lacking. Pharmacists in government served under poor work environment, poor remuneration package, not being included in decision-making committees in the hospital hierarchy, career stagnation, and limitation of professional privileges.

Tell us more about controversial issues that characterised your time

Discrimination against the profession was not limited to pharmacists in state service. It permeated the specialist and teaching hospitals and even the army. It was not until 1980 that the Federal Chief Pharmacist was upgraded to Director of Pharmaceutical Services, GL 16. My classmate who joined the Nigerian Air Force had to leave because he was started on GL 07.

During our time, pharmacists in government service were denied the right to private practice. We did not have the opportunity of coordinated continuing education programmes in Pharmacy,as is the case today.

Perhaps one can say some of the controversiesback then included poor working conditions for pharmacists in the public service; reluctance of most state governments, teaching and specialist hospitals to accept newly qualified pharmacists for internship training, leading to a great number of them roaming the streets for placement; and dominance of doctors as heads of hospitals at all levels.

Others included cheap substitution in hospitals for pharmacists using sub-professional health personnel; open drug markets and circulation of fake, counterfeit and substandard medicines; practising doctors keeping drug stores and dispensaries,in defiance of extant drug laws; and protest from the Nigerian Medical Association (NMA) against the appointment of a pharmacist as Minister of Health in 1993, the very first pharmacist to be so appointed.

There was also the proliferation of patent and proprietary medicine vendors in the cities and the complete lack of political will by government to curb the situation. Then came thepoisoned paracetamol syrup episode in which about 109 Nigerian children died. This dealt a devastating blow on the image of pharmacists.We had not fully recovered from the shock when the tragic death of Miss Cynthia Osokogu was reported,leading to the arrest of a young pharmacist, who is currently standing trial for murder.

In your opinion, what are the main challenges facing pharmacy practice in Nigeria and how can they be surmounted?

The pharmacy profession has a multitude of challenges to contend with. Many of the challenges have been there over the years. For instance, our laws in pharmacy practice are unwieldy and are not supportive of theprofession. There are manyoverlaps, leading to conflicts and faulty implementation. This problem can be overcome if the PSN is given the statutory function of formulation of policies and execution of laws governing the practice of Pharmacy.

Another challenge is absence of professional recognition. Pharmacists in government are engaged under poor conditions of service. The number employed is usually grossly inadequate,leading to cheap substitution with sub-professional health personnel to render pharmaceutical functions in hospitals. They are poorly remunerated and not promoted as and when due, leading to stagnation and frustration. Pharmacists in hospitals are not involved in decision making committees of the hospitals.

Pharmacy also has the issue of uncoordinated drug distribution and the menace of fake and counterfeit medicines. The flushing outof quacks and charlatans will help reduce the situation. Pharmacists should also be encouraged to move into rural areas. Government should develop the political will to implement the guidelines on drug distribution.

 Are there still some other burning issues?

Yes. There is the problem of fragmentation in the PSN. We should work hard to achieve internal consolidation in the PSN. There is a need for the PSN to be seen as one house, speaking with one voice. A situation where the position of a state branch on an issue conflicts with that of the national body on the same matter does not augur well for us.

Professional jealousy is yet another. The opposition that greeted both the appointment of a pharmacist as Minister of Health in 1993 and the creation of the Pharm. D. programmeare two clear cases. I have already talked about the professional jealousy, in respect of hospital pharmacists.

Another challenge is doctors’ strikes.Should the federal government be negotiating with the NMA, a non-labour body?This is one of the many occasions the government treats doctors as sacred cows. It is rather embarrassing.

 What solution would you proffer to these problems?

To tackle these challenges, the PSN must be seen as one house. Individual Pharmacists must be disciplined, and must develop both professional and political clout. We should avoid fighting back as response to provocation and conflicts, but rather adopt the more effective approach of dialogue and due process. We should understand and respect one another. Above all, more pharmacists should be encouraged to occupy positions of strength.

How would you rate Nigerian pharmacists?

We are not doing badly. You will recall that a pharmacist was appointed Minister of Health in 1993. Same year, Prof. O.K. Udeala was appointed Vice Chancellor,University of Nigeria, Nsukka.The late Prof. Dora Akunyili was D.G. of NAFDAC and later Minister of Information.

Pharmacists are today governors and deputy governors in their states. We also have pharmacists as ambassadors, commissioners, captains of industries and permanent secretaries. I recall that, in 1996, a Nigerian pharmacist represented the third world countries on the executive board of FIPfor community pharmacists. We are doing well. We still pray that more pharmacists occupy these positions of strength.

How best do you think the issue of fake drugs and counterfeit medicines can be curbed?

Many years back, we had a beautiful and reliable supply/distribution system for drugs. This system was destroyed in 1980 when government started issuing import licences to businessmen who are not pharmacists. This led to the involvement of quacks and charlatans in drug distribution, the development of open markets and the circulation of fake drugs.

To curb the circulation of fake and counterfeit drugs, we must evolve a new drug supply/distribution chain that will eliminate the involvement of quacks and charlatans in drug distribution and supply. The open drug markets must be dismantled. The federal government’s”guidelineson drug distribution” is the answer. Government should develop the political will to implement the guidelines.

I expected that, by now, various state governments should have set up StateDrug Distribution Centres (SDDC), as demanded by the guidelines. I also expect the PSN to take the lead in the implementation of the guidelines,as this is the only sure way pharmacists can reclaim the drug business in Nigeria.

The Anambra State PSN has registered a Mega Drug Distribution Centre (MDDC) in Onitsha. The centre is yet to take off because government lacks the political will to enforce compliance.

 What were your key involvements in pharmaceutical activities?

I was appointed State Director of Pharmaceutical Services(DPS) in1997 before I retired in 2007. This implies that, for close to a decade, I was monitoring pharmacists and the practice of Pharmacy. I was chairman of the Pharmaceutical Inspection Committee (PIC), member of National and State Executive Councils of PSN.

As DPS, I was also a member of the governing council of the Pharmacists Council of Nigeria (PCN) for two tenures, and served as a member of the Appointment, Promotion and Disciplinary Committee of the council. I served in the Enugu/Anambra Joint Task Force on Fake and Counterfeit Drugs,and was later appointed chairman of the Task Force in Anambra State. I regularly attended PSN meetings and conferences, both at national and state levels.

 Were there some major awards given to you in recognition of your selfless service?

Aside from my being made a Knight of the Roman Catholic Church in 1999, I was made a Fellow of the Pharmaceutical Society of Nigeria ten years later (2009). In appreciation of my valuable service as a member (1999-2002), the PCNhonoured me with a PCN Certificate. Same recognition was accorded me during the 2003-2006 and August 2006-November 2007 regime,in acknowledgement of my contribution to the PCN. I was also aPSN Anambra State Merit Award Winner in 1998.

I equally have in my possession a PANS Certificate of Honour (UNN 1974-75), in appreciation of my excellent service as a member and secretary of the Pharmaceutical Association of Nigerian Students.

How do you see the annual PSN national conferences?

In the past, the national conference of the PSN was like a ritual. Every year we gathered and discussed matters affecting the profession. In some of the topics, we would fail to reach agreements,and where resolutions were reached, most of them were either partiallyimplemented or not implemented at all. The following year, the same topics would be presented again, and so on.

Today,a lot has changed. Most decisions are followed up. However, one feature of the AGM that has not changed is its rowdy nature, which is a reflection of the fragmentation within the PSN. It is also believed that the South has, for a long time, dominated the leadership of the Society. Efforts should be made at unification of interests, so that we can have a unified Pharmaceutical Society of Nigeria.

Is there an ideal age for a pharmacist to retire?

An active pharmacist should retire at 75 years. He needs some time to rest and reflect on his spiritual life.

 As an elder in the pharmacy profession, what is your advice to young pharmacists?

My advice is simple: Be disciplined, honest; work hard and remain focused. They should adapt to professional advances in clinical pharmacy and pharmaceutical care. I believe that the future of pharmacy lies in specialisation. We should therefore de-emphasise drug trading and emphasise drug consultancy.

Young pharmacists should make themselves relevant to the socio-economic welfare of any community in which they live. As I mentioned earlier, the future of Pharmacy and pharmacists is bright, but we must be committed to the course of Pharmacy.