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Ebola Update: British experts urge US to offer experimental Vaccine to Africans …as prevention campaign heightens in Nigeria

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image Ebola

As the Lagos State Government commenced an intensive search for 27 secondary contacts, who might have had contacts with doctors, nurses and health workers, who attended to the late Liberian-American Patrick Sawyer, at a Lagos private hospital, Britain has also engaged US and WHO in a plea to make the trial vaccine available to West African countries.

Three of Britain’s leading Ebola specialists have said experimental treatments for the deadly Ebola virus must be offered to the people of West Africa, after two US aid workers were administered with the “cure” in Liberia.

The two missionaries, Dr Kent Brantly and Nancy Writebol, are alive and now being cared for at a specialist isolation unit in Atlanta.

Lagos State Commissioner for Health, Dr. Jide Idris, who spoke at a press briefing in Lagos on Wednesday, said the government was also planning a life insurance cover for doctors and other health professionals, who volunteered to work with experts monitoring and testing suspected cases of the Ebola Virus Disease.
Though the pair remain weak – and there is no way of knowing at this stage how much of a help the new drug has actually been – the fact that it was given to the two Americans has resulted in widespread criticism and recriminations in West Africa.

Now Peter Piot, who discovered Ebola in 1976, David Heymann, the director of the Chatham House Centre on Global Health Security and Jeremy Farrar from the Wellcome Trust have said there are in fact several drugs and vaccines under study that could be used to combat the disease.

“African governments should be allowed to make informed decisions about whether or not to use these products – for example to protect and treat health care workers who run especially high risks of infection,” they wrote in a joint statement.

While the negotiation is still on, a professor of Epidemiology and Community Health Sci­ence, University of Ilorin, Kwara State, Tanimola Akande, has described the Ebola virus, which is ravaging Guinea, Sierra Leone and Liberia and has killed a nurse in Nigeria, as the biggest health challenge facing the sub region at present.

Akande says that its mode of transmission is a major reason why it is deadlier than most viruses.

He says, “That Ebola has no cure is not the reason why it is deadly.HIV also has no cure, yet it does not kill all its victims, if it is properly managed. Ebola is deadlier because it is easy to contract; it is in all the body fluids of an infected individual as its infection can be through saliva, blood, sweat, sperm, excreta, body tissue. It can also be contracted by touching the surface an infected person has touched.”

“Also, the natural host for Ebola is fruit bats, chimpanzees and other forest animals that many eat daily in different parts of the country. You can get it just by coming in contact with the blood of an infected animal. Any virus that can be contracted through food has the potential to wipe off many lives.”

The physician, who says that Ebola virus, has very tricky symptoms, which often mimic that of common illness, such as malaria, dengue, lassa and typhoid fever, notes that many health workers may have already come in contact with an infected patient without knowing it.

He adds, “When a patient comes to your hospital and presents you with symptoms, such as fever, headache, general body pain, you are likely not to wear gloves or biohazards suits before treating the patient. That is the tricky part. You are infected before you know it is Ebola.”

To contain the transmission of the disease, Akande urges Nigerians to stop eating bush meat, as well as to wash their hands and fruits regularly before eating.

 

UI Pharmacy faculty inducts 40 graduands

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 No fewer than 40 Pharmacy students were recently inducted into the Pharmacists Council of Nigeria (PCN) by the Faculty of Pharmacy, University of Ibadan, at a ceremony held at the school’s lecture theatre.

The glamorous occasion, which took place on 3 July, 2014, had several students, parents, pharmacists, pharmacy professors and members of the PCN in attendance.

Welcoming the audience to the institution’s 27th induction ceremony, the Vice Chancellor, Prof. Isaac Adewole, who was represented by the Deputy Vice Chancellor (Administration) Prof. Emilolorun Ayelari, stressed that the past 30 years had seen the Pharmacy faculty develop into an enviable academy, due to its significant contribution to meeting the manpower needs of the nation’s pharmaceutical sector.

Prof. Adewole noted that the commitment of the faculty to excellence contributed toits recent establishment of the Centre for Drug Discovery, Development and Production (CDDDP) through the MacArthur Grant for Excellence.

On her part, Prof. Chinedum Peace Babalola, the first female dean of the faculty,congratulated the graduands and theirwell-wishers present at the ceremony.

She declared that the faculty had produced great professionals and currently houses great minds who have won laurels, grants and recognitions, locally and internationally.

While observing that the faculty was the only one teaching herbal medicine in Nigeria, Babalola urged other Pharmacy faculties to embrace the initiative.

Also applauding the graduands, PCN registrar, Pharm. Elijah Mohammed, charged them to discharge their duties professionally, as well as provide innovative services that would distinguish them.

Muhammed however lamented that it was quite unfortunate that brain drain had led to shortage of pharmacists in the nation’s pharmaceutical sector. He reassured the graduands that his administration would reposition Pharmacy registry for effective service delivery and institutionalisation of good pharmacy practice in Nigeria.

The highpoint of the event was the award of the much coveted PCN prize for the best graduating student, which was won by Abiola Adenike.

 

Facts about the Nigeria Academy of Pharmacy

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(By Prince Julius Adelusi-Adeluyi)

There is nothing as successful as an idea whose time has come. Over the last one score and ten years, leaders of the pharmacy profession in Nigeria have brainstormed on strategies to achieve a turn-around towards making the profession a more fulfilling and meaningful enterprise, not only for pharmacists but also the communities in which they serve. The conclusion has become obvious. Only pharmacists can save Pharmacy, especially in a situation where Pharmacy, like every other profession is severely challenged.

We are in a knowledge-driven economy. In order for Pharmacy to participate meaningfully in the current national economic arrangement, there is an urgent need to provide a platform for creating a new paradigm to elevate the relevance of the practice of the profession at all levels, particularly in the areas of improved patient care and international best practice. That platform is the Nigeria Academy of Pharmacy.  This idea was also encouraged by the existence and role of similar academies in the developing and developed world.

The Academy brings together successful senior pharmacy professionals who have distinguished themselves in the corporate world, academia and public service. Every effort has been made by the organisers to ensure that the foundation Fellows of the Academy are drawn from the widest possible spread professionally, occupationally and geographically. The product may not be perfect, but it is a qualitative beginning, by any standard. It can only get better.

Pharmacy practice in Nigeria is fortunate to have an abundance of bright minds whose education and experience can be jointly and severally shared, while they are still physically with us. The Academy will, inter alia, provide expert opinion and thought leadership in the education and practice of Pharmacy. It will provide a platform to influence national and state policies which will enable the fulfilment of the vision, mission, rights and obligations of Pharmacy.

The Academy will network with similar academies within and outside Nigeria. It will also partner with relevant regulatory bodies and associations to ensure high ethical standards in the practice of the profession and in the war against fake, adulterated and substandard products in the health sector.

The Academy will equally champion the cause of interdisciplinarity, by working steadfastly to promote harmony and team spirit among all members of the health team and other relevant professions, so that every patient enjoys wholesome and beneficial health care. It will champion the cause of transformational change and innovation by encouraging industry, Research and Development and seizing the several technology advancement opportunities open to Pharmacare.

The Academy will, most importantly, concentrate on mentoring the younger generation to confidently build on the foundation being laid today and to facilitate sustainability in the areas of capacity and character building, self-confidence, solid professional reputation and efficient delivery of pharmaceutical service.

It is a new day for Pharmacy, a new day for the health sector and, indeed, a new day for our nation, Nigeria. So help us God!

 

Address delivered by Prince Julius A. Adelusi-Adeluyi, OFR, mni, president,Nigeria Academy of Pharmacy (NAPharm.), at the inauguration ceremony of NAPharm. on Thursday, 26 June, 2014, at the Sheraton Hotels & Towers, Ikeja, Lagos.

 

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Japan’s $85 million polio eradication loan to Nigeria

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Recently, the Federal Government of Nigeria and the Federal Republic of Japan signed a Memorandum of Understanding (MoU) for a loan facility to the tune of 85 million US dollars. The loan given to Nigeria by Japan is to help eradicate polio in the country.

According to Prof. Onyebuchi Chukwu, minister of health, the loan is part of international support to the national polio eradication programme to ensure vaccine availability for the polio campaign from June 2014. He added that the loan would serve as a guarantee for the procurement of the vaccines for polio campaign by UNICEF.

Prof. Chukwu, who was speaking during the signing ceremony of the loan in Abuja, said the objective of the polio eradication project was to optimise the immunisation of children under five years against polio and thereby contribute to the eradication of polio in the whole country. He added that Nigeria had recorded significant achievements in 2013 in the eradication of poliomyelitis with, at least, 58 per cent reduction in the number of wild polio virus (WPV) cases compared to 2012, adding that the federal government was committed to interrupting polio transmission in Nigeria in 2014.

Ordinarily, any effort aimed at eradicating poliomyelitis, a viral disease caused by the wild polio virus (WPV), in Nigeria should not only be commended but fully supported. This is not just because of the untold havoc the disease has wreaked and is still wreaking on the lives of children but because recent statistics on the disease shows that Nigeria still holds the unenviable record of having 94 per cent of the world’s polio cases – with virtually all the cases concentrated in the northern part of the country. Pakistan and Afghanistan jointly account for the remaining six per cent of polio cases in the world.

Nigeria is also reported to be the only country with on-going transmission of all three serotypes: wild poliovirus type 1, wild polio virus type 3, and circulating vaccine-derived polio virus type 2.

Still, it is debatable whether taking a loan of 85 million dollars from Japan is the way to go in our quest to finally exit the ignoble league of polio endemic nations. While we acknowledge that taking loans is a very practical way of raising funds for vital projects, the Nigerian government must tread carefully in taking foreign loans to avoid plunging the nation into unnecessary indebtedness that will become a problem for coming generations.

It would be recalled that the Nigerian government, in 2006, had to pay almost 20 billion US dollars to two international syndicates – the Paris and London Club of creditors – to settle foreign debts in order to get about 18 billion US dollars debt relief from our creditors. Until that was done, Nigeria was groaning under a huge debt burden. The country must avoid falling back into the same quagmire.

It must also be emphasised that with the mammoth support the nation has repeatedly received from Rotary International and other partners like WHO and UNICEF over the years for polio eradication campaigns, factors other than inadequate funding are evidently more culpable for our inability to kick out polio from Nigeria.

It is our view that aside strengthening the polio immunisation programme through provision of adequate vaccines, other challenges, such as insecurity of health workers in the affected states during immunisation exercise, ignorance of some citizens on the benefits and safety of the polio vaccines and lack of support for the immunisation exercise by some traditional, spiritual and community leaders in the affected northern states should be surmounted to succeed in our polio eradication efforts.

It is equally important to focus more energy on containing the polio virus in the few areas of the country still affected and ensure it doesn’t spread to other areas. The experience of India in 2012 when it decisively won the battle against the disease has made it clear that success is achievable.

What is required is a strong political will, not only to ensure adequate funding but also judicious and conscientious spending, so as not to continue to pour scarce resources down the drain. Consistent and coordinated mass enlightenment campaigns for locals, proper and strategic surveillance exercises, enlistment of the support of opinion leaders, as well guaranteeing the safety of immunisation staff, are other significant factors that will facilitate and expedite our polio eradication goal.

Ridding Nigeria of polio is not so much about perpetual borrowing and spending as about genuine commitment to pragmatic actions.

 

Fundamentals of clinical leadership

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 (By Dr (Mrs) B.A. Aina)

             Clinical leadership refers to both a set of tasks to lead to improvements in the safety and quality of health care, and the attributes required to successfully carry them out (Victorian Quality Council, 2005).

According to the Centre for Innovation in Health Management (CIHM), University of Leeds, UK, clinical leadership is important because healthcare organisations are professional organisations where frontline clinical staff possesses a high degree of control over their work.

Professionals in health facilities e.g. ward sister, clinical pharmacists and medical laboratory technologists providing clinical services to patients, may have roles including a clinical leadership element; hence, according to clinical leadership in nursing, the essence of clinical leadership can be summed up in the vision provided by Florence Nightingale when she said “let whoever is in charge keep this simple question in her head…how can I provide for the right thing to be always done?”

 Clinical leaders

The best clinical leaders strive to do the right thing; they ensure their staff and support services always do the right thing for patients. They go the extra mile to find better ways of getting the work done.

Clinical leaders are exceptional individuals with caring values, intelligence, physical and emotional resilience and dexterity. Their leadership results in excellent patient experience and outcomes.

When clinical leadership falls short, the result is low staff morale, leading to higher rates of incidents and a poor patient experience.

 Analysis of a study by HPERU of the BMA 2012

According to the Health Policy & Economic Research Unit (HPERU), vision is important to clinical leadership. The ability to offer a vision to the widest audience within the health service was considered a quality that sets clinical leadership apart from management.

Thus, clinical leadership is defined to comprise skill-based leadership by example, innovative clinically-engaged demonstrated expertise and the provision of vision to colleagues.

Attributes and skills required for clinical leadership include communication skills, political skills and clinical credibility.

Separating leadership from management

Leadership is like the abominable snowman whose footprints are everywhere but who is nowhere to be seen (Benniset al., 1985). This quote neatly encapsulates one of the characteristics of leadership.

Leadership is different from management. Leadership is about setting a new direction or vision for a group, influencing others and managing change; while management is concerned with the marshalling and organisation of resources and maintaining stability or directing and controlling according to established principles.

This classification tends to make management seem boring and unsatisfying and hence the question ‘who would want to manage when they can lead’?

Leadership Series 2

 Leadership requires more of personal power

Clinical leadership has a strong focus on the patient and clinical specialty. According to the CIHM, it is largely based on a combination of ‘personal power’ (credibility, respect, trust, persuasion etc.) and ‘expert power’ (knowledge of clinical condition).

Managerial leadership, on the other hand, tends to take corporate or organisational view point and is largely based upon ‘positional power’ (CIHM).

Leadership and management are complementary

Current theorists see leading and managing as distinct but complementary activities. Both are important for success and the separation of the two functions – management without leadership and leadership without management – is seen as harmful.

 Leadership theories

In the first half of the twentieth century, leadership theory revolved around personal qualities that you either had – usually in conjunction with a Y chromosome – or didn’t have. From the 1950s onwards, however, attention shifted from the personal characteristics of leaders to their behaviours or styles. This relates to how leaders make decision and their primary focus of concern. A new paradigm emerged later which is that of transformational leadership

Decision-making style models include styles which range from autocratic to abdicatory (Tannenbaum and Schmidt). The focus of a leader’s attention should be distributed flexibly between the task, the team and the individual.

In transformational leadership, the leaders release human potential through the empowerment and development of followers. Vision and values are clearly stated and the organisation and the work of individuals within it are aligned to the achievement of longer-term goals. Transformational leadership has proved an enduring model, and therefore incorporated into many public sector frameworks such as the UK’s NHS leadership framework.

Leadership framework

Leadership framework provides a consistent approach to leadership development for all staff in health care, irrespective of discipline, role, function or seniority and represents the standard for leadership behaviours that all staff should aspire to.

Fundamental to the development of the leadership framework is a desire to create a single overarching framework for all health care staff, building on best practice standards for leadership development such, as existing leadership frameworks used by different staff groups.

The leadership framework was developed by the National Leadership Council (NLC), UK, after extensive research and consultation with a wide cross-section of staff, patients, professional bodies and academics.

The leadership framework has five core domains and two additional domains

The five core domains are:

  • Demonstrating personal qualities
  • Working with others
  • Managing services
  • Improving services and
  • Setting direction

     The two additional domains comprise:

  • Creating the vision
  • Delivering the strategy,

Not everyone is necessarily a leader but everyone can contribute to the leadership process by using the behaviours described in the five core domains of the leadership framework. The final two domains recognise that a relatively small group of people do hold designated senior positional roles, and are required to act as leaders in formal hierarchical positions.

Leadership series Diagram

These two domains therefore focus more on the contribution of individual leaders rather than the general leadership process. They apply particularly but not exclusively to individuals in senior positional leadership roles.

 The leadership context

The strategy and opportunity to demonstrate leadership will differ, and the context in which competence can be achieved will become more complex and demanding with career progression. The leadership context

Four stages are used to describe this and to help staff understand their progression and development as leaders.

4 Stages of the Leadership context

Stage 1: Own practice/immediate team

Here, leadership is about building personal relationships with patients and colleagues, often working as part of a multi disciplinary team. Staff will need to recognise problems and work with others to solve them. The impact of the decisions staff take at this level will be limited in terms of risk.

Stage 2: Whole service/across teams

This is about building relationships within and across teams, recognising problems and solving them. At this level, staff will need to be more conscious of the risks that their decisions may pose for self and others for a successful outcome.

 Stage 3: Across services/wider organisation

The leader will be working across teams and departments within the wider organisation. He or she will challenge the appropriateness of solutions to complex problems. The potential risk associated with their decisions will have a wider impact on the service.

Stage 4: Whole organisation/health care system

Leadership here is about building broader partnerships across and outside traditional organisational boundaries that are sustainable and replicable. At this level, leaders will be dealing with multi faceted problems and coming up with innovative solutions to such They may lead at national/international level and will be required to participate in whole systems thinking, finding new ways of working and leading transformational change.

Their decisions may have significant impact on the reputation of the organisation/system and outcomes and would be critical to the future.

 More on leadership framework

As earlier noted, the leadership framework comprises seven domains. Within each domain are four categories called elements and each of these elements is further divided into four descriptors. Descriptors describe the leadership behaviours, knowledge, skills or attitudes expected for each element. Also for each element there are contextual indicators.

An exhaustive review of the Leadership framework can be seen at http://www.leadershipacademy.nhs.uk/wp-content/uploads/2012/11/NHSLeadership-Leadership-Framework-LF-Quick-Reference-Guide-Summary-of-Domains-Elements-and-Descriptors.pdf

Below are the elements of each domain:

 

First core domain: Demonstrating personal qualities

Effective leadership requires individuals to draw upon their values, strengths and abilities to deliver high standards of service. This requires them to demonstrate effectiveness in:

  1. Developing self-awareness
  2. Managing themselves
  3. Continuing personal development
  4. Acting with integrity

 Second core domain: Working with others

Effective leadership requires individuals to work with others in teams and networks to deliver and improve services. This requires them to demonstrate effectiveness in:

  1. Developing networks
  2. Building and maintaining relationships
  3. Encouraging contribution, and
  4. Working within teams

 Third core domain: Managing services

Effective leadership requires individuals to focus on the success of the organisation(s) in which they work. This requires them to be effective in:

  1. Planning
  2. Managing resources
  3. Managing people
  4. Managing performance

 Fourth core domain: Improving services

Effective leadership requires individuals to make a real difference to people’s health by delivering high quality services and by developing improvements to services.This requires them to demonstrate effectiveness in:

  1. Ensuring patient safety
  2. Critical evaluation
  3. Encouraging improvement and innovation
  4. Facilitating transformation

 Fifth core domain: Setting direction

Effective leadership requires individuals to contribute to the strategy and aspirations of the organisation and act in a manner consistent with its values. This requires them to demonstrate effectiveness in:

  1. Identifying the contexts for change
  2. Applying knowledge and evidence
  3. Making decisions
  4. Evaluating impact

 Sixth domain: Creating the vision

Those in senior positional leadership roles create a compelling vision for the future, and communicate this vision within and across organisations. This requires them to demonstrate effectiveness in:

  1. Developing the vision for the organisation
  2. Influencing the vision of the wider healthcare system
  3. Communicating the vision
  4. Embodying the vision

 Seventh domain: Delivering the strategy

Those in senior positional leadership roles deliver the strategic vision by developing and agreeing on strategic plans and ensuring that these are translated into achievable operational plans. This requires them to demonstrate effectiveness in:

  1. Framing the strategy
  2. Developing the strategy
  3. Implementing the strategy
  4. Embedding the strategy

 The Leadership framework finds application in so many different settings, which include:

*    As a tool to raise awareness that effective leadership is needed across the whole organisation.

*    To underpin a talent management strategy.

*    As part of an existing leadership development programme.

*    To inform the design and commissioning of training and development programmes.

*    To develop individual leadership skills.

*    As part of team development.

*    To enhance existing appraisal systems.

*    To decide an organisation’s recruitment and retention processes.

Generic behaviours

There are behaviours observed when an individual is not yet demonstrating any of the listed domains.

First domain – demonstrating personal qualities

*    Does not understand own emotions or recognise the impact of own behaviour on others.

*    Approaches tasks in a disorganised way and plans are not realistic.

*    Unable to discuss own strengths and development needs and spends little time on development.

*    Demonstrates behaviours that are counter to core values of openness, inclusiveness, honesty and equality.

*    Lacks confidence in own abilities to deliver results.

 Second domain – working with others

*    Fails to network with others and/or allows relationships to deteriorate.

*    Fails to win the support and respect of others.

*    Does not encourage others to contribute ideas.

*    Does not adopt a collaborative approach.

Third domain – managing services

*    Disorganised or unstructured approach to planning.

*    Wastes resources or fails to monitor them effectively.

*    Does not effectively manage and develop people.

*    Fails to identify and address performance issues.

 Fourth domain – improving services

*    Overlooks the need to put patients at the forefront of their thinking

*Does not question/evaluate current processes and practices

*    Maintains the status quo and sticks with traditional outdated ways of doing things

*    Fails to implement change or implements change for change’s sake

Fifth domain – setting direction

*    Unaware of political, social, technical, economic, organisational factors that impact on the future of the service /organisation.

*    Does not use an evidence-base for decision-making.

*    Makes poor decisions about the future.

*    Fails to evaluate the impact of previous decisions and actions.

Sixth domain – creating the vision

*    Does not involve others in creating and defining the vision.

*    Does not align their vision with the wider health and care agenda.

*Misses opportunities to communicate and share understanding of the vision with others.

*    Lacks enthusiasm and commitment for driving the vision.

 Seventh domain – delivering the strategy

*    Does not align the strategy with local, national and/or wider health care system requirements.

*    Works to develop the strategy in isolation without input or feedback from others.

*    Absolves oneself of responsibility for holding others to account.

*    Fails to enable an organisational culture that embraces the strategy.

The leadership framework sets out the standard for leadership to which all staff in health care should aspire. The needs of the people who use services have always been central to healthcare. Delivering services to patients, service users, carers and the public is therefore at the heart of the leadership framework. All staff have to work hard to improve services for people and every staff in health is a potential leader.

The question is “which stage of leadership context are you and which stage of leadership context are you aiming at?”

 

By Dr (Mrs) B.A. Aina lectures at the Department of Clinical Pharmacy and Biopharmacy Faculty of Pharmacy, University of Lagos.

 

 

 

Treating ear, nose and throat infections

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ENT is a medical abbreviation for ears, nose and throat. A doctor who specialises in treating disorders affecting these organs is called an “ENT,” or, less commonly, an otolaryngologist.

ENT-related conditions constitute a major burden of infections in Nigeria. The bulk of the available studies on these conditions are derived from hospital-based studies that underestimate the extent of the problem. Few studies have explored the perceptions of community residents on the causes and treatment of these conditions. Below are some examples of ENT disorders:

  • Tonsillitis

When the tonsils become inflamed for long periods of time, they may have to be surgically removed. This procedure is called a “tonsillectomy.” Though tonsillitis used to be treated with tonsillectomy frequently, it is no longer the practice and is now only done in specific instances. When inflammation is severe enough, it can interfere with swallowing and breathing. Tonsil removal is indicated in cases of extreme obstruction of the airways or swallowing. Often tonsils are enlarged, swollen and painful during tonsillitis. Less absolute indications for tonsillectomy include: recurrent acute throat infections, chronic tonsillitis that does not improve with antibiotics, obstruction leading to bad breath or changes in voice. There are many causes of tonsillitis.

  • Ear infection

Ear infections are one of the most prevalent ENT disorders. They occur when germs become trapped inside the inner ear. The Eustachian tube, a tiny tube that originates in the ear and drains in to the back of the throat, usually keeps unwanted germs out. If this tube is too small or becomes clogged by fluid and mucus, bacteria or other microbes may be able to enter the ear and cause an infection. Signs and symptoms of an ear infection include:

*    recent history of an upper                   respiratory infection

*    pain and pressure

*    fever

* loss of balance

*    difficulty hearing

*    nausea and vomiting

*    fluid discharge from the ear (this indicates perforation of the tympanic membrane)

 

Ear infections are more common in children. If your child has an ear infection, it may be difficult to detect. Here are some things you may notice about your child:

*    pulling or tugging on the ears

*    increased fussiness, especially at bedtime

*    fails to startle at loud noises or does not consistently respond to name

*    eating or drinking abnormally

  Strep Throat

Strep is an abbreviation for a family of bacteria called “streptococci.” Strep throat occurs when the throat and surrounding structures become infected with this germ. While strep throat is a common infection, many other infections have the same symptoms. You must have an actual strep test at your doctor’s office to be certain that your symptoms are associated with a streptococcal infection versus a different bacterial or viral infection. Symptoms are usually abrupt in onset, including:

*    red, sore throat

*    difficulty swallowing

*    enlarged tonsils

*    enlarged lymph nodes

*    white patches on the tonsils or in                    the back of the throat

*    fever

*    body aches

*    fatigue

*    skin rash (rare)

Notably absent in strep throat are a runny nose and cough. You may also suspect strep throat if you have been exposed to someone with a strep infection in the last two weeks. Children between the ages of 5 and 15 are most at risk. You are also more likely to get a strep infection during the winter months.

Sinusitis

Sinusitis occurs when a germ finds its way in to the hollow recesses of the skull that surround your eyes and nose. The infection can then become trapped there, causing inflammation, pressure and pain. Acute sinusitis is often secondary to a common cold, so you are more likely to get sinusitis during the winter months. Chronic sinusitis is sometimes an inflammatory disorder caused by untreated allergies or conditions, such as bronchial asthma. Sinusitis can last from weeks to years, if left untreated. Symptoms of sinusitis are:

*    headache

*    cough

*    nasal discharge of various colours and consistency

*    congestion

*    toothache

*    fever

*    fatigue

Sleep apnoea

Apnoea is a medical term meaning to stop breathing. Sleep apnoea is a disorder causing one to stop breathing for brief periods of time while sleeping. Sleep apnoea is a common disorder and can cause severe health problems, if left untreated. If you suspect that you have sleep apnoea, see a doctor. Symptoms include:

*    waking up frequently in the                middle of the night

*    feeling unrefreshed upon                                awakening

*    daytime drowsiness

*    mood swings

*    depression

*    waking up with a dry, sore throat

*    morning headaches

In addition to these symptoms, many individuals with sleep apnoea have often been told by a spouse or other family member that they snore, gasp or choke while sleeping. Family members may have observed an episode in which you stopped breathing while asleep. You are more likely to have sleep apnoea if you are overweight, have enlarged tonsils, take sedatives at bedtime or have inherited a shorter airway than the general population. People who are obese and have uncontrolled hypertension are more likely to have obstructive sleep apnoea.

The majority of people will experience one or more of these disorders in their lifetime. While visiting with your physician, discussion of your symptoms may help your doctor to come up with a diagnosis of an ENT disorder.

Diagnosis of ENT disorders

Many tests are used to diagnose ENT disorders. Regardless of your particular ailment, there is specific information you should always have ready for your physician to help him diagnose your problem. Here are some of the questions your doctor may ask:

*    What are your symptoms and                         when did they start?

*    Have you been taking any medications (over-the-counter, including vitamin and herbal supplements or prescription)? If so, your doctor will want to know the dosage.

*    Are you allergic to any medications? If so, what are they and what kind of reaction did you have?

*    Do you have a previous history of ENT disorders?

*    Do you have a family history of ENT disorders?

*    Do you have any other medical conditions?

*    Have you been running a fever?

Here are additional questions if the patient is a small child:

*    Has the child had nausea and vomiting? If so, has the child continued to have wet diapers?

*    Has the child been abnormally fussy or lethargic?

*    Has the child had balance problems?

*    Has the child’s eating and drinking habits changed?

*    Has the child shown signs of decreased hearing, such as not responding to their name immediately or not startling at loud noises?

 Diagnosis of ear infections

If you have signs and symptoms of an ear infection, your doctor will use an otoscope to visualise the outer ear and eardrum. If an infection is present, the ear may appear red and swollen. There may also be a fluid discharge. Unlike other infections, the exact bacterium that is responsible cannot always be determined. As such, doctors choose antibiotics that will cover the most likely organisms when they suspect a bacterial source. This is because it can be difficult to obtain a sample from the ear for a culture. Antibiotics will not cure a viral infection, and it can take as long as three weeks for your body to fight off the virus.

Diagnosis of swimmer’s ear

With swimmer’s ear, the outer ear and ear canal may be red. Upon examination, the doctor may notice pus in the ear canal, and the skin may be scaly or shedding. The doctor may be able to obtain a fluid sample for culture.

Diagnosis of sinus infections

If a sinus infection is suspected, an endoscope may be used to go up the nose and visualise the opening in to the sinus cavity and take a direct sinus culture. Nasal swabs are not useful due to false positive results that do not reflect the sinus pathogen. By endoscope, the doctor will be looking for inflammation and/or discharge. Four view x-rays or a CT scan may be indicated, if other tests are inconclusive.

Diagnosis of strep throat

Strep throat causes enlarged reddened tonsils that sometimes have white patches on them; however, many viral infections can cause this as well. If strep throat is suspected, a throat culture will be taken and sent to the lab. This test is quick and easy to perform with only mild discomfort as it may cause a gagging sensation. A cotton swab is brushed against the back of the throat then sent to the lab to test for streptococcal bacteria, the cause of strep throat. The standard test can take one to two days; however, a rapid strep test can also be performed, which only takes a few minutes.

If the rapid strep test is positive, antibiotics will be started. If the rapid strep test is negative, you will be sent home and the standard culture will still be performed. About 20 per cent of negative rapid strep tests will become positive after a day or two in the laboratory. Sometimes your doctor may make the diagnosis based on classic symptoms and signs to treat you presumptively even without a swab.

 

Diagnosis of sleep apnoea

Sleep apnea is a disorder causing one to stop breathing for brief periods of time while sleeping. In your first visit, the doctor will begin by obtaining a comprehensive medical history. Before ordering a sleep study, he or she will likely ask some of these questions:

*    Have you ever been told that you snore?

*    Have you ever been told that you have stopped breathing while asleep?

*    Do you awake refreshed in the morning or do you suffer from daytime drowsiness?

*    Do you suffer from mood swings or depression?

*    Do you wake up frequently in the middle of the night?

The doctor will look inside your mouth for evidence of enlarged tonsils, uvula(a bell-like piece of tissue that hangs down from the roof of the mouth toward the back of the throat) or other structures that may be blocking the airway. The uvula contains some glands and affects vocal resonance. If the doctor suspects sleep apnoea, they may order a sleep study. Sleep studies are usually conducted at a sleep centre. After you fall asleep, a monitor, which measures the oxygen concentration in your blood, will be placed on your finger. Normal oxygen saturation during sleep in otherwise healthy men and women is 95 per cent to 100 per cent. If you stop breathing while asleep, this number will drop.

Another sleep study used to diagnose sleep apnoea is called a “polysomnogram.” It measures not only the amount of oxygen in your blood, but brain activity, eye movement and muscle activity, as well as your breathing and heart rate.

Based on your present symptoms, your doctor may choose to use a combination of these tests to diagnose your specific disorder. He will then use this information to create an effective treatment plan.

 

ENT treatment

ENT treatment can be handled by either a general practitioner or an otolaryngologist (ENT). Though general practitioners treat a number of ENT disorders, your family doctor may not feel comfortable treating you and may refer you to an ENT specialist. Seeking out a specialist on your own may also be helpful, if you are unhappy with the care you have received, need a second opinion or want more information than your general practitioner can provide.

How can I find an ENT specialist?

If you have been referred to an ENT specialist by your family doctor, he or she probably already has a specific doctor in mind. If not, you can use the directory from the American Academy of Otolaryngology to find a list of ENT specialists in your area.

What ENT treatments are available?

The best ENT treatment will vary according to what type of problems or symptoms you are having. In the early stages of a disorder, surgical procedures may not be warranted, as in tonsillitis, for example. Early treatments will also depend on whether or not the disorder is related to an infection. If an infection is suspected, tests may be performed to determine whether the cause is bacterial or viral. Viral infections will not respond to antibiotics.

If surgical procedures are indicated, the doctor or nurse will give you instructions to follow before the surgery, including when you need to stop eating solid foods, when to stop drinking clear liquids and whether or not you will need to start or stop any medications before the surgery.

Are there other specialists I need to see for my ENT treatment?

In some cases, an ENT specialist may diagnose your problem, but ultimately send you to another specialist for treatment. For example, many ENT doctors will diagnose cancer of the head and neck. They may surgically remove tumours and then send you to an oncologist for radiation or chemotherapy. Likewise, some children with chronic ear infections may have delayed speech development. In these cases, the ENT specialist and a speech pathologist may work together, as a team, to treat the child. Your ENT doctor can assist you in seeking out other medical specialists.

Of course, prevention is the best treatment for any disease, but if you find yourself battling an ENT disorder, remember that information is powerful. Make sure you find a physician who lets you become involved in the treatment of your own disorder. You are your best advocate.

 

Report compiled by Adebayo Folorunsho-Francis with additional from American College of Allergy, Asthma and Immunology; National Heart, Lung and Blood Institute and National Institute on Deafness and Other Communication Disorders

 

How to exceed your limits

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I learnt one lesson from my mother when I was a young boy, growing in the village.Our compound was full of trees which provided a haven for small birds. They enjoyed chirping and hopping on the trees and flowers. Throwing stones at them became my pastime. Then, at my request, my mother bought me a catapult for shooting them. Nearly on daily basis after school, I spent time hunting the birds, which appeared to have got familiar with my face.

For a long time, I did not succeed in hitting any of the birds. But one day, it happened. I aimed carefully at one of them that was perching on a low twig and hit it by the side. The little bird simply looked at me, nodded, and flew away.

I was very unhappy that I could not kill the bird and when my mother returned from the market I narrated to her what happened. She laughed and told me that I aimed at the bird right but did not stretch my catapult enough to release the stone with force. “Next time, stretch it well and you will kill the bird”, she counselled.

I have since discovered that stretching is a principle of life. In fact, life is all about stretching. There is nothing you can achieve without stretching. The more you stretch the better you perform and become.

When I was in secondary school, Physics was not my favourite subject but my uncle insisted that I must study and pass it in order to take any science course in higher institution. I had no choice but to tackle and pass it at HSC and GCE A Level. Before that time, I preferred to stay within my comfort zone of Chemistry and Biology. But stretching in Physics helped me to gain admission to study Pharmacy.

In his book, “The 15 Invaluable Laws of Growth”, John Maxwell said, “Rubber bands are useful only when they are stretched.” Many people use only a small fraction of their ability and rarely strive to reach their full potential.

Some people are willing to settle for average in life. Such people can never excel in whatever they do. W. Somerset Maugham said, “Only a mediocre person is always at his best.” Edmund Gaudet added, “To be average is to be forgotten once you pass from this life.  The successful are remembered for their contributions; the failures are remembered because they tried; but the “average,” the silent majority, are just forgotten. To be average is to commit the greatest crime one can against one’s self, humanity, and one’s God. The saddest epitaph is this: “Here lies Mr Average – here lies the remains of what might have been, except for his belief that he was only “average.”

Do not settle for the status quo. It leads to mediocrity and ultimate dissatisfaction. There must be changes for the better. Being in your comfort zone may make you feel good but, ultimately, you will be unhappy.

A question one should be asking always is, “Is this the best I can do? Is this the farthest I can go? These are questions winners and champions ask themselves. If your answer is yes then you immediately place a limit on your potential. The truth is, you never reach that limit except the one you impose on yourself. No person has been known to reach his limit. You can always stretch further.

At the annual national conference of the Pharmaceutical Society of Nigeria (PSN) held last November in Abeokuta, I told my colleagues that I had attended the PSN annual conferences for 40 years (1973 to 2013) without interruption. Although that was definitely a record attendance, the question is, is it the highest someone can ever achieve? The answer is no. By stretching myself I can attend more conferences.

Stretching requires effort, discipline, perseverance and courage. It takes little or no effort to maintain your position. But to move, you have to break the force of inertia. For an aeroplane to take off, a lot of energy is required. You put your car on gear one in order to start moving. It is the same as leaving your comfort zone. You must gather enough momentum to get out of your comfort zone.

For the past 35 years I have been contributing some editorial materials in Pharmanews. Sometimes I ask why I should stretch myself writing, even when it is not convenient.  The temptation is to skip one or two editions. If I do that I will save some time and use it for other things.  But I know that it is like stopping midway in stretching your catapult or rubber band. When you stop, it tries to return to the original position and will require more energy to start again. Whatever you thought was gain would turn to loss eventually when you stop stretching

How to get the best from cosmetics, by PZ Cussons

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Mrs. Mildred Bagshaw, marketing manager (personal care) PZ Cussons family care, is a specialist in cosmeceutical trends. In this edition of Beauty and Cosmetics, Bagshaw spoke with Temitope Obayendo on some pertinent issues affecting the cosmetics industry. She revealed reasons behind skin irritations in babies and adults, and also gave tips on getting maximum benefits from cosmetics products. Excerpts:

PZ Cussons family care is one of the household brands in beauty and cosmetics. How has it been since inception till now?

            PZ Cussons has always been known for the manufacture and marketing of household products. We started as a trading organization over 114 years ago; however, our hearts have always been into the manufacturing of household and family care products. We have a wide range of products that cut across different categories that are relevant for the care and protection of every family. For instance, we are particularly well known for our Personal Wash and Fabric Care products such as Premier, Joy and Imperial Leather in Personal Wash and Zip and Canoe in Fabric Care.

We also have products in the Dish Wash category with Morning Fresh and in Beauty and Cosmetics, we have our signature beauty brand: Venus, which has been around for over 50 years as well as a thriving Baby Care brand with Cussons Baby; and not forgetting Robb, our number one brand in the Medicaments category. A host of other brands are available in our portfolio, such as Stella Pomade, Jet cream, Danduala and a few others.

Our primary mission is to ensure that the African woman has all she needs to keep her family looking and feeling good always, thereby making their lives better at every given opportunity.

 

What made PZ Cussons go into production and marketing of family care products?

Our aim is to make life better for consumers by providing the products every home requires in meeting their personal and homecare needs; to keep them healthy and clean at all times.

Could you explain the relationship between the usage of your products and the health of the consumers?

PZ Cussons prides itself in the development of products that are designed to meet specific consumer needs. We work with robust consumer insights before going into the production of any product. We also behave ethically in respect to our consumers’ safety by ensuring that we meet and exceed legal requirements.

 

Babies are naturally born with smooth skin but, in most cases, when mothers start applying lotions and pomades on them, they develop rashes. Can you mention the substances responsible for this?

There are many reasons why a child may develop rashes and a few more why they develop them after they use lotions and pomades on their skin. In most cases, rashes are evidences of incompatibilities between baby skin, baby environment and skin care applications. When creams that are made for temperate climates are used in tropical climates, users (whether they are babies or adults) tend to feel uncomfortable, sweat and develop skin rashes from their use.

Usually it’s because of the textural and protective contents of the creams which are heavier on the skin and more suited to the colder regions of the world than they are to the warmer climates like West Africa. For babies to be more comfortable, sweat less and be rash-free, they have to use skin care products developed for the particular climate in which they are applying them.

These days, parents apply all sorts of chemicals -relaxer, nail polish, toning creams etc -on children just to make them fashionable. What are the adverse effects of these chemicals on children’s health?

Chemicals, like every other substance which enhance lives, are only safe at prescribed levels. Beyond these levels, issues of concern may indeed arise from their uses. Therefore, most cosmetics raw materials are subjected to various stages of safety and toxicological screening before being approved for release. It is after this serious and severe vetting stage that ingredients can be used in skin and hair care products.

In general, the manufacture, supply and marketing of cosmetics products is regulated. The skin care products we place on the market are researched and tested to the strictest level to ensure that they are safe and do work and deliver on the claims to the consumer. This ensures that our products enhance and protect the consumer rather than subject them to adverse effects.

However, if a product that is clearly mark for adults is used for a child, then, it could have an adverse effect. Thus, I will advise that parents should always ensure they use products particularly made for children, for children; while adults should keep to their own products.

Now that the rains are here, are there some cosmetics products you would suggest for cold weather?

I think the major results from the cold weather are cold, cough, and catarrh. PZ Cussons Robb offers relief from pains and symptoms of cough and cold. The Robb brand has different products that will help soothe people during this rainy season. These include Robb Original Ointment, for relief from symptoms of cold and nasal congestion; and Robb inhaler, to soothe nasal congestion.

 

The beauty and cosmetics industry is filled with counterfeits products. How do you ensure the genuineness of your products in circulation?

Counterfeiting is something the regulatory agencies, genuine manufacturers and consumer bodies need to work together to fix. It requires putting the right regulations, monitoring and enforcement, as well as consumer education to make this change happen. What was done to the pharmaceutical sector to revamp it should also be done across the length and breadths of all consumer goods to ensure only genuine, quality products are available to the Nigerian consumer. This way, the economy benefits, as healthy people will only drive increased productivity and consequently, the economy.

At PZ, we do try to ensure the genuineness of our products by having tamper-proof evidences and seals in place to protect the products and, in turn, our consumers. We also do quality control checks within the marketplace to spot incidences of rogue products.

 What is your advice to victims of harsh cosmetics?

I think we need to be clear on what we mean by harsh cosmetics. Your question implies an unpleasant resultant effect of cosmetic products on the skin and we need to foremost understand the driver of this. Some harshness could be due to non-compliance with the usage guidelines, while others could be due to the sensitivity of the individual’s skin to certain actives in the product and, in some other cases, it could be due to the presence of carcinogenic substances, the effect of which would happen over time and will impact all who use the product.

On areas of advice, firstly, consumers need to understand their skin types and the kind of products that are appropriate for them. Secondly, consumers need to read instructions on usage and product guidelines that come with the product when using for the first time. Most, if not all products, come with instructions on how to use them for maximum impact. Consumers should learn to read through these instructions and adhere to the usage guidelines; otherwise the result from not doing that could be most unpleasant. An awareness of the nature and effect of actives contained in these products will go a long way in avoiding some of these effects.

Community pharmacists speak on 33rd ACPN conference

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The 33rd annual national conference of the Association of Community Pharmacists of Nigeria (ACPN) was held in Ilorin, Kwara State, from 2 to 6 June, 2014. Our reporter, Oladejo Adebayo who was at the event, sought the opinions of some participants regarding the event. Their views are presented below:

 

One of the best so far

This is one of the best conferences I have attended in my life because it was quite educative and several professionals in the field of Pharmacy, including the likes of Pharm. Olumide Akintayo, Prof. Femi Oyewo, Pharm. Bukky George and the rest, were present. There were also many pharmaceutical companies around to showcase their products; and to cap it all, the presence of security personnel was quite commendable.

I am not disputing the fact that the conference can still be improved upon for subsequent editions, but I am happy with what I saw on ground this year because every aspect of the conference was well taken care of – security was tight, there were lots of spaces for pharmaceutical companies, the environment was tidy and the road network to the conference venue was superb; what else should one expect?

The only minor issue I have is that I would have preferred the conference to hold at a venue that is well covered. I believe this will better ensure that drugs on display are not exposed to direct sunlight. Though the spaces allocated to some of the companies were covered, there were still some who could not stay inside the covered areas for some reasons. It would have been better if the whole conference venue was covered. Aside from that, I will say kudos to ACPN!

ACPN4
Pharm. Bola Lawal Lagos State

 

 

 

 

 

 

 

 

 

 

Kudos to ACPN, but…

This is the first time I will be attending an ACPN conference and, if you ask me to assess the event based on what I think one of this magnitude should look like, I will give it a 100 per cent vote. Apart from the fact that the conference was well-planned, it also gave me the opportunity to meet and learn from some of my senior colleagues, whom I had been longing to see, especially the likes of Pharm. Bukky George, Prof. Femi Oyewo and the rest. The conference has increased the confidence I have in community pharmacy and, by virtue of that, I am proud to be a community pharmacist.

I like the way the conference was organised and I am impressed with the keynote address and some of the goodwill messages delivered by my senior colleagues. I have learnt that community pharmacy is beyond buying and selling of drugs.

However, I think the organisers should work more on the issue of time-management. A situation where a programme is scheduled for 10am but doesn’t start until 11am or thereabout is not good enough because it will definitely affect other programmes for that day. Also, the rate at which people move in and out of the hall should be reduced, so as to reduce distractions.

Apart from those two challenges, I give kudos to ACPN for putting up the well-packaged programme.

ACPN3
Pharm. Patience Sanni Ota, Ogun State

 

 

 

 

 

 

 

 

 

 

ACPN should emulate PSN

I was at the conference last yearin Calabar, so I can confidently say this year’s conference was superb, in terms of organisation and logistics.Things could have been betterthough, compared with what happens at PSN conferences. I thinkACPN should learn from the parent body on how best to handle registration of delegates because this is one of the important areas that determine the success or otherwise of every conference. There were lots of lapses in the way the registration was done and the registration area was also a bit crowded.

However, despite the registration issues, there were noticeable improvements in the way the exhibition stands were allocated and demarcated, which was an improvement on what we had last year. There was a recommendation at the last conference that drugs should not be left in the open, under direct sunlight, and we noticed that there was improvement this year; however, the change came with its own challenge because the noise coming from the exhibitors’ cornerwas a major disturbance and distraction for people in the conference hall. So, the organisersmust find a way to completely separate the exhibition area from the conference hall in subsequent conferences. Overall, it was a good conference.

Pharm. Sumonu Ismail Kola  Lagos State
Pharm. Sumonu Ismail Kola Lagos State

 

 

 

 

 

 

 

 

 

 

 

 

 

Good, but conference venue is no marketplace

I had a wonderful experience. I never thought ACPN conference could be so interesting and educative. Now I can boastfully say that I have a broader view of what is expected of me and what other opportunities I can explore,as a community pharmacist, courtesy of this year’s conference. The speech of Pharm. Bukky George, whom I have always seen as a mentor, was really an eye-opener for me.The speech of Pharm. Shina Opanubi was also a very good one, while the keynote address was well researched and highly educative.

However, I think the ACPN should ensure that subsequent conferences are organised in such a way that people are discouraged from coming with the sole aim of buying drugs but, rather, to learn how to improve in their profession. Buying and selling activities should be more restricted, so that more people will participate in conference discussions, rather than busy looking for what to buy.

I have noticed that more people attend the conference with the primary aim of increasing their stocks and this is not good enough. In all, it was a well-planned conference.

Pharm Aika Isabel  Benin City, Edo State
Pharm Aika Isabel
Benin City, Edo State

The gains of self-discipline

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“Men are anxious to improve their circumstances, but are unwilling to improve themselves; they therefore remain bound. The man who does not shrink from self-crucifixion can never fail to accomplish the object upon which his heart is set. This is true of earthly as of heavenly things. Even the man whose object is to acquire wealth must be prepared to make great personal sacrifices before he can accomplish his object; and how much more so he who would realize a strong and well-poised life.” – JAMES ALLEN

 

You require high levels of self-discipline if you truly desire to develop all your inner resources and fulfill your true potential. Throughout the ages, in all religions and philosophies, the highest human good or idea has been peace of mind. Your ability to achieve your own peace of mind is the true measure of your success and the key determinant of your happiness.

To develop spiritually, and to become a fully functioning person, you must regularly apply self-discipline and self-control to your thoughts, feelings, and actions. Spiritual development, inner peace, and the experience of joy all require self-mastering and self-control.

 

Learning to “detach”

To succeed in the “outer world,” you must discipline yourself to focus and concentrate, work hard at your job, take continuous action toward your goals, and become better and more capable, as you move onward and upward in life.

To succeed in the “inner world,” however, requires almost the opposite abilities. To achieve inner peace, you must discipline yourself to let go of everything that can disrupt your sense of inner peace and contentment.

The main cause of human suffering and unhappiness is “attachment.” People become attached to ideas, opinions, and material things, and then they are reluctant to let go of them. Sometimes people become so preoccupied with these external factors that it affects their mental and physical health – even keeping them awake at night.

When you practise detachment, separating yourself emotionally from things or outcomes, the negative emotions involved stop as well, like unplugging a light from the socket.

Priority of happiness

Most people have a deep down need to be right. However, when you stop caring if you are right or wrong, all the emotions surrounding this need for rightness disappear. Dr. Gerald Jampolsky asked the great question: “Do you want to be right, or do you want to be happy?” Some people become passionate about their political or religious beliefs, all of which have been learnt from someone else in some way. But when you put those beliefs aside for a while, they lose their ability to stir your emotions or to inflame your anger.

I have friends and meet people with ideas and opinions that range all over the political and religious spectrums. In most cases, we get along well together because we simply put aside the discussion of opinions on which we differ. We consciously and deliberately discipline ourselves to detach from these ideas, and we focus instead on subjects that we agree on and in which we share common interests.

 

Quit the blame game

The chief cause of negative emotions and the primary destroyer of inner peace is blame. As I mentioned earlier in the book, it is not possible to have a negative emotion without having someone or something to blame in some way or for something.

Blame requires one or both of two factors to exist. The first is identification. This occurs when you take something personally: You identify with it. As soon as you decide to feel that someone has done or said something negative that affects your personal interests in some way, you immediately become angry and blame that person.

Even if someone who is hurrying to work, completely preoccupied, and who may have just had a fight with his or her spouse accidentally cuts you off in traffic, you can immediately become angry at that person, a complete stranger, because you took his driving behaviour personally.

But when you discipline yourself to detach and stop taking things personally, the negative emotional charge connected with the person or incident stops almost immediately. For example, when someone cuts you off in traffic, you can detach from the situation emotionally by saying to yourself, “Oh well, he’s probably in a hurry to get to work. Maybe he’s late.”

Culled from THE POWER OF SELF-DISCIPLINE by BRIAN TRACY

 

 

How to make your mind productive

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A man’s mind may be likened to a garden, which may be intelligently cultivated or allowed to run wild. But whether cultivated or neglected, it must, and will, bring forth. If no useful seeds are put into it, then an abundance of useless weed seeds will fall therein, and will continue to produce their kind.

Just as a gardener cultivates his plot, keeping it free from weeds, and growing the flowers and fruits which he requires, so many a man tend the garden of his mind, weeding out all the wrong, useless, and impure thoughts, and cultivating toward perfection the flowers and fruits of right, useful, and pure thoughts. By pursuing this process, a man sooner or later discovers that he is the master gardener of his soul, the director of his life. He also reveals, within himself, the laws of thought, and understands, with ever-increasing accuracy, how the thought forces and mind elements operate in the shaping of his character, circumstances, and destiny.

Thought and character are one, and as character can only manifest and discover itself through environment and circumstances, the outer conditions of a person’s life will always be found to be harmoniously related to his inner state. This does not mean that a man’s circumstances at any given time are an indication of his entire character, but that those circumstances are so intimately connected with some vital thought element within himself that, for the time being, they are indispensable to his development.

Every man is where he is by the law of his being; the thoughts which he has built into his character have brought him there. And in the arrangement of his life there is no element of chance, but all is the result of a law which cannot err. This is just as true of those who feel “out of harmony” with their surroundings as of those who are contented with them.

As a progressive and evolving being, man is where he is that he may learn that he many grow; and as he learns the spiritual lesson which any circumstance contains for him, it passes away and gives place to other circumstances.

Man is buffeted by circumstances, so long as he believes himself to be the creature of outside conditions, but when he realises that he is a creative power, and that he may command the hidden soil and seeds of his being, out of which circumstances grow, he then becomes the rightful master of himself.

That circumstances grow out of thought every man knows, who has for any length of time practised self-control and self-purification, for he will have noticed that the alteration in his circumstances has been in exact ratio with his altered mental condition. So true is this that when a man earnestly applies himself to remedy the defects in his character, and makes swift and marked progress, he passes rapidly through a succession of vicissitudes.

The soul attracts that which it secretly harbours; that which it loves, and also that which it fears.It reaches the height of its cherished aspirations; it falls to the level of its unchastened desires and circumstances are the means by which the soul receives its own.

Every thought seed sown or allowed to fall into the mind, and to take root there, produces its own, blossoming sooner or later into act, and bearing its own fruitage of opportunity and circumstance. Good thoughts bear good fruit, bad thoughts bad fruit.

The outer world of circumstances shapes itself to the inner world of thought, and both pleasant and unpleasant external conditions are factors which make for the ultimate good of the individual. As the reaper of his own harvest, man learns both by suffering and bliss.

Following the inmost desires, aspirations, thoughts, by which he allows himself to be dominated (pursuing the will-o’-the-wisps of impure imaginings or steadfastly walking the highway of strong and high endeavour), a man at last arrives at their fruition and fulfilment in the outer conditions of his life. The laws of growth and adjustment everywhere obtain.

A man does not come to the alms-house or the jail by the tyranny of fate or circumstance, but by the pathway of grovelling thoughts and base desires. Nor does a pure-minded man fall suddenly into crime by stress of any mere external force; the criminal thought had long been secretly fostered in the heart, and the hour of opportunity revealed its gathered power. Circumstance does not make the man; it reveals him to himself. No such conditions can exist as descending into vice and its attendant sufferings apart from vicious inclinations, or ascending into virtue and its pure happiness without the continued cultivation of virtuous aspirations; and man, therefore, as the lord and master of thought, is the maker of himself, the shaper and author of environment. Even at birth the soul comes to its own, and through every step of its earthly pilgrimage, it attracts those combinations of conditions which reveal itself, which are the reflections of its own purity and impurity, its strength and weakness.

Men do not attract that which they want, but that which they are. Their whims, fancies, and ambitions are thwarted at every step, but their inmost thoughts and desires are fed with their own food, be it foul or clean. The “divinity that shapes our ends” is ourselves; it is our very self. Man is manacled only by himself; thought and action are the jailers of Fate – they imprison, being base; they are also the angels of Freedom – they liberate, being noble. Not what he wishes and prays for does a man get, but what he justly earns. His wishes and prayers are only gratified and answered when they harmonise with his thoughts and actions.

In the light of this truth, what, then, is the meaning of “fighting against circumstances”? It means that a man is continually revolting against an effect without, while all the time he is nourishing and preserving its cause in his heart. That cause may take the form of a conscious vice or an unconscious weakness; but whatever it is, it stubbornly retards the efforts of its possessor, and thus calls aloud for remedy.

Men are anxious to improve their circumstances, but are unwilling to improve themselves; they therefore remain bound. The man who does not shrink from self-crucifixion can never fail to accomplish the object upon which his heart is set. This is as true of earthly as of heavenly things. Even the man whose sole object is to acquire wealth must be prepared to make great personal sacrifices before he can accomplish his object; and how much more so he who would realise a strong and well-poised life?

 

Culled from MIND IS THE MASTER by JAMES ALLEN

 

The medical representative’s manual

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  1. Summary and Conclusion: Tell them what you have told them.

Where you have a guest presenter, make sure that you are there as an active participant for      effective follow-up and learning purposes. Do not get yourself engaged or engrossed with trivial matters.

Write down all the questions asked and ensure that appropriate answers are provided.

Write and send your report to the head office within 24 hours.

Your seminar will be useless and a waste of resources without effective follow-up. You must have a follow-up plan.

  • Follow the SOP that your company may attach as appendix to this manual.

 

  1. Revenue generation:
  • Your company is a limited liability company whose continuous existence (growth and development) depends on the revenue generated by the activities of her component parts and staff.
  • You are a critical factor and even an indispensable element in the revenue generation process. The company can only do well when you are doing well. Unfortunately, the reverse is true.
  • It is, therefore, important that all your activities must be focused on generating revenue for the company. You must do everything possible to deliver your target on each product.
  • It is always good to assume that the company depends on you for her nourishment. There should be passion for target achievement.
  • No goods should be sold without a clear agreement on payment terms. Avoid dumping of goods. The customer will want to use you and your products to enhance his/her own business. It is left for you to disallow such tendency.
  • Creating profitable customers is the sole purpose of your employment. You must carry this fact with you 24 hours of the day.

 

  1. Expenses:
  • During the course of revenue generation, expenses, must, as a rule, be incurred. These expenses include travelling, accommodation, telephone, seminar, vehicle repair and maintenance, meals, PR, etc.
  • The company has given you a float (the disbursable and refundable fund given to a field staff at the beginning of service) to help you cope with these expenses.
  • You are expected to fill the expense reimbursement form to be submitted by the end of first week of each month. This form will be checked and approved by your manager before it gets to the head office for further treatment. You must submit your expenses on a monthly basis or as otherwise stipulated.
  • Expenses are not additional allowance and it is expected that you have created value for the company as a result of the expenses incurred.
  • Expenses must have a direct bearing with the revenue. If you are not meeting your target, you must watch your expenses. Ideally, the total expenses (salary + bonus + operating expenses) incurred on you must be within the range of 0.1 to 3% of the total revenue generated by you.
  • It is therefore your responsibility to watch your expenses and make sure there is a healthy relationship between the amount you are claiming and the cash lodgement made during the month.
  • Fiddling with or manipulating your expenses for personal gain is career limiting. It will tarnish your record and retard your progression up the career ladder. It is always better to keep your expenses in check.

 

  1. Vehicles and other tools:
  • Vehicles and other tools (laptop, iPad, phones, projector) are provided to aid the discharge of your duties and responsibilities.
  • They are not provided as a matter of right but as a privilege which can be withdrawn if not properly utilised.
  • There are terms and conditions to be met before some of these tools can be provided. It is your responsibility to check with the admin department on the provision of these tools.
  • A vehicle should be made available to a medical representative who has been found worthy not later than 6 months after employment. The brand, model and age of the car is EXCLUSIVELY at the discretion of the management.
  • The vehicle must be well taken care of and the head office must be informed of any unusual development (accident, unexpected mechanical development, etc).
  • The vehicle should be used strictly for the business of the company and also for limited private use. Any trip outside the territory must be brought to the attention of the field manager and or the admin manager.

 

  1. Promotional Materials:
  •  You will be given promotional materials whose effective use will make your job easier.
  • These materials include: detail aids, pens, key holders, scientific reprint, stickers, posters, gift items, detailing bags, product samples, etc.
  • There will never be a time when you will have these materials in sufficient quantity. It is, therefore, your responsibility to ensure optimal usage for maximum sales effects.
  • The detail aids are not ordinary papers to be kept without care in your car boot or under your bed at home. They should not be distributed anyhow at conferences or seminars. They should be used mostly when you are having a physical ‘one-on-one’ contact with the doctor or pharmacists.
  • Product samples are to be utilised in the most cost-effective manner; vide a donation to the department or units or individuals with the highest potentials to make an impact.

 

  1. The medical representative as a MANAGER:
  • You are the ambassador of the company in your territory. You must manage all the company assets effectively which include the products, the customers, the relationship, etc.
  • You must protect the interest of the company and must not be seen or caught denigrating the company, her management or personnel, no matter your personal grievances.
  • You must not re-invoice any head office supply without obtaining prior approval from your manager. Invoicing at arbitrary prices is an offence against the organisation. The company has invoicing price range for the different categories of customers and this must be strictly followed.
  • If you collect goods from a distributor, you must make sure that the money is remitted instantly.
  • You must follow the policies of the company as laid down. This is the only path to growth and development. If you have any concern with any of the policy statement, you must first comply before you can bring up your points for management’s consideration.
  • You must manage the territory as a business entity. Goods should not be allowed to expire with the customers whether in the hospitals or pharmacies.
  • No money collected for goods supplied must be appropriated without management approval. All sales proceeds must be paid into the company’s account.
  • You must constantly seek to do things better. There must be a reason why you are in the territory and in employment. You are primarily a salesman and if you cannot sell and collect money, you have lost your right to employment. Things must be managed as if you owned them.
  • Prices are fixed based on the information at management’s disposal. You are not allowed to tamper with the prices without prior arrangement and written approval.
  • If you wish to leave the company for any reason, the best thing to do:
  1. Have an audience with your manager explaining (optional) why and when you want to leave.
  2. Write a resignation letter and submit to the appropriate quarter. It is wrong and insulting to send email without any prior discussion!!!
  3. Clean up your account both with the company and all third parties: distributors, institutions, etc.
  4. You must work FULLY to the last day of the notice period.
  5. Submit all company properties, reconcile your account and obtain a clearance letter before your final departure.
  • It is wrong to leave the company arbitrarily. You may be jeopardising your future by so doing.

 

  1. Why medical representatives fail

      Fixation on problems

  1. Most failures occur as a result of incessant complaints and getting fixated on problems rather than seeing them as opportunities and challenges to overcome.
  2. Some of these complaints include but not limited to:

*    Our prices are too high, nobody is ready to buy.

*    There are cheaper alternatives.

*    Customers already have products that they are using.

*    The doctors or the pharmacists are not co-operating.

*    The head office staff are bad. They are not responsive.

*    The job is too tedious.

*    The salary is too small and the expenses allowed too low.

*    My manager is not good.

*    My territory is dry

*    Etc, etc.

  1. The purpose of your employment is to solve problems. If you get fixated on problems, then you become a problem (yourself) to the company.
  2. Failures dwell on problems whereas achievers seek solutions to problems.
  3. Take a decision on which one you want to be.

 

  • Laziness:

 

  1. Our business is a third-party business. In most cases, you cannot talk to the consumers directly. You have to go through a third party: the doctor and the pharmacist, and convince them to recommend your product.
  2. Doing this requires a lot of hard work, knowledge, perseverance and focus. Failures are not interested in this long run. They want to short-circuit the process which has never worked. If you push your product to the pharmacy without generating demand, you are bound to fail. Either the pharmacist will not pay for the goods supplied or there will be no repeat order.
  3. A medical representative’s job is not an arm-chair job. It is for those who are ready to dig for water in a stony or rocky environment. It is a job for long-distance runners and not for the faint-hearted.

 

      Lack of knowledge:

  1. You cannot give what you don’t have. Most medical representatives lack knowledge about their products and therefore have no confidence to face the doctors and pharmacists.
  2. Without basic knowledge about the products that you are detailing, you cannot succeed.
  3. Self-development is your personal responsibility. You cannot be taught all you need to know within a classroom setting and the limited time allowed for training. You must re-train yourself. Learn more about your products, competitors and the business environment.

 

Dishonesty:

  1. Failures in this field set out woefully. They see their employment as an opportunity to steal and become ‘rich’ rather a chance to prove their worth and advance in a chosen career path.
  2. Dishonesty manifests in different forms:

*    Manipulating expenses. Making false or exaggerated claims.

§*  Re-invoicing goods received from the head office at a higher price.

*    Over invoicing. We had a case of a medical representative selling a product for N400 at a time when the distributor’s price was N160! To make matters worse, he still failed to remit the company’s share of the transaction.

*    Misappropriating company’s resources. Representatives failing to remit money collected from customers.

*    Working for two or three companies at the same time.            Etc

  1. You can only run for a little while. Eventually, you will be caught and sacked. You may even be jailed if the case assumes a legal dimension.

 

Insubordination:

  1. Failures do not obey rules
  2. They do not write their reports, nor do they follow up on regional or head office assignments.
  3. They carry on as if they owed allegiance to no one.
  4. Such individuals cannot last in the organisation.

 

  1. Success Factors:

Good planning:

  1. You must plan very well for your success.
  2. Gather planning data for your territory (number of hospitals, pharmacies, agencies, doctors, nurses, laboratories, etc.)
  3. Plan how to cover the target audience effectively.
  4. Create your own environment of success.
  5. Territory management is a must. Avoid zig-zag travel.

 

Relationship:

  1. People will buy into you first before they into buy what you represent.
  2. Effective salesmanship is relationship-building. You must have key doctors, pharmacists, etc., who are doing something for you in all the facilities, departments, units or agencies. You and your product must be known. There must be a minimum of five customers who can buy N500k – N1m or above of your product per month. You cannot be successful without these partners.
  3. These relationships are not built in one day or one month. It takes persistent efforts to get through.
  4. It starts from you: your dressing, attitudes, mannerism, salutations, motivation, etc.

 

Knowledge:

  1. You must have knowledge about your products and the competing alternatives.
  2. You must have knowledge about the patho-physiology and management of the disease condition.
  3. You must have knowledge about your operating environment.
  4. You must constantly update your knowledge.

 

Focus:

  1. Success requires focus on the assignment. You cannot succeed when your mind is on so many things at the same time.
  2. Many newly-employed medical representatives have their minds on:

*    going back to school for postgraduate studies;

*    Doing business;

*    Travelling abroad;

* Etc.

  1. Salesmanship is a profession that demands focus, adequate tutelage and concentration for advancement.

 

Humility:

  1. You cannot succeed if you see yourself bigger than the job.
  2. The initial period is usually very hot, hard and there will be a lot of insults and rejection. You have to humble yourself and in most cases stoop to conquer.

 

Other Attributes:

  1. Hard work and determination.
  2. Perseverance
  3. Tenacity of purpose
  4. Characteristic honesty.

 

  1. Career Path:
  • A very good medical representative should, within two or three years, have the opportunity of being promoted.
  • Possible positions in ascending order include area manager or product manager, field force manager or group product manager, national sales manager or marketing manager, sales or marketing director and managing director.
  • Job rotation is also possible. A very talented and interested medical representative can move to human resources or supply chain functions.
  • At the end of the day, IT IS ALL ABOUT YOU!

Okwor tasks community pharmacists on ethical practice – As IDEA zone ACPN holds 6th Annual Seminar

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(By Adebayo Oladejo)

 In its quest to sharpen the ethical and entrepreneurial acumen of its members, the Association of Community Pharmacists of Nigeria (ACPN), Ipaja, Dopemu, Egbeda, Akowonjo (IDEA) Zone, recently marked its 6th Annual Pharmaceutical Business Growth Seminar.

The seminar, which was tagged “Maximising Opportunities for Achieving Excellent Community Pharmacy Practice”, had in attendance eminent personalities and stakeholders in the profession, including Pharm. Deji Oshinoiki, who was the father of the day; Pharm. Anthony Bola Oyawole, chairman of the occasion; pharm. Bukky George, managing director/chief executive officer, HealthPlus Pharmacy and Casabella Ltd; Pharm. Azubike Okwor, immediate past president, Pharmaceutical Society of Nigeria (PSN), who was represented by Pharm. N.A.E Mohammed; Pharm. Lekan Asuni, managing director, GSK Pharma Nigeria Limited, who was represented by Pharm. Ijeoma Eruchalu; and Pharm. (Mrs) Chukwuma B.O, vice-chairman, PSN, Lagos State who represented the chairman.

In his lecture which had the same title as the theme of the event, Pharm. Azubike Okwor, who described pharmacists as educated and trained healthcare professionals charged with management of the distribution of medicines to consumers and engaging in appropriate efforts to ensure their safe and efficacious use, noted that good pharmacy practice requires that the utmost concern of every pharmacist should be the welfare of the patient.

“Good pharmacy practice requires that the core of the pharmacy activity is to help patient make the best use of medicines, while it also requires that the objective of each element of the pharmacy service should be relevant to the patient,” he said.

The PSN former boss also stressed that establishing standard pharmacy practice requires the cooperation and interaction between the pharmacist, the patient and the other stakeholders in healthcare, working in the overall interest of the patient.

In his remarks, Pharm. Deji Oshinoiki urged all community pharmacists in the zone to collectively tackle the challenges facing good healthcare delivery in the country and ensure they gain back the trust which the public once reposed in them.

“Where pharmacy practice Is today is a reflection of where we are as a country because I remember in those days when I started practising newly, patients would have queued up in front of your pharmacy as early as 6 and 7am and by the time you arrived, you already had enough people to attend to that day; but things are no longer the same nowadays,” he lamented.

In his own address at the seminar, Pharm. Madehin Gafar Olanrewaju, zonal coordinator, ACPN, IDEA Zone explained that the theme for the seminarwas timely, considering the disturbing paradox in the practice of Pharmacy in Nigeria.

“Presently we have around 17,000 registered pharmacists in the country and they are meant to provide pharmaceutical care to over 150 million Nigerians; yet majority of those pharmacists are in the lower rung of the ladder of economic prosperity. The reason for this is either that we do not see the opportunity around us or that we are overwhelmed by the challenges around us or that we are not well positioned to utilise the opportunities for economic growth”, he noted.

Also speaking at the event, Pharm. Bukky George who presented the address, “Sourcing and Managing Finance and Human Resource in Achieving Excellent Community Pharmacy Practice” disclosed that to overcome factors that hinder excellent community pharmacy practice, all stages of pharmacy training must be revamped in order to align with current global standards. She added that there is a need for increase in the number of schools of health technology for the training of pharmacy technicians and assistants, who will provide the critical support required in community pharmacies.

Speaking further, the HealthPlus boss stated that to achieve good pharmacy practice, pharmacy premises should have a suitable place for discussing confidential information with customers and patients; maintain and improve professional performance; manage patients’ medication therapy; and comply with national professional obligations, guidelines and legislation, among others.

Why nursing profession is dominated by women – Animashaun

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Ms Faosat O. Animashaun is the assistant director of nursing services at the Lagos State Health Service Commission (LSHC). In this exclusive interview with Temitope Obayendo, the vibrant, veteran nurse provides a comprehensive appraisal of nursing practice in the state, noting areas where progress has been made and those requiring improvements. She also reveals why nursing profession is dominated by females, while also giving valuable tips to nurses desirous of self-improvement principles. Excerpts:

 

 On assumption of office as the assistant director of nursing services, what were your goals and vision for nurses in Lagos State?

On assumption of office, my goals were to enlighten nurses on their roles within the health care team; to reduce the gaps between theoretical and clinical nursing; to ensure conformity of LSHC nurses to N&MCN’s code of conduct of the profession; to ensure maximum utilisation of available nursing personnel, i.e. both senior and junior staff; to ensure adequate staffing of distant hospitals (e.g. Badagry, Epe, Ijede etc); and to encourage nurses to improve themselves through in-service training in different nursing specialties e.g. Peri-operative, Orthopaedics, and Accident & Emergency etc.

My vision for Lagos State nurses was to see them become leading initiators of health care services among the health care providers through early identification of clients/patients’ present or potential problems and ensuring collaboration with other health professionals to solve the identified problems in a conducive/therapeutic environment with empathy.

 

What is your assessment of nursing practice in Nigeria, compared to other countries?

Nursing is defined as protection, promotion and optimisation of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human responses and advocacy in health care of individual, families, communities and population.

Nursing practice in Nigeria is yet to get to the advanced level compared to other developed countries in terms of interest in research, conducive work environments, advancement in medical science and technology, implementation of nursing process and nurse-patient ratio.

 

What are the major areas requiring improvements in the profession?

The health care delivery environment is dramatically changing and nursing has found itself in the midst of these revolutionary changes. Health care providers are expected to be able to provide safe, competent care in a highly technical and digital environment. Today’s nursing requires nurses to be constantly aware of new developments, new medication and new technology among others.

The concerned areas for improvement in nursing profession include: One, higher education in nursing – nurses should engage in higher nursing education to improve their cognitive and skills development. This could be by way of Bachelor’s degree, Master’s degree and Doctor of Philosophy (PhD) degree in Nursing. Two, nursing informatics – with the era of technology, nurses should be versatile in digital environment, using technology in providing care to their patients. Three, quality assurance – quality assurance units must be established to ensure auditing of nursing services. Four, research – nurses must involve in research and be able to utilise research findings to improve nursing practice and to provide evidence-based practice. Five, continuing professional development – the profession can only improve if nurses involve in continuous training/workshop/seminar to keep abreast or update their knowledge.

Other areas include autonomy, nurse-patient ratio, gap in theoretical and clinical nursing, mind-set on nurses’ image, work environment and funding of health care delivery.

 

Nursing schools were said to start operating on their own some time ago. What is the situation now?

Nursing in Nigeria today is far different from what it used to be years ago and it is expected to continue changing during the 21st century. Like other health professions, nursing education started with little or no formal education and the nursing practice is mostly based on intuition and trial and error.

Presently, no nursing school can operate without accreditation by the Nursing and Midwifery Council of Nigeria which is the professional regulatory body in Nigeria that specified the curriculum code of conduct and ethics guiding the profession.

For any institution that runs nursing programme, the approval of this regulatory body must be sought and the said institution must meet the accreditation requirements to some extent before nursing programme can be instituted.

Previously, unwilling candidates with one or two ‘O’ Level credit passes were coaxed into the profession because nobody wanted to carry bedpan.Presently, however, all eligible candidates admitted into the schools of nursing must be willing, committed and meet entry requirements of five (5) credits in Science subjects before admission.

Nursing education has now gone beyond schools of nursing; it is presently incorporated into theuniversity education system.Candidates can be admitted either by Direct Entry or Unified Tertiary Matriculation Examination (UTME) of four and five 5 years programme respectively. After this first degree programme, nurses can proceed to Master’s degree, PhD degree, and even professorship.

This exposure of nurses to increased body of knowledge prepares them to use critical thinking in identifying clients’ problem and making plans to solve them. It also enables nurses to use evidence-based nursing practice, thereby edifying and strengthening nursing as a profession.

 

Strikes by resident doctors are not uncommon in this part of the world.To what extent can nurses work without doctors?

Whenever doctors are on strike, nurses will still continue to manage the admitted patients with their treatment regimen. Also, nursing care plan, based on critical thinking and evidence-based practice, will be applied to treat new complaints.

However, if a patient’s condition deteriorates or becomes an emergency that nursing care alone cannot solve, consultants are always around during strikes, and they will be called upon to see such a patient.

At the outpatient department, first aid treatments are given to new patients, depending on the severity of their conditions. All booked ante-natal cases are attended to, deliveries are taken by midwives, while consultants are called to see complicated cases. Patients on daily injections and dressings are also attended to.

 

In other climes, nurses are allowed to prescribe for patients in some situations. Is this applicable in Nigeria?

Yes, it’s applicable. To some extent, nurses,especially midwives,have the autonomy to prescribe drugs for patients under the legislation governing the use of drugs and medicines by the midwives in Nigeria. Also, nurses with public/community health certificates are allowed to prescribe drugs for patients with the use of standing order.

As nursing roles are expanding, new dimensions for nursing practice are being established, nurses with varieties of nursing specialties (e.g. critical care, mental health, accident and emergency, maternal and child health, anaesthesia, public/community health etc.) through education are now advanced practice nurses (APNS) and even nurse consultants in developed countries.

These categories of nurses provide direct client care as nurse practitioners, nurse-midwives, certified registered nurse anaesthetists, clinical nurse specialists etc. With their education and certification, which depends on state regulation, they are allowed to provide primary care and prescribe medications for patients in some situations.

Presently, there are few of them in Nigeria; hence, more nurses should be encouraged to further their education in order to broaden the autonomy which will enhance health care delivery in Nigeria.

 

Why are there so few men in nursing profession?

Globally, nursing is perceived as a profession exclusively for women and, as a result, it is not attractive to many men.There are misconceptions about male nurses, resulting in drastic reduction of admission quota of male candidates into Basic School of Nursing.

There are also unwritten policies about male candidates entering the profession, especially areas like midwifery. This is why men have not been admitted into midwifery schools.

There should be career enlightenment campaign in secondary schools. This will help to create more awareness about nursing profession among male pupils.

 

Are there challenges facing nurses in the state?

Nurses in the state are performing their duties diligently but this is not without some challenges. These include one, ever increasing population of the state – the population of patients in hospitals is increasing every day and putting more pressure on the available nursing personnel. Two, funding of health care industry – it is a well-known fact that funding of health care industry should not be the exclusive reserve of the government. Public-private partnership is required. Three, inadequate nursing personnel – there has been agitation by nurses for mass employment which was done last in 2004.There is acute shortage of nurses largely due to expansion of health care facilities such as construction of Maternal and Child Centres.Also, nurses are retiring from active service. Four, many nurses now reside in new sites around Ikorodu, Sango-Ota, Igando/Ikotun and, at the same time, working in Lagos Island/Lagos Mainland. This has resulted into many nurses requesting for transfer to hospitals that are nearer to the new sites.

In addition, with advances in health technology, there is need for the state hospitals to be equipped with new equipment that will enhance nursing service delivery. There is also the issue of welfare of nurses. Nurses are agitating for salary parity with contemporaries working at federal health institutes. Provisions of loan facilities such as car loan, mortgage loan are also being requested for by nurses. Nurses also want opportunity for advanced training, seminars and conferences.

 

What then is your advice to all nurses?

Nurses should be empathetic and ensure provision of quality nursing care to their patients; including the relatives.They should ensure that they maintain an effective and therapeutic communication with their clients/patients for better understanding and acceptance of care to be rendered.They should constantly ensure proper documentation of services rendered, as this will guide against litigation and will also ensure continuity of care.

Moreover, nurses should take it personally upon themselves to improve on their educational background by furthering their education. They should attend seminars and conferences. They must ensure that care rendered is according to the best available scientific evidence at all times using nursing process. They should show concern about socio-political security issues in the country.

Above all, they must be good ambassadors of the profession wherever they may be at any time by keeping to the code of conduct and ethics of the profession.

Ahmed Yakasai award produces first winner

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(By Adebayo Oladejo)

          A community pharmacist from Ibadan, Oyo State, Pharm. Kunle Amusan, has been announced winner of the maiden edition of the Ahmed Yakasai Community Pharmacy Practice Support Award.

The award was presented at the Arca Santa Event Centre, venue of the opening ceremony of the 33rd annual national conference of the Association of Community Pharmacists of Nigeria (ACPN).

Beaming with smiles and waving to the applauding audience, Pharm. Amusan received the award, which comes with an award plaque and a cash prize of 300,000 naira.

Expressing his delight, Pharm. Amusan, who is the managing director of Pharmalot Pharmacy, Ibadan, described the award donor, Pharm. (Alh) Ahmed Yakasai, as a man who truly had the love of pharmacy at heart.

Amusan attributed his emergence as winner of the award as an act of God. “I give God the glory for making me the first beneficiary of this award,” he said,” and I say a big ‘thank you’ to Alhaji Yakasai for putting a smile on my face, even at a time that I thought there was no hope again.”

National chairman of ACPN, Pharm. (Alh) Olufemi Ismail Adebayo, noted at the event that the Ahmed Yakasai Community Pharmacy Support Award was a timely and significant intervention for community pharmacists.

“It was a big coincidence because the National Executive Council (NEC) was discussing how we were going to start assisting community pharmacists that having challenges.The donor just came without discussing with anybody and without knowing what we were discussing in NEC and decided to institute that award; and true to his word, the promise was fulfilled,” he said.

Adebayo further added that Alh.Yakasai, had through the presentation of the maiden edition of the award to a pharmacist outside of his state and tribe, portrayed himself as a truly forthright and detribalised Nigerian.

In his own remarks, Alh.Yakasai, who was once Commissioner for Land and Physical Planning, and later, Commissioner for Commerce, Industry, Cooperatives & Tourism in Kano State, disclosed that he organised the award to give back to the profession that had benefitted him over the years.

“ I felt I have to contribute to the development of Pharmacy from the token God has given to me and that is why I decided to give a meagre300,000 naira only for the next ten years. And to further prove my love for Pharmacy, my first daughter is rounding off her Pharm.D programme,” he revealed.

 

 

Swipha plans contract manufacture for multinationals – Launches five OTC products

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(By Yusuff Moshood)

 Swiss Pharma Nigeria Limited (Swipha) is fully set to produce essential medicines for non-governmental organisations (NGOs) and contract manufacture for multinational pharmaceutical companies, Mr Colin Cummings, chairman/CEO, Swipha, has said.

Mr Cummings made this disclosure while speaking with pressmen at a press briefing on the company’s GMP certification and the launch of five new over-the-counter (OTC) medicines. The events were held at Sheraton Hotel & Towers, Ikeja, Lagos, recently.

According to the Swipha’s helmsman, with the achievement of Swipha as the first pharmaceutical company in Nigeria and indeed the whole of the West African sub-region to be declared compliant with the standards of Good Manufacturing Practice (GMP), by the World Health Organisation (WHO), the company is bolstered to produce more quality products and compete with other reputable pharmaceutical companies globally.

Speaking further at the well-attended event, chaired by Prince Julius Adelusi-Adeluyi, the Swipha boss said that with this feat, the company has placed Nigeria on the global map of countries that can provide finished pharmaceutical products comparable in standards with other developed economies.

On what prompted the introduction of five new over-the-counter products by the company, Mr Cummings revealed that Swipha is always looking for new ways to meet its customers’ needs, providing solutions to their healthcare needs, and thereby helping to consistently improve the well-being of Nigerians.

The new products are SUPRA-FIT, SUPRA-KIDS, SUPRA-C, STAVLAN and GUAFENSIN.

Mr Cummings explained that SUPRA-FIT was formulated with the Nigerian diet and lifestyle in mind, adding that it is specifically for adults who need to supplement their daily vitamins and mineral intakes for optimal well-being. SUPRA-KIDS, he said, is a chewable multivitamin tablets for children aged 12 years and above.

SUPRA-C, according to him, is an anti-oxidant and an appetite stimulant for children, while STAVLAN is an adjunct in the treatment of liver disease. He further explained that GUAFENSIN is a non-drowsy cough expectorant for symptomatic relief of cough and cold.

The highpoint of   the occasion was the official unveiling of the new products. The unveiling was done by the chairman of the event, assisted by other top-dignitaries that graced the memorable occasion.

 

 

Annual conference was successful – ACPN chairman

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 (By Adebayo Oladejo)

 

         This year’s annual national conference of the Association of Community Pharmacists of Nigeria (ACPN) might have come and gone but memories of the notable event will linger for long in the minds of community pharmacists across the nation. One person in particular has every reason not to forget about the conference so soon. He is the national chairman of ACPN, Alh. (Pharm) Ismail Olufemi Adebayo.

Speaking with Pharmanews in his hotel room shortly after the one-week-long event, Alh. Adebayo was full of appreciation to God for making the conference, the second since he became national chairman, one of the best in the history of the association. He also disclosed some of the programmes his administration has in store for the association in the next one year before the end of his tenure. Excerpts:

How would you assess the just concluded 33rdannual national conference of your association?

That’s an interesting question, but I would have preferred somebody outside the executive team to answer it. Personally, I have been asking stakeholders, companies, members of ACPN and others that came for the event for their comments about the conference. The reports have been quite encouraging.

I particularly want to appreciate my members because, last year, our capitation was increased and majority of them willingly complied, agreeing with us that the increment was justified because the cost of living had actually increased. Consequently, I promised them that they would have value for their money. This is why we decided to raise the standard of the conference arrangement, from feeding to conference materials and other logistical considerations. As a result, people have scored us not less than 80 per cent in all aspects of the organisation.

It is my joy that I was able to organise a good conference and our people are really happy. I wish to appreciate the Governor of Kwara State, Ahmed Abdulfatah, for creating an enabling environment for us to hold our conference and also the Honourable Commissioner for Health, Hon Abdul Kayode Issa, who represented the governor and his entourage.

 

What informed the theme, evolving best practices in community pharmacy”?

As you know, the ACPN is a technical arm of the PSN; while the PSN is also a member of the International Pharmaceutical Federation (FIP). The norm is that whatever we are going to come up with as a theme in our annual conferences must be derived from the last theme of the PSN conference, while the PSN on its own part takes its themes from FIP. The aim is to ensure that whatever information that is disseminated at the top gets to the last cadre. This is why we had that theme for our conference this year.

 

In the last two years as ACP national chairman, what would you say have been your greatest achievements?

I want to first and foremost appreciate the support of the executive members, NEC members and the entire members of ACPN for the trust they had in me and making me their leader. One of our major achievements is our effort towards institutionalising the professional indemnity insurance scheme – that is, the insurance for professional malpractices that might occur. We took it up as group insurance and I am happy that we were able to surpass the minimum number required for us to pay the minimum required amount. This is why I am appreciating my members because if not for the trust they had in me, they wouldn’t have subscribe to it.

Secondly, we have been able to positively affect our members through various training and retraining programmes organised by different bodies to empower members and update their knowledge base. Whenever we call on our members for these trainings, the response is always positive and there are testimonies that it has improved their businesses.

Also, we have been interacting with government agencies like the National Health Insurance Scheme (NHIS). Our usual complaint before now was that we had been short-changed. Fortunately, the NHIS now has a new executive secretary and we have made a courtesy call on him and informed him about the situation of our members. He has promised that something will be done in that direction.

Additionally, there are several ways we have been partnering with government agencies and the federal ministry of health. For example, there is the National Drug Distribution Guidelines which was launched last year and there is an implementation committee which has just been formed. We have been recognised as part of that committee. Also, at NHIS, there is a steering committee which looks holistically into the operation of NHIS, and we have been nominated and recognised as part of that committee as well. So we have been contributing our quotas in different agencies of the government; and we hope that, very soon, all these efforts will reflect on the practice of our members.

We have also done so much on the publicity and advertisement of our neon sign, which is our emblem in the media. We have called several press briefings on this and we are happy that it is paying off.

 

What should your members expect in the next one year before your tenure is over?

I want my members to continue to pray for me because the major thing I had in mind while contesting for this post was the issue of empowering my members; and even after leaving office, I want to leave a good legacy behind. I am praying to God that I will have something substantial to point at after leaving the office in the next one year.

I want my members to be more committed. The turnout at our conferences has not been encouraging enough, considering the population of community pharmacists that we have nationwide. I am imploring them to inculcate the habit of attending conferences because, once they pay their capitation, attendance is free. Even though the economy is not really good, they should try and identify with their profession. I therefore pray that all my efforts to take this association to the next level will not be in vain.

I will also implore the government to encourage professionals, especially pharmacists, because as food is important, so also are drugs. Pharmacists are important, and by virtue of that, when there is a special programme like loan for people in agriculture, there should be same for us in Pharmacy and the healthcare sector in general because there is always that support in other countries of the world.

I am calling on government to establish a low-scheme fund for pharmacists, with a single digit interest rate. This will make drugs more accessible and affordable to the common man on the street.

INTERNATIONAL WORKSHOP ON HEALTH CARE FINANCING AND INNOVATION

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Pharmanews Dubai Advert

 

 

 

 

                             

                                DUBAI, UAE.  19– 23 July, 2014

This workshop, designed for executives in the health care sector, would focus on helping participants develop the requisite management capacity and attitude required to provide leadership in a changing health care sector. Delivered in the beautiful city of Dubai and in partnership with a large international hospital, this would be a great time of reflection, learning and networking.

Date:            Saturday 19 – Wednesday 23 July, 2014

                     (Saturday and Wednesday are arrival and departure days respectively)

Time           9.00a.m – 5.00p.m (daily)

Venue:         Aster DM Health Care, 33rd Floor,

                     Tower D – Aspect Towers, Executive Towers at Bay

                     Avenue, Business Bay, Dubai, United Arab Emirates

 Target Participants

Doctors, Pharmacists, Nurses, Medical Laboratory Scientists and other clinical, administrative, management and technical personnel in the public and private health care system.

 Course Contents:

  • Essentials of Health Care Financing
    • Public-Private Partnerships in Health Care Delivery
    • Fundamentals of Health Care Entrepreneurship
    • Essentials of Clinical Leadership
    • Quality Management in a Multi-Facility Care Delivery System
      • Case Studies/Syndicate Sessions

 Learning Objectives:

At the end of the workshop, participants will be able to:

  • Understand global health care financing models, challenges and opportunities for Innovation in Africa.
  • Comprehend best practices and current management approaches and strategies for achieving effective public-private partnerships.
  • Acquire the necessary skill set and attitude required to drive sustainable and innovative health care service delivery systems in both public and private settings.
  • Lead effectively, communicate clearly and deliver optimal health care service outcomes.
  • Acquire proficient management skills for delivering total quality management in large and medium health care service settings.

Registration Fee

  • $1,500 (or Naira equivalent) per participant on or before 20thJune, 2014.
  • $1,600 (or Naira equivalent) per participant after 20thJune, 2014.

 Group discounts: 3 – 5 participants: 10%,    6 participants and above: 15%

Registration fee covers: Tour, workshop materials, tea/coffee break, lunch, certificates, and visa processing ONLY.

Participants are to take care of their travel expenses, dinner, and accommodation.

 Activity Focus

 The workshop would be highly interactive as it would be driven centrally by our custom Activity Focus Learning Modules that would set the pace for syndicate sessions.

Each group would work on case studies that simulate innovation – driven interventions in the Nigerian health care system. Assisted by our resource team, each group would seek to develop evidence – based pragmatic proposals for specific health projects.

Tourist and Business Potential

Dubai has emerged as a leading regional commercial hub with state-of-the art infrastructure and a world-class business environment. It has now become the logical place to do business in the Middle East, providing investors with a unique and comprehensive value added platform.

It also hosts a number of tourist attractions and has since become one of the world’s leading tourist location.  Dubai therefore offers an opportunity for a renewed global business perspective, networking and a superb tourist spot.

 Summary

The International Workshop on Health Care Financing and Innovation is designed to equip leading health care executives in Nigeria with the requisite attitude and skill-set for their new roles in developing our health care system in a private sector – led global economy. Designed in partnership with a global hospital chain – Aster DM HealthCare, which has world-class expertise, the workshop would equip and motivate participants for greater growth and development.

Hotel Accommodation

Participants will be accommodated in a hotel close to the workshop venue at a reduced rate of $80 $100 per night.

Cancellation

For cancellation of registration fee, 70% of the fee will be refunded, if cancelled at least seven (7) days to the workshop and the information communicated to us by sms or email, using: info@pharmanewsonline.com

There will be no refund if cancelled thereafter.

Method of Payment

Participants should pay registration fee into Pharmanews Ltd account in Zenith Bank Plc (A/c No.

1010701673) or Access Bank Plc (A/c No.0035976695) and send their full names and bank deposit slip

numbers by sms or email to Pharmanews Ltd. Payments in dollars should be made to Pharmanews Domiciliary Accounts: GTB A/c No. 0005082226

  Payment Online

Payments can also be made through our payment portal on GTBank SME market hub facility. To make payment online, visit: https://pharmanews.smemarkethub.com

Please note that payment in naira can only be accepted in Nigeria. In Dubai, the dollar equivalent will be paid.

 Financial Transactions in Dubai

Your financial transactions in Dubai will be done in the local currency, UAE Dirham. The current rate is 3.7 Dirham to 1 US$.

Arrival and Departure

Participants are expected to arrive Saturday 19thand depart Wednesday 23rd.

City Tour

For the tour, temperature will be at an average of 35° Celsius. We advise casual wear with shoes suitable for walking. Cameras will be useful for pictures.

Travel Information

 By Air

Intending participants are advised to make reservation for flight ticket to Dubai through these online booking sites: www.wakanow.com or www.opodo.co.uk. Available airlines on the booking sites are Emirates, Kenyan Air, Etihad, Ethiopian Airways, and Qatar Airways, among others.

Visa

After registration, participants will be contacted on the procedures for visa procurement. The visa fees are covered in the registration fee.

For further information, please contact:

Cyril Mbata                                –   +234 706 812 9728

Nelson Okwonna                         –   +234 803 956 9184

Elizabeth Amuneke                    –   +234 805 723 5128

 

   Click here to download the International workshop flyer

 Register for the Dubai International Workshop today!

Click Here to  register

To pay online  using our online payment portal 
click-here-5


 

 

Prof. Esimone becomes NAU deputy vice chancellor

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Pharm. (Prof.) Charles Okechukwu Esimone, has been appointed deputy vice chancellor (DVC) – Academic, Nnamdi Azikiwe University (NAU), Awka.

The new DVC, a professor of biopharmaceutics and pharmaceutical sciences of the university, holds B.Pharm., M.Pharm., and PhD degrees from the University of Nigeria (1995, 1998 and 2002 respectively).

Prof. Esimone, the pioneer dean of the Faculty of Pharmacy, NAU, who became a professor at the age of 37, emerging as the youngest professor in the university and first professor of pharmacy, is also the first professor of pharmaceutical microbiology in south-eastern Nigeria.

He has well over 180 publications to his name. He has pioneered research in the use of recombinant viral vectors as surrogates for high throughput antiviral screening studies and on the use of indigenous medicinal plants as immunomodulators, vaccine adjuvants and anti-infectives. His vector-based antiviral screening technique developed between 2003 and 2005 in Germany has significantly revolutionalised high-throughput screening for anti-HIV compounds worldwide.

Esimone is a recipient of several awards, which include the Alexander von Humboldt Fellowship to Germany (2003-2005), Visiting Scientist to the University of Pittsburgh, USA (2007-2008), the ANDI Bright Contest Award for the Best African Innovative Researcher, South Africa (2009), Young Scientist (representing Nigeria) at the “Summer Davos” Annual Meeting of New Champions, Tianjin, China (2010) and the CV Raman Senior Fellowship, India (2013).

He is a member of the Governing Council of the Pharmacists Council of Nigeria, the Nnamd iAzikiwe University and the Nanomedicine Society of Nigeria; he is, indeed, the pioneer national president of the Nanomedicine Society of Nigeria.

Prof. Esimone, who has successfully supervised over 35 postgraduate students, is a recipient of various national and international grants and a reviewer to several national and international journals. He is a member of several professional bodies including the Global Young Academy and the American Society for Cell biology. He is happily married.

Hospital pharmacists don’t steal drugs – Pharm. Fasipe

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(By Adebayo Folorunsho-Francis) 

 In this interview with Adebayo Folorunsho-Francis, Pharm. Akinrinola Fasipe, current director of pharmaceutical services in Osun State Hospitals Management Board (OSHMB), bared his mind on some boggling issues in the health sector, including why hospital officials erroneously think pharmacists misappropriate drugs. Excerpts:

 Tell us a bit about yourself

After my early education at St Claire’s Primary School, Osogbo, I proceeded to Olivet Baptist High School, Oyo State (1975-1980). On completion, I was fortunate enough to gain admission same year into the University of Nigeria, Nsukka for my degree (1980-1986). I had my internship at Jericho Nursing Home, Ibadan; and later, my National Youth Service programme at the 82 Army Division, Enugu.

Is it right then to say you cut your teeth at Enugu?

(Laughs) Not really. I have always been in hospital pharmacy. I entered the service in 1988 post-NYSC and my first duty station was at Adeoyo Maternity Hospital in Ibadan. Back then, the old Oyo State also included what we now know today as Osun State.

As a DPS in Osun Health Board, how is your state handling the issue of drug procurement & distribution to prevent influx of counterfeit medicines?

First, let me say that the Ministry of Health is in charge of drug procurement on behalf of hospitals management board based on perceived need (our dialogue with them). Unlike in other ministries, the drugs are bought centrally. This is one way government ensures fake drugs don’t find their way into the hospital as suppliers would be held responsible if their drugs are found wanting. No supplier, of course, wants to be blacklisted for supplying fake and sub-standard products. Besides, suppliers are always made to sign an agreement that their consignments will be taken back if they are found wanting.

 

How is Osun State ensuring that private hospital proprietors keep to laid down principles by offering qualitative service?

In the Nigerian environment, we are always having this problem of quackery trying to infiltrate every business. The same can be said about private hospitals. However, government has set up a department to monitor and check out such activity. It is called the Department of Tertiary and Non-Government Organisations. It is that department that goes out on inspection and monitors the activities of these hospitals. Besides, they are expected to register with the ministry of health to oversee the function of those private hospitals. Any hospital that is not registered or engages in unwholesome or unprofessional activities is shut down by the government.One thing I can say is that the department is indeed up and doing.

 

As the DPS, how do you handle the accusation that some pharmacists in hospital practice hoard and pilfer drugs in their care?

The allegation is baseless. I did mention earlier that the state government, realising the importance of sound health to the populace and realising that many of our people would not be able to maintain their health because of cost implications, has graciously put in place a free health policy which includes dispensing drugs totally free, irrespective of gender. But as we know, everything that is free is always open to abuse. Just because government said the drugs are free, some people see it as their share of the national cake. But the department has put in place measures and systems to ensure that drugs put in care of pharmacists are not pilfered and stealing reduced to the barest minimum. Also the amount of drugs dispensed to each patient is collated and, at the end of the month, submitted to the relevant authority for scrutiny. And where there are discrepancies, the HMB (Hospitals Management Board) and the ministry of health are expected to take steps to investigate it.

 

What other challenges are facing hospital pharmacists today?

There is a paradigm shift now from product-focus to patient-focus. In that wise, we are talking of taking on more clinical duties by the pharmacist. This includes going on ward round, monitoring adverse drug effect, public health talk to patients and drug information activities. Then you need to counsel patients on proper use of drugs to get maximum benefit.

Secondly, proper documentation of drugs must be taken into consideration. Let me say the first major challenge we have in hospital practice is lack of adequate personnel to carry out the aforementioned duties. Though the government is trying, we cannot deny that. This is exemplified by the fact that 10 more pharmacists were employed in 2012 to cover up the lapses. Apart from that, there is need for adequate infrastructure for these activities to take place. For instance, there is need for privacy to counsel patient. As at this point, I must also add that government has voted a huge sum of money to renovate our hospitals. But just like Oliver Twist, we believe they can do more.

The government needs to motivate staff through adequate and proper remuneration. For instance, we have lots of staff leaving for greener pasture.

 How would you rate government’s effort?

            The government is trying as I said. But it can also strive to continue with the renovation works on ground. Equipment is another area to look in. There is also need for training and retraining. For instance, the advanced world is talking about e-dispensing and e-medicine. But we are yet to get there.

 

Kwara governor wants stiffer penalties for drug fakers

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(By Adebayo Oladejo)

The Executive Governor of Kwara State, Alh. (Dr) Abdulfatah Ahmed has joined his voice to calls by stakeholders in the pharmaceutical industry for stiffer penalties for drug counterfeiters.

The governor, who was guest of honour at the 33rd annual national conference of the Association of Community Pharmacists of Nigeria (ACPN), made the call while speaking at the opening ceremony of the conference, held at the Arca Santa Event Centre, Ilorin, Kwara State, last month.

Governor Ahmed, who was represented by Kwara State Commissioner for Health, Dr Abdul Kayode Issa, said the menace of counterfeit and substandard drugs has continued to diminish the standard of healthcare delivery at all levels in the country.

He added, for the benefit of community pharmacists at the well-attended event that it is a crime against humanity for anyone to knowingly procure and distribute fake or substandard drugs that can take people’s lives and damage the health of people in the quest for profit making.

“I therefore urge you to base your practice towards global best practices, so that our people will continue to enjoy quality pharmaceutical services”, he challenged the practitioners.

While appreciating the ACPN for coming at a time his administration was marking its third year in office, the governor also urged ACPN to be more stringent in its regulation of the practice of pharmacy in order to ensure that only qualified professionals were allowed to dispense drugs to the public.

He also used the opportunity to disclose that his government was already working on the establishment of a drug distribution centre in compliance with the new drug distribution guidelines of the federal government set to take off very soon. “At the last national council of health meeting that we had with the minister of health in Abuja, we actually mentioned there that June 30 deadline set for the take-off of the programme may be extended while it is also important to inform this gathering that the state is giving adequate support to the fake and counterfeit drugs task force activities in the state”.

Also speaking at the event, emir of Shonga, Dr Haliru Ndanusa Yaya (OON), called on the ACPN to sanction any pharmacist guilty of prescribing wrong drugs for patients, adding that pharmacists and other health workers are required to be more professional in their chosen field.

The emir further stated that health workers should strive to avoid embarking on industrial strike due to the crucial nature of their job.

“Doctors and other health workers are not supposed to go on strike. We are working for the patient. Imagine if doctors embark on strike and a patient loses his life, how do we restore the life? Also, our drugs are getting into wrong hands and we should be mindful of that as pharmacists. Let us stand together as a team and put sentiments aside, so that patients who are our primary target will benefit from the care we are offering.”

While making his own contributions, Chairman of the Pharmacists Council of Nigeria (PCN), Pharm. Bruno Nwan kwo, noted that the effect of community pharmacy in Nigeria was impacting positively on the image of pharmacy profession in Nigeria. He however observed thatthere were still problems plaguing the practice, which community pharmacists in particular must help to tackle in order to move the profession forward.

“The challenge of non-pharmacists who pretend to deliver pharmaceutical services to the public is seriously affecting the fortune of community practice,” he said,”but I want to appeal to us not to respond to this encroachment by giving up on our value. Pharmacy stands for good pharmaceutical services and patient care to the utmost and our unfortunate competitors are nowhere to give pharmaceutical care; so when we drop our standard and services in competition to them, what we do is hurt ourselves and hurt our future”.

The PCN boss warned that pharmacists flouting the council’s regulations and compromising pharmaceutical standards should be ready to face stiff sanctions.

“You will not expect us to say get rid of the patent medicine vendors and spare the absentee pharmacists.So if you own a premisesand you are not there to practise as required by law, you are as good as the ‘register and go’ offender or as good as the patent medicine vendor,” he stressed.

In his goodwill message to the ACPN, President of the Pharmaceutical Society of Nigeria (PSN), Pharm. Olumide Akintayo, disclosed that the Society haddecided that all arms of inspectorates should henceforth ensure that there must be compulsory monitoring and control at least once in every month in order to crackdown on unregistered and illegal premises in all the states of the federation.

“We must be ready to support this initiative in terms of finance and logistics because I believe very strongly that ACPN will be the major beneficiary,” he said.

Earlier on in his address at the opening ceremony, National Chairman of ACPN,Pharm. (Alh) Olufemi Ismail Adebayo, said the theme of the conference “Evolving Best Practices in Community Pharmacy” was meant to clearly convey the message that the roles of pharmacists need to evolve from drug compounders and dispensers to providers of quality drug products with patient-centred care, which includes the functions of counselling, drug information and monitoring of drug therapy in patients.

Highlights of the opening ceremony include the presentation of the first Ahmed Yakasai Community Pharmacists Support Award which was won by Pharm. Kunle Amusan from Oyo State and the signing of the signing of a Memorandum of Understanding (MoU), between ACPN and Globacom Limited.

 

 

 

Neimeth launches Norduet to tackle hypertension

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To help fight against the scourge of hypertension in Nigeria, Neimeth International Pharmaceuticals Plc, has introduced Norduet, a new antihypertensive into the Nigerian market.

The product was unveiled at a colourful ceremony recently organised by Neimeth at its head office in Ikeja, Lagos, and graced by top health professionals.

Speaking with Pharmanews at the event, Pharm. Emmanuel Ekunno, the managing director/CEO of the company, said Norduet was a novel product specially formulated and produced through years of dedicated research and development in Neimeth’s continued effort in the fight against hypertension. Norduet, he said, combines the vasodilator action of Amlodipine with the diuretic actions of Hydrochlorothiazide and is indicated for mild to moderate hypertension.

Pharm. Ekunno noted that Norduet was a great addition to the company’s FITGAH (Fight the Good Fight Against Hypertension) initiative, which is Neimeth’s reversed marketing innovation aimed at reducing the cost of antihypertensives by 50 per cent. This is in order to use affordability to drive therapeutic compliance in hypertensive.

He said that the company, through FITGAH, was fighting hypertension on three fronts, Awareness, Availability and Affordability. He traced Neimeth’s intervention in the fight against hypertension in Nigeria to 1978 when the company introduced Minipress, its first antihypertensive. He added that the company had since then introduced five other products in its tremendous strides in hypertension management in Nigeria. They include: Novasc in 1991, Normoretic in 2001, Miniplus in 2003 and Amlover in 2007.

Pharm. Ekunno further noted that FITGAH, launched in 2013,was a scheme implemented in partnership with teaching hospitals, state hospitals, primary health centres, Hypertension Society and Cardiac Society of Nigeria, as well as other institutions, towards the improvement of quality of life of the hypertensives in Nigeria.

FITGAH, he said, had helped to make Neimeth’s antihypertensive more affordable to both prescribers and users in the effective management of hypertension because affordability had more often than not been implicated in non-adherence, in terms of therapeutic compliance.

The highlight of the occasion was the formal unveiling of the new product by the top dignitaries at the occasion.

Pharm. Mohammed now PCN registrar

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The Pharmacists Council of Nigeria (PCN) has appointed Pharm. N.A.E. Mohammed as registrar of the Council.

Mohammed’s appointment was confirmed through a letter from the PCN dated May 28, 2014.

The new PCN registrar is a holder of a B.Pharm. from the University of Benin (1984); Master in Business Administration (MBA) from Edo State University, Ekpoma (1999); and Master of Science in Health Management from the College of Medicine, University of Lagos (2008).

Pharm. Mohammed was a very active person in organised pharmacy and was former national secretary, Pharmaceutical Society of Nigeria (PSN), from 2005 to 2008; national treasurer, PSN(2002-2005); national financial secretary, PSN(2002); and secretary, PSN technical committee on NHIS (2003-2005).

He has been secretary of the African Pharmaceutical Forum (APF) since 2006; member, Commonwealth Pharmaceutical Association (CPA); member, International Pharmaceutical Federation (FIP) and was a member of the Think Tank Group of the West African Postgraduate College of Pharmacists in 2007.

Pharm. Mohammed who was, until his appointment, general manager, Swiss Biostadt Limited, Lagos, was a healthcare management consultant for PATHS/DFID, Nigeria (2006); healthcare management consultant, Federal Ministry of Health (Food & Drug Division), from 2006 to 2011; member, Pharmacists Council of Nigeria, 2006; member, technical working group, National Pharmacovigilance Policy Development, from 2010 to 2011; member, Presidential Committee on the Pharmaceutical Sector Reform, from 2003 to 2004; and member, Governing Council of Pharmacists Council of Nigeria (PCN), from 2005 to 2007.

The new PCN registrar, who has been the secretary of the Board of Fellows of PSN since 2012, is also a certified professional member, Nigerian Institute of Management (NIM).

Pharmacists are public health advocates – Prof. Femi-Oyewo

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(By Adebayo Oladejo)

           Dean of the Faculty of Pharmacy, Olabisi Onabanjo University, Shagamu, Ogun State, Prof. (Mrs) Mbang Nyong Femi-Oyewo, has stated that the professional roles of pharmacists have evolved in recent years from mere drug dispensing and distribution to more patient-oriented, point-of-care services, involving pharmaceutical care models, medication therapy management, and effective patient education to achieve good therapeutic outcomes.

The university don, who made the statement while delivering her keynote address at the 33rd annual national conference of the Association of Community Pharmacists of Nigeria (ACPN), in Ilorin, Kwara State, further stated that good pharmacy practice (GPP) and point-of-care services are essential for best practices in community pharmacy.

According to her, good pharmacy practice (GPP), as defined by the World Health Organisation (WHO) and the International Pharmaceutical Federation (FIP), “is the practice of Pharmacy that responds to the needs of the people who use the pharmacist’s services to provide optimal, evidence-based care.”

She reiterated that the mission of pharmacy practice is to contribute to health improvement and to help patients with health problems, adding that pharmacists should be acknowledged as healthcare professionals whom patients can consult for health-related problems.

“Problems that require additional diagnostic skill or treatments not available from a pharmacist can be referred to an appropriate healthcare professional or site-of-care.”

Continuing, she said, “The traditional role of pharmacists is changing and pharmacists should now be identified as ‘public health advocates’…As healthcare professionals, pharmacists play an important role in improving access to health care and in closing the gap between the potential benefit of medicines and the actual value realised and should be part of any comprehensive health system.”

Prof. Femi-Oyewo also tasked pharmacists on the need to pay attention to the various aspects of the process of medicines use, each of which is important to achieving good outcomes from treatment. The process, according to her, begins with ensuring the integrity of the medicine supply chain, including detecting spurious/falsely-labeled/falsified/counterfeit medicines, proper storage and preparation of medicines; proper prescribing of medicines; providing instructions for use; ensuring that medicine–medicine/medicine–food interactions are prevented; and also preventing adverse reactions and other contraindications.

She emphasized that, in facilitating good pharmacy practice, it is essential to have an established national framework of quality standards and guidelines. This, she said, had been prepared and published by the Pharmaceutical Society of Nigeria (PSN), under the National Good Pharmacy Practice Guidelines, 2012.

“Every pharmacist, especially the community pharmacist, must have a copy, as it is essential for good pharmacy practice. The guidelines is very comprehensive, as it includes facilities, personnel, quality policy and service strategy training, complaints and recalls, documentation system, procurement, inventory management, storage prescription handling and dispensing, patient information and counselling, medication records and patients follow-up, self-care and health promotion, development of professional role, pharmaco-vigilance and audit (including checklist for quality audit),” she urged.

Eat mango to prevent liver diseases, cancer, diabetes, others

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(By Temitope Obayendo)

Mango is, no doubt, an appealing and appetising fruit. And that’s why many are so fond of it. But there is more to this juicy fruit than its look and taste: it is also loaded with health benefits. Scientists have reported that extracts of mango have hepatoprotective, anti-diabetic, anti-viral, anti-tumour, as well as gastroprotective properties, among other attributes.

 

Generally regarded as “the king of fruits” and scientifically called Mangifera indica, mango fruit is known as mangoro among the Yorubas, mangolo among the Ibos, ogwi among the Edos, and mangwaro among the Hausas.

The mango tree is believed to have originated from the sub-Himalayan plains of the Indian subcontinent. Botanically, this exotic fruit belongs to the Anacardiaceae family of plants, a family that also includes other numerous species of flowering plants.

Each mango fruit measures 5 to 15cms in length and about 4 to 10cms in width. It comes in different shapes and sizes depending on cultivar types. Its weight ranges from 150g to around 750g. Outer skin is smooth and is green in unripe mangoes but turns to golden yellow, bright yellow or orange-red when ripened, also depending upon the cultivar. Fresh mango season lasts from April until August.

Internally, mango flesh is juicy, orange-yellow in colour with numerous soft fibrils radiating from its centrally placed, flat, oval-shaped stone (enveloping a single large kidney-shaped seed). Its flavour is pleasant and rich, and tastes sweet with mild tartness. A high-quality mango fruit should feature no or very little fibre content and minimal sour taste. Mango seed (stone) may either have a single embryo or could be polyembryonic.

According to a study titled “Evaluation of aqueous stem bark extract of Mangifera indica on the liver of wistar rats”, published in the Asian Journal of Pharmaceutical Biological  Research, 2012, laboratory results show that the histological sections of the liver showed  normal tissue architecture, no form of cell distortion as the tissue architecture were  well preserved.

The research which was conducted by Oyewo O. O., Onyije F. M ., Ashamu E. A ,  Akintude O. W . ,  and Ayeni O.J of the Department of Human Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria, examined the effects of mango extracts on the liver of wister rats.

Methodically, twenty Wister rats of both sexes (150-200g) were selected, and they were randomly divided into four groups of five each and tested as follows:

Group O- control (distilled water), Group A – M. indica extract (1.0 ml/kg, orally), Group B – M. indica extract (1.5 ml/kg, orally), Group C – M. indica extract (2.0 ml/kg, orally). Each ml contains 0.11g of the extract. After 21days of treatment, the livers were dissected for histological examination, and it was discovered that no form of distortion was found on the rats livers.

The researchers however noted that the report could be dose-dependent and may show effect in higher doses, therefore caution should be applied when using higher doses of M.indica extracts.

Other studies also corroborated that the leaf, root and stem bark of mango are widely used for medicines. Mangifera indica is used medicinally to treat ailments such as asthma, cough, diarrhea, dysentery, leucorrhoea, jaundice, pains, malaria, diabetes, infertility, lupus, prostatic hyperplasia, gastric disorders, mouth sores and tooth pain.

 

Nutritional contents of mango

Nutrition by the Numbers

One cup (225 gms  contains the following. Percentages apply to daily value.

105 calories

76 per cent vitamin C (antioxidant and immune booster)

25 per cent vitamin A (antioxidant and vision)

11 per cent vitamin B6 plus other B vitamins (hormone production in brain and heart disease prevention)

9 per cent healthy probiotic fiber

9 per cent copper (copper is a co-factor for many vital enzymes plus production of red blood cells)

7 per cent potassium (to balance out our high sodium intake)

4 per cent magnesium

In a related, titled: “Phytochemical screening for active compounds in Mangifera indica leaves”, conducted by O.O. Aiyelaagbe and Paul M. Osamudiamen, the result revealed the presence of saponin, steroids, tannin, flavonoid, reducing sugars, cardiac glycosides and anthraquinone.

The report stated that Mangifera indica (Edward variety) from Ibadan, Oyo State were screened for the presence of chemically active compounds by standard methods, and the result confirmed that mangos are loaded with a lot of medicinal properties for human wellness.

According to the study, dried mango flowers, containing 15 per cent tannin serve as astringents in cases of diarrhoea, chronic dysentery and chronic urethritis. The bark contains mangiferine and is astringent when used against rheumatism and diphtheria. Leaf decoction when taken is a remedy for fever, chest pains, diarrhea, diabetes and hypertension. Extracts of bark, leaves, stem and unripe fruits are used as antibiotics for many ills.

Tannins are reported to exhibit antiviral, antibacterial, anti-tumor activities. It was also reported that certain tannins are able to inhibit HIV replication selectivity and  also used as diuretic (Heslem, 1989). Plant tannin have been recognised for their pharmacological properties and are known to make trees and shrubs a difficult meal for many caterpillars (Heslem, 1989).

Cardiac glycosides are known to work by inhibiting the Na+/K+ pump. This causes an increase in the level of sodium ions in the myocytes, which then lead to a rise in the level of calcium ions. This inhibition increases the amount of Ca2+ ions available for contraction of the heart muscle, which improves cardiac output and reduces distension of the heart; thus, they are used in the treatment of congestive heart failure and cardiac arrhythmia. They are also used to strengthen a weakened heart and allow it to function more efficiently, though the dosage must be controlled carefully, since the therapeutic dose is close to the toxic dose (Denwick, 2002).

Plant steroids are known to be important for their cardiotonic activities; they possess insecticidal and anti-microbial properties. They are also used in nutrition, herbal medicine and cosmetics (Callow, 1936), they are routinely used in medicine because of their profound biological activities (Denwick, 2002).

In a recent chat with Dr. Olufunke Adeniji, of the Redeemer’s University, Redemption City, Mowe, on the health benefits of mango, she asserted that mango is a rich source  of dietary fibre, with a trace of fat, sodium, zinc, copper and selenium.

Adeniji, who is a nutritionist, also noted that mango leaf and tree have medicinal properties, which could cure diabetes, gum inflammation and others.

According to her, mango contains calcium, phosphorous, potassium, vitamins A, B, E K and folate. It is high in vitamin C and high content of water and trace of ash.

 

Other health benefits of mango

1.  Prevents cancer:

Research has shown antioxidant compounds in mango fruit have been found to protect against colon, breast, leukaemia and prostate cancers. These compounds include quercetin, isoquercitrin, astragalin, fisetin, gallic acid and methylgallat, as well as the abundant enzymes.

 

2.  Lowers cholesterol:

The high levels of fibre, pectin and vitamin C help to lower serum cholesterol levels, specifically Low-Density Lipoprotein (the bad stuff).

 

3.  Clears the Skin:

Can be used both internally and externally for the skin. Mangoes clear clogged pores and eliminate pimples.

 

4.  Eye health:

One cup of sliced mangoes supplies 25 per cent of the needed daily value of vitamin A, which promotes good eyesight and prevents night blindness and dry eyes.

 

5.  Alkalizes the whole body:

The tartaric acid, malic acid, and a trace of citric acid found in the fruit help to maintain the alkali reserve of the body.

 

6. Improved sex:

Mangos are a great source of vitamin E. Even though the popular connection between sex drive and vitamin E was originally created by a mistaken generalisation on rat studies, further research has shown balanced proper amounts (as from whole food) does help in this area.

 

7. Improves  digestion:

Papayas are not the only fruit that contain enzymes for breaking down protein. There are several fruits, including mangoes, which have this healthful quality. The fibre in mangos also helps digestion and elimination.

 

8. Remedy for heat stroke

Juicing the fruit from green mango and mixing with water and a sweetener helps to cool down the body and prevent harm to the body. From an ayurvedic viewpoint, the reason people often get diuretic and exhausted when visiting equatorial climates is because the strong “sun energy” is burning up your body, particularly the muscles.  The kidneys then become overloaded with the toxins from this process.

 

9. Boosts immune system

The generous amounts of vitamin C and vitamin A in mangoes, plus 25 different kinds of carotenoids keep your immune system healthy and strong.

 

References: Asian Journal of Pharmaceutical Biological Research, 2012; Home Journals Plant Sciences Research Volume 2

Human resource management in health care delivery systems: Challenges, trends and strategies

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Dr Femi Olaleye

 

 

 

 

 

 

(By Dr Femi Olaleye MB.ChB., MBA)

 

Human resource management (HRM)is defined as the “integrated use of procedures, policies, and practices to recruit, maintain, and develop employees in order for an organisation to meet its desired goals.”

HRM includes six major functions:

·     Personnel policy

·     Performance management

·     Training

·     HR data systems

·     HR strategy development

·     General leadership and management

 

HRM in sub-Saharan Africa

The acute shortage of health care workers in sub-Saharan Africa is well-documented, but little attention has been paid to those who have HRM responsibilities; i.e. the individuals who are tasked with developing and leading a productive, motivated, and well-supported health workforce capable of delivering quality and accessible health services.

It is interesting to note that Africa produces up to 25 per cent of the world’s healthcare workforce but retains only 1 per cent of this workforce, despite the huge disease burden plaguing the continent! This deficit is largely from brain drain (internal and external) as a result of poor understanding of HRM issues and the appropriate interventions needed to generate improved performance of the health worker.

 

The ‘brain drain’ effect

Nigeria (and Africa as a whole) is currently reeling under the negative effect of massive migration of health workers over the past 3 decades. The net effect of this migration is that we are essentially subsidising health care for other nations.

However, there are many reasons for this migration, chief of which are:

·     Poor prevailing economic climate.

·     Huge financial ‘barriers to entry’ into private practice.

·     Lack of opportunities for training and specialisation.

 

Human resource managers

The lack of well-trained human resource managers mirrors Africa’s shortage of health care professionals, in general.  Hence, addressing the shortage of human resource managers is a key factor standing between success and failure in Africa’s effort to alleviate its crushing burden of disease and the imminent inability of African countries in meeting the Millennium Development Goals (MDGs) in 2015.

Building the capacity of human resource managers in the health sector is therefore critical at this time when countries need to scale-up services relating to HIV/AIDS, tuberculosis, malaria, maternal and reproductive health to meet the health challenges facing their populations.

 

Prevalent HRM gaps

A four-country study (Kenya, Tanzania, Ethiopia and Zambia) funded by USAID found competency gaps in the six major HRM functions in healthcare across all the administrators and managers responsible for HRM and productivity in these countries.

HRM challenges identified by the respondents (n=98) include:

·     Understaffing (67 per cent)

·     Lack of staff satisfaction on the job (65 per cent)

·     Lack of skilled HRM staff (63 per cent)

·     Poor working conditions for staff with HR responsibilities (60 per cent)

·     Staff grievances (52 per cent)

These competency gaps and challenges are severely limiting the capacity of health service organisations and healthcare professionals to meet the needs of their populations.

 

Bridging the HR competency gap

After the study, the following recommendations were made:

·     Create a professional cadre of HR managers with responsibility for the welfare of health staff.

·     Provide in-service orientation and training on effective HR management practices to health managers at various levels who have HR responsibility.

·     Put proven, practical tools directly into the hands of HRM health managers.

·     Review national-level HR policy to identify and address obstacles that inhibit effective HRM.

·     Strengthen HR information systems to collect timely data for informed decision-making.

·     Develop and implement training programs in HRM at local management schools.

·     Review the pre-service and in-service training and provide courses on HRM, general management, and leadership.

 

What works?

To drive progress in human resource management within the health care sector, there is the need to conduct an evidenced-based assessment. One of such is the landmark study titled Human Resource Management Interventions to Improve Health Workers’ Performance in Low & Middle Income Countries. The study systematically reviewed 48 published studies on HRM from 1997 to 2007 to find out the particular intervention strategies that were employed, the time of deployment, the contextual success factors, the mechanisms that influenced or triggered change and the results. They found that, with continuing education, the proportion of health care providers correctly performing specific tasks improved by 18 per cent to 39 per cent, depending on tasks and type. Also, training in communication showed improvement in the short-term. Continuing education of untrained (auxiliary) nurses was found to improve their performance –even outperforming physicians in certain tasks.

These improvements in the health workers’ performance were found to be triggered by three mechanisms, namely: (1) improved knowledge and skills; (2) critical awareness on the functioning of health services; and (3) an empowerment to implement change.

It was equally found that for success to happen there was the need for a participatory approach to be deployed. The course contents should be developed based on local problems, while relevant materials must be adapted to fit the local situation.

Another critical finding was that practising the tasks in the field under supervision during the training greatly improved performance. Also, the development of a cascade training scheme with health care workers being trained as trainers greatly improved the success of the continuing education programme.

 

Workers’ supervision

A study investigating the role of supervision in public facilities (stock management and treatment protocols)was evaluated and it showed a difference of about 14 per cent to 47 per cent in adherence to various aspects of stock management protocols and standard treatment guidelines, compared to the control groups.

A critical contextual factor, though, was the presence of regular drug supplies. In other words, the availability or non-availability of relevant resources (in this case, drug supplies) greatly affected adherence to the guidelines.

It was found that when the supervision was done in a participatory manner, with mutual respect between supervisors and health workers, the workers gained increased skills and knowledge.  Also, the health workers gained a sense of belonging.

 

Payment of incentives

Four studies evaluated the results of paying incentives to health workers,three of which introduced user-fees and paid staff from patients’ fees, community cost-sharing schemes or DRF. The studies indicated that paying incentives can improve performance of a facility and can increase job satisfaction, staff motivation and patient satisfaction.

In Cambodia, payment of staff accompanied by other interventions, such as organisational changes, increased the average number of deliveries significantly from 319 to 585 per month, and the average bed occupancy rate from 51 per cent to almost 70 per cent.

Certain contextual factors influenced the success of the interventions:

·     The utilisation of services was not necessarily influenced by user fees when patients were accustomed to paying informal fees.

·     The utilisation of certain services dropped in urban areas in Uganda and in rural Nigeria after introduction of user fees.

·     In the Nigerian study, delay or non-payment of salaries and drug stock-outs caused a decline in staff motivation over time, with a negative influence on performance.

 

Some observations and inferences were also drawn from the studies:

·     Linking individual salary to functioning of health facilities can improve staff performance.

·     The mechanism that enabled this link was staff motivation, leading to development of staff initiatives to improve quality or to increased presence at work and reduced absenteeism.

·     In Cambodia, staff motivation to develop initiatives appeared to be a result of staff awareness that they were able to influence use and quality of care and of staff empowerment to introduce change.

·     Self-confidence to continue developing initiatives for change was created when these changes actually improved quality of care.

·     On the contrary, in Nigeria, the study showed that staff were motivated to increase drug sales and financing, due to government focus on cost recovery and health workers’ interest for revenue generation.This led to over- and irrational prescribing behaviour and a preference for curative services at the expense of health preventive services and community health promotion.

 

Effects of decentralisation of HRM functions

Two studies – one  in Mozambique and  the other in China –investigated the impact of decentralisation of HRM functions

The studies showed that decentralisation of HRM functions could have a positive impact, but complementary interventions to create an enabling environment were required. These include management training, changes in bureaucratic procedures and appropriate preparation in structures and staffing.

In Mozambique, it was found that the political interference of district administrators influenced transfers of health workers, and administrative constraints prevented adequate performance evaluation.

In China, managers faced problems in addressing appropriate recruitment, due to social pressure to recruit (incompetent) relatives and friends and they faced organisational pressure to increase hospital income.

 

The role of regulation

One study (In Laos) evaluated the effectiveness of regulatory interventions such as inspection visits, selective punishments and provision of regulatory documents on the practice of private pharmacies.

Evaluation occurred immediately after the interventions and showed improved practices, as follows:

i.    An increase of 34 per cent in the availability of essential dispensing material and of 19 per cent in order in the pharmacies.

ii.   Adding intensive supervision of drug inspectors caused a significant change only in availability of essential dispensing material.

 

Quality Improvement interventions

Seven Quality Improvement (QI) interventions were identified, all using a participatory approach, analysing performance data by staff involved in service delivery, identification and implementation of local opportunities to improve performance.

Research indicated that QI interventions improved the performance of tasks and case management, and that they could be successful in different contexts.For example, QI implemented in hospitals in Ghana and Jamaica caused significant changes in obstetric care in both countries, such as an increase from 65 per cent to 93 per cent of patients with genital tract sepsis treated with broad-spectrum antibiotics.

Critical implementation aspects of the interventions contributing to success include:

·     Involving staff, communities and local health authorities in setting standards – possibly through audits and clinical meetings.

·     Receiving support from the management of the facility and senior officials.

·     Using available funds and developing feasible plans for local teams

It was found that improvements from QI interventions were due to increased job satisfaction, improved staff morale due to feedback meetings,and community involvement and ownership. Another additional mechanism that led to the observed changes includes increased knowledge, due to training and acceptance of indicators and willingness to adhere to self-set standards.

 

Conclusions

The review of published HRM interventions offers an opportunity to gain a better understanding of how different HRM interventions can improve performance, depending on circumstances and groups of health workers.

To improve health workers’ performance, health managers need insight into the context within which interventions achieved results elsewhere and an understanding of the mechanisms that triggered change.

The general principle that financial incentives trigger motivation, which leads to improved performance, can be misleading because such incentives produced negative outcomes in terms of over-prescribing and over-treating when health workers were solely rewarded by cost-recovery and revenue generation.

Non-financial rewards, such as improved patient satisfaction or patient outcomes, improved quality of care, improved relations with colleagues and managers, recognition and appreciation were only to a limited extent implemented and researched. Various studies have shown that health workers perceive non-financial incentives as more important motivators than financial incentives. It will be interesting to evaluate the use of non-financial rewards to improve performance.

The most often published HRM intervention was continuing education, despite the available evidence of limited success of ‘training’ as a single HRM intervention. Examples of additional HRM components that could bring about change are mainly related to staff motivation and feeling obliged to change by both users and providers of healthcare.

Research in high-income countries shows that “bundles of interlinked human resource practices” that are aligned to the strategy and mission of an organisation are effective in enhancing workers’ performance. These best practices need to be shared across board and evaluated for effectiveness before being adapted for different settings and scenarios.

Finally, to gain a better understanding of outcomes of HRM interventions, the mechanisms that caused change, and the context within which this change occurred, as well as a combination of further qualitative and quantitative research methods, are essential.

 

Dr. Femi Olaleye is the MD/CEO of Optimal HealthCare (Nig), Optimal Cancer Care Foundation and Wish for Africa (UK).

Effective management of asthma

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Asthma is a chronic disease characterised by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. Symptoms may occur several times in a day or week in affected individuals, and for some people become worse during physical activity or at night.

 

Asthma attack

During an asthma attack, the lining of the bronchial tubes swell, causing the airways to narrow and reducing the flow of air into and out of the lungs. Recurrent asthma symptoms frequently cause sleeplessness, daytime fatigue, reduced activity levels and school and work absenteeism. Asthma has a relatively low fatality rate, compared to other chronic diseases.

Asthma 2

Causes of asthma

The fundamental causes of asthma are not completely understood. The strongest risk factors for developing asthma are a combination of genetic predisposition with environmental exposure to inhaled substances and particles that may provoke allergic reactions or irritate the airways. These include:  indoor allergens (for example, house dust mites in bedding, carpets and stuffed furniture, pollution and pet dander); outdoor allergens (such as pollens and moulds); tobacco smoke; chemical irritants in the workplace; and air pollution.

Other triggers can include cold air, extreme emotional arousal such as anger or fear, and physical exercise. Even certain medications can trigger asthma, including aspirin and other non-steroid anti-inflammatory drugs, and beta-blockers (which are used to treat high blood pressure, heart conditions and migraine).

Urbanisation has been associated with an increase in asthma. But the exact nature of this relationship is unclear.

According to WHO estimates, about 235 million people suffer from asthma globally. Although asthma cannot be cured, appropriate management can control the disorder and enable people to enjoy good quality of life. In addition, some children with milder forms of asthma outgrow their symptoms with age.

 

Asthma in Nigeria

According to the Chief Medical Director (CMD), University of Uyo Teaching Hospital, Professor Etete Peters, about 25 million Nigerians have been diagnosed of the respiratory condition known as asthma in Nigeria.

Professor Peters, who disclosed this on 8 May during the World Asthma Day held at the conference hall of the hospital, said the number was estimated to rise in the nearest future, as a result of industrialisation and better diagnosis facilities.

Speaking on the theme, “You can Control Your Asthma,” the CMD stated that  asthma accounts for about one out of every 250 deaths recorded worldwide, stressing that the number of deaths arising from asthma disease is similar to that of killer diseases such as diabetes and cirrhosis.

The medical practitioner, who is also president of the Nigerian Thoracic Society (NTS), described asthma as “the chronic inflammatory disorder of airway, with a global prevalence ranging from one to 18 per cent.”

Types of asthma

The following types of asthma have been identified:

Child-onset asthma

Asthma that begins during childhood is called child-onset asthma. This type of asthma happens because a child becomes sensitised to common allergens in the environment, most likely due to genetic reasons. The child is atopic – a genetically determined state of hypersensitivity to environmental allergens.

Allergens are any substances that the body will treat as a foreign body, triggering an immune response. These vary widely between individuals and often include animal proteins, fungi, pollen, house-dust mites and some kind of dust. The airway cells are sensitive to particular materials, making an asthmatic response more likely if the child is exposed to a certain amount of an allergen.

Adult-onset asthma

This term is used when a person develops asthma after reaching 20 years of age. Adult-onset asthma affects women more than men, and it is also much less common than child-onset asthma. It can also be triggered by some allergic material or an allergy.

It is estimated that up to perhaps 50 per cent of adult-onset asthmas are linked to allergies. However, a substantial proportion of adult-onset asthma does not seem to be triggered by exposure to allergen(s); this is called non-allergic adult-onset asthma. This non-allergic type of adult onset asthma is also known as intrinsic asthma.

Exposure to a particle or chemical in certain plastics, metals, medications, or wood dust can also be a cause of adult-onset asthma.

Exercise-induced Asthma

If you cough, wheeze or feel out of breath during or after exercise, you could be suffering from exercise-induced asthma. Obviously, your level of fitness is also a factor – a person who is unfit and runs fast for ten minutes is going to be out of breath. However, if your coughing, wheezing or panting does not make sense, this could be an indication of exercise-induced asthma.

As with other types of asthma, a person with exercise-induced asthma will experience difficulty in getting air in and out of the lungs because of inflammation of the bronchial tubes (airways) and extra mucus.

Some people only experience asthma symptoms during physical exertion. The good news is that with proper treatment, a person who suffers from exercise-induced asthma does not have to limit his/her athletic goals. With proper asthma management, one can exercise as much as desired. Mark Spitz won nine swimming gold medals during the 1972 Olympics and he suffered from exercise-induced asthma.

80 per cent of people with other types of asthma may have symptoms during exercise, but many people with exercise-induced asthma never have symptoms while they are not physically exerting themselves.

Cough-induced asthma

Cough-induced asthma is one of the most difficult asthmas to diagnose. The doctor has to eliminate other possibilities, such as chronic bronchitis, post nasal drip due to hay fever, or sinus disease. In this case, the coughing can occur alone, without other asthma-type symptoms being present. The coughing can happen at any time of day or night. If it happens at night it can disrupt sleep.

Occupational asthma

This type of asthma is triggered by something in the patient’s place of work. Factors such as chemicals, vapours, gases, smoke, dust, fumes, or other particles can trigger asthma. It can also be caused by a virus (flu), moulds, animal products, pollen, humidity and temperature. Another trigger may be stress. Occupational asthma tends to occur soon after the patient starts a new job and disappears not long after leaving that job.

Nocturnal asthma

Nocturnal asthma occurs between midnight and 8am. It is triggered by allergens in the home such as dust and pet dander or by sinus conditions. Nocturnal or night-time asthma may occur without any daytime symptoms recognised by the patient. The patient may have wheezing or short breath when lying down and may not notice these symptoms until awoken by them in the middle of the night – usually between 2 and 4am.

Nocturnal asthma may occur only once in a while or frequently during the week. Night-time symptoms may also be a common problem in those with daytime asthma, as well. However, when there are no daytime symptoms to suggest asthma is an underlying cause of the night-time cough, this type of asthma will be more difficult to recognise – usually delaying proper therapy.

The causes of this phenomenon are unknown, although many possibilities are under investigation.

 

Steroid-resistant asthma (severe asthma)

While the majority of patients respond to regular inhaled glucocorticoid (steroid) therapy, some are steroid resistant. Airway inflammation and immune activation play an important role in chronic asthma. Current guidelines of asthma therapy have therefore focused on the use of anti-inflammatory therapy, particularly inhaled glucocorticoids (GCs).

By reducing airway inflammation and immune activation, glucocorticoids are used to treat asthma. However, patients with steroid-resistant asthma have higher levels of immune activation in their airways than do patients with steroid sensitive (SS) asthma.

Furthermore, glucocorticoids do not reduce the eosinophilia (high concentration of eosinophil granulocytes in the blood) or T cell activation found in steroid resistant asthmatics. This persistent immune activation is associated with high levels of the immune system molecules IL-2 (interleukin 2), IL-4 and IL-5 in the airways of these patients.

Management of asthma

Although asthma cannot be cured, appropriate management can control the disease and enable people to enjoy good quality of life.

Short-term medications are used to relieve symptoms. People with persistent symptoms must take long-term medication daily to control the underlying inflammation and prevent symptoms and exacerbations.

Medication is not the only way to control asthma. It is also important to avoid asthma triggers – stimuli that irritate and inflame the airways. With medical support, each asthma patient must learn what triggers he or she should avoid.

Although asthma does not kill, on the scale of chronic obstructive pulmonary disease (COPD) or other chronic diseases, failure to use appropriate medications or to adhere to treatment can lead to death.

Diagnosing asthma

Asthma diagnoses are based on three core components: a medical history, a physical exam, and results from breathing tests. A primary care physician will administer tests and, if you have asthma, determine your level of asthma severity as intermittent, mild, moderate, or severe.

Medical history

A detailed family history of asthma and allergies can help your doctor make an accurate asthma diagnosis. Your own personal history of allergies is also important, as many are closely linked to asthma.

Information about asthma symptoms is also useful. Be prepared to divulge when and how often they occur and what factors seem to exacerbate or worsen symptoms. Common symptoms and signs include:

·     Wheezing

·     Coughing

·     Breathing difficulty

·     Tightness in the chest

·     Worsening symptoms at night

·     Worsening symptoms due to cold air

·     Symptoms while exercising

·     Symptoms after exposure to allergens

It is also wise to make note of health conditions that can interfere with asthma management such as runny nose, sinus infections, acid reflux disease, psychological stress, and sleep apnoea.

It is often somewhat harder to diagnose young children who may develop their first asthma symptoms before age five. Symptoms are likely to be confused with those of other childhood conditions, but young children with wheezing episodes during colds or respiratory infections are likely to develop asthma after six years of age.

Physical exam

A physical examination will generally focus on the upper respiratory tract, chest, and skin. A doctor will use a stethoscope to listen for signs of asthma in your lungs as you breathe. The high-pitched whistling sound while you exhale – or wheezing – is a key sign of both an obstructed airway and asthma.

Physicians will also check for a runny nose, swollen nasal passages, and nasal polyps. Skin will be examined for conditions such as eczema and hives, which have been linked to asthma.

Physical symptoms are not always present in asthma sufferers, and it is possible to have asthma without presenting any physical maladies during an examination.

 

Asthma tests

Lung function tests, or pulmonary function tests, are the third component of an asthma diagnosis. To measure how much air you breathe in and out and how fast you can blow air out, physicians administer a spirometry test.

Spirometry is a non-invasive test that requires you to take deep breaths and forcefully exhale into a hose connected to a machine called a spirometer. The spirometer then displays two key measurements: Forced vital capacity (FVC) – the maximum amount of air one can inhale and exhale; and Forced expiratory volume (FEV-1) – the maximum amount of air exhaled in one second. The measurements are compared against standards developed for a person’s age, and measurements below normal may indicate obstructed airways.

It is common for a doctor to administer a bronchodilator drug to open air passages before retesting with the spirometer. If results improve after the drug, there is a higher likelihood of receiving an asthma diagnosis.

Children younger than five years of age are difficult to test using spirometry, so asthma diagnoses will rely mostly on symptoms, medical histories, and other parts of the physical examination. It is common for doctors to prescribe asthma medicines for four to six weeks to see how a young child responds.

 

Other tests

A “Challenge Test” (or bronchoprovocation test) is when a physician administers an airway-constricting substance (or something as simple as cold air) to deliberately trigger airway obstruction and asthma symptoms. Similarly, a challenge test for exercise-induced asthma would consist of vigorous exercise to trigger symptoms. A spirometry test is then administered, and if measurements are still normal, an asthma diagnosis is unlikely.

Physicians use allergy tests to identify substances that may be causing or worsening asthma. These tests cannot be used to diagnose asthma, but they can be used to understand the nature of asthma symptoms.

Doctors may also test for another disease with similar symptoms as asthma, such as reflux disease, heartburn, hay fever, sinusitis, sleep apnoea, chronic obstructive pulmonary disease (COPD), airway tumours, airway obstruction, bronchitis, lung infection (pneumonia), blood clot in the lung (pulmonary embolism), congestive heart failure, vocal cord dysfunction, and viral lower respiratory tract infection.

Tests may be administered for these ailments such as chest x-rays, EKGs (electrocardiograms), complete blood counts, CT (computerised tomography) scans of the lungs, gastroesophageal reflux assessment, and sputum induction and examination.

A new test using exhaled nitric oxide is being evaluated, since physicians are looking for a test that is more accurate than spirometry. Higher levels of nitric oxide are linked to higher degrees of asthma severity. The current drawback lies in the high cost of the test and the specialised equipment required measuring this chemical marker.

An asthma specialist can usually be avoided, as most primary care physicians are capable of diagnosing asthma. An asthma specialist may be necessary, however, if you need special asthma tests or have had a life-threatening asthma attack in the past. In addition, specialists can be of use, if you need more than one kind of medicine or higher doses of medicine in order to control your asthma, if you have overall difficulty controlling asthma, or if you will be receiving allergy treatments.

 

Treatment for asthma

Asthma is not so much “treated” as it is “controlled”. As a chronic, long-term disease, there is no cure. However, there are tools and medicines to help you control asthma as well as benchmarks to gauge your progress.

 

The peak flow meter

A peak flow meter is a simple, small, hand-held tool that can help you maintain control of asthma by providing a measurement of how well air moves out of the lungs.

After blowing into the device, the meter reveals your peak flow number. A physician will indicate how often to test, as well as how to interpret the result to determine the amount of medication to take. Some people record scores every morning, while others use the peak flow meter intermittently.

Often, each test with the peak flow meter will be judged against your “personal best” peak flow number (found during 2 to 3 weeks of good asthma control). If peak flow tests begin to decline – even before other symptoms are present – it may indicate a looming asthma attack. After taking asthma medication, the peak flow meter can be used to test the effectiveness of drug therapy.

 

Good control

Asthma is considered “well-controlled” if:

·     Chronic and troublesome symptoms (coughing and shortness of breath) are prevented and occur no more than two days per week.

·     There is little need for quick-relief medicines or they are needed less than two days per week.

·     You maintain good lung function.

·     Your activity level remains normal.

·     Your sleep level remains normal and symptoms do not wake you from sleep more than one to two nights per month.

·     You do not need emergency medical treatment.

·     You have no more than one asthma attack each year that requires inhalation of corticosteroids.

·     Your peak flow stays above 80 per cent of your personal best number.

 

These benchmarks can be obtained by working with a doctor and avoiding factors that can make your asthma flare up. Also be sure to treat other conditions that may interfere with asthma management.

Good control also means avoiding things that trigger asthma or asthma symptoms such as allergens. This may mean limiting time spent outdoors when pollen levels or air pollution levels are highest and limiting contact with animals. Asthma linked to allergies can also be suppressed by getting the necessary allergy shots.

 

Preventive check-ups

Part of good asthma control is seeing a doctor every two to six weeks for regular checkups until it is under control. Then checkups may be reduced to once a month or twice a year.

It is a good habit to keep track of asthma symptoms and attacks and diagnostic numbers such as the peak flow measurement. Doctors and nurses will ask about these and about daily activities, in order to gauge the status of your asthma control.

 

Medicine

Medication for asthma is broadly categorised as either quick-relief medicine or long-term control medicine. Reducing airway inflammation and preventing asthma symptoms is the goal of long-term control medicines, where as immediate relief of asthma symptoms is the goal of quick-relief or “rescue” medicines.

Medications can be ingested in pill form, but most are powders or mists taken orally using a device known as an inhaler. Inhalers permit medicines to travel efficiently through the airways to the lungs.

 

Inhaler

Medication may also be administered using a nebuliser, providing a larger, continuous dose. Nebulisers vaporise a dose of medication in a saline solution into a steady stream of foggy vapour that is inhaled by the patient.

SMART (Single Inhaler Maintenance and Reliever Therapy) is better for the relief and preventive treatment of asthma symptoms in adults, compared to standard therapy, researchers reported in The Lancet Respiratory Medicine (March 2013 issue). SMART refers to using ICS (corticosteroid) plus LABA (long-acting â2 agonist) in one inhaler.

 

Long-term control

Long-term control medicines are taken every day and are designed to prevent asthma symptoms such as airway inflammation. Inhaled corticosteroids are the most effective long-term control medicine – the best at relieving airway inflammation and swelling. They are usually taken daily to greatly reduce the inflammation that initiates the chain reaction of the asthma attack.

Even if taken every day, inhaled corticosteroids are not habit-forming. However, the medicines do have side effects such as the mouth infection known as “thrush”. Thrush occurs when the corticosteroids land in your throat or mouth. Spacers or holding chambers have been developed to help avoid this. Thrush can also be avoided by rinsing the mouth out after inhalation.

Inhaled corticosteroids also increase the risk of cataracts (clouding of the eye’s lens) and osteoporosis (weakening of the bones), if taken for long periods of time.

There are other long-term control medicines available that doctors may prescribe. Most of them are taken by mouth and are designed to open the airways and prevent airway inflammation. Examples include inhaled long-acting B2-agonists (used with low-dose inhaled corticosteroids), leukotriene modifiers, cromolyn and nedocromil, and theophylline.

 

Quick-relief medicines

Quick-relief medicines relieve asthma symptoms when they occur. The most common of these are inhaled short-acting B2-agonists – bronchodilators that quickly relax tight muscles around the airways, allowing air to flow through them.

The quick-relief inhaler should be used when asthma symptoms are first noticed, but should not be used more than 2 days a week. Most people carry the quick-relief inhaler with them at all times. Quick-relief medicines usually do not reduce inflammation and therefore should not be used as a replacement for long-term control medicines.

 

Pregnant women

Proper asthma control is necessary for pregnant women, in order to ensure a good supply of oxygen to the foetus. Babies born of asthmatic mothers have a higher chance of premature birth and lower birth weight. For pregnant women, the risks associated with having an asthma attack outweigh any risks associated with asthma medicines.

 

Vitamin D may reduce asthma symptoms

Researchers from King’s College, London, have discovered how vitamin D can reduce asthma symptoms. Catherine Hawrylowicz and team explained in the Journal of Allergy and Clinical Immunology (May 2013 issue) that their findings may offer a new way of treating the debilitating and usually chronic condition.

Asthma patients are currently prescribed steroid tablets, which may have harmful side effects. There is a type of asthma, however, that is resistant to steroid therapy. Patients with this type are susceptible to severe and often life-threatening asthma attacks.

The scientists found that people with asthma have higher levels of IL-17A (interleukin-17A). IL-17A is part of the immune system that protects the body against infection. However, this natural compound also worsens asthma symptoms. Large amounts of IL-17A can reduce the clinical effects of steroids.

The team found that asthma patients who were on steroids had the highest levels of IL-17A. They also found that vitamin D significantly lowers IL-17A production in cells. Hawrylowicz believes vitamin D could be a safe and useful add-on treatment.

 

Non-medical treatments

Some people treat asthma using unconventional alternative therapies, but there is little formal data to support the effectiveness of these methods. There is research, however, that has found acupuncture, air ionisers, and dust mite control measures, to have little or no effect on asthma symptoms or lung function.

Evidence is inconclusive to support or reject osteopathic, chiropractic, physiotherapeutic, and respiratory therapeutic techniques. Homeopathy may mildly reduce the intensity of symptoms, but this finding is not robust.

It is also wise to make note of health conditions that can interfere with asthma management such as runny nose, sinus infections, acid reflux disease, psychological stress, and sleep apnoea.

It is often somewhat harder to diagnose young children who may develop their first asthma symptoms before age five. Symptoms are likely to be confused with those of other childhood conditions, but young children with wheezing episodes during colds or respiratory infections are likely to develop asthma after six years of age.

 

 Report compiled by Temitope Obayendo with additional information from: Global Initiative for Asthma and medicalnewstoday.com

 

Asthma stepwise management, action plans and patient education

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Dr. Funsho

 

 

 

 

 

(By Dr. Funsho Festus Oloruntoba)

Virtually all international guidelines recommend using a stepwise approach to pharmacologic therapy to gain and maintain control of asthma and reduce both impairment and risk of exacerbations and progression.

Written asthma action plans not only help individuals track and implement the stepwise approach, it also allows asthmatics to daily monitor and adjust their medications in response to changing signs and symptoms, thus reducing their risk of exacerbations. Every asthmatic should have a written action plan.

 

Stepwise management

The stepwise management plan organises asthma treatment into different steps or levels based on an individual’s signs and symptoms at a certain moment, and reflects increasing and decreasing intensity of treatment (dosages and/or number of medications) required to achieve and maintain asthma control.

The steps are determined on a case-by-case basis with respect to the age of the individual and severity of their asthma. The medication, dosage, and timing of the therapy are determined by the level of asthma severity assessed at the initiation of therapy and the level of asthma control needed for adjusting therapy.

By utilising the stepwise management plan, therapy can be stepped up or down as needed to maintain control. The goal of step-down therapy is to identify the minimum medication necessary to maintain control.

Asthma action plan

A written asthma action plan is a document developed jointly by the health care provider and the individual. The plan should include the individual’s daily treatment plans, key points to help them recognise changes in their condition, and steps they can take to manage these changes. The patients’ ability to self-adjust their medications in response to acute symptoms or changes in their PEF measurements is the basis of most written plans.

An asthma action plan should include two sections as a minimum: daily management and emergency response. The daily management section should incorporate directions for the daily management of their asthma including the names of medications, dosages, and times they should be taken. It should also include daily monitoring information, steps to control environmental allergens, and directions for avoiding any known triggers.

The emergency response section should include information on how to recognise symptom changes and the specific steps ( i.e, medications to take, dosage, and timing ) they should follow in response to these changes. It is critical that the plan includes information on the identification of signs, symptoms and PEF measurements that indicate the need for urgent medical attention.

Individuals with asthma and their immediate care providers must be provided with the red zone parameters that indicate the need for professional care beyond this point. It is a good idea that the written asthma plan also includes emergency telephone numbers for the physician, nearest emergency department, and any emergency transport system/service that individuals can call quickly to assist them.

School/sports plan

The goal of asthma management is gaining and maintaining control so that the individual can lead a normal, active life. Students with controlled asthma can attend school and participate in sports without fear of their condition interfering. However, teachers,coaches, school administrators should be made aware of student’s condition and informed of the proper steps to take should asthma attack occur.

Even if the school district has a school nurse programme and/or an asthma response program/plan, it is a good idea to have a written plan and information available in the event of an emergency.

Travel plan

Whether an individual is a student or an adult, organising his or her health information when travelling is important. Filling out this form and also leaving a copy with a healthcare provider or emergency contact prior to departure can provide useful documentation in event of emergency.

Patient education

In addition to developing the preceding documents, patient self-management skills and education play a critical role in gaining and maintaining control of asthma. The development of a partnership between the healthcare providers and the individual has been shown to be an effective strategy for improving asthma outcomes.

Whenever possible it is important to include the asthmatic individual in decision-making process and the development of a written asthma action plan. The components of a successful asthma education plan include:

·     The individual’s ability to demonstrate an understanding of their triggers and symptoms.

·     A discussion/implementation of action steps to minimise environmental triggers.

·     The individual’s ability to demonstrate proper technique when taking their medications and completing their self-monitoring (peak flow, symptoms scores etc.)

·     A written asthma action jointly developed by the practitioner and the individual

·     An emergency plan that clearly outlines the steps to take when asthma symptoms are not responding to the written asthma action plan,

 

References

1.   National Heart, Lung, and Blood Institute. National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma Full Report 2007. http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.pdf.  Accessed April 2, 2009.

2.   The Global Initiative for Asthma (GINA) 2009 Update of the GINA Report. Global Strategy for Asthma Management and Prevention. http://www.ginasthma.com. Accessed April 1, 2010.

 

TIDES 2014 Interview: Jared A. Gollob, M.D., Alnylam Prescription drugs, Inc.

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On this interview from TIDES 2014, Jared A. Gollob, M.D., Vice President, Medical Analysis, Alnylam Prescription drugs, Inc. discusses siRNA, their supply options, selecting illness indications for the appropriate success, the appropriate supply options of the medicine and extra.

This interview was filmed at TIDES 2014. TIDES takes place each Might. For extra data on the occasion, go to our webpage: http://bit.ly/1ji2KQy

supply

SKG Pharma rewards trade partners

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– Re-launches Novadex brand of paracetamol

(By Adebayo Oladejo)

 

SKG Pharma Limited recently organised a special conference to appreciate and reward its trade partners for their loyalty in the year 2013.

The conference which was held at the De-renaissance Hotel, Ikeja, Lagos, also witnessed the re-launch of the repackaged Novadex brand of Paracetamol by SKG Pharma.

While speaking at the event, Managing Director of SKG Pharma, Pharm. Okey Akpa, reiterated that the conference was a “family meeting” which would enable the company and its partners to share ideas that would lead to enhanced relationship.

“The motive behind the trade partner conference is to appreciate our trade partners who are truly our very vital link to reach the final consumers and also to hear some quality feedback from them about the factors that are affecting the business and to share the business plan for the New Year with them as partners,” Akpa said.

Speaking on the newly packaged Novadex Paracetamol, the SKG boss explained that though the brand had been a heritage brand having been in the market since 1986 and remained one of the best paracetamol brands, the company thought of repositioning the product as it was doing for others.

“When you look at Novadex, we have given it a new look and it’s a lot more consumer friendly – the blisters are a lot better, the tablets are highly improved and easy to swallow, the pharmacokinetic properties is fast dissolving and so it’s quick active. Above all, what will interest you is that, in its class, it’s the best in term of profit gap. That means in the amount we are selling it and its market cost, we are a lot better than the key competitors,” he disclosed.

In his own contribution, National Chairman of the Association of Community Pharmacists of Nigeria (ACPN), Pharm. (Alh) Olufemi Ismail Adebayo who was also the guest of honour at the event, congratulated SKG on its successes over the years in producing high quality pharmaceuticals.            On the newly unveiled Novadex Paracetamol, the ACPN helmsman said, “There is no gainsaying that the product is tested and trusted while the packaging is superb.”

The high point of the event was the presentation of awards and gifts to deserving distributors in various categories. In the national category for the Best Distributor Award, Eternity Pharmacy and Simba Pharmacies came third and second respectively, while Jonaco Pharmacy, Onitsha, won the Best National Distributor Award.

The distributors who were obviously delighted by the company’s initiative took turns to testify to the quality of SKG products, as well as its relationship with distributors and customers.

Commending SKG Pharma, visibly elated Mr. Chizoba Okeke of Jonaco Pharmacy could not hide his joy at the honour bestowed on him by the company’s management.

“I feel very happy and as I am talking to you. I still don’t believe I came first; so it’s a thing of joy to me and I appreciate God for the success. Actually I never expected it but I have been working towards it for a long time now. So I will say it’s a thing of joy that it has finally happened. My prayer for the company is that God will continue to help them to take the right decision at the right time and I am hopeful that God will help me to repeat same feat next year”, Okeke enthused.

Also expressing her satisfaction with the outcome of the conference, Mrs. Pat Iloba, SKG Pharma’sgeneral manager (Sales and Customer Care) described the conference as extremely successful and highly rewarding to both the company and the distributors. She also thanked the distributors for their efforts and commitment to the company’s drive towards delivery of quality pharmaceuticals to Nigerians.

skg

(Middle) Mr.Chizoba Okeke of Jonaco Pharmacy, Onitsha, Winner of the National Best Distributor Award pose with his trophy. On his immediate right is Mrs. Pat Iloba, GM Sales & Customer Care and on his immediate left are Pharmacist Olufemi Ismail Adebayo, national chairman, ACPN and Pharm OkeyAkpa, managing director, SKG Pharma.

Strategies for purpose and dominion

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Imagine that you have been walking along an isolated road for two days with no food or water and the sun is blazing down on you.  Suddenly, you notice a well in the distance. Even though you are tired, you run with anticipation because you know that your thirst will be quenched. When you reach the well, however, you see a rope dangling over the opening, but no bucket. Deep down inside the well is what you need to satisfy your thirst and sustain your life, but you have no access to it.

This is a picture of humanity cut off from its life-giving source.  The leadership spirit exists deep down inside the makeup of every person because we are made in the image of our Creator and have an inherent dominion spirit. Yet we cannot fully manifest this gift in our lives because we do not have the resources to access it.  We have lost the Spirit of the Creator, and we have lost our awareness of the leadership spirit, as well as the mind-set that enables us to exercise it effectively. Humanity’s lack of connection with the leadership spirit has led to a loss of true leadership in the world.

Let us look more closely at our dilemma through two related illustrations. First, water is potentially a source of power. When it is harnessed, it can be used to run machinery, such as in a water mill. For this to happen, however, (1) you have to have access to the water, and (2) you have to have the machinery in place. If you are unable to harness the water or you donot have the proper machinery set up, then the mill cannot fulfil its purpose. It is the same with the spirit of leadership.

The loss of the spirit of leadership is also like buying a new computer that has all the hardware to enable you to run programmes and carry out their functions but then not having any power source to run the computer.

Suppose, then, that you discover a power source and plug it in. The computer is powered on and ready to go, but you still need software for it to be of practical use to you.  You have the knowledge of what the computer has been designed to do, and all the components of the hardware are ready for use.  The potential is there, the ability is there, everything the manufacturer put into it is there, but it is almost as if you do not own a computer because you canot do anything with it.

These two examples illustrate the two-pronged nature of our problem.  First, even though our potential as leaders is still within us, we have lost our connection with our Source of purpose and power. Second, even if the connection were to be reinstated, unless we obtain the right “machinery” or “software” – that is, unless we discover how a leader is meant to think and operate (the spirit of leadership) – we still won’t be able to fulfil our potential. Simply put, the leadership spirit is the inherent hardware, and the spirit of leadership is the software necessary for the hardware to function.

In the Bahamas where I live, we are located in an area called the “hurricane zone.” From time to time, we are subjected to the uncontrollable force of nature, as the phenomena of the elements conspire to remind us of our vulnerability. During the hurricane season of 2004, when the monster hurricanes named Gene and Francis followed each other on a path right across our archipelago, I remember how helpless I felt. My wife and I made all our preparations and then sat waiting for the long-announced arrival of the category 4 and 5 storms. During one of the storms, the winds bore down on us like a living monster and shook the battened-down windows.

Suddenly, the electricity went out, and we were left sitting in darkness.I reached for the flashlight and surveyed the room. Then I took a walk through the darkened house and checked everything to make sure the shutters were holding. As I examined the rooms with the flashlight, I noticed the many items we had accumulated that had become so important to us, but that now were completely useless: the large-screen television, VCR, CD players, air conditioners, computers, printers, and other high-tech “toys” we had purchased.

I stood there in the dark for a moment and thought about all the power, potential, benefits, pleasure, and untapped functions trapped in each of these items that were completely useless and unbeneficial to me at that moment. They existed, but they could not contribute to my present situation and life. They were filled to capacity with possibility, but they could not deliver. Why? Because they were cut off from their source – theirpower-supply.

I then saw a true picture of mankind: a powerful creature full of divine potential, talents, gifts, abilities, untapped capacity, creativity, ingenuity, and productivity, who himself had been cut off from his power supply.  Now, he walks the earth, living far below his intended privilege and capacity, victimised by his ignorance of both his Source and himself.

The loss of our source of purpose and power has led to a myriad of negative outcomes because of the confusion that inevitably resulted. The following questions have been asked by countless generations since Adam declared independence from his Source:

* Who am I?

* Where am I from?

* Why am I here?

* What am I capable of doing?

* Where am I going?

 

These five questions summarise the essence of the human struggle and are what I, over the years, have called the questions of the human heart. They control everything that each human being does and are the motivation for all human behaviour.  All our social, economic, spiritual, and relational activities spring from the pursuit of answers to these questions. Until they are answered satisfactorily, there can be no personal fulfilment, and life will have no meaning.

These questions address the five most important discoveries in the human experience: identity, heritage, purpose, potential, and destiny. They are the heart of the leadership struggle, and when answered, they give birth to true leadership.

 

Culled from THE SPIRIT LEADERSHIP by DR. MYLES MUNROE

 

 

Tapping the resources of your mind

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The story is told of a certain man who bought a new gadget – unassembled – and after reading and rereading the instructions, he still could not figure out how to put the device together and make it work.

Finally, he sought the help of an old handyman who was working in the backyard. The old fellow picked up the pieces, studied them, then began assembling the gadget. In a short time, he had it put together.

“That’s amazing,” said the man who bought the gadget. “And you did it without even looking at the instructions!”  “Fact is,” said the old man, “I can’t read, and when a fellow can’t read, he’s got to think!”

Indeed, whatever we achieve or fail to achieve in life is largely  the result of the way we think. Our thinking shapes our lives and influences our destinies. Proverbs 23:7 says, “For as he thinketh in his heart, so is he…”

You may ask, “What of family background, connections, education, opportunities, luck, environment, location and so on?” As a matter of fact, these factors have some influences on successes and failures but the critical factor, as illustrated in the opening story and many other examples all around us, is how we think.

Successful people think differently from unsuccessful people.David J.Schwartz once said, “Where success is concerned, people are not measured in inches or pounds or college degrees or family background; they are measured by the size of their thinking.”

People are different because they think in different ways. You want to be close to someone primarily because of the way he or she thinks. This is because thinking determines behaviour and attitude. For this reason, no normal person wants to befriend a mad man. His thinking makes him crazy.

Everything begins with a thought.  For instance, you get up from bed in the morning and many thoughts start coming into your mind. You think of brushing your teeth, doing your morning devotion, bathing, dressing up, having breakfast, making important calls, planning for the day’s work and general activities. Everything is first thought of before decisions are made and actions are taken. Faulty thinking at this stage can mess up your day. This is why you need to think accurately. This is also why you need to base your decisions on facts and not mere hearsay.

Many times we take certain things for granted. Do you know that everything in the world was created by thought – radio, TV, the Internet, cars, computers etc? You know about Thomas Edison who developed tin foil phonograph, light bulbs, electricity, film and audio devices, and many more. You also know about Alexander Graham Bell, who, at the age of 29, invented the telephone. Do not forget Johannes Gutenberg, the German goldsmith, who invented the printing machine. Can you imagine the world without a printing press?

Do you ever challenge yourself to think of one good thing for which you would be remembered when you’re gone?  It has been said that most people use only 10 per cent of their brain capacity. That means that you can think and do much more than you are doing today. Your potential is yet to be fully exploited.

One of the reasons people do not achieve their dreams is that they desire to change their results without changing their thinking. Every change in decisions, actions and results must first start with thinking. You must first change your thinking before any other change can be effected.

It was Albert Einstein who defined insanity as “doing the same thing over and over again and expecting different results.” He also said, “We cannot solve our problems with same thinking we used when we created them.”  Goran  Carstedt put it this way, “We need a new way of thinking to solve the problems caused by the old way of thinking.”

Your situation in life can change only when you change your thinking for the better.  Have a mental picture of what you desire to achieve in future. Visualise and meditate on it. If it is God’s will for your life, it will come to pass.

Your thoughts are seeds which you sow. According to James Allen,” You are today where your thoughts have brought you. You will be tomorrow where your thoughts take you.” Before I entered the university to study Pharmacy, my mind was fully occupied with how to become a pharmacist. After graduation, my thoughts and desires changed to what aspect of Pharmacy practice to engage in – community, hospital, industrial, academic etc. I actually tried these areas but did not have fulfilment until I took the decision to go into publishing.

Note also that while thinking is said to be productive, only positive thinking will bring positive results. Therefore, make it a principle to avoid negative or destructive thinking – thinking about past mistakes or failures or possible losses, accidents, ill-health, disaster, death etc.

As Jerry Bruckner rightly said, “We become and attract what we think about most of the time.” The subconscious mind makes no distinction between constructive and destructive thought impulses. It works with the material we feed it, through our thought pattern.

Innovation: Key to excellence in pharmacy practice

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Pharm. (Barr.) Steve Azubuike Okoronkwo

 

 

 

 

 

 

 

By Pharm. (Barr.) Steve Okoronkwo

 

The healthcare landscape is constantly evolving. The dynamic nature of healthcare is said to be the major driver of change and innovation in pharmacy practice1. Innovation is at the core of pharmacy practice. It has played a key role in the significant growth and development witnessed in the field of Pharmacy.

Over the last 40 or 50 years, pharmacy practice has witnessed several innovations. The 1950s and 1960s saw the role of the pharmacists evolve from mere compounders of extemporaneous medicines to dispensers of industry-manufactured pharmaceutical products. Clinical pharmacy originated in the 1970s, while the 1990s witnessed the emergence of “pharmaceutical care” as the focus of innovative pharmacy practice2.

Whereas, some authorities canvass the concept of Medication Therapy Management, as an innovation in the pharmacy practice of the 2010 and beyond, others believe that this concept can be subsumed in the broader concept of pharmaceutical care, which is still being flaunted as the innovative key to excellence in contemporary pharmacy practice.

In Nigeria, innovation in pharmacy practice has become very imperative, in the light of changes in the drug regulation and drug distribution framework. With the promulgation of the National Agency for Food and Drug Administration and Control (NAFDAC) Decree of 1993, the rapid increase in the number of pharmacy schools, as well as the recent proposed Mega Drug Distribution system, the practice of Pharmacy has indeed changed. Accordingly, innovation, more than ever before, is now a sine qua non to achieving excellence in practice.

 

Understanding innovation

Innovation is the application of better solution that meets new requirements, unarticulated needs or existing market needs. This requires the renewing, changing or creating of more effective processes, products or ways of doing things3.

Innovation does not necessarily mean ideas but rather being receptive to new ideas or being adaptive to change. According to Theodore Levitt (1962), ideas are useless unless used. Innovation also differs from invention. It could, however, mean changing your business model or adapting to changes in your environment to deliver better products or services.

Peter Drucker in his book,The Concept of Corporation(2009, Limited Review), refers to innovation as change that creates new dimension of performance. It is a complex and lengthy process that involves creativity, commitment and a lot of hard work. It is usually developed through a sequence of events.

Innovation can also be seen as the price to pay to reach the next level. This price, however, must not come at the risk of patient’s safety, nor will it come as a compromise to professional ethics. Innovation must therefore be distinguished from so-called “cleverness” bordering on unethical conduct, which ultimately leads to professional damnation.

Several factors –both external and internal– drive innovation. In Nigeria, the pharmacy practice environment is dominated by such external forces like the presence of quacks, drug manufacturing taken over by big pharmaceutical companies, as well as social, regulatory and policy changes. These external factors, together with the internal factors (such as the need to improve profitability and quality, and the pressure for improved cash flow) have resulted to changes in the practice landscape4.

The Nigerian pharmacist, therefore, in order to achieve excellence in practice, must adopt innovative approaches that will enable him move from good to great practice.

 

Innovation in pharmacy practice

Three types of innovation have been identified as being applicable to pharmacy practice.  These are: Product Innovation, Service Innovation and Business Model Innovation5.

While it may not be pertinent to go into a detailed discussion of these models, given our target audience, suffice it to say that the nature of innovation that can lead to excellence in pharmacy practice may simply mean looking beyond the traditional view of pharmacy practice or the traditional way of doing things.

The following have been identified as innovations which when adopted by pharmacists, especially those in community practice, can lead to professional excellence.

 

1.   Innovation is properly defining your practice

Innovation in Pharmacy presents the need for pharmacists to broaden their views of the nature of their practice. The Nigerian pharmacist must come to terms with the professional-cum-commercial nature of pharmacy practice in Nigeria. He must also understand the chaotic environment in which he practises.

Undoubtedly, pharmacists are the undisputed custodians of drugs. However, it is counter-innovative for pharmacists to define their practice in terms of selling and provision of quality drugs. The activities of the National Agency for Food and Drug Administration and Control (NAFDAC) have reduced the weight attached to this assertion. Nowadays, even quacks also claim to sell only NAFDAC-registered products.

Pharmacists must therefore define their practice in terms of doing the things that will make patients and customers want, not only to visit their pharmacies, but to make repeat visits.  A pharmacist in pursuit of excellence must realise that selling quality products can, at the very best, only translate into a good practice. Quality drug is not the ultimate end; rather it is an indispensible tool in attaining the ultimate goal of the health care system, namely, to improve the patient’s health-related quality of life.

In order to achieve excellence in practice, pharmacists must be perceptive enough to spot where future growth may lie. The current practice model where the pharmacist’s role is only associated with drug production and delivery must be re-engineered to include many additional responsibilities, such as patient care, primary care and public health services6.

An innovative pharmacist must understand that he is in the business of helping patients get better. Whereas pharmacists by their training are very proficient in both the biological and physical sciences, the practice environment however dictates that for pharmacists to achieve professional excellence in practice, they must also be conversant with the human sciences, which include sociology, psychology, economics and management/marketing. Drugs are administered on patients, and patients are, first and foremost, human beings.

 

2.   Innovation is building a competitive advantage

A competitive advantage is an innovative tool that can be employed to provide superior performance in practice. In Pharmacy, competitive advantage goes beyond selling quality drug products or computerising one’s premises. Products and technologies are visible and well defined and can be copied by any person who is willing to make the investment.

According to Jean-Claude Larreche (1998), a competitive advantage, in terms of capabilities, is the ultimate advantage. Capabilities are intangible and comprise elements such as innovation, human resources and corporate culture7. A competitive advantage built on capabilities is pervasive and sustainable, and it is a veritable tool for value creation, both in the short and long terms. A pharmacist can recreate the value proposition for his/her patients by adding value to the product and service offerings, as well as appealing to the health care needs of the patients.

One way to add value is by following up on the patient through a phone call a few days after the supply of a prescription, in order to monitor the medication usage. Creating a competitive advantage that can provide superior performance and translate into excellence in practice means developing an atmosphere that will always make your customers and patients feel disappointed when they go elsewhere.

 

3.   Innovation is marketing your services

Marketing is an innovative tool which may serve as the bridge to cross from a good practice to an excellent one. Whereas, the Code of Ethics for Pharmacists in Nigeria prohibits pharmacists from advertising their pharmacy8, it does not however preclude pharmacists from marketing their services.

The word “marketing” here is not used in its generic sense. Marketing connotes building a practice beyond mere money-making. According to Peter Drucker in his book, ThePractice of Management(1954), marketing is not a function; it is the whole practice of Pharmacy seen from the point of view of the patient.

One challenge the profession of Pharmacy faces is patients’ lack of awareness of the role a pharmacist can play within the health care team outside of dispensing medications9. Therefore, any pharmacist who desires to excel in practice must adopt marketing as an innovative approach. Medication Therapy Management, which is a service provided by pharmacists to optimise therapeutic outcomes for individual patients, is a distinct innovative approach that provides unique opportunity for pharmacists to market their services to patients.

There is the need for pharmacists to develop closer relationships with their patients by listening to and engaging them during pharmacy visits. Pharmacists should also identify unmet health care needs and present appropriate solutions/services during encounters with patients.

The practice of pharmacists handing over medications to patients like vending machines is out-dated and does not fit into contemporary pharmacy practice. Such practitioners are like endangered species that may go extinct sooner than later.  A pharmacist should utilise every meeting with a patient to market his/her service. This could be achieved by using customer-friendly language, taking time to explain what the services are, giving patients realistic expectations of the service and having a plan of how to meet these expectations10.  As the renowned painter Pablo Picasso has eloquently stated, “It is your work in life that is the ultimate seduction.”

 

4.   Innovation comes from continuous learning

Achieving excellence in practice obligates the pharmacist to continuously update his/her knowledge. Pharmacy is a social profession. Society is dynamic. As the society changes, the profession inevitably evolves to meet the demands of the changing society.

Most pharmacists would invariably like to be the best. Unfortunately, only a few will develop the strict self-discipline and make the rigorous efforts required to excel. There is this general unwillingness among pharmacists to expand their horizons. Some stop learning the moment they graduate from the university. Most pharmacists, especially those in community practice, get carried away by the fact that they are making money or good sales in their pharmacies.

Excellence in pharmacy practice transcends sales or money making. You can always make money by doing what every other person is doing – selling quality drugs, locating your pharmacy in a strategic neighbourhood, using lower mark-up to attract patronage, etc.Excellence, on the other hand, is striving to be different. And one sure way to stand out is through continuous learning.

The saying that “a company surrenders tomorrow’s businesses when it gets better without getting different” is quite apt here.The knowledge base of the pharmacy graduates of the 2000s is different. This change in knowledge base has also affected the way Pharmacy is practiced now. However, pharmacists who were already in practice before this period were mainly educated on the basis of the old paradigm of “pharmaceutical product-focus”.  If these pharmacists are to contribute effectively to the new paradigm of “patient-centred pharmaceutical practice”, they must make serious effort to continuously update their knowledge-base and skillset, in order to adequately empower themselves for modern day pharmacy practice.

In recognition of the importance of learning to the role of the pharmacist, as a member of the health care team, the World Health Organisation (WHO, 1997), in conjunction with the International Pharmaceutical Federation (FIP), listed one of the attributes of the “seven- star pharmacist” as a life-long learner.

Describing the “seven-star pharmacist” as a life-long learner, the WHO/FIP observe that it is no longer possible to learn all one must in school, in order to practise a career as a pharmacist. The commitment to life-long learning must begin while attending pharmacy school and must be supported throughout the pharmacist’s career. Pharmacists should learn how to learn11.

 

5.   Innovation is practising “pharmaceutical care”

Ever since the Hepler and Strand treatise on the on the concept of pharmaceutical care in the 1990s,so much has been written on this concept which, arguably, is still being held as the most innovative approach to achieving excellence in contemporary pharmacy practice.

The FIP (1998), in an adaptation of the definition by Hepler and Strand, defined the term more realistically as the “responsible provision of drug therapy for the purpose of achieving definite outcomes that improve or maintain a patient’s quality of life”12. The concept of pharmaceutical care marks a clear departure in pharmacy practice from the age-long focus on medicine supply towards a more inclusive focus on patient care. Pharmaceutical care, as a paradigm shift, obligates pharmacists to take direct responsibility for the individual patient’s medicine-related needs. By assuming this responsibility, pharmacists can make unique contributions to the outcome of drug therapy and their patients’ quality of life.

In order to effectively carry out this new mandate of pharmaceutical care, the WHO (1997) introduced the concept of the “seven- star” pharmacist, which was adopted by the FIP (2000) in its policy statement on Good Pharmacy Education Practice. It describes the pharmacist as a care-giver, decision-maker, communicator, manager, life-long learner, teacher and leader. These attributes of the “seven-star” pharmacist are used as a benchmark to measure pharmacists who have achieved excellence in practice and are regarded as leaders of the profession.

Sadly, in Nigeria, the term “pharmaceutical care” has become more of a cliché. Whereas, every pharmacist talks about it, only very few practise it.

The belief that a pharmacy is doing well or growing and is, therefore, secure must never be allowed to overshadow the need for the pharmacist to practise pharmaceutical care. This is one sure route through which sustained excellence in practice could be achieved.

 

Conclusion

Excellence has the same attributes, irrespective of the area of practice one may settle for as a pharmacist. Achieving excellence in practice goes beyond doing well or being good. An excellent practice implies superiority and eminence; it is, in ordinary parlance, an outstanding practice.

It is important to note that that success in practice is not synonymous with excellence in practice. While it may be easy to measure how successful a person is in practice by the amount of money he/she may have made, an excellent practice transcends monetary parameters. Excellence in practice is achieved when the driving force in one’s practice goes beyond just making money.  Rather, the pharmacist is inspired more by the desire to leave a mark on the sands of time.

Pharmacists achieve excellence in practice when driven by the desire to contribute in making the society disease-free. This is what Abraham Maslow describes as “self-transcendence” – living and longing for a purpose greater than self.  When you transcend self, you stop competing with others; at every moment, you are intrinsically propelled by the excellent spirit to do better and improve yourself.

Finally, excellence in practice can be achieved by any person who earnestly strives to be different. It does not matter what grade you graduate with. Pharmacy training is different from pharmacy practice. Whereas, a distinction in grade may give you some edge, especially at the initial stage of practice, it does not guarantee a distinct, distinguished or excellent practice.

I leave you with these wise words by Jon Stewart in the fervent hope that you will commit it to heart:  “College is something you complete. Life is something you experience. So don’t worry about your grade, or the results or success. Success is defined in myriad ways, and you will find it; and people will no longer be grading you, but it will come from your own internal sense of decency.”

 

(Presented at the induction/oath-taking ceremony of the new graduates of Pharmacy at the School of Pharmacy, College of Medicine, University of Lagos Teaching hospital, Idi- Araba, Lagos on 8May, 2014).

 

References

1.     Uden, D: Innovation in Pharmacy through Pharmacy Practice: A Call for Papers: Pharmacy Practice, 2010,vol 1, No.1, Article 2

2.     Management Committee: Moving Forward; Pharmacy Human Resources for the Future. Innovative Pharmacy Practices Volume 1: Analysis and Overview. Ottawa (ON). Canadian Pharmacists Association (2008)

3.     Innovation: Wikipedia, the Free encyclopedia. en. Wikipedia.org/wiki/innovation

4.     Canadian Dairy Commission: Innovation Why is it so important?. www.milkingredients.ca

5.     Change Management and Community Practice Project: Options for Pharmacy

6.     Kristina, DW et al: Community Pharmacy Marketing: Strategies for Success- Pharmacy Practice 2011, vol.2. No 3.Article 48

7.     Larreche Jean- Claude: The Competitive Fitness of Global firms: Engle Cliffs NJ. Financial Times. Prentice Hall, 1998

8.     Code of Ethics for Pharmacists in Nigeria: Section iv(a)(i-iv)

9.     Law AV, Okamoto MP, Brock K:- Perceptions of Medicare, Part D enrolles about Pharmacists and their roles as providers of medication therapy management. J.Am Pharm Assoc. 2008 48(5): 648-653

10.   Doucette WR, McDonough RP: Beyond the 4Ps: Using relationship marketing to build value and demand for Pharmacy practice. J. Am Pharm Assoc. 2002: 42(2): 183-194

11.   WHO Consultative Group on “Preparing the Future Pharmacist” (Vancouver, 1997). Adopted by the FIP in its Policy Statement on Good Pharmacy Education Practice (Vienna, 2000)

12.           FIP Statement of Professional Standard on Pharmaceutical care (!998, The Hague)

INSPIRATION

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Shallow men believe in luck or in circumstance. Strong men believe in cause and effect. – Ralph Waldo Emerson

Great opportunities come to all but many do not know they have met them. The only preparation to take advantage of them is simple fidelity to what each day brings. – A. E. Dunning

Opportunities do not come with their values stamped upon them. Everyone must be challenged. A day dawns, quite like other days; in it a single hour comes, quite like other hours; but in that day and in that hour the chance of a lifetime faces us. – Maltbie Davenport Babcock

Accept responsibility for your life. Know that it is you who will get you where you want to go, no one else.

Challenges are what make life interesting and overcoming them is what makes life meaningful. – Joshua J. Marine

In order to succeed, your desire for success should be greater than your fear of failure. – Bill Cosby

 The only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. – Steve Jobs

The only thing that stands between you and your dream is the will to try and the belief that it is actually possible. – Joel Brown

Though no one can go back and make a brand new start, anyone can start from now and make a brand new ending. – Carl Bard

Don’t judge each day by the harvest you reap but by the seeds that you plant. –  Robert Louis Stevenson

 

How regular use of sunscreen products prevents wrinkles – Pharm. Kio

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 In this enlightening chat with Temitope Obayendo, Pharm. Alfred Imonite Kio, the superintendent pharmacist of Duwin Pharmaceutical & Chemical Company Ltd., Lagos,  reveals, among other valuable beauty tips, how constant use of sunscreen products and herbal cream formulations can delay the ageing process in humans. Excerpts:

 

What motivated Duwin Pharmaceutical to go into cosmetics production and circulation?

The connection of Duwin with cosmetic products is through her sister company named Edkeen Industries Ltd., which is into the manufacturing of Movate brand of cosmetic products, where I served as the general manager.

Edkeen went into cosmetics production to meet the needs of consumers for customised and better formulated products that impart beauty, nourishment and protection to the skin and hair of the users. The company is also capitalising on the positive reputation of the brand name Movate has acquired in ethical pharmaceuticals.

 

The world is rapidly going herbal in health-related matters. Are there some natural molecules that can enhance body beauty aside from artificial cream?

 

Well-formulated cosmetic products, when used by the consumer, ensureprotection of the skin, cleanliness, personal hygiene and nourishment to the body; thereby promoting the health of the individual.

Formulation of herbal creams in cosmetic products add useful enhancement to the beauty of the body. Examples are aloe vera gel, jojoba, shea butter, neem oil and even fruit acids like glycolic acid, citric acid, lactic acid, malic acid and tartaric acid. These natural molecules have different enhancement properties to the body of individuals. These properties are cleansing, lightening, moisturising, protecting, and so on.

 

As a stakeholder in the beauty and cosmetics industry, how effective is the anti-ageing and sunscreen claims of some creams?

Sunscreen products, from the name, are basically intended to prevent harshness of sunlight on the skin of individuals. It is well known that harsh sunlight can lead to sunburn, darkening of the skin, skin cancer and dermatitis. These symptoms are more common in the North, where the sun is harsher.

Use of sunscreen prevents these symptoms. Continuous use of sunscreen products prevents development of wrinkles and sagging skin and this property is referred to as anti-aging. Sunscreen agents, when used with skin lightening products, enhance lightening effect because of the sunscreen property.

 

It was once reported that deodorants have adverse effects on users. Is this true?

Deodorants are used to prevent body odour. They are mostly formulated with perfumes and anti-perspirants. Anti-perspirants have aluminum salts in their formulation. When applied to the skin, mostly the armpit, the aluminum moiety reacts with the electrolytes to form a gel. This gel blocks the sweat pores, thereby reducing perspiration or sweating. But aluminum salts are implicated in allergic reactions in some people and contact dermatitis in others.

 

So, which would you advise for use: perfumes or deodorants?

It is advisable to use perfumes or deodorants without aluminum salts.

 

What is your advice to dealers in the industry, as regards circulation of counterfeit products?

Counterfeit products, from the name, are never the same as the original products. There could be defects in formulation, production procedure, purity of raw materials, etc. Their use could be dangerous to the health of the consumers. For instance, use of substandard relaxers can burn or damage one’s hair and even burn the underlying skin. The general advice is that dealers should avoid counterfeit products. 

PSN cautions on proposed Lagos Health Plan Bill

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(By Temitope Obayendo)

 

PSN

 

L-R: Pharm. Akintunde Obembe, immediate past chairman,PSN, Lagos State; Pharm. Gbenga Olubowale, PSN chairman, Lagos and Pharm. Olumide Akintayo, president, PSN, during the event.

 

The Pharmaceutical Society of Nigeria (PSN) has advised the Lagos State government to exercise caution in its formulation of the proposed Health Plan Bill, in order to prevent professional rancour among health care providers when the bill is eventually approved.

The newly inaugurated chairman of PSN, Lagos State branch, Pharm Gbenga Olubowale, gave this recommendation at the annual luncheon of the Society, held on 4 May, 2014, at the Sheraton Hotel & Towers, Ikeja, Lagos.

The chairman, who expressed the association’s support for the bill as a Universal Health Coverage initiative for providing managed health care to the residents of the state, emphasised the need for adequate consultation with all health care providers, as well as delineation of responsibilities, with the ultimate goal of providing quality health care to patients.

His words: “We caution the government to take into consideration the various submissions of all health care providers concerning the bill to make it all-encompassing, where there will be respect for each health care team player. This will guarantee the avoidance of the pitfall which the National Health Insurance Scheme (NHIS) has found itself.”

Olubowale also commented on the recent wave of violence and insurgency in the country, calling on stakeholders at all levels to help restore confidence in the capability of the government to fulfil its primary obligation of protecting the lives and properties of the citizens. He added that no nation can make any significant growth with the level of chaos being witnessed in the country.

In his own contribution, chairman of the occasion, Pharm. Layi Gobir, MD/CEO, Smart Mark Ltd., stressed the need for pharmacists to be financially empowered, adding that without this, the profession would not develop as expected.

The Smart Mark boss, who alluded to his life experience as a young pharmacist, noted that but for his timely realisation that his meagre salary would take him nowhere and that he needed to have better plans for his career, he would still have been a struggling pharmacist today. He therefore charged pharmacists in Lagos to be proactive professionally and financially.

The multifaceted event also featured inauguration of new executives, presentation of awards to past chairmen of the Society, and awards to the eight best graduating students of the 2012/2013 session of the Faculty of Pharmacy, University of Lagos.

 

 

Compulsory HIV test for prospective couples

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HIV couple 1

 

A new National HIV/AIDS Prevention Plan recently released by the federal government (FG) stipulates mandatory HIV/AIDS test for all intending couples in Nigeria. The Director of Bauchi State Agency for the Control of HIV/AIDS, TB, Leprosy and Malaria, Dr. Yakubu Abubakar, revealed this plan while speaking during the National Prevention Plan Validation meeting held in Abuja on 5 May.

Dr. Abubakar noted that the new plan was pertinent to prevent new HIV infections and curb further spread of the disease in the country. He explained that, from the experiences of the previous plan, it was realised that there were variations from state to state, in terms of prevalence rate, mode of transmission, culture, and general approach to HIV prevention. He added that the participation of the major religions, to ensure that no marriage takes place until a valid HIV test has been undergone and confirmed, is crucial for the new prevention plan.

It must be emphasised that this new plan, like all proactive strategies aimed at curbing the spread of HIV/AIDS in this clime, is a step in the right direction. Ordinarily, intending couples should be willing to submit themselves to all relevant and important medical examinations. It is for their benefit.

 

For HIV/AIDS, in particular, a recent research published in the Pan African medical journal shows that the disease has become the leading cause of premature death in sub-Saharan Africa and the fourth largest killer worldwide.  Nigeria currently has over 3 million people living with HIV.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated in 2012 that about 2.2 million children in Nigeria have become orphans due to HIV/AIDS, while deaths due to the disease are about 240,000.Mandatory HIV testing before marriage will thus help in our quest to reduce the HIV scourge in the country.

Still, it must be noted that this new prevention plan equally raises some issues that must be adequately addressed to ensure its effectiveness.

First and very important is the issue of stigmatisation of people living with HIV/AIDS. Stigmatisation is still a major challenge in the fight against the epidemic in Nigeria.  It is a major reason so many people are not submitting themselves for voluntary testing.  A situation whereby an HIV positive person is ridiculed and isolated cannot help in our quest to contain the spread of the disease. Not even a compulsory test before marriage can help in tackling the HIV menace, if the fear of stigmatisation still prevails.  Some people can resort to procuring fake test reports to overcome the hurdle.

The way out is to ensure that people living with HIV/AIDS are treated with love and respect in the country. The government can facilitate this by enacting laws to ensure the protection of their rights.

Another important issue is how to ensure proper testing of patients to eliminate errors as much as possible because there have been reported cases of wrong diagnosis, not just for HIV but for other health conditions in our hospitals.  The government must put measures in place to ensure that test results are accurate. In doing this, there is a need to also take cognisance of the window period, during which an infected person may test negative.

Also related to this is the cost of HIV test. To make this plan work, the government must consider making HIV test free in all government hospitals.

It is also necessary that the FG provides adequate support for HIV positive people by way of proper care and management. More people will be encouraged to go for tests and ascertain their HIV status when they are sure of therapeutic support.

Treatment for AIDS is a lifelong issue. Once a patient starts taking the antiretroviral drugs to manage the condition, it is expected to continue for the rest of his/her life. Treatment support for patients is thus very crucial.

Perhaps the most important consideration to make this new prevention plan a success is increasing the awareness of Nigerians about HIV/AIDS. There are still many misconceptions about the condition. The involvement of religious leaders in helping to clear these misconceptions can help, but the religious leaders themselves must be properly orientated and fully involved as partners in this quest. They must be well-informed on the controversies surrounding the disease before they can be used as effective agents of enlightenment and control in the country.

The philosophy of science: Beyond survival

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nelson okwonna

 

 

 

 

 

 

(By Pharm. Nelson Okwonna)

 

 

Science is the systematic study of natural phenomena; it often is intended to be for the purpose of improving the lot of humanity.

In the pharmaceutical Industry, science is that which we engage in to find better products and processes for the diagnosis, prevention and treatment of diseases.

It is a given that science should be done in a manner that assures sufficient profitability for all stakeholders in the venture. The aim of profitability is to encourage future engagement in the pursuit of such interesting matters.

On another plane, science is owned in a way by the individuals that have exerted or are responsible for the exertion of mental, physical and technological resources, in the quest of developing relevant solutions. We have established Intellectual Property laws and systems to ensure that these individuals are sufficiently rewarded for their ownership.

The philosophy of science is, therefore, a theoretical evaluation of the principles by which individuals engage in these beautiful process; it deals with how we  decide on what to study, how to study and how to ensure that the products emanating from our quest are actually useful to humanity and in such manner that humanity will appreciate our efforts.

This last bit on “appreciation” may not be apparent to everyone; however, it is at the heart of modern day science. Also, the need for utility (or usefulness) of the products of research efforts may not be apparent to everyone either. Notwithstanding, to the individual or entity responsible for the cost of engaging in scientific enterprise, a certain degree of reward is expected – not necessarily monetary, but a reward nonetheless.

On a macro level, science and the organisation of science have greatly changed our world and have created the world economies. The productivity of every nation is directly proportional to the effectiveness and efficiency of its science and the management of same. Sensible governments therefore take their sciences seriously; they know that much more than volume, management and effectiveness are essential. Hence, on a macro level, the philosophy of science would deal with the attitude required to lead science and development efforts.

In a recent debate at the British House of Commons, Prime Minister, David Cameron, was quizzed by the leader of the opposition party on the preparedness of his cabinet to mitigate the effects of the planned takeover of AstraZeneca by Pfizer on British jobs and science. In a heated response, Mr. Cameron stressed the country’s past and continued policy of engaging the drug makers to ensure that British science, technology and jobs are adequately protected. Both leaders understood the critical relationship between the ownership of their science and the economic fate of their nation.

On a micro level, the philosophy of science seeks to evaluate the mannerisms of the individual engaged in scientific processes – their vision of reality and its dynamism, as well as their procedure for making inferences from observed phenomena.

This article however seeks to look more at the macro level – on the leadership of science.

 

The management of innovation

The pharmaceutical industry is changing on a global scale. We are seeing and will definitely see more mergers and acquisitions, as global brands seek to increase the profitability of their firms. This may not lead to an improvement in health but is essentially more for the benefits of shareholders. These changes are caused by the declining results from research and development investments (an issue that a study of the philosophy of science evaluates at a micro level), leading to fewer blockbusters; and as patents expire, it is not surprising that companies are shifting grounds.

Also, with the increasing shift towards generics prescribing in the wake of broader national health insurance coverage and declining government expenditures on health, there are more reasons for concern. For us in developing economies, the point to note is that, as global brands consolidate, the next thing from a business point of view will be for them to build structures that will help harness the best of the market that exists here. We already have significant Asian presence; but we will see more in the near future. There is great need, therefore, if we could borrow from Prime Minister Cameron’s concerns, to engage every party that seeks to do business in Nigeria in such a manner that will help us in the long run.

The dynamics of a global economy portend that developing countries like Nigeria with little or insufficient manufacturing capacity and poor physical infrastructure will have a non-competitive business economy, except their governments could adopt policies that will considerably insulate their economies from global shockwaves. This will require a lot of skilful manoeuvring and bargaining and for the leaders of their sciences to focus their efforts on maximising their few competitive advantages.

For Nigeria, the growing market size, GDP and availability of potential raw materials comprise our major competitive factors. The essential feature of the leadership of science for us is to provide the motivation for science. In other words, it is only by protecting our market and delineating the most profitable paths for our research endeavours and promoting sufficient engagement can we be said to be really poised to providing sustainable research and development (R&D) leadership.

In this light, the effort to sanitise our drug distributorship network is not a matter of personal preference; it is a necessity for survival, without which any little decrease in the GDP of our nation will simply make our indigenous firms to disappear. This disappearance has happened before and it is for the simple reason that most of our local manufacturing facilities were not competitive and operated in an unprotected environment. Protective government policy, therefore, is not a gift but a necessity for survival.

 

Beyond survival

To lead science in a global economy, we will need to look beyond survival, as protective government policies may not be relied upon for a lifetime. We should desire to fly, as it is only in such flight that our future will be most secure.

To achieve flight in this age, there is the need to look to our science to help us devise structures that provide a certain level of synergistic efficiency. By this, I refer to technological clusters that allow for the availability of the principal elements for entrepreneurship within a particular geographical setting.

Like most big cities, the city of Lagos, for example, provides an illustration of what clusters offer. The sheer volume of human beings, certain level of infrastructure, and regulatory and financial organisations provide the pool, comprising the market, finance, human and technological resources required for productivity to happen, and at a relatively cheaper rate.

R&D/manufacturing clusters seek to create similar efficiencies for certain industries. For them to happen effectively, sufficient science is required to delineate the modus operandi; management will and muscle must be exerted and government commitment must not only be heard but also seen. Hence, there willbe the need to achieve a meeting of minds; in other words, leadership must happen and for sufficient duration.

The challenge with the nature of leadership required is that the sheer magnitude of skills required to achieve the thoughts enumerated here are hardly domiciled in any particular individual, and even when they are, there are obvious limits on the rate and efficiency of deployment; hence it is not a leader that must emerge but, rather, leading teams.

For the pharmaceutical Industry, these teams would need to combine market skills with research skills and sufficient influence with the government, not to mention that some folks must come along with bags full of money!

Another important challenge is that for individuals with the skill and dexterity required to lead science in our age, their competences are already enough to achieve survival and a bit more. If this article is effective, it will be that it has helped someone decide for somewhere beyond survival.

If we think about it on a micro level, survival was never the goal of science; Adam did not have to worry himself contemplating why ripe bananas turn yellow before he could eat them. However, we will always thank God for those Adams who ask those important; “beyond-survival” questions.

 

PCN inducts 39 pharmacists from Madonna University

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(By Adebayo Folorunsho-Francis)

 

No fewer than 39 graduates of Faculty of Pharmacy, Madonna University, have been offered licences to practise by the Pharmacists Council of Nigeria (PCN), shortly after their induction and oath-taking ceremony.

The colourful event, which attracted parents, friends and several pharmacists, took place at the school conference hall on 11April, 2014.

In his speech at the event, the vice-chancellor of the university, Prof. Chuks Ezedum, welcomed the PCN registrar, Pharm.  Gloria Abumere, and her entourage and thanked the founder of the university, Rev. Fr. (Prof.) Emmanuel Edeh, whose philosophy made it possible for the training of future pharmacists in the institution.

Prof. Ezedum assured the PCN that the graduands passed through a devoted dean and proficient lecturers, and therefore, were academically and morally qualified for the oath-taking and induction ceremony.

While remarking that Madonna University students were always of international standard, he urged the graduands to distinguish themselves as unique pharmacists in the pharmaceutical world.

The vice-chancellor also thanked the parents and guardians of the young pharmacists for investing positively in their future.

In his own speech, acting dean of the faculty, Pharm. Felix Osuala,also expressedgratitude to the founder of the university, as well as members of staff of the faculty, for their high sense of commitment and devotion to the training of the future leaders.

Osuala noted that the faculty had secured full programme accreditation from both the National Universities Commission (NUC) and the PCN.

Also speaking at the occasion, Pharm. Abumere expressed her joy that Madonna University hadsucceeded in producing the 5th set of pharmacists and thanked the university management for its effort in giving the best quality education to its students.

Earlier, in her speech, Abumere highlighted the rules and regulations of the Pharmacy profession to the young pharmacists and urged them to always consider the health and safety of their patients first in discharging their duties.

The PCN registrar also conducted the Pharmacists Oath on the 39 Pharmacists and afterwards issued them with practising licenses.

The high point of the event was the presentation of achievement award to Celine Chukwu, who emerged the best graduating student of the year in the faculty.

Don’t blame poverty for malnutrition – NSN president

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(By Temitope Obayendo)

 

NSN presido

 

 

 

President, Nutrition Society of Nigeria (NSN), Professor Ngozi Nnam, has said that contrary to popular belief, the prevalence of malnutrition and related diseases in the country has little to do with its financial capacity.

 

Speaking with Pharmanews in an exclusive chat, Professor Nnam, who is also Head of Department, Human Nutrition and Dietetics, University of Nigeria, Nsukka, noted that neither affluence nor penury makes a nation feed well, but adequate knowledge of what should comprise the daily diet of its citizens.

The dietician condemned the feeding pattern of most families in Nigeria, noting that even children from wealthy families suffer malnutrition nowadays, due to monotonous diets.

According to her, “The socio-economic situation is not the major problem but lack of nutrition knowledge. Individuals should be educated on how to select and combine foods within the limits of their resources. Nutritionally, adequate diet is not necessarily an expensive diet but diet that contains all the food nutrients in adequate quantity and quality.”

Nnam further advised that, in order to prevent chronic degenerative diseases which set in later in life, people should regularly feed on diets that contain all food nutrients in adequate quantity and quality.

She also recommended more consumption of living foods, especially fruits and vegetables, increase in fibre intake, which helps in blood sugar control, and a reduction in salt, sugar and oils to the barest minimum.

“As people grow older, there is decrease in the functioning of their organs. This calls for reduced intake of sugar, fats and oil and increased intake of fruits and vegetables,” she noted.

Reiterating the essence of nutritional education in the society, the university don stressed that nothing can remedy poor diet than the knowledge of knowing the right things to feed on and the right sources of the substances.

“That poor woman in the village should be encouraged to include the fruits and vegetables that are most times found wanting in the family meal to make for adequate diet,” she counselled, adding that “judicious combination of locally available foods in villages and towns within the limit of family resources could give nutritionally adequate diet.”

 

The magic in your diet

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Have you ever wondered why there are such marked physical differences in the various classes of humanity? In some persons we see diseased and distorted figures, and in others we see fine and perfect personifications of radiant health? It depends so much on their thinking and eating.

Most people are only hanging on to life; they are not able to work magic. But you, as a magician, must know just how to be radiantly fit and mentally alert. As a magician, you must know how best to keep fit, and how to extend your life and live a long, long time. All the magic in the world that you may work for yourself is of little value unless you are radiantly fit and able to live a long time to enjoy it.  If you are beginning to make wonderful demonstrations (and you should be doing so by now), then you need glorious health to enjoy the fruits of your success.

By eating the right foods you will be able to say, “Gone are the aches and pains, the feelings of fatigue, the deadly lassitude that kills.” You will no longer turn over in bed in the morning to sleep a while longer. You will be up with the lark, singing, glad to be alive.

You will not be touchy and irritable any more. You will never know what it is to be exhausted. This is the perfect existence. Life for you will be grand.  “The wind’s on the health, brother; who would wish to die?” That’s how you will feel when you are well.  Your swimming pool, your Rolls-Royce, your yacht, your palatial home, your dreams that have come true through the magic in your mind, what use are they if you are sick and tired? How can you enjoy your new-found treasures, if you are old and weak?

Youth! Eternal youth! That’s what you want. Bronzed and beautiful and everlasting. Are you losing your youth? How are you losing it? And why? Left too long, youth can never be recovered. If you are not as young as you used to be when life was fun, if you are fully conscious that you are getting older, and begin to feel as one does during the last dance of a ball, tired but keen, then decide right now to do something about it.

You can remain young in spirit and fit in body until well over a hundred. Many people do. It is not just a matter of your attitude to life and thinking the right thoughts, but it’s a matter of what you eat. There are foods which help enormously towards giving you the power to work magic. And there are foods which gradually numb the mind, like slow poison, so that you can never, never have that power.

Let magic play a vital and fuller part in your health plan. As a magician, you have the power to bring health and beauty to the highest standard that the world has ever known, and a real tranquility to your mind.

So let us consider food, and what we eat often.

 

·      Bread

Bread, they say, is the staff of life. What sort of bread? Brown or white? This argument has been going on officially since Nero put the Romans on a diet of bread. Nero and his Court liked it white. Is there any difference between brown bread and white, as regards food value, sufficient that it matters?

I think so. A lady said to me the other day, “My son and daughter have each collected some tadpoles to observe their metamorphosis into frogs. My son put some white bread crumbs in his bowl for them to eat; my daughter put brown bread crumbs into her bowl. The next day, all my son’s tadpoles were dead, but my daughter’s are still thriving.”

You like white bread and you eat quantities of it. White bread is treated to maintain its colour, but the agent used may be slowly doing to you as a white-bread eater what it rapidly did to the more fragile tadpoles.  Don’t you agree? Maybe it is slowly killing that “something” in your mind that works magic.  That precious “something.”  I don’t say it is, but I think there is a strong possibility.

Brown whole-wheat bread is the best, because the wheat germ and the outer coating of the wheat contain most of the vitamins and minerals we need, whereas white-bread bakers remove the essential ingredients before selling to other firms, or as animal feeding. They can make a little money on the side, so to speak.

Do we lose anything from our diet by eating white bread instead of brown whole-wheat? “Of course we do,” says Mr C. Donald Wilson, member of the Soil Association. “The millers take out 30 per cent of the nutrition in wheat.” Like this, even if they put a little bit of it back, essential vitamins are lost from our diet.

When you start adding chemicals to food and adulterating natural food, harm and ill-health are bound to result. Why do the Indians, the Africans, the Hunzas, enjoy such perfect health? Because they eat pure food grown on natural soil. To bring out the magic in your mind, you must give thought to these things.

 

 

Culled from BRING OUT THE MAGIC IN YOUR MIND by AL KORAN

 

 

 

How to reduce mortality in Nigeria, by Melanie Bird

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(By Temitope Obayendo)

 

 

Melanie J. Bird is a registered nurse in the UK and deputy head of the Department of Primary and Public Health at Anglia Ruskin University.  She lectures on a variety of nurse-related courses offered by the university and supervises students undertaking both undergraduate and postgraduate dissertation modules.

Recently, the health care expert came to Nigeria and held a series of trainings aimed at upgrading the skills of the country’s health care practitioners. In this exclusive interview with Pharmanews, Ms. Bird expressed her views on the Nigeria’s public health care system and suggested strategies for improvement. Excerpts:

 

Please tell us about your mission in Nigeria.

With the increasing numbers of patients affected by public health-related illnesses, I became interested in the wider public health agenda.  After completing a teaching qualification and further professional development courses relating to public health, I worked as a Public Health Nurse Advisor for the NHS and have since moved into teaching public health to future public health professionals from around the world.

 

How possible is it for Nigeria’s health indicator to mirror that of the UK?

Nigeria has made great strides over recent years to improve the healthcare provision and public health of the population. The Nigerian government is working hard to implement strategies that will result in moves towards the WHO goal of ‘Global Health’.  These include improved infrastructure, increased training of healthcare workers and improved access to healthcare.

To move closer to the health indicator of the UK, Nigeria will need to keep moving forward with these strategies.  The life expectancy in the UK averages 86(F) and 83(M) years – which brings a different burden to UK public health. However,the Nigerian life expectancy is much lower at 55(F) and 49(M) – althoughthis has increased slightly over the last few years. Maintaining the strategies, as stated aboveshould, see an increase in life expectancy.

 

Also, infant and maternal mortality is still on the rise in Nigeria.  What assistance can your institution give to reduce this to the barest minimum?

Many of our MSc. public health students study MMR  (Maternal Mortality Ratio) as their chosen dissertation topic.  This gives them an increased knowledge base, with which to return to Nigeria and help this cause.

One of the most important aspects of reducing MMR is not just about training the healthcare professionals – it is about empowering the community to understand lifestyle risk factors, as well as educating them about medical issues.  One way of doing this is through motivational interviewing.

 

What are the new skills and courses your institution is offering Nigerian health care practitioners?

We have a variety of skills based workshops and courses that are applicable to a wide range of healthcare services, from midwifery courses (for registered midwives), advanced nursing courses (for registered nurses) and short courses in relation to managing diabetes, hypertension, wound care management, motivational interviewing and many others.

 

What advice do you have for health care professionals in Nigeria?

Nigerian healthcare professionals are achieving great strides in moving the health of the population forward.  I would urge more people to think about a career in healthcare and healthcare related roles.  More radiographers, pharmacists, microbiologists, etc. are needed.

Traditional birth attendants are growing. However, they need further education and training, in order to adopt relevant and contemporary birthing skills with further skills in monitoring the mother and baby prior to birth, to be aware of any complications.

 

 

NHIS law has limiting flaws – Dr. Olaniba

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Dr. Adenike Olaniba is the medical director, Olaniba Memorial Hospital, Surulere, Lagos, and national president, Healthcare Providers Association of Nigeria (HCPAN). In this exclusive interview with Adebayo Oladejo, the consultant public health physician spoke on the lingering crisis in the health sector. She also spoke on some issues relating to the National Health Insurance Scheme (NHIS), as well as the appointment of the Surgeon General of the Federation. Excerpts:

 

What were the objectives of HCPAN at the inception?

HCPAN is the umbrella body for all professional health groups that are participating in managed care and the National Health Insurance Scheme in Nigeria. The association was formed in compliance with Decree 35 of 1999 setting up the National Health Insurance Scheme (NHIS) with particular reference to Part 1, Section 11, Subsection 2 (g) and Part 11, Section 6 Subsection 2(d), enumerating the roles of health care providers in the country.

The association was established in August 2004 and was formally registered in 2005 with the Corporate Affairs Commission. So, it is a corporate body; a legally registered association. Membership of the association covers medical practitioners, dental practitioners, pharmacists, nurses and midwives, medical laboratory scientists, physiotherapist, radiographers and nutritionists, and their roles are enumerated in the Act.

 

Does it worry you that many public officials travel abroad for medical treatment?

Of course, it does worry us and we believe that health should be sourced for in Nigeria. However, it has been discovered that many of these people who travel abroad for treatment are attended to by Nigerian physicians who are based in those countries, especially the US and the UK. The belief is that we do not have basic infrastructure in Nigeria, which is why many of them travel abroad for treatment.

In a way, this is an indication that the Nigerian government has not paid enough attention to the development of our health sector, as there is insufficiency of trained personnel and inadequacy of medical facilities. So, until government pays attention to these, people will keep going to other countries to source for healthcare services.

However, it’s really a concern to those of us who are practising here. We believe that if the money they spend abroad could be invested in the nation’s health sector, we should have developed a better health system than what we have today.

 

Some healthcare providers have been calling for the removal of the health minister over claims that he is favouring medical doctors above others. What is your view on this?

I think that claim is a bit untrue. I am saying this because, in any country, especially countries that are running health insurance of any sort, medical doctors are always the first port of call. They are the primary physicians and any patient would naturally want to see them first. Traditionally, it is the doctor that refers patients to other healthcare providers, be it for diagnosis or for drugs.

In order to have a health system that follows the best practices, as forward in other countries, doctors must be the primary care personnel. That is the only way we can have an organised system. Although it is true that, in many countries, patients go first to the pharmacist, this is allowed because there are community pharmacists all over the place; and doctors themselves can go there for first-line drugs. I am happy that even here, in Nigeria, the jingles you hear on radio and television state that if you take a particular drug for three days, and you do not see any result, consult your doctor. This goes to confirm the role of the doctor in the health system.

So, for the health minister to place doctors as leaders of the health team is not out of order and it does not, in any way, mean that doctors are more important that other health care providers. The point he is making is that, in any team, there must be a leader and doctors will always be the leader of the health team, especially if that health team is to achieve the goal of providing qualitative healthcare to the masses.

 

How do we resolve the unending rivalry among healthcare practitioners in Nigeria?

The professional health group is a conglomerate of health practitioners, and if we all focus on the goal we are there to achieve, there will be no rivalry. The goal of the health system in any country is to provide qualitative healthcare for the citizenry. So, it doesn’t matter where the care is being provided or who provides it – the fact is that the care must be provided and the patient must be the focus of everybody in the healthcare team. Our concern should be on how to ensure that the patient gets qualitative healthcare.

To achieve this objective, we must agree among ourselves on where the patient should go first, and if we all agree that the first port of call should be the doctor, then we should allow them to lead the team. Since it is the provision of qualitative health care for the patient that we are all working towards, we should adopt the best practices that are prevalent in other advanced countries, so that our goal will be achieved at the end of the day.

As it is now, our health indices are so abysmal to the extent that our infant mortality rate, maternal mortality rate and others are below the average in the whole of Africa. So, we healthcare providers need to come together and close the gap. We should stop thinking about professional statuses and start focusing on the care we want to provide for the patients.

Incidentally, this issue of rivalry has caught the attention of the presidency and a committee has been set up to look into it. The committee is headed by the former Secretary to the Government of the Federation, Dr. Yayale  Ahmed. Members of the committee include Prince Julius Adelusi-Adeluyi and Prof. Akinsete, among others.

 

The decision of the FG to appoint a Surgeon General of the Federation has been kicked against by some non-medical health practitioners. What is your reaction to this?

As far as the issue of Surgeon General is concerned, in the developed countries, the Surgeon General is appointed to take care of technical situations in government. For example, if a government official decides to go abroad for medical treatment, somebody has to advise the government whether that treatment should be funded by the resources of the government or not. So, the essence of all this is to conserve the revenues of the country, so that government officials do not spend frivolously on overseas medical treatment.

Before the government can sponsor any official on overseas treatment, somebody must sit down to analyse, investigate and advise the government whether that expenditure should be incurred or not. That’s majorly what the Surgeon General will be doing and, obviously, it is a medical doctor that will be in that office. His role is to advise the government; he has nothing to do with private individuals who want to travel abroad for medical purpose. So, I see no reason why anybody or group should kick against it, in as much as it’s in the interest of the country.

 

Will you pass vote of confidence on the NHIS?

The NHIS is a veritable means of health financing in Nigeria but the enabling Act that brought it into existence has some flaws. This is why we are calling for immediate review and overhaul of the Act.

For example, there is a clause in the Act that makes it optional for Nigerians to have health insurance. We believe that the clause should be reviewed and every Nigerian must have a form of health insurance, instead. Once that clause is reviewed, it gives NHIS the ability to apply health insurance to all Nigerians. I think this is the major handicap that NHIS currently has.

Nevertheless, it is encouraging that the NHIS has been able to provide qualitative healthcare to members of the federal civil service, pregnant women, and children under the age of five; but this is still a meagre percentage of the population. About 95 percent of the population is in the informal sector, and this is why some people are scoring the NHIS low in performance because the vulnerable groups and the indigents are still there in the dark, and they need to be catered for.

 

Where do you hope to see HCPAN in the next five years and what message do you have for your members nationwide?

In the next five years, we hope that HCPAN, as recognised in the NHIS Act 35 of 1999, will be the major association under which all other healthcare professional associations will be operating the health insurance. This however does not mean that we are taking over the roles of individuals and professional health groups, as our own focus is on health insurance.

So, we are hoping that, in the next five years, all health facilities that are providing health insurance in the country will come under the HCPAN umbrella. This is necessary, so that we can regulate ourselves and be able to impart adequate knowledge in the implementation of health insurance in Nigeria.

To my members, I wish to say that, as healthcare providers, we must work together to ensure we achieve the goal of qualitative healthcare at affordable cost. Let us look at Nigeria as being able to achieve universal health coverage by the end of 2015 because we all know that 2015 is close. Let us join hands towards that goal.

 

Lagos ALPs receive newly graduated female pharmacists

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(By Adebayo Oladejo)

 

 

The recent induction and oath-taking ceremony of 141 Pharmacy graduates of the University of Lagos took a more glamorous and celebratory dimension, as it was announced that a total of eight students who graduated with distinction were all females.

Chairperson of the Association of Lady Pharmacists (ALPs), Lagos State Chapter, Pharm. Modupe Ologunagba, and other members of the association present at the induction beamed with delight at the disclosure.

While speaking with pressmen, Pharm. Ologunagba said she was even more delighted that over 50 percent of the graduands were females.

“The fact that over 50 percent of the graduands today are ladies is a thing of pride to the association…This is a good development for the pharmacy profession because females are more stable in their careers and if we go back to history, Pharmacy actually started with the women; so it’s like bringing back history to reality.”

She seized the occasion to advise the female graduands not to abandon the practice of Pharmacy, assuring them that ALPs has a very strong platform for them to excel in whatever area of the profession they wished to pursue.

The ALPs boss further revealed to the graduating students that the scarves bearing the name and logo of the association, which were shared to them, was a symbol of their acceptance into the association.

“The scarf is an innovation and we are doing this in order to motivate and mobilise our membership, and now that we have realised that majority of the graduands are females, we want them to start having a sense of belonging from today, so that they can contribute positively to the vision of the association.”

Reacting to the warm gestures of ALPs, one of the female graduands, Fasanmade Abiola Odunayo, who was clearly overjoyed, said she was happy to be part of the ceremony, adding that she was prepared for the challenges ahead because she had been taught a lot of things that she needed to know, in order to cope in the real world.

“I am going to practice Pharmacy and nothing will take me away from Pharmacy,” she enthused.

On her opinion of ALPs, Odunayo said, “I am already a member because they have given us forms to fill and we have done every necessary thing to become part of them and I can’t wait to join them.”

 

Patient referral should begin with community pharmacists – Pharm. Olanrewaju

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(By Adebayo Oladejo)

 

 

In this interview with Pharmanews, Pharm. Madehin Abdulgafar Olanrewaju, the national financial secretary, Association of Community Pharmacists of Nigeria (ACPN) and zonal coordinator, ACPN, Ipaja, Dopemu, Egbeda and Akowonjo Zone, explains why he thinks community pharmacists are not being recognised and rewarded enough in the country and what can be done to improve the situation .Excerpts:

 

Tell us about yourself and how you became a community pharmacist.

I am a community pharmacist and I graduated from the University of Ife, now Obafemi Awolowo University, Ile-Ife. I had my MBA degree from the University of Maiduguri in 1997.

I had developed interest in community practice before I gained admission into the university and it was the community pharmacists in my area in Ibadan, especially Mol Chemist, that influenced my decision to study Pharmacy, even though most of my loved ones wanted me to study Medicine.

By the time I gained admission and started studying Pharmacy in 1983, my interest in community pharmacy was already awakened. So, right from school, I had begun considering some names for the pharmacy I would operate after graduation. The only hospital experience I had was during my youth service, after my internship. But immediately after my youth service, I entered into community practice, and it was not just a community practice where I would go and register somebody – I was fully involved.

I joined Namu Pharmacy Limited, Bornu State, in December 1999, in form of a partnership. I was in that partnership for 15 years, until I decided to relocate to Lagos. I did this for two reasons:one was the challenge of political instability, which usually led to crisis and chaos then, and I was not comfortable with the thought of raising my children in that place; the other reason involved the typical challenges associated with partnership. I realised that my expectations were not being met.Though I still have good relationship with them till today,I had to leave then.

When I left Namu Pharmacy in December 2003, I relocated to Lagos and started working towards having my own premises, but it was not really easy getting a good location.So,along the line, the opportunity of working with Emzor Chemist came. At that time, the Chemist wasn’t doing very fine and they were looking for somebody to revive it.So,I was given employment, as the superintendent pharmacist there.

I joined Emzor in January 2004, and by the time I left in 2008, we were already making sales of about three million naira monthly –the  records are there for anybody to verify. Meanwhile, I had to leave because the initial reason I joined was to learn a few things about retail pharmacy and to understand the terrain very well. My experience with Emzor made me to know all that, and to understand the distribution system.So,by the time I was leaving, I had garnered enough experience.

I resigned from Emzor and started my own pharmacy, Epsilon Pharmacy Limited. It was incorporated in 2008 and the premises were registered in 2009.Since then, I have been doing what I love best because, to me, community practice was just like a calling and I have answered the call.

 

How would you assess community pharmacy in this part of the country?

Community pharmacists have a lot of potentials because, as community pharmacists, we render services to people.It is however unfortunate that Nigerians have not realised the full potentials of the community pharmacist and therefore not tapping into it.

The knowledge that pharmacists have is enormous; yet Nigerians don’t see them as people who have anything special to offer, rather than mere drug sellers. This is a mistaken perception because there is so much information that pharmacists have and are willing to share with the public. Components of this information provide the key to effective therapy.

Many Nigerians have not realised that, while drugs can be helpful, they can also be harmful. They don’t know that the only person that is trained to guide people on proper usage of drugs is the pharmacist. Meanwhile, other developed countries have realised this and this is why every prescription must go through the pharmacists before it gets to the final consumer.

Aside from that, we have a deregulated environment where people do things the way they like – they buy drugs and start selling, as they wish. And, due to ignorance,the consumers may not know that there is a need for them to see a qualified pharmacist before purchasing or consuming a drug. If the consumers are aware of this, charlatans would have been put out of business.

 

What are the challenges that come with community practice and how can they be surmounted?

The major challenge we have in community practice is empowerment. I mean empowerment in the area of knowledge and finance. A community pharmacist needs finance to undergo financial training, management training and others. Let me say here that it is the masters programme that I did that actually exposed me to the fact that those traders who have made success out of the drug distribution trade understand some rules of the thumb which wetrained pharmacists do not know.The only way we can learn all these rules is to go for trainings.

Still on finance, the community pharmacy profession is attached to the article of trade, even though it is not purely trading.For example, if one owns a pharmacy outlet and the person is very sound in the knowledge of pharmacology, pharmaceutical care, etc. – if people come to his pharmacy and find his shelf empty, they will lose confidence in him because they would have been disappointed with what they see in his pharmacy.

The state of your pharmacy determines the first impression people have of you. And by the time the first impression has been defeated, even though you are talking sense, they may not listen to you. But if they enter your premises and the place is neat, well-stocked and you are looking good, you have already broken the barrier of lack of confidence, and they will be willing to listen to you. This is where finance comes in.

If the government really appreciates the role of pharmacists as the interface between the drug and the consumer, they will develop deliberate policy in two areas: one is how they can increase the number of pharmacists being produced by pharmacy schools by funding those schools and establishing new ones; the second is to financially empower practising community pharmacists because, whether we like it or not, community pharmacies are like primary health centres, where majority of people visit first when they have a health challenge. By the time the government increases their capacity, they will be able to deliver effectively and, when necessary, they will also be able to refer patients to the appropriate professionals. In the real sense, the referral system should begin with the community pharmacy because that is where the patient goes first, and the community pharmacist should then refer to other professionals.

 

How lucrative is community pharmacy?

As it is now, there are lots of potentials in community practice and that is why everybody wants to sell drugs. Even professionals outside the healthcare system like lawyers, bankers, engineers and so on, are all interested in selling drugs.The reason is that they all see it as a very lucrative business. What determines whether a business is lucrative or not is the rate at which people demand for it. No one can do without drugs; drugs are consumed from the cradle to the grave. This is why everybody wants to go into the business of drug-selling.

Yet, it is not everybody that is trained to handle drugs because they are special products. It is now left for the government to deliberately prevent the profession from being hijacked by those who are not formally trained.

In a nutshell, community pharmacy practice is a lucrative business but the problem is that many pharmacists are not psychologically and technically positioned to tap the potentials of community pharmacy in their environment.

 

What are the major health conditions that bring patients in this area to the pharmacy and why is this so?

I will say it is malaria that often brings people to the pharmacy because by the time they come and complain and we give them a malaria drug, within the next two to three days, they will be okay. This is why I think we should be able to empower community pharmacists to take care of malaria and other minor illnesses, while the serious ones can be referred to the hospital.

 

How do you see the war on fake drugs?What strategies can be adopted to effectively tackle the menace?

The challenge of fake drugs is a global problem but other societies have identified the challenge and developed strategies to take care of it. In Nigeria, we have also developed strategies but we are not doing enough.The reason is that we are losing focus.For example, there is the task force on fake and counterfeit medicine set up by the federal government and is managed in all the states of the federation, but the members are not empowered to work. They should be able to go to any place where medicines are sold and be able to deal with anybody that stocks fake products. They should be able to trace those who are behind the pushing of fake drugs into the markets because they are all human beings and not ghosts. The regulatory bodies should also be empowered to do monitoring constantly, in order to ensure that people are doing the right thing always in the distribution system.

Another major area we have failed to look at is that in the process of moving a drug from the manufacturer to the consumer, the drug could become adulterated, due to poor storage. Many people do not know that poor storage can make the active ingredients in a drug to reduce, thereby making the drug substandard. So, the regulatory agencies have to start investigating whether those that are in the system have the proper capacity for storage.  Monitoring is essential.The manufacturer, the importer and, finally, the retailer should be properly monitored.

Pharmacy Faculty, UNILAG, launches annual alumni lecture

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(By Adebayo Folorunsho-Francis)

 

The Faculty of Pharmacy, University of Lagos, recently held its first annual alumni lecture and luncheon in honour of the 2012/2013 graduating students.

The lecture, held at the Old Great Hall of the Lagos University Teaching Hospital (LUTH), witnessed a massive turnout of Pharmacy students, as well as eminent pharmacists and professors in the country, including Prof. Fola Tayo, pro-chancellor & chairman of council, Caleb University;Pharm. Matthew Akinyemi, chief pharmacist of LUTH; Pharm. Wale Oyenuga, managing director of Cipla Evans; Pharm. Ade Popoola, managing director of Reals Pharmaceuticals; and Prof. Cecilia Igwilo, a Fellow of the Pharmaceutical Society of Nigeria.

Dean of the faculty, Prof. Olukemi Odukoya, explained that the lecture was organised to bring prominent and successful alumni of the faculty together so they can share their wealth of wisdom and experience with staff and students.

“Lecturers are also chosen among the alumni who have repeatedly proven themselves with tremendous achievements at the highest levels in their respective fields,” she said. “In this way, both the students and faculty benefit, in terms of alumni support and overall exposure.”

Addressing the alumni, the dean noted that the faculty anticipated that they should be able to educate and encourage fresh Pharmacy graduates on opportunities and challenges that await them as professionals.

“As alumni, you must be ready to put back into the system that made you; to create a synergy between you, our students, the faculty and the university; embrace giving; in truth as men of honour, we join hands to make the Faculty of Pharmacy, University of Lagos, a proud and excellent centre of reference,” she remarked.

Corroborating the dean’s assertions, Prof. Fola Tayo praised the resilience of the 2012/2013 graduating students, while equally affirming that things are no longer as rosy as they used to be in the health sector and in the nation, as a whole.

“Watching the drama performed by the students today made me weep inside,” he said.”It exposes the level of corruption in the society. Please, don’t join corrupt people in the health sector.”

Using his own experience over the years to challenge the participants, the professor, who retired as a don in the same Pharmacy faculty of UNILAG, declared that despite having worked in all the various aspects of Pharmacy, those who know him can readily vouch that he had never been fraudulent.

“For over 50 years, I insisted exclusively on doing the right thing. One thing you should know is that no amount of money will be enough for you. As you steal, you will definitely develop an appetite to steal more. But always remember the motto, ‘As men of honour…’” he stressed.

Guest speaker at the event, Pharm. Oyenuga, who delivered the lecture, “Successful Pharmacy Practice: Priming the New Graduates,” described the graduate pharmacist as a highly favoured professional, who already has greatness deposited in him.

According to him, the key to unlocking the inherent potential, while navigating the professional terrain, lies in continuous effort, not necessarily strength or intelligence. In his words, “choice, not chance determines success.”

 

UNILAG

L-R: Pharm. Ike Onyechi, managing  director of  Alpha Pharmacy; Prof. Cecilia Igwilo, a Fellow of the PSN; Prof. Olukemi  Odukoya, dean, Faculty of Pharmacy, University of  Lagos; Prof. ‘Fola Tayo, pro-chancellor & chairman of council, Caleb University; and Pharm. Wale Oyenuga, managing director of Cipla Evans, cutting the alumni lecture cake.

Personality of the month-Pharm. (Barr.) Steve Azubuike Okoronkwo

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Pharm. (Barr.) Steve Azubuike Okoronkwo, managing director of Al-Tinez Group (Al-Tinez Pharmaceuticals, Centaur Pharma, Xcel Pharma, Al-Tinez Visions Limited and Al-Tinez Consumer Care Limited) was born on 20 December, 1967.

A native of Akokwa, Ideato North Local Government Area of Imo State,Okoronkwo  attended  Dennis Memorial Grammar School, Onitsha from 1980 to 1985 and University of Nigeria, Nsukka (1986-1991) where he studied Pharmacy.

In 1998, the versatile pharmacist was admitted to study Law at the University of Lagos, Akoka. On graduation in 2005, he attended the Nigerian Law School and finished in 2006.

Due to his passion for continuous self-development, Okoronkwo went through the West African Postgraduate College of Pharmacists programme between 2002 and 2007. Two years after, he was back at the University of Lagos, Akoka for his MBA (2009–2011).

His work experience began at the Murtala Mohammed  Specialist Hospital, Kano, in 1991, where he worked as a pharmacist. He was also at the NNPC Medical Clinic, Benin City, in 1993, as part of his NYSC programme.

Between 1996 and 1997, he was a superintendent pharmacist at BC &Partners Limited, Onitsha. He also worked at Al Pharma Limited in 1998. He eventually started his own company, Al-Tinez Pharmaceuticals, in 2001.

A member of the Federal Government of Nigeria’s delegates on trade mission to Vietnam in 2008, Okoronkwo is also the director of Al Pharma Limited, Pharmachoice Limited and Vixel Resources Limited (pharmaceutical wholesalers).

The pharmacist is a member of the following associations: Nigeria-Chamber of Commerce, Pharmaceutical Society of Nigeria (PSN), Association of Industrial Pharmacists of Nigeria (AIPN), Nigerian Bar Association (NBA), American Association of Pharmaceutical Scientists (AAPS) and Fellow, West African Postgraduate College of Pharmacists.

Among his numerous awards are:Platinum Mentor Award of the Young Pharmacists Forum (2007);Distinguished Good Ambassador of the Advent of Our King Anglican Church, Egbu, Owerri (2008); Friendship Award of District 404A Lion Club Nigeria (2010) and Entrepreneurship Award of the Association of Community Pharmacists of Nigeria (ACPN), Anambra State chapter (2012).

Others are: Certificate of Merit in Recognition of Contribution to Health Care Delivery System and Pharmacy practice in Nigeria by the PSN, Abia chapter (2012) and Distinguished Merit Award by the Nigeria Bar Association, Badagry branch, Lagos State (2013).

As part of his extra-curricular activities, Pharm Okoronkwo enjoys travelling, reading and listening to music. He is married, with four children.

Private hospitals without qualified pharmacists should be sanctioned – Pharm. Debo Tade

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 (Adebayo  Folorunsho-Francis)

 

 Pharm Dedo Tade

 

 In this interview with Adebayo Folorunsho-Francis, Chairman of Mastoofy Supermarket & Electronics Ltd, Pharm. (Deacon) Adebowale Robert Tade, expresses weighty views on the different areas of pharmacy practice in Nigeria and why he thinks pharmacists in the country are not respected or appreciated enough.Exerpts:

 

 

Tell us a little about yourself

For someone who believes in both paternal and maternal sides, I always claim to hail from two states in Nigeria – Ijagbo community in Kwara and Ikogosi in Ekiti.

I was born on 16 February and presently nosing 70 years. I went to Baptist Boys’ High School, Abeokuta (a school whose motto is “nulli secondus” – second to none – and has produced a head of state, top academicians, erudite jurists, business moguls, top company executives for this nation and myself). I graduated from the School of Pharmacy, Ahmadu Bello University (ABU), Zaria, where I attended from 1965 to1970.

I have travelled extensively across the globe for general and senior management studies, courses in financial management/accounting studies and strategic planning skills. I had my internship in one of the busiest children hospitals in Africa, Massey Street Hospital, Lagos. After working there for a while, I made up my mind to quit hospital pharmacy because there was no respect for the pharmacy profession in hospital pharmacy practice.

 

Why did you say that?

I will come to that later. It is not something I want say at the beginning of this interview.

 

Tell us about your work experience then         

I first worked with Burroughs Wellcome. I was one of those who first launched Septrin, Actifed, Neosporins and some others. I later moved up north and worked with Beecham. At a point, I wasn’t satisfied with the state of things at the company because I was the only sales representative covering the most of the then northern states up to Lake Chad. I was always busy travelling from one end to the other. Eventually I got fed up. One day, I was forced to ask myself what I was doing in the Chad area. I left the company and returned to the south where I got an appointment with Pfizer in 1973 as medical representative.

I got promoted as the ethical product manager in 1975, after some very competitive on-the-job tests and interviews. Thanks to Pharm. Douglas Egbuonu for his forthrightness and the Late Pharm. Dr Fred Adenika for his thoroughness and leadership. Detribalised Nigerians they were.

 

How did you feel about your promotion?

I can only thank God for His grace because, shortly after that, I moved in quick succession from product manager in 1976 to marketing manager in1978 and head of the pharmaceutical division as division manager in 1981.

By dint of hard work, I worked my way up to becoming Pfizer’s deputy managing director in 1985, the first Nigerian pharmacist to be so appointed and also elected to the Board of Directors of the company. It was a long wait but I enjoyed it anyway to the glory of God. Pfizer businesses registered astronomical growth in income and competitive edge in the short and medium term after my historic elevations.

Again, because of politics in the workplace, coupled with subterranean manoeuvres, I was moved to the then ailing Animal Health division of Pfizer to grow the business under the notion that I was an excellent turnaround management expert. I was named the country manager of Pfizer’s Animal Health Business, which included Livestock Feeds Plc.and veterinary pharmaceutical business. Pfizer divested its businesses in Nigeria later between1996 and 1997 and I became the chairman and managing director of Livestock Feeds Plc.

Following the divestment, Pfizer needed a seasoned manager for its 100 per cent-owned Pfizer Specialties Ltd., a company which operates in Nigeria, Ghana, Liberia, Sierra Leone and The Gambia. I was recalled by Pfizer New York headquarters and was named country manager, chairman and managing director. I was very active in all the regions. I launched some new Pfizer ethical products, including Viagra and Norvasc, and also posted unprecedented profits in all of the regions. I was at the helm of affairs for seven years and retired thereafter in 2005 in excellent health. Glory to God Almighty.

I thank God that I am still standing, long after my retirement. Now, I have dedicated my full time to doing God’s work and assisting in the running of Mastoofy Limited, a company my wife established after her earlier retirement in 1998.

 

In retrospect, can you confidently say studying Pharmacy was a good decision?

I will say that it was a good decision. After all, I achieved my set objectives of becoming a pharmacist and made my mark in the industry. I was also fortunate to have led the biggest pharmaceutical company in the world in terms of research and development, high volume sales and relatively high bottom-line figures over years.

 

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

Depending on where you place yourself. In my day, the respect was really not there. But today, it is even worse, which is why I mentioned earlier that it depends on where you place yourself, your personal profile and the angle you are looking at it from. Do you respect yourself? Fine. The public will respect you likewise.

 

Tell us more about controversies surrounding the practice during your time

(Laughs) This also depends on the arm of pharmacy practice you are referring to. If it is industrial pharmacy, respect was there; it is still there and will still be there. In the industry, people like me competed with other professionals. It is a multi-disciplinary sector. Even as a pharmacist and deputy managing director also in charge of Pfizer Animal Health, I was privileged to head the animal feed section. In spite of my not being a veterinary doctor or an animal health specialist, I had veterinary surgeons who reported to me daily. That was born out of the profound respect they had for me. In me, they saw an innovative management guru, and an informed leader.

As general manager of Pfizer and, later, as chairman/managing director, I had finance directors, veterinarians, medical doctors, human resources directors and manufacturing plant directors who actively reported to me over the years. All of these people are candidates for the top job in the pharmaceutical industry and the best is usually given the top job. So, it is a competitive arena and you just must be proven to be ahead of them in all parameters of business and management of people and financial resources.

I thank God that Pfizer exposed me to relevant postgraduate general management and financial courses, some of which were done at Columbia University and Turfs University in the USA. I also thank God that I was trainable and progressively justified the rationale for my wide exposures to worldwide seminars and interaction.

 

Does that mean you never had any controversial issue at the industrial pharmacy level?

I cannot really say the challenges I encountered can be called controversy per se. But you have to prove your mettle still, especially when you have diverse people reporting to you all the time.

To me, Pfizer remains the biggest pharmaceutical giant to date. Whoever works in the company must be adequately equipped to do the job well. If, in the process of training, you don’t perform well, they will drop you. Unlike some pharmaceutical companies where you could present unproven reports, in Pfizer, operating results emanating from you must be robust and in line with the company’s short to medium business plan.

For our annual budget, I was in charge and, honestly, an annual budget document was about 200 pages,A4, single space, in narratives and data, all supported by research and encompassing secondary/desk research and primary/in-depth interviews. New products launch plans were rooted in so many surveys, requisite research work, collating etc. All of these ordinarily were veritable documents/thesis which qualified for PhD awards (laughs).  Many of our budget documents, new products lunch plans were references for future managers to develop their skills and excel in our competitive business operations environment.

 

What about controversies at hospital, academic and community pharmacy levels?

Yes, I agree there were problems in hospital pharmacy. Now we have the directorate of pharmacy which wasn’t there before. But before this could be achieved, it was “battle royale”. Quite some intrigues there.

In the area of academic pharmacy, there were some things missing in the past that have now been addressed. At least, we now have deans heading various pharmacy faculties. This was missing in the past. We thank God for the elders and forerunners who fought gallantly to have them in place. That was another battle.

But when it comes to hospital pharmacy, the kind of intrigues going on there is quite disturbing.

 

Maybe you can tell us why you had to quit hospital practice

I told you I would come back to that. Well, when it comes to health institutions, especially at the Massey Street Hospital where I worked, we resumed as early as 8.00am, counted tablets at the counter, prepared mixtures, made some emulsions and read/interpreted prescriptions and dispensed as necessary.

I remember I once queried the hospital specialist’s prescription. He was furious but I stood my ground because my training was instructive that he was wrong. Thank God, my superintendent pharmacist had to agree with me, albeit reluctantly.

We rarely prepared emulsions. You see, when I left pharmacy school, I was of the opinion that we would have a small production unit to work from. Definitely not what I encountered! There was no desired respect for us (pharmacists) because our scope of operation was limited. Patients’ counselling on use of medicines, ward-round checks on prescriptions were not allowed or readily tolerated in the system. That was why I made up my mind to quit. I was wasting away at the hospital.

 

Do you mean the general public don’t accord pharmacist due respect too?

They don’t even have an idea of what we do. Doctors, surprisingly, also pretend not to understand what pharmacists could do, or are trained to do. That is why you hear them at times asking, “What do pharmacists do?”

Do you know that there are times we are compelled to query some of these doctors’ controversial prescriptions? But the public wouldn’t know this. Their concern is just to pick up whatever is prescribed for them. In truth, the average pharmacist is not putting up to 10 per cent of what he/she studied in pharmacy school into practice. In a serious society, the government would have addressed such issues. But here in Nigeria, our government is not encouraging pharmacists at all.

Are you aware that in Europe and in the USA, some drug labels and adverts carry inscriptions that patients should contact pharmacists or doctors for consultations as necessary? The understanding of roles of pharmacists and doctors is clear and well-understood in the civilised countries

 

What about pharmacists working in private hospitals?

Those ones are worse. The kind of scandals that go on in private hospitals are more serious. How many private hospitals have a standard pharmacy in place, with pharmacists in charge? Only a few. In some cases, what you see are bunch of untrained nurses and illiterate salespersons placed behind a counter to dish out drugs. It is an insult to the profession. It is a serious issue that I think the government should look into.

I don’t want to make it look like the PSN is not doing enough. But I believe most [erring] private hospitals in Nigeria should have been brought to book. Any private hospital without a pharmacist should be sanctioned. Just imagine all the professional charges they collect! In most cases the private hospitals inflate the prices of drugs. The content of hospital bills in private hospitals is lopsided, cost of medicines is about 50 per cent of total hospital bills, and no pharmacist is in the employment of the private hospital. What a shame!

 

You didn’t say anything about community pharmacists. Are you impressed with them?

(Laughs). If we have to address community pharmacy practice in detail, I will say it is quite enormous. But I will just mention a few. In our days, our headache used to be patent medicine dealers. But today, I have observed that the problems associated with community pharmacy are worse than before.

Tell me, how many pharmacists who retired from hospital, academic or industrial pharmacy practice can wholeheartedly say they are interested in setting up a community pharmacy? Not many. This is because they are aware of the problems with running such practice now. Too many quacks have taken over the profession.

Additionally, community pharmacy is a key service arm of pharmacy practice which many pharmacists desire to be involved in. But community pharmacy has currently been dominated and changed into family business in locations with relatively high economic activities. Other locations available are yet to open up for minimal sustainability. Many are just crawling and slowly growing into sustainable economic levels that could make a pharmacist break even in the practice.

Establishing pharmacies in village-type streets in urban areas will not support the basic living conditions of young pharmacists or even some elderly ones, who were not favoured to open up community pharmacies on lucrative streets and are edged out by a cartel of powerful pharmacists who influenced “regulations” to become everlasting “lords” on commercial roads with high human traffic, even dominating hospital zones.

The truth is that some older and very influential pharmacists have cornered community pharmacy practice without qualms, a selfish and domineering behaviour, forgetting that the whole earth is for the Lord God and we all are mortals who will pass away someday.

 

What are the challenges facing pharmacy practice in Nigeria and how can they be surmounted?

Several challenges have evolved over the years, and the culture, attitude and environment have constituted the main problems for Pharmacy and every other profession and, indeed, the individual Nigerian.

Until justice and fairness become our watchword, there can never be peace in the professional arena. The challenge of practising any profession morally and ethically would always be a distraction and any gain by one would be viewed as a loss for the other. There are certainly enough laws guiding the profession, but respect for the law is often applied subjectively.

 

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

The problem of fake drugs started several years back. When I was the marketing manager of Pfizer, I tried my best to curb it, as majority of Pfizer products were also being counterfeited.

I recall a time when we took some offenders to court, the subject matter is described in legal parlance as ‘passing off’. We had about 35 varieties of counterfeited Pfizer’s TERRAMYCIN in the market ranging from names like Termicin, Tercin, Tamycin and about 30 others. We managed to win some cases, but we lost others.

Personally, I think the government is not doing enough to help us in this regard. There should be punitive laws for culprits. While I will not support death sentences for culprits, I think long term imprisonment will serve to deter several others

 

How do you mean?

It is simple. Why allowing open drug markets in Nigeria when, actually, in China, if the government catches you doing this, they will kill you immediately? But Nigeria has been treating the issue with kid’s gloves because of vested interests. We need an enabling law. I remember how my life was at risk during the raid we carried out on Onitsha market back then. Open drug markets are now everywhere, in Lagos, Kano and others.

 

What is your view concerning growing fears among young community pharmacists that the old ones are not accommodating?

This is why I said earlier that community pharmacy has been messed up. My grouse is that patent medicine stores and even pharmacies not owned by pharmacists are sited within the 200-meter gap and without sanctions. This “rule” must be abrogated or systematically reviewed to be devoid of selfishness of elders in the profession.

Also, some elders are lording their appetite for domination over current and upcoming generation of pharmacists. Some elders in the profession should rescind abuse of their previous exalted positions and privileges previously enjoyed which influenced the 200 meters “rule” to their advantage. This unpopular “rule” is not an Act of parliament and the implication is clear. The examples often cited of some countries and elsewhere are in error as there are lots of enabling incentives for young and upcoming pharmacists I those places. The draconian 200-meter gap rule should be significantly reduced to about 20  meters in hospital areas.

My view is that in hospital areas of about one kilometre radius, ideally, pharmacies could cluster as close as 10 meters apart. Competition should be allowed to play itself not domination and perpetuity of family practice, as it is today. In areas distant from hospital catchment, not more than 25 meters should be allowed. To ask pharmacists to open premises in untapped streets and villages, places without access roads, infrastructure and economic viability are non-existent, is outright invitation to militant resistance and litigations against PSN/PCN in no distant future. The time is now for review.

 

Is the rule not an attempt to make more pharmacists move into rural areas instead of the over-saturated urban areas?

So I was told. But where is the potential in that? Where is the economic activity? Now you expect the pharmacist to make N100 all day, not even N1,000. The proponents of this policy or call it selfish elders are not realistic. It is not a law of parliament but a policy put together by some selfish elders. It is an outright infringement of the fundamental human rights of pharmacists, yes it is. Very unaccommodating, I must say!

 

 How active were you in PSN-related activities?

I, together with the likes of Pharm. Ogundibo, Pharm. Bob Manuel of Glaxo and some few others pioneered the establishment of the Industrial Pharmacists group, an arm of the PSN in the early ‘80s. From my time as marketing manager to general manager, deputy managing director, to chairman/managing director, I strived to cause Pfizer to support the PSN at local and national levels in meetings, debates, and in resolving topical issues, including policy of engaging pharmacists by companies as pharmaceutical representatives, pricing guidelines to companies, ethical practices by companies etc.

Every year at the PSN annual national conference from 1977 to 1988 and, particularly, in the era of Nigeria’s SAP(Structural Adjustment Programme), as a pharmacist at the helm of affairs in Pfizer, I made sure Pfizer solely sponsored all key PSN conference opening buffet lunch. Pfizer painted the PSN conference programme red with products adverts to inform and educate all on Pfizer research -based products.

Pfizer partnered well with the PSN. It was a win-win deal as Pfizer successfully launched many of its key research -based products at the time. Several other companies are today on the queue to support the PSN with programme adverts and buffet lunch at the annual PSN meetings.

Let me seize this opportunity to commend the literary ingenuity of Elder Pharm. Atueyi for his pioneering efforts on the Pharmanews journal. Pfizer, under my leadership partnered with him through innovative centre-spread adverts, which commenced with FELDENE centre-spread advert from 1980/1981 and beyond. It is now well emulated by other companies. It was Atueyi then and I in action.

From my exposure to Pfizer veterinary pharmaceutical business from 1987 to 1998, I knew that veterinary business, if well managed, is more profitable than human pharmaceutical business but many pharmacists are unaware. Some level of understanding is required by pharmacists to also be involved in veterinary pharmaceutical practice. Therefore, in 1992, I got together the deans of the faculties of Pharmacy in three of our universities, dean of a veterinary institution and the then registrar of the Pharmacists  Council of Nigeria to deliberate, decide and agree on curriculum/courses on veterinary medicine in Pharmacy degree programme. The blueprint from the two-day meeting, which was held at the Sheraton Hotel, Lagos, seems moribund but I pray it will be revived soon.

I am a Merit Award winner, Courtesy of PSN, Lagos State Branch; a Fellow of the Pharmaceutical Society of Nigeria (FPSN);and a Fellow of theWest African Postgraduate College of Pharmacists (FPCPharm.).

 

How do you see the annual PSN national conferences?

The jamboree aspect is about 60 per cent, while the scientific aspect which is educational, sort of continuing education in Pharmacy, is about 30 per cent. The balance of 10 percent is for politics. I enjoy it though. But it is advisable to shift the priorities when we have policy decisions – we should know who is to do what and strive to report back by next conference.

 

If you were not to be a pharmacist, what other profession would you have opted for?

When I was in secondary school, there was this dog we had with yellow eyelids. One day, the dog misbehaved, became a threat to people and my father shot it. Being a biology enthusiast, I took it upon myself to bury it. I exhumed it after some weeks and skilfully put every skeletal bone in their proper place. As brilliant as I was, I identified all the bones, the vertebral column as I was thought in school (including the skull) correctly. Perhaps I could have become a surgeon or doctor. Against all expectations, I turned out to be a pharmacist. I think it was partly because I saw some pharmacists compounding medicines at the Ilorin General Hospital when I was on the queue to collect a cough medicine. I was really impressed!  I also saw a pharmacist at a time searching for herbs and also sorting out some leaves, combining and grinding them to make some concoctions. You know that pharmacognosy is also a vital part of Pharmacy.

 

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

They need to be definitive and decide early enough which arm of pharmacy practice they desire to be involved in. They need not beat about the bush. It doesn’t matter whether you are in hospital, industrial, community or academic pharmacy practice– the sky is your limit. They must work hard, adequately equip themselves and, above all, allow the fear of God and the direction of the Holy Spirit to guide and direct them. That’s the key to success.

I think they can also take a cue from Pharmanews.  Atueyi is someone I know is quite principled. He knew what he wanted to do from day one. At one point, he was editor of the PSN journal. He wasn’t well equipped for the job because the PSN wasn’t taking the publication as serious as he and, indeed, some of us desired. But his flair for hardwork and focus saw him succeed. This is why I said people should work toward their goals.

Reckitt Benckiser celebrates 50 years of Dettol in Nigeria

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Reckitt Benckiser, the global health, hygiene and home care products manufacturer, has enumerated the various contributions of its flagship brand, Dettol, to the delivery of healthcare in Nigeria over the past five decades of its presence in the country.

A member of the Global Hygiene Council, Dr. (Mrs.) Nneoma Idika, spoke on behalf of the company, during the scientific session at the recent 54th Annual General Conference and Delegates Meeting of the Nigerian Medical Association (NMA) in Benin, Edo State.

In her presentation titled, ‘Dettol’s Contribution to Health and Hygiene in its 50 years in Nigeria’, Idika noted that, since its launch 50 years ago, Dettol has been part of the national efforts to improve healthcare delivery in the country by amplifying the benefits of hygiene promotion.

‘‘Hygiene promotion has become increasingly important to public health policy makers as a low cost illness reduction strategy,’’ she said.

Idika further highlighted some Reckitt Benckiser’s corporate social responsibility initiatives, one of which is the Dettol hygiene contact programme,which has benefitted  over one million new mothers and over three million children from 1,000 schools in Nigeria  since 2009.

“Over 1,000 public and private schools have been touched in the last three years, in collaboration with state governments, through the Universal Basic Education boards, while  1,152,745 new mums in 2,053 hospitals in 44 cities have been reached since 2009,” she revealed.

On other initiatives carried out by the brand in Nigeria, Dr. Idika said they include participation in the annual World Health Day, conduct of a memorability test for school children on hand washing, sponsored research studies on hygiene and campaigns promoting hygiene lessons.

She further stressed the need for Nigerians to embrace common hygiene behaviours that could improve cleanliness and lead to good health.

“Hygiene practice in the home, environment and hospital plays an important role in preventing infection transmission like common cold, influenza, gastroenteritis, diarrhoeal infections and so on,” she said.

Dr. Idika  also explained that studies have also shown a reduction in bacterial population in water for bathing by Dettol antiseptic liquid, in comparison with local purification agents like alum, lime, salt, potash alum and Moringa  oliefera seeds.

In furtherance of the company’s contribution to accelerate healthcare delivery in the country, the Reckitt Benckiser representative assured of its expansion of the coverage of various initiatives, including continued support for adequate data generation on numerous activities on good hygiene, as well as development of other intervention strategies.

President of the NMA, Dr. Osahon Enabulele, while giving his welcome speech, specifically commended Reckitt Benckiser for the Dettol brand, which he said had been endorsed by NMA for over a decade.

 

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L-R: Brand Manager, Dettol, Reckitt Benckiser, Ms. Morolake Onifade; Speaker for Reckitt Benckiser on Gastro Oesophageal Reflux Disease, Dr. Michael Ezeanochie; Member, Global Hygiene Council/Speaker for Reckitt Benckiser on Dettol, Dr. Nneoma Idika; and Marketing and Activation Lead, West Africa, Reckitt Benckiser, Mrs. Omotola Bamigbaiye-Elatuyi at the 54th Annual General Conference and Delegates’ Meeting of Nigerian Medical Association (NMA) held in Benin, Edo State, recently.