In this interview with Adebayo Oladejo, Pharm Gbolagade Iyiola, national assistant general secretary, Association of Community Pharmacists of Nigeria (ACPN) and managing director, Cifax Pharmacy Limited, reveals valuable lessons he has learnt since moving from hospital practice to community practice some years ago. He also expresses his views on the challenges of fake drugs and quackery in the industry. Excerpts:
Tell us about yourself
I am Gbolagade Michael Iyiola. I am a community pharmacist and have been in this locality, Ajegunle, for about 15 years now. I started community practice in this area with the establishment of my pharmacy, Cifax Pharmacy Limited about eight years ago and, since then, I have been impacting people’s lives. Also, by the grace of God, I am the publicity secretary of the Association of Community Pharmacists, Ifelodun Zone, and I have been the assistant general secretary at the national level for the past three years now.
As someone who has been in practice for some time, how would you access community pharmacy in this area?
As far as this zone is concerned, I will say community pharmacy is evolving. I remember when I came to this area, I started working with a private hospital, Tolu Medical Centre and, from there, I found out that most of the so-called pharmacies sited in this area were being run by traders. When you visited them and requested for a pharmacist, they would tell you he or she was not around. I discovered that most of them were actually using ‘register and go’ (R and G) pharmacists to open their pharmacies, which made it difficult for people to get any useful service from them. At that time, premises that were operated by dedicated pharmacists were not more than three. Imagine only three community pharmacists covering a population of about 2.5 million people!
It was at that point that I got the idea that I had to start offering something back to the society from what the profession has deposited in me. So I started my own pharmacy and I found out that it was not as bad as we thought and that there was so much we could give to the society as community pharmacists, in terms of medication advice, intervention, as well as changing the orientation of our people about drug and health matters.
Since I started, majority of the charlatans have disappeared and most of those that are still around have gone back to selling the provisions they started with.
How would you compare hospital practice with community practice?
In the hospital, you would have to wait for the prescription of the doctor before you could dispense. Moreover, since it was not yet the era of pharmaceutical care, where you could make necessary interventions regarding doctors’ prescriptions, what was common then was to dispense while doctors prescribed – this was even more so in private setups where cost consideration is very important. Interestingly, it is that same cost consideration that makes the pharmacist to be relevant in such settings because, being the custodian of drugs, you’re able to make much money for them; so they see you as being very relevant.
Being in hospital practice also makes pharmacists to be very sound clinically, being always in the midst of doctors – but this depends on how much a pharmacist is willing to avail him/herself of the opportunity of interacting with other professional colleagues.
On the other hand, as a community pharmacist, you need to study the environment where you want to establish. You need to study the people, the community, the diseases that are prevalent in the area and so many other things. For example, the diseases that are prevalent in highbrow areas like Victoria Island and Ikoyi are not the same with places like Ajegunle. Accordingly, their drug needs would also be different. So, for a community pharmacist to succeed, he or she needs to put all these into consideration.
In our own environment here, where most of the people living around are not company workers and where there are no company hospitals, their first port of call is definitely the community pharmacy. The community pharmacy is to them a primary healthcare centre; so any community pharmacist there is expected to know the diseases that fall into the purview of primary healthcare and must master them in order to provide necessary interventions and, before you know it, the person would have become a known figure in the community.
What challenges have you faced as a community pharmacist and how did you tackle them?
My initial challenge was adapting to the practice of sitting down in one place for hours. And, you know, when you are just starting, sales may not pick up immediately; and when you consider so many things like your family need that is staring you in the face, the various expenses that you have to make and so on, you may want to have a rethink. But I discovered that whatever God has called you for, He will definitely be there for you.
Also in this area, there is really not much to do in the morning and I was almost tempted to go take another appointment because I was still very young then and there was so much energy in me; but along the line, I found out that community pharmacy involves more than just sitting down from morning till night and that it entails moving out to meet with other colleagues, getting involved in the association’s activities, discussing issues about the profession, offering advice to other colleagues, attending PSN, ACPN meetings at the state and zonal levels, etc. Before I knew it I became deeply interested in the practice and it has been wonderful.
Another major challenge I faced was the issue of space because Ajegunle is not a place where you can easily get a space for business ventures. When we started initially, we got a small room and it was very difficult getting the place registered. But we appreciate God that we now have more spacious place and we believe God that we can get bigger than this (laughs).
How lucrative is community pharmacy practice in Lagos State?
It depends on the side you are looking at from. If you are looking at being able to pay your bills, being able to record profit, being able to afford a place you can call your home, being able to have a good car that will make people respect you, I believe any community pharmacist that has passion for the profession should be able to achieve these.
Also, if you are looking at it from the perspective of earning money like those working in oil companies – there are so many community pharmacists that are richer than those working in oil companies. What is most important, however, is passion for the practice. So if it is about being rich, one can do community practice and be rich.
But if it is about being wealthy, I don’t think so because professionals are not usually wealthy. The major problem we have in Nigeria is that we have to enforce all the existing pharmacy laws and regulations before pharmacy practice can be very lucrative. Imagine if there were no charlatans in this area and let’s assume we were just 20 pharmacists in the community servicing about 2.5million people. We would have moved from being rich to being wealthy.
What are the most common health conditions that bring patients in this area to the pharmacy and why is this so?
The most common one is malaria. As you can see, our drainages are not covered and there are stagnant waters. So it’s like we are rearing mosquitoes in this community. Apart from malaria, the second most common is sexually transmitted infections (STIs) and the reason is that this area is densely populated and the sexually active people are the young adults. Tuberculosis is also common because of accommodation problem.
If you were not a community pharmacy, what other aspect of the profession would you have chosen?
If I was not a community pharmacist, I would have been in the industry. But since I started community practice, it has been the most rewarding part of my career, in terms of recognition, financial gains and the satisfaction that I derive from doing it. If you are in community practice, you are indirectly a counselor or a cleric because people are looking up to you. In fact, you will be settling marriage disputes in your community and all those experiences are what makes one a man.
Even if I was working in a telecoms company today, I don’t think I would have been more fulfilled because the day I graduated as a pharmacist was one of the happiest days of my life.
How do you see the war on fake drugs? What other strategies do you think can be adopted to effectively tackle the menace?
We thank God for the National Drug Policy, from which the National Drug Distribution Guidelines have evolved. I believe if the guidelines can be implemented to the letter, it will be the best solution to the challenge of fake drugs.
What is actually encouraging fake and unwholesome drugs is that our distribution channel is faulty. Imagine a situation where a manufacturer or importer can sell directly to the end users, as if drugs were like clothes and wristwatches, forgetting that drugs are products of technical expertise that require to be administered to people with proper instructions and advice. So until the new guidelines are properly implemented, the charlatans will still have the upper hands.
What advice do you have for young pharmacists out there who are willing to come into community practice?
I want to encourage them that the more, the merrier. If they intend to come into the practice and they know their onions well, coupled with the passion that they have for the profession, they will definitely make it through.
However, they should have it in mind that charlatans will always compete with them but the only thing that will make them to succeed is their passion for the profession.
Also, they shouldn’t look at monetary rewards, especially at the beginning, as Rome was not built in a day.
One important thing is to be focused and have passion for what they are called to do. The era we are in is the era where all young pharmacists want to work in oil companies, banks, insurance companies, telecommunication companies, and I doubt if they really have any passion for studying pharmacy at all.
So, those willing to come into the practice should not come with the mind-set that money will not start falling as soon as they start because the only thing that will sustain them at the beginning is the passion they have for the profession.