Dr (Mrs) Ann Uketui, a hospital pharmacist of over three decades in the United States, has stressed the need for Nigerian healthcare practitioners to embrace teamwork in order to reposition the country’s healthcare system for improved healthcare delivery.
Uketui, who spoke with Pharmanews in an exclusive interview highlighted the benefits of having a collaborative healthcare team, while examining other positive indexes for a better healthcare delivery system in Nigeria.
A native of Nimo in Njikoka Local Government Area of Anambra State, Nketui, who was born and trained by educationist parents, explained how she has managed to escape from being infected with the COVID-19 virus, since the commencement of the global pandemic, as she tasked the Nigerian government on the effective implementation of Universal Health Coverage in the country.
Below is the full text of the interview.
Your profile revealed that you were married before you embarked on the study of Pharmacy. How easy was it combining family life with studies?
Prior to my arrival in New York, my husband had already secured my admission to UMKC (University of Missouri, Kansas City) for the prerequisites for a Bachelor’s Degree in Science. Everything was falling into place, but the only brief setback for me was that classes had already started two weeks prior to my arrival. However, I buckled up, worked hard and was able to catch up with the rest of the students.
Once I settled into my new school, I started thinking about a major. My husband was my first mentor in pharmacy career. He was working on his master’s degree in Pharmacology. He introduced me to his friends that were pharmacists, who mentored and guided me.
I was thrilled to choose Pharmacy as my major. I completed my prerequisites, applied for admission and was accepted. At this time also, we found out that we were having our first child. We were elated by these two good news.
Going through pharmacy school and being pregnant was hectic, to say the least. The situation was also complicated by being in a foreign country, without relatives other than my husband. We were both in school and working to sustain ourselves. We supported each other and made it work. Most importantly, God was on our side.
When I look back on that segment of my life, I’m shockingly in awe of how we survived. Our Nigerian upbringing definitely was a source of strength for us. It’s worthy to note that we had three more children later on, and one of them, my first daughter, actually is now a PharmD holder. I’m very proud of her accomplishment. To God be the glory!
I graduated with a Bachelor of Science degree in Pharmacy in 1983 and started my pharmacy career in a hospital setting. Years later, I decided to go back to school to obtain the Doctor of Pharmacy Degree (PharmD), which I completed in 2004. It provided me more tools and skills to be a better clinician.
As a pharmacist, you have practised in the hospital setting for over three decades. What informed your decision to settle for this?
This is an easy question for me. As a pharmacy intern while in pharmacy school, I worked in the retail pharmacy setting, where we filled prescriptions for patients, counselled them on their medications and recommended over the counter (OTC) drugs for them, under the supervision of the pharmacist.
The pharmacist usually spend a lot of time dealing with insurance issue, and revenues for the retail company. Then all changed when, during my last year in pharmacy school, I had the opportunity to do a clinical rotation in a Teaching University Hospital setting in a big city.
It was absolutely like night and day. I was provided the opportunity to care for acutely ill patients, took their medication history, mixed intravenous solutions under the supervision of a pharmacist, made rounds with physicians and medical students as they saw patients, and above all, just being part of the patient care team was incredible. I did not have to deal with billings. At the end of this rotation, I fell in love with working in the hospital setting.
Luckily for me, I must have impressed the director of the pharmacy department during my rotation, that he hired me after my graduation. So, that’s how my hospital pharmacy journey began. I would like to make it categorically clear that every practice setting has a lot of benefits for patients. It just depends on the individual pharmacist’s preference.
From your wealth of experience in hospital practice, how should an ideal healthcare team operate?
From my perspective, teamwork in healthcare has evolved through the years and it keeps getting better and better. The purpose of teamwork is to deliver optimal healthcare to our patients as a cohesive team. In order to be successful, the team must be efficient, effective, collaborative, competent, with supportive team members. Always remember this: “There is no ‘I’ in ‘team’”.
The teams that I have been part of through the years may include pharmacist, nurse, dietitian, social worker, chaplain or patient advocate. The physician is on-call in case needed. The team has a leader that oversees the running of the team meetings and serves as the coordinator.
Some advantages of effective teamwork in healthcare include improved patient’s satisfaction and outcome, due to the versatile and cohesive team. Moreover, it is convenient to address all the patient’s problems in one setting and save time. Again, in a team you increase your knowledge by pulling resources together from other team members with different backgrounds, as the team cares for the patient.
Universal health coverage is the goal of every nation, to boost accessibility to healthcare. With the Nigerian Healthcare Insurance Scheme (NHIS) bedeviled with ills, how would you advise the Nigerian government to achieve this goal?
This is a billion dollar question! The failure of the nations of the world to establish an efficient Universal Health Care (UHC) system for their citizens is a gross injustice and inhumane. It is appalling and catastrophic for the citizens indeed. For instance, the United States spends billions of dollars on healthcare annually and yet, the poor and the disenfranchised are unable to obtain healthcare. The consequences are economic burden and unnecessary deaths.
The first thing that has to happen is to bring all the necessary stakeholders together with a unified approach. There’s a need to assemble a team of experts and professionals that are progressive and knowledgeable about what’s ailing our current healthcare system and are willing to make sacrifices for the country and our citizens. The members of this team MUST be vetted intensely. It will not be business as usual because this is a matter of urgency. Nigerians are dying unnecessarily.
The budget to implement the UHC plan must be carefully computed so that once the process begins, it will be smooth sailing. It’s going to be very costly, no doubt; but in the end, the healthy citizens will help keep the Nigerian economy booming. The project will pay for itself many times over. It will be a tremendous investment for our country.
As they say, “the devil is in the details”. The idea of service integration among the various areas of healthcare providers, technology, service quality, sustainable pharmaceutical companies, medical devices, transportation services, security, electricity, discrimination when it comes to rendering services, availability and cost of medical device, Internet services, eradication of fake and adulterated drugs, water, medical insurance companies role, to name a few. These issues must be ironed out upfront to be successful. It is advisable to check out some of the functioning UHC system in the world to see if it will benefit the Nigerian model.
With the COVID-19 pandemic, the US president has been pleading for more healthcare professionals to join those in the United States. How has it been, surviving as a clinical pharmacist without being infected?
First of all, it’s been tough for everyone during this pandemic but especially for the people that work in hospital settings. These caregivers, including myself, work diligently with the COVID-19 patients. It has been very fulfilling for me to be part of the healthcare team managing these patients till they recover. It has been emotionally and physically draining to the staff but we are deeply committed to our patients.
Each day, when I go to work, I wear all the necessary PPEs to protect myself while taking care of patients. In fact, in hospitals here, it’s mandatory to wear masks the entire duration you are inside the hospital whether you are a staff or a visitor.
So far, I’m free of coronavirus infection. I get myself tested often and I abide by all the prescribed measures to prevent from being infected.
I work at a community regional hospital and our COVID-19 cases are not as high in number and not as critical as in some bigger hospitals, like in New York, California and Texas. So far, we have not lost a caregiver in our hospital but some other hospitals have lost their staff that contracted coronavirus at work.
The coronavirus pandemic affected our hospital tremendously in the beginning. We lost so much revenue due to a significant drop in our hospitalisation census. Other hospitals were in the same boat. We went from 350 bed occupancy to about 100.
In addition, all non-emergency surgeries and invasive procedures were cancelled. We were in a financial crisis. The leadership decided to reduce the staff temporarily to cut expenses. Currently, all the staff have returned to work and all surgeries have resumed. Our admission rate has bounced back to normal. Thank God.
In Nigeria, supply of drugs for other ailments has been disrupted, due to concentration on COVID-19. Please tell us how other patients are being managed in the US presently?
My answer to this question is specific to my institution. I don’t know how other hospitals have been impacted by your question. Again, the location of our hospital in a small Midwestern City provides us with better availability of medications because it is local and it’s the only hospital in the city. That’s not the same situation in bigger Metropolitan cities. Usually, these cities have multiple hospitals and they compete for available wholesalers in their areas for medication supplies.
Once coronavirus pandemic was announced, our leadership did a good job and proactively ordered as many medications as possible. So, when things got worse, we were in a better shape than other hospitals. However, once in a while we are out of some drugs, and we use alternative agents for substitution. I don’t recall a situation where a patient went without a necessary drug therapy because we were out of the drug.
For instance, when plaquenil was being evaluated for coronavirus therapy some wholesalers were running out of the drug. Prior to coronavirus, plaquenil was primarily indicated for Lupus here in the US. In our hospital we reserved all our supply for COVID-19 patients and for patients who use it for Lupus, they were placed on other agents for lupus temporarily. Or they were allowed to bring their supply from home if they have some, to use as inpatients. Coronavirus is still alive and well in America and we don’t know what tomorrow will bring.
What is your advice to aspiring younger pharmacists who want to practise in Diaspora like you?
Thanks for this particular question. I am always excited to see pharmacists like me in Diaspora. The younger ones actually remind me of my younger self, many years ago. There is strength in numbers. Lately, I have seen some statistics that lauds Nigerians for achievements in Medicine, Nursing and Pharmacy here in America.
When I attended NAPPSA conferences, I met young Nigerian pharmacists that trained in Nigeria and came over here to practise Pharmacy. They have no difficulty passing their Pharmacy Board Exam.
What I deduced from that was that the pharmacy schools in Nigeria are doing a fantastic job educating future pharmacists of Nigeria. We are everywhere representing our homeland.