Why Nigeria must Collaborate with Advanced Nations to Attain UHC – Erinne

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Captain Ogechukwu Erinne is a clinical pharmacist (PharmD) and board-certified pharmacotherapy pharmacist, serving as an officer in the US Army. She is from the prominent Erinne family in  Okija, Anambra State. She earned her dual pharmacy degrees and an MBA in 2018, from Oregon Health & Science University and Oregon State University, respectively. In this exclusive interview with Temitope Obayendo, the health system and pharmacy leader, who currently practises in a US military treatment facility in Germany, urges the Nigerian government to partner with advanced countries that have successfully implemented Universal Health Coverage (UHC). This, she says, will help in using their experiences to expedite same execution in the country. She also emphasises the necessity of prioritising preventive health above curative health. Excerpts:

Could you share with us, what informed your decision to study Pharmacy?

I remember going to see a doctor when I was young because of an illness, and they prescribed an antibiotic called Septra. Suddenly, I developed a reaction on my upper lip with no apparent cause. When I returned to the doctor, my parents pointed out my lip, and to my astonishment, I was prescribed the same medication again. I feared I would lose my lip because I could barely talk, eat, or use it properly. Seeing a young girl who loved to talk struggle with speech made my parents realise how serious my condition was. We went to a pharmacy to get the refill dose, and just by looking at my lip, the pharmacist immediately recommended that I stop taking the antibiotic. My parents questioned how a local pharmacist could know better than a doctor, but I hesitated and stopped taking it without their consent. Gradually, my lip returned to normal. The pharmacist's knowledge about medications sparked my interest in pharmacy; I was certain I wanted to become a pharmacist. I became curious about how medications interacted with the body's systems. My passion to become a pharmacist stemmed not only from a desire to gain more knowledge but also to offer support, care, and counseling to patients.

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So after becoming a pharmacist, why the choice of the United States Army of all places?

I chose to join the United States Army as a pharmacist because I wanted to make a greater impact on the pharmacy profession and give back to community. By joining the US Army, I was able to reach a larger population by serving those who serve the country. I appreciate the opportunity to contribute to policy changes and improvements that enhance the care of soldiers who protect our nation.

As a relation of Sir Ifeanyi Atueyi, would you like to share some cherished moments you've had with him?

I've been acquainted with Uncle Atus since the day I was born. He's my father's cousin, and we all come from Okija, Anambra State. One cherished memory I have with Uncle Atus is our leisurely walks to his village compound during the festive season to indulge in roasted yam and palm oil, accompanied by our favourite cold “mineral” drinks. Those evenings were eagerly anticipated by my siblings and I. Uncle Atus continues to inspire me with his brilliance, intellect, and remarkable contributions to our field. Unbeknownst to him, he has played a significant role in shaping my career as a pharmacist.

As a board-certified pharmacotherapy specialist, what differentiates the practice of pharmacotherapy from hospital pharmacy?

As a board-certified pharmacist, my clinical expertise is broadened, allowing me to work in various pharmacy settings, including hospitals. Being a board-certified pharmacist enables me to engage in interdisciplinary discussions with clinicians to provide patient care in hospital settings with a variety of illnesses. In clinics, I manage patients with chronic diseases, such as hypertension, diabetes, smoking cessation, hyperlipidaemia, and more, improving patients’ access to care.

The Army is known for discipline. Could you tell us your most challenging moment as a new professional in the military?

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My most challenging moment occurred in 2019 when I arrived at Weed Army Community Hospital in Fort Irwin, California for my first assignment as an assistant chief of pharmacy. Three months after my arrival, the chief of pharmacy transferred earlier than expected to another assignment, necessitating me to step up and assume the role of chief of pharmacy.

This transition happened concurrently with managing the challenges posed by COVID-19 and the implementation of a new electronic health record system. Though this was a challenging time, it provided the opportunity to polish my leadership and project management skills, bringing the team together and maximising their skills. Despite the challenges, the mission had to continue. I am immensely grateful to my pharmacy team for their flexibility and dedication, as we implemented several initiatives and policies to ensure the safety of our team, the organisation, and the community during the pandemic.

With the scarcity and soaring prices of essential medicines in Nigeria, how can Nigerian pharmacotherapy specialists sustain their practice?

The root cause of the rising prices and scarcity first needs to be identified. Some things to consider are the remarkably high level of inflation and non-existent presence of the pharmaceutical industry to manufacture medications locally.

It is imperative and essential that big pharmaceutical companies invest in Nigeria. I am very passionate about creating ways to enhance patients’ access to affordable and safe medications. In the interim, I want to inspire other pharmacists and medical professionals to consider preventive measures in their practices. Medication is not always the solution; offering routine wellness visits through primary healthcare has been proven to prevent the need for medications.

Clinical pharmacists are valuable assets, underutilised in healthcare settings worldwide. We need to increase the access to care through maximising the utilisation of pharmacists which will lower the barrier to healthcare.

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From your experience over the years, to what extent can you say the German government has achieved Universal Health Coverage, and what lessons can be drawn for Nigerian government on the subject matter?

My understanding of Germany and other European countries’ achievement of universal health coverage (UHC) comes from my academic studies, as I do not practise in Germany. I practise in a US military treatment facility in Germany. However, what these countries have in common is government involvement to achieve UHC. It is crucial for the Nigerian government to collaborate with countries that have successfully implemented UHC to learn from their experiences.

Health insurance is another means of achieving UHC, but Nigeria is yet to get it right. From your experience, how do you think Nigeria can get it right on health insurance?

Universal health coverage is not always a perfect answer, but access to care is always important. But the question remains how it would be paid for. However, to achieve UHC, the Nigerian government must prioritise its citizens. There should be standardisation across health insurance companies and hospitals.

The presence of primary health clinics is crucial in addressing preventable healthcare disparities. Nigeria’s current system of payment before service or self-payment should be eliminated. The Ministry of Health should engage a multidisciplinary team to tackle these disparities.

What is your advice to young pharmacists, especially female pharmacists aspiring to be like you?

The sky is the limit! To my fellow pharmacists, we are the catalysts for the change we aspire to see. We must persist in seeking a seat at the table and advocating for provider privileges. By making a difference one patient at a time, we can create meaningful change. Do not limit yourself.

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