Emmanuel Omehe is a community pharmacist practising in the United States of America and Nigeria simultaneously. He is a partner at Total Pharmacy, Dallas, Texas, USA, and president of SKP Pharma Ltd., in Ogba, Ikeja, Lagos. He is also the treasurer of the Nigerian Association of Pharmacists and Pharmaceutical Scientists in the Americas (NAPPSA). In this in-depth interview with Pharmanews, he charges the Pharmacists Council of Nigeria (PCN) and the National Universities Commission (NUC) to work towards including immunisation training and certification programmes in the pharmacy curriculum, saying this is the only way pharmacists can be readily qualified to participate in vaccination activities. He also x-rays pharmacy practice in Nigeria and outlines contemporary roles that pharmacists can assume to maximise their potentials and relevance. Excerpts:
Tell us a little about your background and professional practice.
I am an independent community pharmacist and partner at Total Pharmacy, Dallas, Texas. I have been in community practice since 1993 and pharmacy ownership since 2004, after having worked as a pharmacy manager at Walmart Pharmacy Inc.
I obtained my Bachelor of Pharmacy from the University of Benin, Benin City in 1988 and a Doctor of Pharmacy from Howard University, Washington DC.
I am a Fellow and current treasurer of the Nigerian Association of Pharmacists and Pharmaceutical Scientists in the Americas (NAPPSA). I am also a director on the Board of Independent Pharmacy Academy (IPA) of the Texas Pharmacy Association – the body that represents all pharmacists in the great state of Texas.
I am the President of SKP Pharma Limited in Ogba, Ikeja, and a member of the Pharmaceutical Society of Nigeria. Thus, I practise in both the United States and Nigeria. For this purpose, I make frequent trips to Nigeria, which affored me the opportunity to be intune with the practice in Nigeria.
Prior to immigrating to the US, I was pharmacist-in-charge and VP at Zevis Pharmaceuticals Limited, Lagos. Pharmacy advocacy is a strong passion of mine, to advance the practice of Pharmacy both here in the United States and in Nigeria. I believe that unless one passionately fights for the rights of our profession, our value will not be appreciated or adequately compensated, and we may continue to be regarded as afterthoughts in the healthcare sector.
What informed your decision to study Pharmacy and why specialise in community pharmacy?
I knew I always wanted to be a pharmacist since my high school days because I wanted to be an entrepreneur and own my business. I also knew I love to help people and the pharmacy profession is a confluence of both desires of mine. I actually got admitted twice to study Pharmacy in the University of Benin both after my O’ and A’ levels. Pharmacy for me was more of a calling than a choice and I have enjoyed every moment of it.
I chose to specialise in community pharmacy after working in the industry and hospital and I did not get the satisfaction that I sought from both areas. Two mentors during my internship personified the ideal patient care experience. Patients always left the pharmacy with smiles on their faces and I wanted to have the joy of taking care of my patients while being my own boss.
Since you are conversant with the practice in both Nigeria and USA, what are the gaps in Nigerian practice compared to what obtains in the USA?
In the United States, Pharmacy education and practice revolve around the Pharmacists’ Patient Care Process (PPCP), which includes collecting – where a pharmacist obtains information from a patient; assessing – information gathered is assessed and analysed to optimise the therapeutic outcomes of the patient’s regimen; planning – in collaboration with other healthcare providers and caregivers, a patient-centred plan of care is devised; implementation (of the care plan) – in collaboration with other healthcare professionals; and follow-up – where the pharmacist reviews outcomes of the plan and modifies in coordination with the other team members if need be.
As you can see, the patient is at the centre of the care process, in collaboration with other members of the healthcare team. In Nigeria, the product is still the focus of medication therapy and that leaves several gaps in the patient care process, while missing out on multiple practice settings and employment opportunities for pharmacists. It also portrays pharmacists as dispensers only, who “count and pour”.
This is however changing with the advent of clinical pharmacy curriculum in colleges of Pharmacy and in hospital settings.
One of your beliefs is fighting for the profession, but is this called for in the US?
You bet! The business aspects of the pharmacy profession is still being largely dominated by Pharmacy Benefit Managers (PBMs) who are middlemen between the health insurance companies or government (payors) and healthcare providers, whose primary objective is to maximise profits for themselves at the expense of the pharmacist.
Pharmacists have to fight for their profession through advocacy, otherwise they will not have a profession to hand to the younger professionals. In some situations, we are reimbursed below what it costs to purchase the medication. Also, certain patient care services were not reimbursed because the pharmacist would gladly do them without being paid. However, that is changing. With the recent US Supreme Court decision (Rutledge vs PCMA), states are now going to be able to better regulate the PBMs, and all of that came through the efforts of advocacy.
This has also led to expanded roles for the pharmacist, such as prescribing certain class of medications, performing CLIA-waived diagnostic test and treating ailments, such as strep throat and flu.
The role of pharmacists in COVID-19 management is considered paramount in the US, but the Nigerian government is yet to engage them in vaccination. What’s your view on this?
Pharmacists are the most accessible healthcare professionals and those in the US have leveraged this to expand the scope of practice to include administration of immunisations. As a result, immunisation training programmes were included in the colleges of Pharmacy curricula and APhA developed Immunisation Certification programmes for those out of school.
In Nigeria, immunisation is currently mainly available via the primary healthcare domain. That needs to change if we are to vaccinate majority of our teeming population of almost 200 million people. Who else is better equipped with the knowledge of immunology, vaccine storage, safety, adverse effect and contraindications, response to anaphylactic reactions and patient education than the pharmacist?
Also, the PCN and the NUC need to include immunisation training and certification programmes as part of the pharmacy curriculum in all faculties of pharmacy in Nigeria. In the interim, to meet current vacuum, those of us in the diaspora can be called upon to help institute a “train the trainer” certification programme.
You own a pharmacy in Nigeria while practising in the US. How do you guard against fraud?
I own a drug importation and distribution company in conjunction with two other partners based in Nigeria and the US. It is not surprising that you ask about guarding against fraud because dishonesty, fraud and corruption are big problems in Nigeria. We mitigate against such with frequent trips to Nigeria, use of technology, tight inventory control, constant monitoring and adequate training to give our employees a sense of ownership. These have helped but have not been able to completely eliminate shrinkage.
Aside from vaccination, what other new roles are appropriate for Nigerian community pharmacists in the face of disease outbreaks?
The focus of the community pharmacist needs to shift from the product to the value and quality of patient care through clinical pharmacy services. This will reduce practice redundancies and drive better health outcomes.
Disease state management, such as diabetes, high blood pressure and high blood cholesterol are services that pharmacists can acquire specialised skills on and these services have been shown to improve medication adherence and clinical outcomes for patients with chronic conditions.
Pharmacists can also play important roles in improving population health, especially in areas such as tobacco cessation and obesity. Here in the US, pharmacists in some states can interpret common diagnostic tools, such as for influenza and strep throat infections and prescribe routine medications to treat them in a “test and treat” model. Hopefully, that will be the case legally in Nigeria someday.
Pharmacists do have significant roles to help address the issue of vaccine hesitancy through continuous patient education, as well as the ever-evolving potential treatment options for the COVID-19 disease, such as monoclonal antibodies.
Nigerian pharmacists need to be an integral part of the CACOVID initiative, if it is to achieve its stated goals of combating the disease and to provide tests and treatments, such as vaccines and new therapies, which include convalescent plasma and monoclonal antibodies.
In what ways can the Nigerian government assist pharmacists in the community to make more impact?
Immediate implementation of all segments of the National Drug Distribution Policy, especially the sale of medications only at approved sites/premises.
The government needs to provide enabling environments for private firms to set up chemical plants for the manufacture of Active Pharmaceutical Ingredients. COVID-19 did reveal the national emergency associated with the restrictions by major sources of APIs in the world, leading to scarcity and high prices.
Government should also make it easier for pharmacists to access low interest loans for small scale drug manufacturing, in the same manner it has done for the agricultural sector through various Central Bank of Nigeria programmes. Currently, these loans are through the commercial banks and they are not easily accessible.
What is your advice to young pharmacists in Nigeria?
Never stop learning. Always improve your skills and knowledge through continuous education. Promotion or advancement happens when opportunity meets preparation. I attend a lot of conferences and trainings to keep updated with current trends in pharmacy practice and that has helped in being a resource to other community pharmacists and young professionals. I recently went back to school to obtain my Doctor of Pharmacy degree after several years of being out of school.
Be active in your local pharmacy associations; this will improve your networking abilities and increase your sphere of influence. Strive for excellence in all you do and get into leadership roles when opportunities present themselves for such.