PEN Magazine #11

INTERNATIONAL DAY OF EDUCATION CELEBRATION YP, POLAND

14 In order to celebrate the day of education, Young Pharmacy (YP), Poland decided to engage our podcast team to record an episode about education in the era of the COVID-19 pandemic.

Our Podcast Team set itself the goal of presenting the problems of pharmacy students from international perspective, so we decided to invite our friend from France to take part in the recording.

In this episode entitled Pharmacy Education during COVID-19, we focused on the general description of education systems in Poland and France, the differences between them and how universities in both countries are dealing with the COVID-19 pandemic.

After recording and post-production we have published the episode on Spotify [click here] We were planning to publish it on YouTube as well, but unfortunately Podcast Team faced some technical difficulties at that matter, so for now this episode is available only on Spotify. We are still planning to upload the episode on YouTube, but for now it is hard to say when it will happen.

Finally, on the 31st of January, we posted the Spotify link on the IPSF Global Family Facebook Group with proper hashtags [click here]

INTERNATIONAL DAY OF EDUCATION CELEBRATION FEBRAF, BRAZIL

16 Education awareness campaigns are the set of actions to promote support for solidarity and life promotion initiatives. Acknowledge the importance of working on high-quality education for everyone and at all levels. Also, recognizing that education is an important tool to build sustainable societies and follow the Sustainable Development Goals.

Our activity was carried out on 12th January 2021, where it occurred a call for members via WhatsApp and e-mail, emphasizing the importance of participating and meeting with experts in this field about the initiative, asking them to record a short video (maximum of five minutes) about this topic.

These videos were posted on Facebook, Instagram, and LinkedIn, culminating with Prof. Elvis Almeida participating in the initiative. We extended the deadline to one day (until 11:59 PM, 25th of January 2021) in order to receive more content from members.

About the results, we posted all content sent by members and tagged @IPSForg. This content was posted during the week, but unfortunately, the video did not have the expected number of people reached, but to improve it we are considering promoting it at other times and in other networks besides Facebook and Instagram.

In the evaluation of the Campaign, we had low participation of the FEBRAF members. Although, all the content gathered had high quality, showing that those who participated were interested in the campaign.

For future campaigns, it would be interesting to set goals for participation and adopt different approaches to achieve that goal. [click here to watch Prof. Elvis’s video]

INTERNATIONAL DAY OF EDUCATION CELEBRATION PPSA, POLAND

18 To celebrate the International Day of Education, PPSA Poland has prepared a series of posts regarding pharmacy education in different countries as well as students' opinion about the impact of COVID-19 pandemic on the work of their universities.

To sum up our campaign, we created a video about the current situation and solutions in pharmacy education used around the world.

While preparing our campaign we tried to focus on comparing pharmacy education in different countries, their curriculas, main subjects and procedures that lead to becoming a registered pharmacist. In order to do that, we released a Google Form and shared it with 7 countries. We received important information regarding studying in countries such as Canada, Costa Rica, Egypt, Nepal, Portugal, Sierra Leone and Slovenia. Students also had the chance to express their opinion on how their universities are dealing with the pandemic.

During the activity, which started on the 27 of January, we shared 3 infographics in total. They covered the topics that we found the most interesting: tuition and scholarships, internship opportunities, the effect that the pandemic had on pharmacy education and possible solutions. On the last day of our campaign, we published a video presenting interesting answers introduced during the period of online teaching in Medical Universities in Australia, USA, Denmark and Japan. It was an amazing opportunity for our volunteers to broaden their knowledge about education in countries in various parts of the globe.

Each one of our posts was viewed by approximately 1700 students; the video shared on the IPSF Global Family Group has reached 2619 students from all over the world.

The COVID-19 pandemic changed pharmacy education permanently as it promoted and facilitated online learning for the pharmacy workforce. To avert further harm posed to pharmacy schooling and practice, universities had to develop innovative online teaching in a short time. Countries responded to this challenge in various ways. Nevertheless, many pharmaceutical students are doing their best to continue self-development and receive the best education possible even during these uncertain times. [click here to watch the video]

SHE CHLOÉ KAYROUH 1 1- LPSA, LEBANON

20 A flower bloomed once upon a time, And was told to look pretty and smile, Forbidden to let her petals shine, She slowly felt the need to resign.

Her beauty was truly unmatched, And her grace was far from scratched, But her thorns would grow weaker, With every blow would sink deeper.

The beautiful flower was a She, As real as you and me, As strong as heroes from mythology, But always fell victim to misogyny.

The tale I write goes further than the stars, And is bled through tears and scars, For the world She holds so close to her heart, Is the one making sure to destroy her art.

I knew flowers that outmatched the skies, With joy and hope shining within their eyes, With the power to hold lives in their wombs, And the strength to nurture them till they bloom.

So don’t you dare tell me She isn’t strong, Don’t you dare disrespect her because you’re wrong, The world revolves around her empathy, She’ll love everyone, even her enemy.

History showed her no mercy, Abuse, silence and sorcery, She was Made the reason for Adam’s fall, But even He realized that She was his all.

She is love, respect and security, She is mother, sister and family, She was made the greatest She could ever be, In everything she is and isn’t, she is SHE.

SOUR QUEST FOR INDIVIDUALITY JANIS JOSE 1 1- MAPS, INDIA

22 Age-old stories of valiant queens, Joining arms, causing a rebellion, Hoping to change misogynistic minds, Bizarre beliefs, masculine dominion.

The revolt proceeds in disputes and debates With women on the frontline, fighting their fate, Craving for a voice to voice their opinion, Craving for rights to choose their companion.

They're sexualized young, yet sexual rights are shunned, Taught to embrace the body entitled to others, Educated to earn but subjected to marital dependency, Encouraged to fly high, within borders of patriarchy.

Centuries passed, many battles ceased, Technology advanced, diseases eased, Yet the quest for individuality continues its fight, Fixing pieces with peace, anticipating equality.

ARTWORK COMPETITION - INTERNATIONAL DAY OF INNOCENT CHILDREN VICTIMS OF AGGRESSION

24 Artwork 1

Artwork 2

25

Artwork 3

Artwork 4

Artwork 5

PHARMACIST: A REWARDING CAREER KONSTANTINOS PEFANIS 1 1- BPSA, UNIVERSITY OF SUNDERLAND, UNITED KINGDOM

1- Introduction

27

It could be argued that the role of the pharmacist has been underestimated by the professional boundaries and the widespread use of the word “professionalism” beyond the established disciplines. Goals, tracking, and managing performance are challenges that all professionals face, and there is a question about how much autonomy an individual has when taking on a role. Many have chosen the pharmacy career as a profession, but often end up pursuing organisational goals that they may not agree with.

However, striving for a flexible, adaptable workforce that can meet the healthcare needs of a growing population with multiple long-term conditions means that there is more work beyond the professional boundaries and professional roles inevitably become more homogeneous. Although taking on new roles can be enriching, there is also the risk of a profession losing its way, or worse, losing its identity. Poorly-defined professional role limits can also be a source of conflict and there is a risk that the interests of patients and the public will not be served.

The role of pharmacists must be in line with the roles of others, such as doctors, nurses, pharmacy technicians, etc. The nature of the power and responsibility between these relationships must be clear, as well as what are the formal and informal expectations between them.

2- The need for the development of the profession Traditional efforts to summarise the pharmacist’s role have been “product-focused”, that is through the drug (usually its manufacture and supply) and the relevant information provided. It could therefore be said that the primary role of the pharmacist was to be an expert in medicines.

Now the focus of the role has shifted towards that of the caregiver - pharmacists are committed to anthropocentric care by ensuring high-quality drug use and counseling. This includes the effectiveness, safety, and experience of the patient.

Pharmacists may also have general roles as an educator, manager, mentor, business/service planner, leader, researcher, etc. The proportion of additional roles taken on will depend on the location of their practice, experience, skills, interests, and other factors. The role may not need to be directly aimed at the patient and focus on the individual.

Pharmacists’ role is changing and will continue to change along with the needs and expectations of patients/users of the service. Change is always present. The structure of national healthcare systems and of the wider economy are changing, with the result that services need to be restructured to fit new care models that are closer to the patient.

Advances in technology, socio-political changes, greater access to information, and the transition to interdisciplinary work (including role replacements, role improvements, and role extensions) mean that pharmacists need to change their way of working.

By defining the basic qualities of the role, appropriate selection, training, training, and workforce planning can be developed. Therefore, pharmacists need to adapt to be able to develop their own practices and roles to meet changing needs. The willingness to be more actively involved in decision-making and take on greater leadership responsibilities should certainly be at the heart of the role. Pharmacists should also be able to move more flexibly, such as between hospitals and the community, and understand that their roles will change throughout their careers.

Science must be a fundamental part of the role so that it can then be applied, for example, to clinical problem-solving.

Other key elements need to be agreed upon, and patients, the public, and other professionals informed about the depth and breadth of pharmacists’ training as well as the skills they can expect from them.

If the role of pharmacists is very limited, we run the risk of poverty and one-sided occupation leading to a stalemate. If evolution is multifaceted and multidimensional, it will make sense. The reward of a true understanding of our role is that we are all committed to the benefit of patients.

References 1. The Pharmaceutical Journal, PJ, January 2018, Vol 300, No 7909;300(7909). DOI:10.1211/PJ.2018.20204131.

BEAUTY BEYOND COLOUR COMFORT TANAKA GUTU 1, LILIAN MUTHONI NGARUIYA 2 1- ZPSA, UNIVERSITY OF ZIMBABWE, ZIMBABWE 2- KEPHSA, KENYATTA UNIVERSITY, KENYA

Abstract

29

Skin diseases such as acne and skin cancer have been on the rise in Africa with the majority of people suffering from these conditions having bleached their skin at some point in their life. Skin bleaching has been a trend in the African continent with the majority of young women aged between 18 and 35 being the most affected. There has been a general consensus that those who bleach have no idea of the adverse effects and only do so because of societal expectations and peer pressure. Therefore, it was the aim of this study to identify the substances used for skin bleaching and assess the general knowledge on their adverse effects in Africa. In order to gather the information, a standard questionnaire was administered both in English and French in Zimbabwe, Uganda, Zambia, Rwanda, Togo, Nigeria, Tanzania, Ivory Coast, and Kenya. The questionnaires were randomly distributed to people between the ages of 16 to 35 in all nine countries respectively. The questionnaire was administered to 514 people across the 9 countries. Answered questionnaires were scanned to a central database in Zimbabwe. The most used product for skin bleaching across the continent was corticosteroids such as hydroquinone, hydrocortisone, and dexamethasone with 86.4% being avid users. More than 43% of those who bleach their skins cited that they did so because of low self-esteem coming from the notion that lighter-skinned people are more attractive and more successful. There was generally low knowledge on the possible adverse effects of skin bleaching with only 1.9% having vast knowledge in the subject matter. Some were willing to bleach their skins regardless of the adverse effects. The results from this study show the need to actively carry out educational campaigns. They also support the notion that most people who bleach their skins have no intimate knowledge of the adverse effects.

1- Introduction 1.1- Skin bleaching Skin bleaching is knowingly modifying the skin’s natural or original color to a state where the skin is lighter. It involves the use of chemical skin lightening agents, manufacture or homemade, or both. Skin lightening dates back to the 16th century through the use of powder and paint. In the present age, skin bleaching is now being practiced mostly among the communities of color (Adu-Gyamfi and Gyasi 2017).

1.2- Products used in skin bleaching The products used for skin bleaching originally were meant for the treatment of hyperpigmentation disorders but, with time communities and societies such as the African and the Asian society began to use these products to lighten their complexion giving a rise in the prevalence of the use of these cosmetic products from 25% to a high figure such as 96%, spreading beyond just the communities of colour, from being a female practice to the inclusion (Darj et al., 2015).

Bleaching products consist of creams, ointments, soaps, capsules/pills, and injections, with the use of soap being high from 1957 to 1980, then after creams were introduced into the cosmetics and products industry. One thing in common with all the products is that they contain hydroquinone, corticosteroids, or mercury, which act through the suppression of the production of melanin - the pigment responsible for skin color. These active ingredients are effective in lightening the skin but are associated with health risks such as dermatitis, impaired wound healing, adrenal suppression, neurological, physiological, and renal effects. Mercury can even cross the placenta, posing health problems in pregnant women and to the fetus (Adu-Gyamfi and Gyasi, 2017).

1.3- Skin bleaching in Africa and its consequences

30

Skin bleaching has been an African trend for years now, and, as a result, there has been a rise in incidences of skin cancer. The use of bleaching chemicals has created problems for the dermatologist who now have the task of dealing with skin-related issues due to the use of bleaching products that contain hazardous chemicals that can cause serious physical harm. The usage of hydroquinone is known to inhibit the production of melanin which consequently results in the person being prone to sunburns. Furthermore, mercury may lead to the impairment of the nervous system and kidney dysfunction (Keitumetse Mmami Keakile, 2016).

Further consequences of skin bleaching are dermatophyte infections, irritant dermatitis, acute cases of scabies, eczema, skin cancer, body odor, thinning of the skin, dyschromia, poor wound healing, and need for corrective surgical dermabrasion. Prolonged exposure to skin bleaching toxic substances can cause damage to the kidneys as well as suppress the immune system, which may result in an individual suffering from opportunistic infections such as tuberculosis and vulval warts (Ajose, 2005). Research has also shown that about 60% of those who practice skin bleaching may incur at least any one of these complications at some point in their lives (Keitumetse Mmami Keakile, 2016).

1.4- Justification Although several research articles related to health, dermatology, drug use and psychology have attempted to examine, analyze and illustrate the practice of skin bleaching, there remains uncovered grounds. Extraction of reliable data and statistics, has itself proven to be herculean for reasons yet unknown. These lapses however have not abated the exponential rise in skin bleaching but rather has potentiated its growth, reasons being that they weaken prospective intervention and also because it presents little attention to the topic.

Africa continues to be the major funders of skin bleaching products as the demand, patronage and usage of such products increase daily, although they are also used in countries like the United States of America and Great Britain. It is paradoxical, how the continent continues to embrace these products while suffering the consequences of their use, some of which are liver and kidney damage, nephropathy, ochronosis, discoloration, and predisposition to cancers. This largely emphasizes the need to further research and evaluate the reason why the act continues to linger within the continent.

Based on several research works, some individuals use skin lightening substances under guidance/prescription by health personnel to treat or manage skin conditions; some use them intentionally to attain a presumed feeling of being more beautiful due to deluded societal standards; while others use them continuously by addiction (due to resulting skin deterioration experienced when they attempt to stop) (Ogo Maduewesi, 2017). From another angle, however, are individuals who utilize these products completely unintentionally due to ignorance of their lightening constituents, use of synonyms of such constituents on labels, or worse even, lack of inclusion of skin lightening constituents on product labels. For instance, some manufacturers resort to using other synonyms of hydroquinone such as 1,4-benzenediol, quinol, p-diphenol, and tequinol (Olumide et al., 2004).

All of these contribute to the lapses obstructing full understanding of the “what”, “who”, “how”, and “why” of skin bleaching. Thus, this research is driven at answering some of the lingering questions with a primary focus on the skin bleaching substances being used and then the assessment of the general knowledge of individuals (users and non-users) about these substances and their adverse effects - within Africa.

Such information gathered will help to further enlighten the public, and help determine the next course of action towards halting the practice, hence making Africans more comfortable in their melanized skin. The research shall influence positive change by first assisting unintentional users to identify skin bleaching substances and their constituents in order to avoid them. It will enhance the rational use of medications containing potential skinbleaching constituents. Also, the identification of these products will help the government, health task force and other well-meaning bodies/foundations to improve regulation of such products and prevent them from unlawfully flooding the legal and black markets.

31 The assessment of the knowledge of individuals on skin bleaching and its adverse effects will aid the determination of the intelligence level of Africans pertaining to the subject and provide a basis for devising better strategies to boost such knowledge if found deficient. The research will also assist in the examination of the degree of societal pressure and addiction to skin bleaching substances being that some persons may be duly informed of short- and long-term implications and still go out of their way to purchase these products.

More so, the degree of addiction deduced will further spur an evaluation of the psychological impact of the skin bleaching practice. More often than not, the reason is lack of confidence in one’s skin - a notion which is highly destructive to the health, psychological and social wellbeing of Africans. Most Africans have limited knowledge on the subject matter and potential adverse effects.

2- Study purpose 2.1- Research question What substances are being used for skin bleaching in Africa and do Africans know the potential adverse effects?

2.2- Hypothesis African skin bleachers have no knowledge of the adverse effects of skin bleaching.

2.3- Problem statement There has been a rise in skin cancers and skin-related problems across Africa as a result of bleaching hence prompting this study. The demographic distribution of this tradition even provokes more questions. According to the World Health Organization, within Africa, 77% of Nigerian women are avid users of skin lightening products, followed by Togo with 59%, South Africa with 35%, Senegal at 27%, and Mali at 25%. Such inordinate distribution is worrisome because it is unclear whether the reason is due to population differences, ignorance of these substances and their consequences, infiltration into the drug/cosmetic market, or several other unlawful reasons.

The number of Africans using these products has prompted an unanswered question of whether or not these people are aware of the potential adverse effects. Most Africans are not confident In their natural black skin and that has led them to lighten their skin in order to archive a perception of beauty.

2.4- Objectives 2.4.1- Main objective The main objective of this study was to identify substances used for skin bleaching and assess the general knowledge on their adverse effects in Africa.

2.4.2- Specific objectives The specific objectives were to: 1. To understand the reasons why people bleach their skins; 2. To identify the age group most affected by skin bleaching.

3- Methodology 3.1- Study sites The study spanned across 9 countries in which IPSF is represented - Zimbabwe, Zambia, Togo, Tanzania, Kenya, Nigeria, Ivory Coast, Rwanda, and Uganda. Any other African living in Africa was free to participate in the study.

3.2- Study design Questionnaires were randomly administered to IPSF AfRO member states by pharmacy students. Answered questionnaires were scanned to a central database in Zimbabwe where it was analyzed using graph pad prism and Microsoft office packages.

4- Results 514 people took part in the research. 70.8% of the interviewees were females and most males were adamant about answering questions regarding the subject matter. 35% of the participants attested to have deliberately bleached their skin to a lighter tone and only 7.5% were not sure if they did but attested to having used skin lightening creams once in their life.

4.1- Products commonly used for skin bleaching About 40% of those who bleached used hydroquinone followed by 26.7% of dexamethasone and 17.9% of hydrocortisone as shown in Figure 1 below. The majority of the avid users use more than one product and this can be a combination of hydroquinone, hydrocortisone, EDTA, mercury, and even injectables.

32

Figure 1: Products commonly used for skin bleaching.

TThey acquire these products mainly through unscrupulous business dealers in the streets, hair salons and/or beauty shops selling creams and ointments for body use. The majority of these products were not acquired in pharmacies however, some participants acquired these from pharmacists without prescriptions. Some even had these products compounded in local retail pharmacies.

4.2- Reasons why people bleach their skins Close to 43% of those who bleached did so in order to give themselves a sense of beauty. The other 25.8% were succumbing to peer pressure and wanted to “look like supermodels in movies and billboards”. Only 7.6% bleached their skins for medical reasons with acne being the most cited condition as shown in Figure 2 below.

Figure 2: Reasons why people bleach their skin.

4.3- Knowledge on adverse effects The study group had some knowledge on the possible adverse effects of skin bleaching with 58.9% claiming that they are aware of the adverse effects. Of the 58.9%, only 1.9% had intimate knowledge of the possible adverse effects.

The majority (41.2%) rated their knowledge as low and close to nothing. 38.9% had a general idea of the adverse effects of skin bleaching and rated their knowledge as low to medium as shown in Figure 3 bellow. Only 18% believed that their knowledge of the adverse effects was slightly above average.

33

Figure 3: Knowledge on adverse effects 5- Discussion Incidents of skin bleaching are on the rise in Africa mainly because of the influence of the media. This, however, has attracted a significant number of adverse effects including cancers that have a negative impact on health. Skin bleaching is slowly becoming a public health threat and is projected to “eat” into the health budget in the near future with unforeseen costs of both purchasing the product and treating the adverse effects. We identified corticosteroids (mainly hydrocortisone, hydroquinone, and dexamethasone) as the most used products for skin bleaching in Africa, mainly because of their cheap price and easy accessibility. A single tube of dexamethasone costs an average of 0.6 USD in Kenya and an average of 1.2 USD in Zambia and an average of 0.9 USD in Uganda and 2 USD in Nigeria. In some countries such as Zimbabwe, some of these products are sold in pharmacies on prescriptions only; for instance, hydroquinone and hydrocortisone are pharmacist-initiated but still find their way to the streets. In most African countries one does not need a prescription to buy corticosteroids hence making them readily available even in pharmacies. Some countries such as Rwanda have banned the use, procurement and sale of these products in their countries.

The notion that lighter-skinned women are more beautiful has caused a lot of young women to bleach. This reason was the most cited in this study. This comes after the use of lighter-skinned women in movies, advertisements and even in marketing. The dark-skinned women wanted to “look like supermodels”, but for some of them it did not go as they were expecting after they experienced some adverse effects. Most dark-skinned women did not find confidence in their skins and the darker ones succumbed to name-calling and thought of themselves as less desirable to men. They had a serious inferiority complex to lighter-skinned women. This reason was universal in all the 9 study countries. Others succumbed to peer pressure after the majority of their friends used skin lightening products at school or at work and they were pushed into using skin lightening products in order to belong to a certain group of friends. Those who were lighter-skinned looked down upon the darker-skinned ones and as a way of gaining recognition and acceptance they bleached their skins. The males that bleached their skins mostly did it because they wanted their tattoos to be more visible on them and to win the favor of white women. Other males who were performers and into music felt more confident in lighter skin and thought they would be more successful in their careers if they did so. They gave examples of their role models such as Vybz Kartel and wanted to be exactly like them.

Some of the participants confirmed to have knowledge of the adverse effects of skin bleaching but still bleached their skins because of the notion of being beautiful and the fear of not finding a sexual partner because of their complexion. They were willing to take the risk even if it endangered their lives. Others were completely amazed that skin bleaching could have delirious effects because they had no prior knowledge of the subject matter, they simply thought it was a trend and in order to look “cool” you needed to bleach your skin. Generally, the study group had low knowledge of the adverse effects and some did not bother to look for them because they were willing to look “beautiful” at all costs.

34 6- Conclusions About 86.4% of the products used for skin bleaching across the African continent are corticosteroids such as hydroquinone, dexamethasone and hydrocortisone, mainly because they are both readily available and affordable.

More than 43% of those who bleach their skins do so because of low self-esteem coming from the notion that lighter-skinned people are more attractive and more successful. The people have low knowledge on the possible adverse effects of skin bleaching with only 1.9% having vast knowledge in the subject matter. Some were willing to bleach their skins regardless of the adverse effects.

7- Recommendations Since the study showed that only 1.9% of the study population had intimate knowledge on the possible adverse effects of skin bleaching, I recommend IPSF and its stakeholders to actively carry out educational campaigns on social media and physically across the African continent. Low self-esteem caused 43% of the people who bleached to bleach therefore I recommend active counseling and engagement to try and boost confidence in dark-skinned people. Corticosteroids constituted 84.6% of the products used in skin bleaching across the African continent and they are mainly being found in the streets and beauty shops therefore I strongly recommend engaging Ministry Health and the police for advocacy in order to have tighter measures on accessing the products. I also recommend retail pharmacists to actively counsel patients on skin bleaching and the possible adverse effects when they purchase these products from their pharmacies.

References 1. Adu-Gyamfi and Gyasi 2017, Skin Bleaching: A Perspective on the Ghanaian Phenomenon, Kwame Nkrumah University Of Science and Technology & Lingnan University, pages 7-13 2. Darj, Infanti, Ahlber and Okumu, 2015, The fairer the better?" Use of potentially toxic skin bleaching products, Health, Uppsala University, Sweden, Norwegian University of Science and Technology, Trondheim, Norway, page 2-4 3. Souza, 2008, The concept of skin bleaching in Africa and its devastating health implications, Aga Khan University, pages 7-9 4. Shankar, P.R., & Subish, P. (2007). Fair skin in South Asia: An obsession. Journal of Pakistan Association of Dermatologists, 17, 100-104.

5. Keitumetse Mmami Keakile, 2016, Motivations, consequences and knowledge of skin bleaching: a study of perceptions of students of the University of Kwazulu-Natal, South Africa 6. World Health Organization 2017, www.who.org

Pharmacy Education Newsletter #11

IPSF PEN MAGAZINE