A 2021 hell on earth ( LPSA, Lebanon The Million Dollar Question - Does the public know their pharmacists’ roles? (BEM FF UI, Indonesia) ……………………………………………………………………………………………................................................. 9

A 2021 HELL ON EARTH WITH PHARMACIST MARWA SALEM AMBASSADOR: MOHAMMAD W. YAMOUT LPSA, LEBANON

It’s clear to anyone who’s brushed through international news recently that the economy in Lebanon has been in freefall for a while, and that the skyrocketing currency’s inflation rate makes this one of the toughest crises in history.

This inflation rate has not only decreased the population’s purchasing power but also induced a forced shortage of drugs. Medications are subsidised by the (currently absent, as by the date this is written) government, however, this is not a solution.

Pharmacist Marwa Salem has given us an overview of the situation in this interview Mohammad: “please tell us briefly about yourself”

Marwa: “I am a pharmacist that has graduated from the Lebanese international university of Beirut (LIU). I have been working in the community pharmacy field for more than 11 years and this has been the worst year ever in my entire life, and entire career.

Mohammad: “What is the most critical problem that the pharmacy profession faces in our country?”

Marwa: “ The economic collapse has led the importers of pharmaceuticals and the medication warehouses to stop distributing medication. They import these medications at an uncontrolled 1 dollar rate of 19,00020,000LL (rising constantly) and yet they have to sell it at a 1$=1500 rate, meaning that they are losing the difference in currency rate. Some medications are subsidised by the Lebanese national bank (BDL, Banque du Liban) but this subside has been lifted from most medications, rendering their rate 12,000, the importers would still be losing the difference in currency, and this has stopped them from distributing medications fairly and adequately, we receive 1-2 boxes of medication at every shipment, and these shipments arrive once or twice a month. Some medications have been cut off from the market, made inaccessible without any replacement, like colchicine and tamoxifen that have been unavailable since the beginning of the year. The crises have many reflections, and the medication shortage is by far one of the lowest points anyone could reach in a country. This is our health! We cannot compromise that. We used to receive as many medication boxes as we asked for, but now we receive the bare minimum of 12 boxes and that’s even if the company warehouses accept to send us medication”

Marwa: “it’s a vicious cycle. A wheel that rolls and alternates between stepping on the pharmacists and stepping on the patients. Patients have reached a state where they take their chronic diabetes and antihypertensive medications every other day rather than every day. And some even 3-4 times a week because they want what little medication they have left to last them as long as possible. We warned our patients to find and leave enough medication for their chronic needs up to 3-4 months, hoping that the crisis would be resolved, we had no idea that we would be rolling down to hell. The pharmacists are also severely affected by this crisis because they have to face the patients, and their nagging, their hurt and the desperate looks on their faces every day, every single day. We try our best to handle the situation with empathy, but we are tired. Our mental health cannot take any more”

Mohammad: “ What steps can be taken to stop and prevent these challenges in our society?”

Marwa: “we have been asking the ministry of public health for a long time to support national medications that are made and distributed in Lebanon, and we would help support the sales of these medications in the local community, rather than importing these medications from outside and paying dollars for it, a currency that has now almost disappeared.

Some people think that since the drugs are subsidised by the ruling authorities, and that because this is the reason they’re not available, the drugs should simply not be subsidised anymore. This doesn’t take into consideration that more than half of the Lebanese population is now living in poverty (by the international standards). The solutions for this have to come from a national and institutional level since the economic crisis is the one that has dragged on all of this.

THE MILLION DOLLAR QUESTION - DOES THE PUBLIC KNOW THEIR PHARMACISTS’ ROLES? WITH APT. NADIA FARHANAH SYAFHAN, M.SI., PH.D. AMBASSADORS: HEIDI & LIMEY BEM FF UI, INDONESIA

Please give us a brief introduction about yourself. Could this be changed to "Please, tell us about yourself:"

I am Nadia Farhanah Syafhan, a clinical pharmacist and lecturer in the Faculty of Pharmacy, Universitas Indonesia. What is the biggest challenge that pharmacists in Indonesia are currently facing in our primary health care system? Looking into the current situation, pharmacists in Indonesia are currently facing several challenges which hamper the sustainability of pharmacists’ service delivery in primary healthcare settings. These challenges include:

a. Macro-level challenges. For instance, constraints related to the healthcare system that are associated with lack of recognition and decisive support from healthcare authorities;

b. Meso-level challenges. For example, organisational and cultural barriers of pharmacists’ services; and

c. Micro-level challenges in terms of individual pharmacists’ competencies. The problems arise due to pharmacists’ lack of knowledge in particular topics, as well as lack of communication skills and teamwork, which lead to the lack of confidence in service provision and interprofessional collaboration.

From the aforementioned issues, the biggest challenge is building trust with healthcare authorities, other healthcare practitioners, patients, and society regarding the fact that pharmacists are medicine experts holding the responsibility to deliver safe, effective, and quality medicines. In addition, the involved stakeholders should also trust in the certainty that pharmacists’ role is essential, thus, it is necessary for pharmacists to be integrated into a healthcare team. Distrust has been a major obstacle for pharmacists to achieve optimal health outcomes.

What do you think is the best way to raise the public’s awareness regarding these problems?

Concerning these problems, the public’s awareness can be raised by showing the fact that pharmacists exist beyond the roles of dispensing medication in several ways. Pharmacists can deliver their roles with more engagement with the patients, such as having a thorough discussion about the patients’ concurrent or past medication, ensuring the safety and efficacy of the medication being dispensed, and maintaining proper adherence by giving information and recommendation through the right patient counselling process. Last but not least, all of these engagement efforts must be continuous, documented, and evaluated.

Since the integration of pharmacists into the healthcare delivery process is essential, pharmacists should be more actively involved in patient care, such as contributing towards the process of medication review, patient counselling, or therapeutic outcome monitoring. This expanded pharmacist’s service could lead to better health outcomes and improved quality of life. To provide these expanded services, pharmacists must enhance and increase their clinical, communication, and interprofessional skills by participating in professional development programs including workshops, training and being actively involved in peer and expert discussions. Pharmacists are also encouraged to be involved as agents of change and propelling “the smart use of medicine” movement.

What can aspiring pharmacists like us do to help solve the aforementioned problems in Indonesia’s primary healthcare system?

As for aspiring pharmacists, they should first follow the curriculum prepared by their own universities. Pharmacy education in Indonesia has adapted its curriculum to better prepare pharmacy students entering their real-life pharmacist practice through implementing problem-based learning which promotes their clinical knowledge and skills development. This is done in hope that the expected high passing rate of the pharmacist’s licence exam could be achieved. Pharmacy students are also expected to be actively involved in organisations comprising other healthcare majors students such as medicine, dentistry, or nursing students to give them an early exposure towards interprofessional collaboration, participating in pharmacy profession awareness campaign, internship programs in healthcare settings, and also brainstorming activities associated with policies surrounding the healthcare system.