Sunday, October 31, 2010

What Pharmacists Do: A Day at Desa Temuan

What got all the staff from a district health office (comprising pharmacists, doctors, dentists, nurses, medical assistants, health officers, administrators and drivers) up at 8 a.m. on a Saturday (30/10/10)? It was the Kem Kesihatan Kampung Orang Asli at Desa Temuan. This is part of the government's health promotion effort, offering the orang asli free medical and dental check-ups, educating them on medicines as well as raising awareness about tuberculosis and smoking.

Left: The Bukit Lanjan Community Centre.
Right: Dewan Seri Temuan.

It rained in the morning so it took a while before the crowd started to throng in.

The pharmacy station.

Busy packing goodie bags, some lucky ones received vitamins for their children.

Left: Simple items such as paracetamol, chlopheniramine, bisacodyl, calamine lotion etc.
Right: Prescription

Dispensing medicine to patient.

We went around pinning badges 'Kenali Ubat Anda. Tanya Ahli Farmasi Anda' on the kids. The kids were really happy to get the badge, they went on to bring their friends and asked us for it.

As we did pinned the badge on them, the 'promotion' of the role of pharmacist went like: 'Ubat ini comel kan? Jadi bila sakit, mesti ambil ubat ya.'

[To the older kids] 'ah kak siapa?' 'Doktor' 'Bukan, ah kak ahli farmasi'
(Nevermind that it may not stick into them yet, at least they know that someone other than the doctor is part of the healthcare team. By the way, I think it doesn't help in our effort to enhance the role recognition of pharmacists among the public when the word 'pharmacist' is not exactly easy to remember-for those not-so-educated ones and for kids to pick up.)

We also took the opportunity to speak to some people (targetting the right audience) about how to spot a genuine product (MAL number, hologram & meditag), proper storage of medicine and its importance as well as the products purported to cure certain chronic diseases which can't be advertised.

The pharmacy team.

Left: Awaiting their turns for medical check-up (blood pressure, immunisation among children, body mass index, any other chief complaints by patients)
Right: Phlegm-taking station (for Mantoux test)

Left: The crowd got larger after 10 a.m., so much so that we stayed till 2 p.m. (beyond the scheduled time)
Right: Lucky draws

Traditional performance by the Temuan girls.

In my opinion, the health promotion could have been better carried out if we were allocated a session to give a talk. Topics can be on 'Kenali Ubat Anda', but we do it in a more interactive way, bringing samples of counterfeit products, getting audience to check the genuine products with the Meditag (it was hard achieve the same outcome at the pharmacy counter though we had goodie bags as the patients came staggeredly and we couldn't hold their attention long enough). We can utilise the goodie bags more effectively (we had initially planned to do so but when we saw only a handful of people earlier on, we decided to give something to whoever who came to our pharmacy station) by giving them to those who ask questions about what we have presented.

Prior to the campaign, the authority could also have urged the people to bring their medicines from home so we can do a
medicine cabinet clean-up for them. However, a colleague told me that when the health inspector did a pre-campaign survey, it seemed that the orang asli wasn't that interested in the whole campaign. Indeed, it is a long way towards raising their awareness about health and medicines. Perhaps the government can look into home medication review for these people as well.

Nevertheless, it was a fruitful morning and we shall strive to be better in upcoming activities!

Disclaimer: This is an opinion piece and therefore subjective by nature. The opinions expressed here are the opinions of the individual author and are not necessarily the views of the particular district health office.

Saturday, October 16, 2010

Latest update on WHO's Antiretroviral Therapy for Children and Infants

Hi frens,

Check out the link if you are interested to know the latest update on antiretroviral therapy for children and infants.

(P/S: Thanks Ka Keat for sharing this out~)


Thursday, October 14, 2010

Scenario in a Klinik Kesihatan

I have a patient discharged from a hospital to our clinic, and he is on life-long tiotropium bromide Handihaler (Spiriva) and Symbicort Turbohaler for chronic pulmonary obstructive disease (COPD). As these medicines are not in the formulary our pejabat kesihatan daerah (district health office), the hospital is to supply us with those medicines.

When I called up the hospital, I was told that my clinic has to find an alternative since the hospital in low on budget and will no longer supply those medicines to my patient. So this prompted my mini search (or rather, refreshing of) COPD guidelines.Tiotropium bromide (List A*) [Spiriva] is a long-acting anticholinergics (duration: 24 hours) used for the long term maintanance treatment of bronchospasm and dyspnoea associated with COPD. It is usually added to standard therapy (e.g. inhaled steroids, theophylline) and the dose is 18mcg od.

Symbicort Turbohaler (List A) contains budesonide (a glucocorticosteroid) 160mcg and formoterol (long-acting beta2-agonist, duration: 12+ hours) 4.5 mcg; the dose is 1-2puff bd,max 4puff bd.

My clinic only has MDI salbutamol, MDI budesonide and MDI Berodual. MDI Berodual contains ipratropium bromide (a short-acting anticholinergics; duration: 6-8 hours) 20 mcg/dose and fenoterol hydrobromide (short-acting beta2-agonist); duration: 4-6 hours)50 mcg/dose.

According to the GOLD guidelines, an inhaled glucococorticosteroid combined with a long-acting beta2 bronchodilator is more effective than individual components in reducing exacerbations and improving lung function and health status.

Regular treatment with long-acting bronchodilators is more effective and convenient than treatment with short-acting bronchodilators.

GOLD guidelines: Therapy at each stage of COPD

Guidelines according to NICE

Since my patient is on a long-acting bronchodilator and inhaled steroids, his stage of COPD must have necessitated the use of these medicines, and that the short-acting bronchodilator and short-acting anticholinergics in my clinic are not sufficient for his condition. These are conveyed to the hospital and arrangement is made for them to supply us with those medicines currently, after which my budget-strained clinic has to exchange similar-valued medicines with tiotropium and Symbicort Turbohaler from the hospital for my patient's life-long supply of medicines. I believe that patient's care should not be compromised even when he is under follow-up in a clinic !

Can We Cure HIV? Update from Harvard Medical School

Research update on HIV

Tuesday, October 12, 2010

SGLT2 Inhibition: A New Kidney-based Strategy to Reduce Hyperglycemia

New and emerging type 2 diabetes therapies with novel MOAs that reduce hyperglycemia while preserving insulin secretion, preventing hypoglycemia and controlling body weight. Explore renal glucose reabsorption via selective inhibition of the sodium-glucose transporter-2.

Please go through below link to understand more.

Center for HealthCare Education