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.

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.

http://www.who.int/hiv/pub/paediatric/infants2010/en/

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

Mai

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

http://www.medscape.com/viewarticle/729212?src=mp&spon=30&uac=103666FX

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

http://www.medpagetoday.com/webcast/CHCE01/?mptts=20101005081329

Lessons from HPAIR Part II

In his seminar on Asia's Entrepreneurship Ecosystem, the interesting point brought up by Dr. Tan Wee Liang (Associate Professor of Entrepreneurship and Law at Singapore Management University) that got me thinking was 'the entrepreneurship question'. Entrepreneurship focuses on creativity, intervention and innovations in all walks of life and enterprises. It does not necessarily mean that you need to start an enterprise to be called an entrepreneur. People who work within companies and show entrepreneurial spirit is no less an entrepreneur.

Dr. Tan Wee Liang

The net outcomes of entrepreneurship are value creation and wealth creation. Wealth is not the same as profits-if you have helped somebody and and you feel great about that (you do not charge anything), that is wealth creation. Indeed, I am sure the pharmacists in Hospital Kuching who 'innovated' a spacer device from the normal saline drip bottle for patients who can't afford the Aerochamber, didn't mind walking to-and-for to the ward to get the right measurement of patient's mouth, trimming the mouth of the bottle etc. in order to ensure a tight fit for patients.
[Note for the unitiated: patients with asthma or chronic obstructive pulmonary disease who are on metered dose inhalers may require Aerochamber to ensure efficient delivery of drug since they (especially the elderly) have problem with coordination-pressing the canister and inhaler the drug at the same time]

Some of us may have big dreams we wish to pursue, like starting a pharmaceutical company eventually or being a pharmaceutical scientist in drug discovery and delivery. The pharmaceutical industry has a rich history of entrepreneurship. As shared with us HPAIR delegates in the seminar on Sustainable Entrepreneurship-A Case Study from the Pharmaceutical Industry by Dr. James Garner (Vice President & General Manager, Takeda Clinical Research Singapore), it dates back to the time of Sir Alexander fleming in deriving penicillin and the eventual implementation of large-scale production of penicillin by Howard Florey and Ernst Chain.

Dr. James Garner

In drug development, only 1 in 500 compounds (which have potential to become drug) make it to phase III of the clinical trial; and only 3 in 10 new drugs ever return their cost of development! Due to changing disease pattern and pandemic outbreak, there is urgent call for consistent delivery of transforming innovation in the pharmaceutical industry.

For us fledgling pharmacists who are in the compulsory service, before we get to be master of our own destiny (be it in clinical, retail pharmacy, sales and marketing, regulatory affairs or drug design etc), let us embrace the innovative spirit in our effort to enhance patient care. I have seen simple gestures by the pharmacists that go a long way towards improving patients' compliance and understanding in their treatment, such as the meticulously compiled pictures (together with captions in Malay, English and Chinese) of food/supplements that patients should not consume while on warfarin; to effort which improves the service of the pharmacy department, such as developing a software for the calculation of total parenteral nutrition. Always think 'What else can I do for this patient?'

So my dear fellow pharmacists, let's be a facilitator of change in your workplace!

Lessons from HPAIR Part I

The Harvard Project for the International & Asia Relations (HPAIR) Asia Conference 2010 was co-organised by Harvard University and Singapore Management University and was held on 20th -24th August in Singapore.



So what got a pharmacist interested in attending a business conference? While I graduated with a pharmacy degree, I have always sought out opportunity to further develop my interest outside my discipline. In fact, the pharmaceutical industry is a global business itself. The launching of a new drug requires extensive market research, SWOT analysis, targetting, position and differentiating the drug from that of the competitor's as well as a good marketing plan. Given the sheer size of a pharmaceutical company, it is no surprise that the management and organisational challenges are manifold.

There were several plenaries for selected delegates to choose from during our application, spanning from political,economic, and business to social and cultural. I was given my first choice: Business Strategy and Management. In the afternoon, there were seminars on various topics from which we had the freedom to select (before the capped number of people was filled and you had to go for your second choice, third choice etc.!!) On field trips day, we visited ExxonMobil and 3M Singapore PTE Limited.

I was truly enriched with the inspiring and interesting pearls of wisdom from the business leaders! It is impossible for me to put down in words but here are some snippets of their sharings.

Business Panel: Session I-Leadership
Distinguished speakers:
Mr. Gerald Chan, Country Head & CEO of UBS, Singapore
Mr. Eikoh Harada, CEO of McDonald's Japan
Mr. Tsun-yah Hsieh, founder & chairman of Linhait-Group

From Left: Ms SuiLin yap (moderator), Mr Gerald Chan, Mr Eikoh Harada, Mr Tsun-yah Hsieh

-The challenges to Mr Gerald:
'How do I motivate and galvanise the engagement of people?'
'How do I build up a management team that is able to capitalise on managerial skills of some people and gelling it with the entrepreneur spirit of some people?'

-The root of crisis is uncertainty. Because of uncertainty, the management learnt in school is not useful; it depends on one's quality (judgement, creativity, courage), not skills or knowledge in coping with crisis.

-Most colleges teach you knowledge, a bit of skills, but none on quality.

-There is a universal qualities of a leader; every progressive company put in time and effort to pinpoint what kind of quality they are looking for (not looking at which schools you graduated from). These qualities (to Mr Hsieh) are:

1. Operating skills
-make things happen
-e.g. set up 100 stores in China

2. Business Development
-You may have the best business plan, but do you know how to launch it?
-Do you know how to make a deal?
-How good is your network?
-Do you know how to originate?

3. Organisational Reform
-Large corporations have one universal characteristic-they have been around for centuries hence a lot of 'cobwebs' (complexities)
-In order to move forward, need leadership talent to 'simplify' process
-Leadership is about moving out of comfort zone and do things that people otherwise won't do


-It is always beneficial to have some perspective in the global market you will be operating in, but it is not critical. The criticality of your success lies in your personality.

-Mr Harada on leadership: leadership is about how to manage myself so that the team can be optimised?

-In order to be a global player, understand your own culture first. Think local before global.

-Has the economic crisis ended? We have relatively little control over those things; a better question to ask will be, 'What do you do now, so that when the cycle picks up, you are 2-3 steps ahead of your competitors?' It is important for one to build the innate ability to look around, to know what is around the corner [well, this reminds me of the lessons learnt in 'Who moved my cheese?]

-The constant compression of time and space brings about challenges (e.g. epidemic-spread from one country to another) and opportunities (e.g. ability to make the world your market place)

-The top management are looking for people who are comfortable with making decisions with less than perfect information.

-Sometimes, you need to slow down. When you are so activity-driven, can you really see the opportunity?

-Important asset to a company: someone who is adaptable to change and instinctively looking for a change



Business Panel: Session II-Global Strategy
Distinguished speakers:
Mr Emirsyah Satar, CEO of Garuda Indonesia
Mr Richard Pond, Global Candy Category Director, Kraft Foods
Ms Christina Ventura-Steinemann, Regional Retail Director, Prada
Mr SD Shibulal, co-founder of Infosys Technologies Limited

From left: Ms Suilin Yap (moderator), Mr Pond, Mr Satar, Mr Shibulal, Ms Ventura-Steinemann

Mr Satar
-We are in the travel service sector, not transport business

-Consumer's choice of airline is based on safety and value-for-money (not the cheapest airfare)

-Fuel: around 40% of operating cost; 20% of fuel price increase can be passed on to customers, the company has to find ways to reduce cost (for the other 20%), e.g. through utilisation of aircraft and create network to optimise utilisation (Garuda worked with local government to increase operating hours for airports-used to close at 6 p.m.)

-Airline is a long-term business; e.g. an aircraft ordered now will only be delivered in 12-18 months, hence need to think of where the cycle of business is then

-Don't see low cost carriers as a threat but complimentary to Garuda as they open up market: 60% of Indonesia are connected by air or sea, Garuda's job is to get people who have flown once with low cost carriers to fly with Garuda

-Good is not good when better is expected; you should never be satisfied as people expect more of what you have achieved


Mr Pond
-Kraft Food operates on skilled centres of excellence complimented by local sites (have small R & D groups within business e.g. flavour development in local group but big scale product development is kept similar is all countries)

-Food market that will be doing well is one that adds nutritional value or tackles nutritional issue (Kraft to reduce sodium content in one of its products)

-Global trends that will change the way you do business: Health & wellness, sustainability

-Take risks, you will learn from your mistakes


Ms Ventura-Steinemann
-China is top 2 buyer in the luxury product market; will be top 1 in 2014

-The average age of consumers in China is 20 years younger than that in USA

-Can target customers well as system can tell how many, what type/colour of the product that the customers have bought

-Need to ensure customers have different experience in stores (in the business of 'delivering dreams')

-4Ps:
Have a purpose in whatever you do
Passion makes the difference
Positive: right working attitude with the team
Persistence: be dedicated, your team will follow


Mr Shibulal
-In Indian schools, students are trained to be individual performers; in company, need to convert them to be team-based performers

-His company adopts a collaboration index to measure collaborative rate of a team through a 360 degrees feedback (everyone rates you, rewards will be given) to send a constant message across that teamwork is important and will be rewarded

-Need to customise product to local market; cites an exmaple of shampoo sale in India-shampoos in bottles didn't sell as people could not afford them, hence shampoos in sachets were marketed


Business Plenary: Session III-Creative Capitalism
Distinguished speakers:
Ms Karin Finkelston, Director of East Asia & Pacific of the World Bank's International Finance Corporation
Mr Kawahar Kanjilal, Global Head of Ovi Life Tools
Mr Sunny Verghese, Group MD & CEO of Olam
Mr Jack Sim, founder of World Toilet Organisation

From left: Ms Suilin Yap (moderator), Ms Finkelston, Mr Kanjilal, Mr Jack Sim, Mr Verghese

-Ovi Life Tools tagline: inform, involve, empower

-If you want to create something of value, it has to be something of daily use: agriculture, healthcare, education

-Charity doesn't help because when it stops, everything stops; need to solve problem via business model [Mr. Jack on the founding of World Toilet Organisation]

-The 'keyword' is OP: Other People: Use other people's money! Use other people's network!

-What blocks you are your ego and the government (addicted to status quo)