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An Arab Pharmacy Spring: Taking matters in their own hands
Recent pharmacy-related activities and developments that we witnessed in several Middle Eastern countries could be the early signs and symptoms of a massive change in the making.
Late last year, the 3rd East Mediterranean Pharmacy Students Pharmaceutical Symposium was held in Khartoum, Sudan. Almost overlapping with it, the 1st International Pharmacy Student Federation (IPSF) conducted its African Pharmaceutical Symposium in Algeria (1;2;2). These were shortly followed by the 58th IPSF World Congress in Hurghada, Egypt, which was held during the first few days of August 2012. All these conferences were well- organized and well-attended by pharmacy students, new pharmacy graduates, as well as several pharmacy academicians and leaders as invited speakers and facilitators. However, developments were not limited to conducting or attending seminars, but extended to practice.
The hospital pharmacy sector in many Arab countries started to host a young, but a rapidly growing, clinical pharmacy service that thrives by the enthusiasm of aspiring pharmacists who acquired new clinical pharmacy knowledge and skills often through distant learning programs, and in most cases paying for these courses through their own limited resources.
Pharmacy employers started picking and choosing those pharmacists with advanced pharmacy degrees and appointing them as clinical pharmacists. Young pharmacists started to attend continuing pharmacy education programs in large numbers and some have started applying for funding to conduct small research projects in collaboration with experienced academics and researchers. Elsewhere in the region, several practicing pharmacists subscribed and joined distant-learning postgraduate pharmacy programs in Ireland, the United Kingdom, and the Unites States. These pharmacists took initiatives to introduce medication utilization review services and disease management in primary care facilities.
What is happening? Several reasons for this phenomenon that is characterized by professional restlessness and self-driven initiative could be proposed. What comes to mind
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first is the nature of the world we live in today. This is a time of globalization. What happens in one country in the world is affected by, and affects, other countries with the speed of light.
This is, too, a world that is governed, driven, and conquered by the fascinating social media technology. Young people now interact, team-up, and campaign through the social media outlets like never before. Social media played pivotal role in the recent political tsunami that swamped the region and took it by surprise. The same young forces could be utilizing the same tools for change in practice after its swift success in politics.
Another equally plausible reason for the impending revolution in the practice of pharmacy in the Arab world (an arguably other developing countries) would be the long professional apathy that this profession had been passing through. Nothing new or significant had been happening during many years in pharmacy practice (especially the community sector) in the majority of countries in this region (3). Aside from a few progressive universities in the region, pharmacy curricula stayed almost the same, give or take a little, since we were students over 20 years ago. What contributed to prolongation of the state of affairs of pharmacy and to restricting it to an old traditional practice that is imprisoned inside the dispensing process was a dire cyclical relationship between a profession poorly equipped with knowledge and skill and that provided limited services dominated by dispensing, and a society that had little expectation from the pharmacist aside from purchasing their medicinal products. Nevertheless, pharmacists enjoyed a ‘courteous’ relationship with the society despite the limited service they provided, and this steady societal regard towards the pharmacist was why pharmacy changed only a little. A false sense of wellness and professional wellbeing dominated and business continued as usual.
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In a recent study, the societal attitudes towards the pharmacist was investigated by El Hajj and colleagues, who reported that the public has poor understanding of the community pharmacist's role in monitoring drug therapy, performing health screening, and providing drug information. They unearthed several issues that could be contributing in this perception, including insufficient pharmacist-patient contact time and unsatisfactory pharmacist knowledge (4).
The perception of other health care professional in most of the countries collectively known as the Middle East is also unflattering. Physicians in the region may be unaware of the role of pharmacists in assuring safe medication use (5). Wilbur and colleagues noted that physicians were more comfortable with pharmacist activities when these activities were closely linked to drug products than responsibilities associated with direct patient care (5).
Consultative clinical roles of pharmacists, they suggested, were less acknowledged by physicians.
It appears that pharmacy students and pharmacists of today are recognizing the bleak situation their profession is at and have decided to change the state of affairs. The pace of change promises to be so swift and rapid that it will be hard to fathom. Middle Eastern pharmacists and pharmacy students are now aspiring to a pharmacy where the pharmacy graduate leaves the pharmacy college equipped with the right set of skills essential for their professional life and career. Fortunately, many colleges of pharmacy in the region started the long and painful, but necessary, road to change. Many waited and hoped for the best. And some resisted. However, no one, it seems, is willing to stand by and bear the price for doing nothing. Pharmacy students have grouped into societies, and associations. Pharmacists have taken matters in their own hands, and are sending a clear and loud message that says ‘If
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pharmacy managers, administrators, directors, teachers, and policy-makers are unable to be our advocates and leaders, the Pharmacy Spring will knock on your doors’.
Change can be painful, slow, or illusive, but it is always inevitable, because (as Heraclitus said) the only thing that is constant is change. And change has been difficult not only in Asia, Africa, east Europe and Latin America, but also in the so-called developed world.
When Helper and Strand proposed their ground breaking philosophy and practice of pharmaceutical care, everyone thought pharmacy will change overnight, and everyone gasped in awe. However, several years later, pharmacy leaders in the United States (US) confessed that major reforms had failed to significantly enhance the profession because there had been no systematic approach to linking the intended outcomes of educational reform to a progressive and generally accepted mission of professional practice (6). But there was a growing consensus among all major pharmacy stakeholders in the US that pharmaceutical care represented the mandate and the mission for the profession of pharmacy. With this conviction, the Commission of the American Association of College of Pharmacy, led a plan that aimed at detailing the functions and responsibilities required of pharmacists to provide pharmaceutical care, and at subsequently linking these functions and responsibilities to the curricula of pharmacy schools and colleges. This was the key for the rapid development of the practice in those countries where pharmacy progressed to other higher levels. The solution, it appears, requires a committed and autonomous professional bodies that take the lead. This is what lacks, so far, and this is exactly why pharmacists and pharmacy students are losing faith on the bureaucrats and are taking matters in their own hands. So, the question that lends itself remains to be: will educators of pharmacy and others who have been entrusted to lead this profession heed the call for reforms in practice and join the tide of
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change or would they sit back and allow it to pass them by, and in the process, be washed aside by the pharmacy spring that lurks around the corner?
Reference List
(1) 3rd IPSF Easterm Mediteranian Pharmaceutical Symposium-Khartoum Sudan. 2012. Ref Type: Online Source
(2) International Pharmaceutical Students' Federation. http://www.ipsf.org/ . 2012. Ref Type:
Online Source
(3) Kheir N, Zaidan M, Younes H, El HM, Wilbur K, Jewesson PJ. Pharmacy education and practice in 13 Middle Eastern countries. Am J Pharm Educ 2008 Dec 15;72(6):133.
(4) El Hajj MS, Salem S, Mansoor H. Public's attitudes towards community pharmacy in Qatar: a pilot study. Patient Prefer Adherence 2011;5:405-22.
(5) Wilbur K, Beniles A, Hammuda A. Physician perceptions of pharmacist roles in a primary care setting in Qatar. Global Health 2012;8:12.
(6) Perrier.D, Winslade N, Pugslade J, Lavack L. Designing a pharmaceutical care curriculum. AJPE 1995;59:113-25.