Human beings are riddled with various ailments right from birth, and therefore the fundamental need for treatment is vital. For this reason, doctors have always had a special status in every society, and so too have those who make the medicines used in their medical work.
There was a time when the treatment of diseases and the manufacturing of medicines were done by the same person. This remains true in many practices even today. But as the health system developed over time, the treatment of diseases and the manufacture, distribution, and overall management of drugs became two distinct branches.
In today's world, the countries in which the health system has been built on a strong foundation or is moving towards one, all have an independent group of professionals and experts called pharmacists. The pharmacists continuously work together with doctors for the holistic management of the health system.
A doctor must know about medicine, but he learns it only from the perspective of treating the patient. Activities such as manufacturing, quality control, storage or distribution of drugs are not his areas of expertise. It is the pharmacy or pharmaceutical science departments in universities that are working to produce such experts.
Now, suppose a doctor diagnosed a patient correctly and prescribed him the right medicine, but the quality of the medicine given to the patient from the pharmacy is off the mark. Would it cure the disease? It might not work as prescribed.
Consider another aspect -- the medicine has been made properly by the manufacturer, but it has not been stored properly in the pharmacy or drug store, and as a result the medicine gets spoiled. If such a medicine is given to the patient, it may not be effective.
When prescribing to the patient, a physician may err on the side of dosages, may prescribe two drugs that have adverse interactions with each other, or may unnecessarily burden the patient with too many drugs without enough ground -- not only financially crushing the patient, but also at the same time, prompting him to take too many drugs together leading to unforeseen consequences such as liver damage or kidney failure.
When dispensing the medicine to the patient, it is necessary to explain many things like when and how to take the medicine -- in the morning or evening, before or after a meal, how to store it, what to do if there are any unwanted side effects and so on. If these things are not adequately explained to the patient and they fail to handle the medicine correctly, it may either not work properly, or the patient may suffer from various complications. Such a huge task and responsibility of giving this important advice cannot be entrusted to a person who does not possess the expert knowledge of the specific medicines.
Understand that not only drug manufacturing or quality control, but also drug storage and distribution is not a child's play. If it were possible for an SSC passer, or someone who undertook a six-month certificate course, to carry out this huge responsibility, then Europe and America would not consider it essential to employ such highly specialized personnel as pharmacists, who studied pharmacy for four to six years at the university level to earn a Bachelor of Pharmacy (B Pharm) or Doctor of Pharmacy (Pharm D) degree, in order to perform this task. Not only in these countries, but even in the Arab states of the Middle East, it cannot be imagined to run a pharmacy (drug store) or manage drugs in a hospital without the direct supervision of graduate pharmacists.
So, why or how are we doing the same job without engaging experts like pharmacists? Ours is a very densely populated country with a huge population. As we have more people here, we naturally have more suffering diseases and ailments. Is it not logical that we need to be more cautious in managing drugs than in Europe, America, or the Middle East?
Perhaps we consider dispensing medicine from a doctor's prescription as a simple task, and we simply cannot understand why such a very simple task should require expert knowledge of medicine. We think that it should be enough if you can just read the prescriptions and know the names of medicines. When we don't even understand that medication management is a very sophisticated job, how can we understand the need of a graduate pharmacist in a pharmacy or hospital?
As per the Bangladesh Pharmacy Council website, there are currently 13 public and 28 private universities offering pharmacy education at the undergraduate level in the country. If an average of 50 graduate pharmacists are produced every year from one of these universities, then we are producing more than 2000 graduate pharmacists per year. While in the developed countries of the world 80-85% of graduate pharmacists perform their professional duties in retail pharmacies (drug stores) or hospitals, in our country about 90-95% of graduate pharmacists are employed in pharmaceutical companies.
Undoubtedly the pharmaceutical industry has grown tremendously with the participation of graduate pharmacists in the country, but the jobs in this sector have already become somewhat saturated. So, where will the large number of graduate pharmacists being produced every year go? As of now, a large part of them migrate to Europe, America, or the Middle East. But by involving them in hospitals and retail pharmacies in this country, we could have institutionalized the health system of the country. This feels like a waste of skilled manpower for a country.
We see no problem running a pharmacy (drug store) with a technician with little academic knowledge of drugs. We consider it sufficient to have at best a diploma pharmacist in the hospital. Even in some cases we may consider it, too, redundant. We feel more comfortable seeing a physician, rather than a pharmacist, at the top of drug administration of the country.
It would not be surprising if things continue like this, but at the same time, we keep expecting that the quality of the country's health services will hastily increase day by day. How ridiculous!
Dr Mohammad Didare Alam Muhsin is Professor and Chairman, Department of Pharmacy, Jahangirnagar University.
