GLIMPSES FROM FORUM - Mr Peter Hearn - Whither Pharmacy 1979

This article was published in Forum in February 1979

Peter Hearn  was chairman of the Natal Inland Branch of SAAHIP in 1981 and served as President of SAAHIP  for three years from 1982. He was Chief Pharmacist at Edendale Hospital for a number of years before he was transferred to  the State Health Department, Pretoria, as Deputy Director. When Pierre Retief retired as Director, Mr Hearn was promoted to Director in July 1989. Mr Hearn resides in Pietermaritzburg and he celebrated his 90th birthday in February, 2022.

Whither Pharmacy?

Quote, "Pharmacists are not considered to be the experts on medicines, and certainly not on dosage." If we are prepared to take an unemotional, unbiased and honest look at this statement, then for many of us we may well find some justification for it. Perhaps to our "new generation" pharmacists it is to a large degree unfair and untrue, but to my generation and those older than I, it surely applies to a greater or lesser degree. What then can be done to change the situation? In our opinion a great deal, but it requires motivation, enthusiasm and hard work, - sustained hard work! As one can usually speak best from one's own experience, I ask your indulgence as I try to tell you about some of the things we have done at Edendale Hospital.

 Pharmacy, like medicine and all other professions is a very broad, complex and highly technical subject. Nobody can be expected to remember all the complexities of the various medicines, e.g., dosage, biological half-life, interactions, etc. However, we keep ourselves well informed. So, a good set of reference books becomes important. Amongst those that we have are:

            Pharmacological Basis for Therapeutics: Goodman and Gilman

A review of Medical Pharmacology: Mayers, Jawetz and Goldfin

27^th Edition of Martindale

25^th Edition of Dorland's Illustrated Medical Dictionary

The usual official books

 There are others, but we feel those mentioned are essential. To help keep ourselves right up to date, we receive the following monthly publications:

            American Journal of Hospital Pharmacy

Drug Intelligence & Clinical Pharmacy

Medicine Digest

Prescribers Journal

Drug and Therapeutics Bulletin

South African Journal of Hospital Pharmacy

British Pharmaceutical Journal

South African Pharmaceutical Journal

 Once you have come to terms with much of the technical and medical jargon, the reading of these journals becomes a much looked forward to pleasure, by both young and old pharmacists alike. You almost have to queue up to get your turn at Edendale! We also have built up a reasonably comprehensive range of literature on specific pharmaceutical products put out by the various firms.

 This is fine, but where to from here? What do we do with all this information? It serves no useful purpose to have something to offer if there is no one to offer it to! How can we hope to be considered a member of the "health team", and the fountain of all knowledge if we neither see nor communicate with the other members? How often are pharmacists as a group, considered to be pedantic obstructionists, locked in their little ivory towers, with a "NO ENTRY" sign hanging on the door!! Just as we dared to open that pharmacy door and move out to spread our influence within the hospital, matrons, sisters and staff nurses, are encouraged to visit the pharmacy at any time, to discuss problems, drugs, drug therapy, to seek information or advice, no matter how trivial or important it may be.

 Eight months ago, we established what we call "The Clinical Committee", made up by the Medical Superintendent as chairman, the heads of all medical departments and the chief pharmacist. Its function is to discuss drugs and drug usage and abuse and to formulate drug policy within the hospital. The chief pharmacist is the convenor and scribe and ensures that the minutes are distributed, and notice of meetings are sent out timeously. He also draws up the agenda. Initially the committee met monthly, but such tremendous progress has been made, that two-monthly meetings are now held. The ultimate aim is for a quarterly meeting. A special 6 monthly meeting is held to review and discuss the use and/or abuse of antibiotics only. We also put out a quarterly Drug Information Bulletin edited by one of the younger pharmacists. This has been particularly well received. Some other areas of involvement include the compiling of our own catalogue of pharmaceutical products, which could possibly form the nucleus of a catalogue for the KwaZulu Department of Health, The Community Health Scheme, which includes the peripheral clinic complex, and vaccination programmes. When a sepsis problem developed in our burns unit, the Department of Surgery, who controls it, solicited the help and co-operation of the pharmacy, to solve the problem. At the moment the Pharmacy Department is conducting a survey of disinfectants, their use and/or abuse, throughout the hospital. This survey will include an assessment of fumigation methods in the hospital.  The resultant report will be tabled at the next meeting of the Clinical Committee. Due to the fact that we have only 6 (yes SIX) pharmacists in the 1640 bed hospital, our ward activity is limited to the 5 intensive care wards, and the operating theatre. Other wards are visited whenever possible.

What have we achieved by all this? We certainly have grown, not only as people and especially as pharmacists, but also in confidence in ourselves and our abilities. We have received praise for our successes (and who does not enjoy that!), sympathy in our failures, and most important, encouragement to go on. A very satisfactory, happy and functional working relationship with our medical and nursing colleagues has developed. We have established a situation of mutual acceptance, understanding and respect. Probably because we do not believe that it is our brief to dictate to our doctor colleagues what they may or may not prescribe, but rather to identify their needs (and it obviously follows from this, the needs of the patients – who are our prime concern), relate to these needs, and to make suggestions and offer all the assistance and information possible to help meet these needs. I quote a remark made by a specialist after a Clinical Committee meeting: "Why did we not do this sooner?"

We have made such tremendous progress and now that we are talking to each other, we are learning to understand each other and are learning so much from each other. "Communication and involvement, and all that these imply, this surely is the name of the game?" Don’t be misled into thinking that everything is a bed of roses. We still have our problems and frustrations, but we like to think that we have established a platform where they can be amicably, reasonably and professionally discussed and satisfactorily worked out.

We may not yet be considered the experts, but we do notice more of our colleagues are seeking us out, not only for information and advice, but also sometimes just for a few friendly words, or a favour. Surely this is as it should be? We like to think that that we have come a long way; we know that we still have a long way to go, but we feel that we can go on, confident that we can come to terms with whatever challenges the future may possibly hold.

And what does the future hold?  Surely this depends a great deal on ourselves, our efforts, attitudes and level of motivation. But we like to think that the future is good, and we remain optimistic.

John Ruskin said: "The highest reward for a man's toil is not what he gets for it, but what he becomes by it." There is a message here for us perhaps??

 PETER HEARN

 February 1979