Consultant Pharmacist, Olumide Akintayo, is the current President, Pharmaceutical Society of Nigeria. He spoke with BOSEDE OLUSOLA-OBASA on controversial issues

Was it your childhood dream to be a pharmacist?

The vogue then was to have people study medicine, law and the likes. I was a rebel of some sort and noble as medicine is, it never caught my attraction. I have always had phobia for blood and tissue and thought that I wasn’t cut out for the hospital thing. To be very honest with you, I didn’t make up my mind for pharmacy until the last two years in secondary school. I loved the community pharmacist in his clean, white garment and wanted to be like him. I didn’t know so much about this field until I entered into it and I have been in practice for 27 years already. By the time I got into the University of Ife, I realised that pharmacists were meant to be life savers. Looking back, I am grateful to God for that choice and if I returned to the world, I would choose pharmacy again.

But people believe that 80 per cent of people who eventually studied pharmacy failed to gain admission to study medicine.

The fourth estate of the realm (The Press) has a sacred responsibility to report and put issues in their right perspective. Your question is an obvious fall-out of deliberate propaganda orchestrated by some stakeholders in healthcare. At the First Doctors Summit in Asaba, Prof. Wole Atoyebi, a past President of the Nigerian Medical Association submitted that part of the problems in health care was that people who could not gain admission for medicine settled for other courses in health care and now want to enjoy the benefit of what they could not attain as students. Graciously they allowed me to participate at that session and in the full glare of the over 1,000 delegates from across the country, I submitted that the entry point for pharmacy was higher in the great University of Ife (now OAU) than any other course in the university system. Ife is the best rated in this country and despite all hiccups, it is still highly rated both in the Commonwealth and Africa. I openly challenged the delegates at the conference like I am still doing even now to controvert evidence that the entry point for pharmacy is not one of the top five in any Nigerian university that it is offered. In my days, the entry point for direct entry students was a minimum of 12 points in physics, chemistry and biology. You may want to find out, no student is admitted into a pharmacy faculty except pharmacy is the course of first choice. So, the chance of opting for pharmacy if you cannot study medicine does not even arise most times. As prelim students in Ife, when pharmacy students take courses in mathematics and excel because you are not allowed to carry over, medical students took courses in sociology and economics because they were failing mathematics in numbers. These are verifiable facts. Do find out what it takes to study pharmacy in our universities and I can boldly confirm to you that the rigour is second to none. Just find out from any neutral person who passed through a university where pharmacy is offered. This is why a pharmacist who is worth his salt cannot be consumed by a persecution complex or siege mentality. Why else do you think pharmacists excel in all sectors? Go to the telecoms and check out the number of pharmacists who are at the top echelon at MTN, Airtel, Glo and Etisalat. In banking, pharmacists are directors and vice presidents and so on. Do find out how many pharmacists are in charge of oil and gas companies in Nigeria.

Why then do people think there are fewer pharmacists in Nigeria than are needed?

It is a very tough course to study, tougher than medicine. Besides, it is abstract and it is experimental. In our days in the university, government subsidised pharmacy students than any other because it was expensive. In school then, pharmacy student ran a very tight study/class schedule.

But that didn’t stop you from having a social life in school.

For me, there was always a way to strike a balance. I was even an active member of the students union and I was not found wanting in the social realm too. We were classified as anti-social. Girls didn’t like to go out with boys in my faculty. Great Ife offered a total package – as we used to say, it is not just important to pass through UNIFE, it has to also pass through you. I indigenously came up with strategies to balance things up.

Some people say that PSN is only struggling to gain recognition like the NMA. React.

Again I don’t know where you got that from. The Pharmaceutical Society of Nigeria has a guiding philosophy not to engage in popularity contests, we don’t need it. My primary responsibility is to align with the dictates of my mandate as reflected in our constitution which expects me to protect pharmacy and pharmacists. This is why I will personally disagree with any specie of God’s creation who attempts to mess up with a pharmacist. Some years ago, a senator with a medical background posited at a public hearing where I represented the PSN after my submission that he had a problem with pharmacists because they rub shoulders with his colleagues. I picked up the gauntlet to tell him he was living in the past if he was assuming that. I drew his attention to new sectors of the economy like telecoms as well as the oil and gas sector where ambitious people were spoiling for action. With modesty, the PSN founded in 1927 is arguably the oldest professional body in Nigeria. In the comity of decent professionals, it is rated as one of the best organised.

Why can’t professionals under the PSN and NMA collaborate to build the health care sector?

When there is propensity to relate with fellow professionals as some conquered species, it gets to a point that they say no more. Working in Nigeria, I have learnt that it is not work done against friction that slows you down but the grains of sands in your shoes – that is talking about distractions. Generations of leaders of the NMA have produced people who failed to accept the reality of the place of pharmacy, there is need for new thinking in the health care sector. Medicine is noble like I said, but it doesn’t rule out pharmacy, the contention is being fuelled by pure ego. For instance, representatives of NMA tell government that they should earn so much, and at the same time tell government not to pay pharmacists so much.

Is this fight not all vague?

Why would I say things that are not true? I don’t think this is healthy at all. What is going on at the ministry of health is very bad. The minister has turned the state and federal ministries of health to ministries of doctors. They disallow the requisite representation that other fields should have on the boards. That is why there is now a presidential committee on harmony in health sector – that tells you it is a serious matter. The grave of the health sector was dug in 1985 during President Ibrahim Babangida’s rule. A law initiated by the late Olikoye Ransome-Kuti was put in place to ensure that all hospital boards in Nigeria are headed by doctors. Of the 720-member boards, over 500 of them are doctors. Less than 50 health professionals represent other health care sectors. That is affecting progress in the health care sector. Again, the introduction of special medical salary scale during Olikoye’s time has created a problem that is still recurring today. Everybody is now going to the open market to ask for better package. The truth is that there is an overburden of medical personnel in public service.

Are you saying they are too many compared to the rate of client patronage?

What do they do? They are too many. Go to the hospital and see for yourself. Many of the consultants will not get to the hospital before 10am and you won’t see any of them again after 2pm.

Are the pharmacists better off?

Go and find out. You would see there that they have better work ethics. Check out when they resume, then check out how many consultants are ever at their duty posts. Resident doctors have also become big boys in Nigeria. They are supposed to be doctors in training, but they now do the real work in our teaching hospitals. There are too many consultants who are just collecting fat salary and adding no value to the system. I did a survey and found that almost 88 per cent of budgetary allocation in the health sector is on recurrent expenditure. Out of this, 61 per cent is for paying the entire health care workers and 50 per cent of this is for paying doctors. It is the number of people multiplied by the value of what they earn. If government wants this sector to succeed, it should privatise clinical service; let all our patients seek attention in private hospitals. Government should make it work and let the teaching hospitals have time for research and take care of in-patients. A consultant is supposed to be fully utilised by consulting for about five hospitals within the same catchment area. What we are doing in Nigeria is day-light robbery; paying people about N1m every month for job not done. That is where all the money goes to. The pay is not commensurate to output.

Are pharmacists now paid so much too?

They are not poorly paid too. They rank among the best paid, especially in the federal service.

What makes a pharmacist different from the drug seller down the road?

Drugs dispensing is a professional area in pharmacy. He gives you information on how the drug should be taken, the possible side effects and so on. The drug seller has been made popular by people who seek cheap things to their own detriment. I call them merchants of death.

The killer ‘mix me drug’ culture appears to be popular because people go first to a pharmacist and not a doctor? Is this right?

I know what you are talking about, but let me say that the ‘mix me drug’ idea is not associated with pharmacists.

Why did you say so?

There is no trained, registered pharmacist who would engage in ‘mixing drugs’.

You don’t seem to be aware of what is happening out there?

What I am saying is that this idea is not a reality of pharmacists. It is a product of quackery. People who know about medicine know that they can’t be mixing nonsense. What are you mixing? I know what you mean; people do so by adding capsules of anti-biotic with an analgesic and so on. No trained health provider will do that.

Who then is the first port of call for a sick person?

The global practice puts pharmacists as the first port of call in terms of access. The reasons include the fact that he is readily accessible; you don’t need consultancy fee to see him. You don’t need to fill a card and he gives you a health advice, which might not include drugs. Where he sees that you need to see a doctor, he refers you appropriately. It is a global norm, community pharmacists are the first port of call.

Doesn’t this practice hamper early medical intervention principles and encourage wrong diagnosis in serious health cases?

Absolutely, it doesn’t. Even a medical doctor most times will not completely diagnose you based on first time experience. Usually, he asks you to undergo clinical tests.

You said pharmacists should be the first port of call for sick people, is it not criminal that some now operate clinics and inject patients?

I never said sick people should compulsorily visit a pharmacy. I only made a statement of fact that it is a global norm for people to access a pharmacy as first point of call in seeking health intervention. Perhaps, I should ask you directly if you have a stomach upset, would you go straight to a hospital for intervention? In 75 per cent of situations, people will visit the nearest pharmacy for help. If you have evidence that a registered pharmacy operates a quack clinic, then report same to the appropriate licensing/regulatory agency. I must however help you by informing that “pharmaceutical care” is becoming a global reality to assist in health promotion and advocacy. Pharmacists play vital public health roles by providing information on family control methods, smoking cessation, diet control, blood pressure monitoring, BMI, cholesterol and sugar level monitoring and so on. When you talk of injecting patients, I can confirm that most pharmacies don’t dabble into it. Let me however ask you why you don’t query a lay person who injects himself with insulin in diabetic care, when you think a care-provider cannot handle same responsibility.

But some people believe that pharmacists are responsible for many deaths in the health care arena, for example the death of Cynthia Osokogu

That is glaring misinformation. It certainly looks more of your own insinuation. In a country where government watches helplessly as merchants of death in open markets and unregistered drug premises hold sway, you are peddling a most damaging rumour by positing that way. I have always taken a position that a country that encourages through government munificence a ratio 1:250 in the balance of registered to unregistered premises promotes the amplitude of a contraption which is tantamount to a consuming evil of voracious appetite. Do kindly note that pharmacists cannot be held responsible for woes in drug distribution because it is the responsibility of government to tackle the menace. With respect to Cynthia, may her soul continue to rest in peace, we must learn to respect the dead because we are Africans. Television footages confirmed how that poor lady was killed. Suspects who are not pharmacists confessed  how they tortured and beat her to death. It had nothing to do with drugs allegedly administered on her. The matter is in court and when we get to that bridge as experimental scientists, it can be proven that drugs had nothing to do with her death.

As the only ones certified to do so, pharmacists are accused of the atrocity of importing fake and substandard drugs and yet you defend them?

You know it is libellous to make inferences on things you cannot prove. I hope you don’t make me believe you are an agent of some clandestine interest groups. Can you mention one case of a registered pharmacist involved in the importation of fake drugs? If you are familiar with our sector, you will recognise from studies and surveys that 49.7 per cent of fake drugs are traceable to medicine vendors. Nigeria’s most notorious fake drug dealer, who is permanently under prosecution at either miscellaneous tribunal or the Federal High Court, is based in the drug market in Onitsha. We don’t defend erring colleagues. This is one of the reasons I have asked the Federal Government to reconstitute Pharmacists Council of Nigeria to enable us to deal with breaches in ethics and laws.

The public believes pharmacists are the brains behind how banned drugs get back to the stores; do you call this commitment to save lives?

I believe in the immutability of the veracity of postulations by people. We must not unduly take advantage of the ignorance of consumers of health. Today in Nigeria, the list of registered pharmaceutical premises has less than 5,000 manufacturers, importers, distributors, wholesalers and retailers that provide legitimate service. While you have less than 5,000 registered players, we have more than one million unregistered operators. You are therefore persecuting pharmacists for the criminality of drug sellers.

But we hear that some pharmacists now perform abortions?

I am not usually a reactionary. This is why my style does not encourage people who speculate. Abortion is a very serious matter in the sight of God and the eye of the law. I put it to you that you are a collaborator and partaker of a crime if you know abortionists and you do nothing to make them accountable for their criminal acts.

Why is it that pharmacists appear to be interested only in appointments to board positions and because of that fault the health bill?

There is no reference to hospital boards in all the provisions of the National Health Bill, so there is no how I can be talking about such. Our contention is that Section 1(1) of that bill provides that a National Health System will “regulate health services” in Nigeria. That is in direct conflict with provisions in existing Acts of Parliament like PCN Act which already provides that the Pharmacists Council of Nigeria, a body corporate, shall regulate and control pharmacy practice in all its aspects and ramifications in Nigeria. There are similar provisions in the MDCN Act, Nursing and Midwifery Council Act and Medical Laboratory Science Council Act. When privileged people play politics with our destiny, we have a responsibility to put them in check. Remember Thomas Jefferson said “resistance to tyranny is obedience to God”. In a neighbouring country, my colleagues went to sleep when the National Assembly was deliberating on similar issues and today, they are lamenting because the council that gives professional autonomy has been repealed after a defective Health Act was passed. We shall not surrender our liberties as free born citizens of the state to some interlopers and usurpers, so those scheming by clever users of untruth will not stand in the country by God’s grace.

The other issue is exclusive privileges for a member of the health team at the detriment of others in a multi-disciplinary sector. For too long it was a way of life in our clime, but we have resolved to cast it to the abyss of extinction.

The constitution of the Federal Republic asserts that you cannot discriminate against a privilege that can be enjoyed by a citizen of the state, so if you say because I am a pharmacist I cannot aspire to be Chairman of the Board of any parastatals in healthcare, you are discriminating against me.

Do you see preponderance of liquid herbal mixtures as breakthrough in drug manufacturing?

If it is standardised, it is okay. All drugs come from natural derivatives. But in our society, every unemployed hungry person mixes all sorts of harmful liquids that have raised the cases of body organ failure and cancers. Even some educated people take these dyes. Laboratory research has shown that many of them are dubious as some orthodox medicines were noticed in the local herbal products.

What is the business of pharmacists with importing drugs for animals (Veterinary)?

A drug remains a drug irrespective of whether it is formulated for humans or animals. It is the same anthelminthic (worm expeller) you administer in humans that you give in animals. It is the dose that varies based on pharmacokinetic parameters which include things like volume of distribution, half life and so on. You miss the point therefore if you think there should be no control with drugs in vet use. The essence of separation of roles in prescribing and dispensing is to ensure that the prescriber or dispenser does not enjoy a pecuniary advantage. If drugs are indiscriminately administered on animals, the products including poultry, beef, pork etc, will be toxic or harmful to humans who consume such products. Today, the law that is the Poisons and Pharmacy Act Cap 535 wisely delineates the jurisdiction of all stakeholders in the public interest.