Doctors and Pharmacists in the country are entangled in a fresh altercation over an age-long struggle over the professional mandate to prescribe drugs in an ideal situation.
In separate interviews with LEADERSHIP yesterday, both the Nigeria Medical Association (NMA) and Pharmacists Council of Nigeria (PCN) gave reasons to justify their claims over the right to prescribe drugs.
President of the Nigeria Medical Association (NMA), Prof Innocent Ujah, triggered the contention when he said it was not appropriate to completely blame the rising cases of self-medication in the country on industrial action by members of the medical union and outbreak of COVID-19.
Rather, he said it should be partly put on the doorsteps of pharmacists who illegally prescribe drugs to patient against the normal procedures.
“If you go to pharmacists, they are even prescribing drugs. This is unethical. When you go with your prescription, their own is to sell drugs to you but they are prescribing. They are exercising the power that doctors have and it is lacking competence”, Prof Ujah said.
The chairman of NMA in Kwara State, Prof Issa Baba and a senior lecturer in the department of Veterinary Medicine at the University of Ilorin, Dr Ghali Alaaya, were unanimous in their submissions that pharmacists have no business in drug prescription for patients.
Baba and Alaaya maintained that only medical doctors are qualified to prescribe drugs for patients.
The duo also traced the causes of self -medication to many factors, including poverty, ignorance, the desire by pharmacists to sell their drugs and make money as well as inadequate healthcare facilities.
But in a swift reaction, the Registrar of Pharmacists Council of Nigeria (PCN), Pharm Elijah Mohammed, accused doctors of taking over the responsibility of pharmacists, saying that doctors who are meant to only prescribe medication are now dispensing as well.
According to him, pharmacists are also prescribing drugs to patients because doctors have refused stick to their practice.
He said, “The doctor is to prescribe and the pharmacist is to dispense, but in Nigeria today, you have dispensing doctors and prescribing pharmacists. When a patient come to the doctor, he prescribes and he dispenses, so what do you want the pharmacist to do? Should they close their shops?
“But when you go to UK and USA, the medical doctor prescribes then the pharmacists will dispense. If that is maintained, when a patient comes to the pharmacy, thepharmacist will ask them to go and get prescription. But now that the doctors are prescribing and dispensing, what do they expect the pharmacists to do? The pharmacist know what the drug is all about then when the patient comes, they will do the needful.”
Mohammed however called for support to tackle open drug market, saying that the present government has come with a coordinated wholesale centre concept whereby they want to create an environment that is well regulated and move these drug traders into those places.
According to him, once that is done, all the markets will be shut, and whoever that is coming to buy drug, will be asked where he is taking it to.
He continued: “We should stop blaming ourselves. Although it was formally known for distributive functions, latest experiences have shown that pharmacists in all settings are now involved in health promotion, disease-state management, and pharmaceutical care, as well as both collaborative and independent prescribing.
“As our roles have evolved to become more clinically focused, prescribing has become a logical extension of the provision of comprehensive pharmaceutical care”.
LEADERSHIP checks revealed that there had been flagrant refusal by some residents to comply with the laid-down protocol of the government relating to testing of persons who have symptoms of COVID-19.
In Akwa Ibom State, It was gathered that, several people who experience these symptoms, such as fever, sore throat and difficulty in breathing no longer contact the Nigeria Centre for Disease Control (NCDC).
It was learnt that most of the residents prefer staying at home and experiment with drugs, especially anti-malaria drugs, in a desperate bid to find a possible cure for the symptoms they are experiencing.
Some residence who spoke to our correspondent in different parts of the state said their main reasons for self-medication, especially during this period is to reduce financial burden and fear of contacting the virus at the Hospitals.
Macus Iniobong, a public servant, said in the wake of COVID-19 he and his entire family had to take chloroquine bought from a local pharmaceutical shop along with vitamin C even though they were all healthy.
“Except for emergency or very serious cases, my family will stay away from hospital for now,” he said.
Similarly, Bassey Eyo, a fisherman from the coastal city of Oron said, “When I felt very feverish during the height of the pandemic the thought of going to the hospital made me scared. I just took anti-malarial drug. I prayed hard that my condition should not get worse to warrant my going to the hospital”
But speaking with LEADERSHIP on the issue, Professor Etete Peters, former Chief Medical Director of University of Uyo Teaching Hospital (UUTH) said self-medication wass common among Nigerians, adding that there was need for adequate education on its potential danger so as to prevent unpleasant consequences.
He explained that hundreds of people suffering from hypertension, diabetes, kidney problem, heart diseases, cancer, malaria and typhoid fever, among others, suffered complications as a result of self-medication.
Peters, a Professor of internal medicine and currently the Provost of University of Uyo College of Medicine noted that it was okay for people to use over the counter drugs when there was minor issues, saying it helps with social distancing as people can stay at home as much as possible.
He however noted that it was important for people to go to the hospital when they observe worsening symptoms.
He said, “Self -medication could easily lead to addiction. Even if you suspect malaria or typhoid, it is better to get tested first because a fever is a symptom of many diseases not necessarily malaria or typhoid. It is wrong to just go to a chemist or pharmacy to pick up medicines”
On who should prescribe medications, he said while pharmacists might perform some basic medical procedures, such as giving patients flu shots, they cannot prescribe medications or perform complex medical procedures.
“Pharmacists’ primary duties are to ensure patients have the right medicine and know how to use it’’, he said.
In Imo State, the vice chairman of the Nigerian Medical Association (NMA), Dr Victor Dike, blamed the resort to self-medication and Pharmacists on poor access to healthcare and higher cost when attended to by doctors.
Dike said, “Rather than visit a General Hospital and spend about five hours to see a doctor, the average Nigerian prefers to go to a Pharmacy or a Nurse who will attend to him or her immediately and then they pay lesser compared to the hospitals”.
According to him, the activities of some pharmacists and nurses are totally against medical ethics, adding that “medical doctors don’t conduct medical tests on patients.
“We send them to the appropriate medical official. They should stop giving medication on face value and allow medical doctors trained to treat them effectively”, he added.
In Kaduna State, LEADERSHIP gathered that many residents purchase drugs without prescription from medical doctors.
Speaking with our correspondent, John who owns a pharmaceutical store in Barnawa said many people come to him for the treatment of malaria and antibiotics to tackle typhoid fever.
According to him, some of the patients only believe that they may be suffering from typhoid and malaria without tests.
He stated: “Since the outbreak of COVID-19, we sell drugs to many people without prescriptions. Some only assume they are suffering from this and that, especially malaria and typhoid. Some do complain they don’t have money to go to hospital”.
When asked if it was not against the ethics of his profession, John replied: “If we can attend only to patients with drugs prescription. We will not make much profit. Mind you, we have staff to pay salaries and to pay our rented apartment. We always refer some of the patients with severe health issues to hospital for their good” he said.
Speaking with LEADERSHIP in Port Harcourt, a retired civil servant attributed self-medication by most Nigerian to lawlessness.
He said, “Pharmacists are not supposed to prescribe medication for any patient at all. They know the drugs, granted, but they have to follow doctor’s prescription.
“Lawlessness is the major thing encouraging self-medication in Nigeria. The laws guiding our health system in Nigeria are not being enforced. Nobody is enforcing the laws.
“Also, education-wise, they are very ignorant. They don’t know the right thing to do sometimes. People just feel that when they see a chemist shop, they can go in with the belief that any person selling medicine should know everything about medication.
“Those who sell these drugs do not even come out to tell these people that they need prescriptions first before taking the drugs. This is something the government should take up through the Ministry of Health and enforce it so that people will sit up.”
In Lokoja, Salman Ador told our correspondent that the incident of self-medication stems from the fact that individuals have different story to tell about their experience in the hands of medical doctors.
A pharmacist with FMC Lokoja, Sule Kadiri, maintained that most patients hardly wait for the result of tests carried out on them. Most of the guardians would always say that the time spent on waiting for test was enough to cure the illness through self-medication.
Speaking with LEADERSHIP in Osogbo, a Medical Laboratory Scientist, Mr Michael Babatunde Dada said, “Self-medication have been constantly practiced in Nigeria even before COVID-19 came. Now that the virus is around, Nigerians are scared of visiting government hospitals for the fear of contacting the disease from in-patients in the hospital.
On prescriptions, the Scientist said, “Pharmacist are not saddled with the responsibility of prescribing medications for patients but to dispense medications that are prescribed by a medical doctor.
“Sometimes a doctor’s prescription may not be ideal for a patient. It is the responsibility of a pharmacist to correct the prescription and give the patient a medication that will improve the patient’s health condition immediately without necessarily being at loggerheads with the doctor.
According to Dada, the role of Scientists in the advent of COVID-19 pandemic cannot be overemphasized adding that accurate and timely diagnosis of the virus is important if a patient with coronavirus will survive.
According to a medical practitioner in Abia State who pleaded anonymity, it is the poor state of health delivery service in the country mostly that led to self-medication and substance abuse.
“The major culprits are the patent medicine stores whose main objective of being in business is profit making. They have so much arrogated the duties of doctors to themselves without minding the consequences.”
He said the standard practice is that doctors do the diagnosis and pharmacists do the prescription, while the combination of the drugs is handled by chemists.
“Similarly, the people themselves have their share of the blame also as it is common to hear even the enlightened saying ‘I am going to a patent medicine for him or her to mix drugs for me’.
On his part, a medical practitioner in Imo State, Dr Harolds Onumo, advised patients with any form of medical conditions to seek the services of a medical doctor for professional diagnosis and accurate prescription of necessary drugs.
Dr Onumo told LEADERSHIP that patients must desist from self-medication, stating that this could result in complications of unimaginable proportion and after the patient would have caused damage to his system, at the end of the day, the patient may likely turn around to blame the medical doctor who has no hand in his predicament.
He called on patients to desist from self-medication as the implications are enormous, indicating that when a patient decides to apply self-medication, he may be applying the wrong medication for a particular ailment.
Onumo however explained that while pharmacists play vital role in the society, their duties revolve around dispensation of prescriptions by a qualified medical doctor.
He stressed that pharmacists have the capacity to interpret prescriptions, and dispense drugs effectively and have close contact with the doctors that prescribed the drugs.
He however submitted that pharmacists could prescribe drugs for minor ailments where they have adequate knowledge and understanding of patient’s conditions.
Onumo revealed that poverty and ignorance are the underlying factor compelling patients to self-medication.
According to him, most patients do not have the resources to pay the exorbitant bills in the hospitals and they have no option than to resort to self-medication.
Meanwhile, the seven-day warning strike embarked upon by the Joint Health Sector Unions (JOHESU) yesterday paralysed activities in the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State.
The health workers embarked on the strike over non-payment of COVID-19 hazard allowance which they claim federal government had promised them.
Chairman of the NAUTH chapter, Mr Ikenna Anahalu, said despite the agreement reached with federal government only some members of the unions were paid 10 per cent instead of the agreed 50 per cent, while many were not paid anything at all.
The union leaders in the state said there were preferential treatment in the handling of issues that affected the workers’ well-being.
They vowed that they would rather go to prison than return to their duty posts until government pay every Kobo owed them.
They insisted that federal government must release funds to pay the arrears of differentials for 2015, 2016 and 2017 promotion allowances to their members. They complained that the payment of April and May 2018 were still withheld and said that government had to pay up.
Anahalu said, “Personal Protective Equipment (PPEs) are not adequately provided in NAUTH and other COVID-19 palliatives.
“Appointment of deputy chairman, medical advisory committee has continued to elude us. We ask that you impress on the NAUTH management to make such an appointment from among other health professionals other than medical and dental practitioners.
“The ADR of National Industrial Court of Arbitration rules that Consolidated Health Salary Structure (CONHESS) salary scale should be adjusted in line with memorandum of understanding signed with the federal government. But to our chagrin the federal ministry of health is yet to implement the directives”.
The union also demanded appointment of consultants and payment of specialists allowance to other health professionals. The members said these had been granted to them in the ADR, but are yet to be appointed.
The situation was the same in most of the monitored health facilities yesterday as management of the At the Federal Medical Center, Makurdi have put on hold admission of patients till further notice.
Our correspondent observed that the strike has partially paralysed activities both at the temporary and permanent sites of the hospital located at the Wadata area and Apir, all in Makurdi, the state capital.
Head of Clinical Service of the hospital, Dr Enye Agada, explained that even although the strike was yet to take its toll on the hospital, management of the hospital have decided not to admit any patient until the union calls off the strike.
A visit by our correspondent to the two sites to monitor the situation revealed that there were partial activities in the hospital with only few resident doctors seen to be attending to patients.
Some of the few nurses seen at the hospital claimed they only came to see if the strike had commenced.
“Am supposed to be on morning duty but when I reported for duty, I was told that (JOHESU) had directed every member to down tool”, one of them said.