PJ Online | Christmas 2003 (Challenges for pharmacists in India)
Christmas miscellany summary
Challenges for pharmacists in India
Before returning to Cardiff University to complete her pharmacy degree, Nicola Husain spent three months working in a hospital pharmacy in India. In this article, she describes her experience
Holdsworth Memorial Hospital (HMH) was built in Mysore, India, nearly 100 years ago to provide accessible and affordable health care to some of the poorest women and children in the city. It was the first hospital to be built in Mysore and the founders chose a site in one of the most deprived areas of the city — a controversial decision because many believed it would attract the “wrong” class of people.
The two dispensaries are situated on the main site and at the children’s hospital, a short distance away, across a busy road. There are eight pharmacists who have studied for a minimum of two years, and the main pharmacy operates 24 hours a day. The pharmacists’ job primarily involves dispensing medicines and supplying surgical equipment for in- and outpatients. I was able to help with the dispensing workload, although locating drugs on the shelves was a near impossible task at the beginning — drugs were grouped by pharmacological action and many of the brands used were different from those in the United Kingdom.
Before my arrival in Mysore in the summer, the hospital had begun to implement a medicines information service and an adverse drug reaction reporting system. Unfortunately, the chief pharmacist, who ran this service, died in a road accident two weeks into my work experience. I was asked to help continue part of this service by answering medicines-related questions from doctors. Most enquiries were concerned with side effects, interactions and the substitute to use when the drug required was not available.
Difficulties and challenges
HMH is affiliated to the Christian Church of South India and is known locally as the “mission hospital”. However, 97 per cent of the hospital’s income comes from patients’ fees so it cannot afford to offer free medical treatment to many patients. Exceptions include students, employees of the hospital and leprosy sufferers. In addition to consultation and overnight fees, patients are charged for medicines, intravenous fluids and all disposable equipment, such as needles, syringes, cannulas and catheters.
Rural health care
In India, 80 per cent of doctors live in urban areas while 80 per cent of the population live in rural villages. This results in a huge imbalance between the health care available for people in cities and those in rural areas. Over half the patients attending HMH come from outside Mysore, some travelling up to 50km, and this, inevitably, delays diagnosis and treatment — patients who live in rural areas are commonly first seen in the later stages of an illness. Furthermore, most people living in the villages surrounding the Mysore area are farmers. This means that a poor crop or drought will affect their income and, therefore, their ability to pay for medical services.
HMH has a community health team of nurses who visit local villages to give immunisations and antenatal check-ups. The government provides DPT (diphtheria, pertussis, tetanus), polio, BCG and measles vaccines free of charge. In the villages covered by the hospital, immunisation rates are high. However, it has taken several years for the nurses to gain the trust of the people. For example, in the beginning, some believed that the injections would convert their babies to Christianity.
The prevalence and treatment of many of the conditions seen at the hospital in Mysore (eg, hypertension, heart failure and diabetes) are similar to those seen in Britain. However, infectious diseases such as tuberculosis and malaria are particularly common and, generally, are harder to treat. Parasitic worm infestations are prevalent and are treated with mebendazole or albendazole.
India faces enormous challenges to provide adequate health care for its vast and growing population. However, at HMH much progress is being made to increase both health care awareness and accessibility.
Citation: The Salvadore URI: 20010873
Recommended from Pharmaceutical Press
FASTtrack: Pharmaceutics – Dosage Form and Design removes the complexity from the major dosage forms that are commonly encountered by pharmacists in professional practice.£25.00
An A-Z pocket book containing concise and practical pharmaceutical information for busy clinical pharmacists.£33.00
Optimise drug therapy for your patients. These case studies help you bridge the gap between theoretical medicines knowledge and practical applications.£43.00
An practical, integrated approach to the pathophysiological and pharmacotherapeutic principles underlying the treatment of disease.£54.00
FASTtrack: Applied Pharmaceutical Practice guides student pharmacists and pharmacy technicians through the main stages of pharmaceutical dispensing.£25.00