By Mary Hearty

With the rising number of COVID-19 cases in the country, health facilities are exceedingly being overburdened due to inadequacy as well as burnouts of health care workers.

In turn, the public are greatly depending on community pharmacists as their first point of contact to fulfill their healthcare needs. Moreover, the public’s fear of contracting the coronavirus in hospitals, has increased this demand.

Community pharmacists’ role has extended to providing advice and treatment for minor illnesses, lab tests, and monitoring patients with chronic conditions such as asthma and diabetes for renewal of medications.

Additionally, they have been educating patients on telehealth services, and delivering medications to patients when necessary. As a result, this has reduced the burden in such health services offered in hospitals.

Wycklife Odhiambo, a community pharmacist in Tassia, Nairobi, has been tremendously fulfilling the healthcare needs of the public and some patients with pre-existing conditions around him by dispensing medications, doing lab tests for illnesses like malaria, blood pressure monitoring, blood sugar testing and referrals, among others.

According to the pharmacist, patients especially those with chronic diseases like diabetes are at a higher risk of suffering severely from COVID-19 infection. Therefore, we have to support them as a community to prevent them from being exposed to this deadly virus.

Brenda Muthoni aged 55, a patient with diabetes has been receiving this support from the pharmacist. Since the pandemic began, she has been ordering her medications, through the pharmacist to reduce her movements to the hospital.

Muthoni appreciates the help she gets from the health worker during this crisis. According to her, Odhiambo is reliable, trustworthy and soft spoken compared to other pharmacists, and his services are affordably priced.

“I trust him more than other pharmacists who perhaps can give me counterfeit medications, since most of them value money more than the quality of medicines they sell. His services are cheaper as well,” Muthoni explains.

Moreover, getting support from the community pharmacist has not only prevented her from contacting the virus, but also during lockdowns when movements were restricted within and out of the Nairobi metropolitan.Additionally, it reduced her anxiety and stress brought by those measures.

Healthcare facilities are becoming overwhelmed with the surging COVID-19 cases, this has posed a greater risk of contracting the virus in hospitals especially now that more healthcare workers are reportedly infected with coronavirus.

Due to this, she has not been going to the hospital regularly to see her doctor. This has brought another challenge for her as she desires physical consultations from a specialized doctor.

“Even though I renew my drugs through the pharmacist, I also need to be examined physically by a specialized doctor on a regular basis, so he can perhaps identify some complications and recommend other medications too. Examination from a pharmacist is not enough, and virtual consultations with my doctor is not satisfying too,” she says.

Furthermore, despite using phones and video calls, Muthoni misses being visited or visiting her friends and family especially during weekends.

“This is not as enjoyable as meeting them physically like before. I also miss going out with my friends regularly. At first, it was so hard to adjust to this new normal that I almost got depressed, but now I am used to it. I have to for the sake of my health,” she explains.

A customer at a community pharmacy

The World Health Organization (WHO) reported a surge of patients with pre-existing conditions suffering from mental health related conditions during this pandemic. This is due to the disruption of healthcare services brought by government restriction measures to help curb the spread of this disease.

“The pandemic has acted as amplifier to these diseases, we therefore need a paradigm shift in the healthcare sector to support people living with non-communicable diseases. This will help them adjust with the impacts of the pandemic,” Dr Bente Mikkelsen, Head of the Secretariat for the WHO Global Coordination Mechanism on the Prevention and Control of NCDs advises.

According to WHO 2020 research on mental health and related conditions, many countries have partially or completely interrupted healthcare services. For instance, survey indicate that nearly 53 percent of the countries have partially or completely disrupted services for hypertension treatment, while 49 percent of diabetes treatments and diabetes-related complications have been disrupted.

Moreover, about 42 percent of cancer treatments have been disrupted, as cardiovascular emergencies experience 31 percent of the disruptions.

Therefore, WHO recommends reaching out to those people living with pre-existing conditions as one of the key response action plans amid this pandemic.

“There need to be more health workers extended at the grass root level to attend to people living with NCDs by giving them psychosocial support during this tough time, instead of going to the hospital,” Dr Cherian Varghese, Coordinator of the Department of NCD Management at WHO says.

During this pandemic, pharmacists go the extra mile to offer counselling and lifestyle modification guidance for better diagnosis. Additionally, there is a growing trend where community pharmacies offer tests such as blood sugar measurements, blood pressure to help them monitor patient response to treatment. This is key in ensuring positive treatment outcomes.

Muthoni has been receiving this support from the community pharmacist on regular basis. Odhiambo has been doing blood sugar tests, as well as counselling her. As a result, this has mitigated the effects of the pandemic on her.

“I am happy and grateful that Achieng’ always ensure my health is okay, it has relieved my anxiety and other stressful situations many times during this time. Also, my family and friends have been very supportive and this makes me feel more loved now that I need them the most.” Muthoni explains.

Josephine Boke 26, has also been seeking medication from Odhiambo’s pharmacy during this pandemic. Before the pandemic, she preferred going to the hospital when any of her family member got sick.

She resorted to seeking minor medications from the pharmacist, following the increasing number of COVID-19 cases reported in healthcare facilities and health workers’ inadequacy in minor healthcare units.

“Right now, so many healthcare workers are reportedly infected with coronavirus. This means that community pharmacies are the first point of contact when one has a minor illness. It is a bit safer there,” Boke says.

Moreover, she says the pharmacist is well trained, and he offers affordable services compared other pharmacies and hospitals. When her son felt ill, she received free consultations from the pharmacist.

“Unlike the hospital, I was never charged for consultation and my son received the best treatment. He tested positive for malaria, we followed the prescriptions and he recovered in one week,” Boke narrates.

According to the community pharmacist, the healthcare demand has increased tremendously during this COVID-19 pandemic.

“I receive more clients with minor illnesses like flu, headaches, allergies, stomach aches, and diarrhea, and other patients suffering from malaria, and typhoid too. I also sensitize them about COVID-19 and how to stay safe because some are ignorant, they come to the pharmacy sometimes without or with inappropriately worn masks,” he notes.

WHO advices on proper use of mask as part of a comprehensive package of prevention and control measures. With the support of community pharmacists and other health workers, it could help reduce the spread of SARS-CoV-2, the virus that causes COVID-19 at the community level.

Even though the pharmacist is committed to fulfilling the healthcare needs of the locals around him, he is concerned about misuse of medicines by the locals.

“For instance, some patients take pain relieving medicines continuously without seeking further help from a doctor. In turn, this can lead to drug addiction which is harmful to our health,” he says.

He further notes that some of his consumers come to purchase antibiotics without seeking advice.

“So I have to let them explain how they feel first before dispensing the medications to avoid emergence of antimicrobial resistance among patients and other risks of self-medication,” he adds.

Globally, self-medication is reported to be on the rise especially during this COVID-19 pandemic. In developing countries people are not only using non-prescription drugs like painkillers, but also prescription only medicines including antibiotics and antidepressants, to self-medicate without supervision.

According to Dr Fred Siyoi, Deputy Registrar, Pharmacy and Poisons Board, whereas self-medication may result in faster access to medicines and offer relief to patients, it is not a completely safe practice, and there are risks that can arise from it.

Risks of self-medication include; incorrect self-diagnosis, delays in seeking medical advice when needed, use of inappropriate medicines that can lead to adverse events, masking the symptoms of a serious disease, and inaccurate dosages, infrequent but severe adverse reactions, dangerous drug interactions, incorrect manner of administration, risk of dependence and abuse, anti-microbial resistance.

“Most commonly abused medicines through self-medication are over-the-counter medicines (OTC medicines). These are medicines that can be bought in pharmacies without a prescription. They include but not limited to painkillers, antacids, vitamins and cough remedies,” Dr Siyoi explains.

The Deputy Registrar describes prescription medicines as drugs that require a prescription before you can acquire them as they are considered to be potentially harmful if not used under the supervision of a licensed health care provider.

Example of prescription only medicines include antimicrobials, anti-hypertensive, anti-diabetics, antidepressants, narcotics analgesics among others.

Dr Siyoi encourages the general public to avoid self-medications. “Let the healthcare professional determine the cause of your ailment and prescribe the right medicines.”

Dr Felicitas Zawaira, Family and Reproductive Health Director, World Health Organization (WHO) Regional Office, during the World Antimicrobial Awareness Week recommended that health workers need to sensitize general public about antimicrobial resistance and encourage best practice.

She also stressed on the importance of effective regulations and the enforcement of those regulations to serve as a deterrent against abuse and misuse. Consequently, this could curtail the substandard and falsified market that tends to flourish when regulations and regulatory interventions are weak or absent.