Dr. Adusa-Poku: Dr Richmond Adusa-Poku PharmD, CEO of Garryson Pharmacy, Kumasi writes:
In the cozy Postgraduate auditorium of the KNUST Business School, the Keynote Speaker, Dr. Emmanuel Tinkorang, who is the Director of Health Service of Ashanti Region, delivered an excellent speech on the topic: ‘Government Policies on Healthy Lives and Wellbeing.’ It was apt for the 10th Biennial Scientific Conference of the College of Health Sciences, KNUST, with its theme: Promoting Healthy Lives and Wellbeing, which began yesterday and ended today, 28th September 2023.
‘Doc, you won’t believe the number of people who had undiagnosed hypertension, which we discovered at Garryson Pharmacy as they walked in for us to resolve their perceived health needs. Their chief complaints were mainly just headaches or tiredness. Imagine what we may discover in over 5000 pharmacies across the country.’ Dr. Alex Owusu-Ofori, who is an infectious disease specialist and a lecturer at the KNUST School of Medicine and Dentistry (SMD), nodded as I whispered to him. We were sitting next to each other yesterday as we listened to the Keynote speaker deliberate on the National Policy on Non-communicable diseases (NCDs) during his speech.
‘Hardly did we learn and discuss national health policies in class when we were health students training to be pharmacists. Were you taught these policies as medical students?’ My question drew an amusing smile on his face. ‘No, we were not taught, but it is important that aspiring health professionals have a basic and broad understanding of our national health policy framework.’ Over 3 decades ago is a long time, I guess students are being exposed to the health ecosystem they would find themselves working in after licensure.
‘Are we a healthy nation?’ asked Dr. Elliot Koranteng Tannor as the 1st Guest Speaker. A senior lecturer at SMD and a Senior Specialist Physician and Consultant Nephrologist at the Komfo Anokye Teaching Hospital (KATH), he was so engaging that the dead listening would have resurrected. Still in the presence of infectious disease, there is an increasing prevalence of non-communicable diseases (NCDs) such as diabetes, hypertension, heart diseases, kidney diseases, and stroke. He stressed on undiagnosed hypertension and poor adherence to medication for even those who know that they are living with hypertension as real pitfalls.
His call for us to change our lifestyles, prevent premature deaths, and increase the quality of our lifespan was buttressed by the 2nd Guest Speaker who addressed ‘What should we be eating for good health.’ I should be visiting Mrs. Efua Owusu-Ansah, who is the CEO of Enjoy Your Health Consult Limited and also a Principal dietitian at KATH, to invest properly in my body. I love what she said: ‘Nutrients do not work in isolation; there is the need for the right combination, the timing of intake, and the consideration of the quantity to match activity level and the body’s needs.’ For what use are our financial investments if we don’t invest properly via the vehicle of eating right, she asked us. We won’t live long to enjoy the return on our financial investments. ‘Remember your diet is your bank account: good food choices are suitable investments (Bethenny Frankel). Take care of your body: it’s the only place you have to live (John Rohn).
The Chair for the session, who also happens to be the Chair of the Advisory Board of the College of Health Sciences, Prof. Peter Donkoh, had to make a couple of hand gestures to signal Dr. Tannor that within the limited time, all good things had to come to an end but not before the young academic and clinician who is the Chairman of the Young Nephrologists Committee of the African Association of Nephrology (AFRAN) squeezed in his brief commentary on the national cry and politicking on the alleged increased cost of dialysis (the machine  process of filtering impurities from the blood of patients who have their damaged kidneys unable to efficiently and effectively do so) at the Renal Unit of Korle Bu Teaching Hospital from 380 cedis to 765.42 cedis per session. I couldn’t fault him for his unapologetic bias.
From yesterday till now, across media channels, the doubling cost of dialysis has taken center stage. Increased cost of imported consumables, depreciating forex, cancellation of waivers at the port by the Government has taken a political twist as parliamentarians and pressure groups take shots at the Government to absorb the cost of dialysis through the National Health Insurance Scheme. How many Ghanaians can afford to pay out of pocket to have dialysis done thrice a week? Korle Bu Teaching Hospital alone has over 400 patients on dialysis, and kidney transplant is not routine but celebrated. Some backtracking is taking place until parliamentary approval is given but the plain truth is that someone should pick up the differential tab or the tab.
It is an emotive subject to discuss and ask how patients, in the first place, got to this position where they get poisoned by their waste and impurities in their blood if the latter are not timeously removed. ‘It is not my mother’s fault that her kidneys are not properly functioning,’ said a pitiful, unemployed daughter who is moving heaven and earth to find money to keep her mom on dialysis amid tears streaming down her face. I was moved and couldn’t continue watching the small screen. It is said that one doesn’t stand in a swarm of red ants and attempt to remove them from one’s body. Ghanaians who culturally love to leave things to God and the government should take a step back and reflect, how did all begin? But will we? We will talk all day and our short attention span would move on to the next fire fighting agenda on our national list of emergencies. Can we take preventative measures to keep our kidneys healthy? Even when your DNA or genes put you in a disadvantaged position?
If you live in a city in Ghana, then there is a chance that less than 400m from where you live, there is a community pharmacist who prides himself or herself as a ‘Friend of the Human Race (Amicus Humani Generis)’ and who has been touting ‘Ask your Pharmacist.’ Maybe it is time to hold the neck of your community pharmacist and ask how you don’t get yourself into this difficult situation. Don’t brush it off and say ‘Tofiakwa, minus me’. Positive thinking takes action, wishful thinking does not. Get some answers and an action plan for health is not wealth but life itself. Time to take matters into your hands, the neck of your community pharmacist.
Let’s meet in the continuing piece, and let’s see how you can get good pharmaceutical care from your community pharmacist from an informed position.”
“Good afternoon, sir. I hope you are well. I brought my blood sugar testing machine to your pharmacy because it seemed to be malfunctioning. The pharmacist on duty, Patrick, showed me how to use the strip to draw a drop of my blood, which was where I was facing difficulties. But it’s resolved now. However, the random value reads 14 mmol/L which seems high according to your pharmacist, though we both understand that I’ve had breakfast.” This was a phone call with a prominent community leader and a client in our area.
I inquired if he had diabetes, to which he replied negatively. I suggested a fasting blood sugar test for the following day, and he reported back with a reading of 8 mmol/L. “Doc, you mentioned that the maximum should be 6.4 mmol/L,” he said over the phone. “Can I meet with you early tomorrow morning? I’d like to discuss this.”
We met the next morning, and he appeared displeased with the results. With a family history and occasional monitoring, now in his mid-fifties, I explained that we needed a test that would give us a more accurate picture of his sugar levels over the last 12 weeks. I also asked if he had any tests prescribed by a medical doctor to check his ‘bad’ cholesterol (there is also ‘good’ cholesterol) and kidney function. His response was negative.
When the lab results arrived a few days later, we found that his glycated Hemoglobin which averaged his sugar level over the last 3 months was high, as were his ‘bad’ cholesterol and triglyceride levels. However, his kidney function and blood pressure were good. I explained that my next step was to provide a referral note to be taken to a medical doctor. “I am not ready to be put on any medication by a physician right now,” he expressed his concerns. I assured him that medication wasn’t the first step. Instead, we would focus on lifestyle modifications, including diet and exercise, followed by monitoring and evaluation. I dedicated 20 minutes to educating and counseling him on the non-drug measures he should take to reduce his blood sugar and ‘bad’ fat levels, ultimately preventing hypertension from setting in and promoting a healthier life.
Now, he’s being closely monitored and evaluated. It’s important to prevent essential hypertension, especially when combined with high blood sugar and lipid levels, as this unholy trinity can lead to heart disease, stroke, and kidney disease.
The most common cause of kidney failure that necessitates dialysis is chronic kidney disease (CKD). CKD can result from various underlying conditions, such as high blood pressure, diabetes, and some infections of the kidney. In our part of the world, we should not forget the role of unregistered herbal medicines which may potentially have damaging effects on the kidney. Properly managing these underlying conditions and seeking early medical attention can help prevent or delay the progression to end-stage renal disease, where dialysis or kidney transplantation may be required.
As a pharmacist, l know that uncontrolled hypertension and uncontrolled diabetes are the two major diseases that lead to end-stage kidney failure. However, for lack of knowledge, my people perish and blame witchcraft and juju in the 21st Century Artificial Intelligence (AI) age.
Community pharmacists can play a significant role in preventing chronic kidney disease (CKD) in developing countries, even in resource-limited settings like IMF reliant Ghana. Here are several ways they can contribute:
1. Education and Awareness: Community pharmacists can educate patients and the local community about CKD risk factors, such as hypertension and diabetes. They can provide information on lifestyle changes, including diet and exercise. On every 25th September, pharmacists all over the world celebrate World Pharmacist Day. Last Monday and through this week, pharmacists have been educating and doing health promotion on TV and FM stations.
2. Blood Pressure Monitoring:
Offering regular blood pressure checks and counseling patients on controlling hypertension is crucial, as it’s a leading cause of CKD. Many pharmacists offer this as a free service or charge just 1 cedi to buy batteries for the BP machine. Just like l checked for this community leader, it is good to know your BP number.
3. Diabetes Management: Pharmacists can help individuals with diabetes manage their condition effectively, including guidance on medications, insulin management, and lifestyle changes. Pharmacists will advise you if your medication seem not to be effective in controlling your sugar levels.
4. Medication Management: Pharmacists can review medication regimens to identify drugs harmful to the kidneys and work with healthcare providers to adjust prescriptions. If you’re taking any herbal medicine or supplements, it is necessary to inform your pharmacist during consultation.
5. Nutritional Guidance: Offering dietary advice, especially in areas with limited resources, can help patients make healthier food choices. Though Community Pharmacists are not dietitians or nutritionists, they have the professional competence to guide you and make referral when appropriate.
6. Preventive Services: Providing vaccinations, such as hepatitis B, can help prevent infections that might lead to kidney damage. Some community pharmacists are licensed vaccinators in Ghana.
7. Access to Essentials: Advocating for improved access to essential medicines and medical supplies is vital in resource-limited areas. Hospital pharmacists and Community Pharmacists in peri-urban and rural settings play critical roles and should be pressed to advocate in the face of the dwindling national cake.
8. Collaboration with Health Providers:
Building partnerships with local clinics and healthcare providers ensures continuity of care for CKD patients. There is nothing wrong if your community pharmacist refers you to a physician after competently assessing you. It is in your best interest so please follow the advice given.
9. Health Screenings: Organizing health screening events can identify at-risk individuals and provide early intervention. During this week while celebrating World Pharmacist Day on Monday,25th September, Pharmacists did health screenings in communities and markets with BP measurements, checking blood sugar levels, weight check and assessment of Body Mass Index (BMI) etc.
Pharmacists in Sunyani would do health screenings in markets today.
10. Documentation and Reporting:
Keeping records of at-risk patients and reporting trends to local health authorities can inform public health programs.
Pharmacists as healthcare professionals are an intelligent solution to strengthening our health systems and supporting societies. Your community pharmacist is your most accessible healthcare professional. It’s crucial to engage with them, seek advice, and take control of your health. Preventing CKD is far more manageable and cost-effective than treating it later. Remember, your health belongs to you, and it’s worth investing in.
Special acknowledgment goes to companies like the First Sky Group Limited for their support to over 200 CKD patients at the Renal Unit of Korle Bu Teaching Hospital over the past 8 years.
Your community pharmacist is there to help you take control of your health, so don’t hesitate to reach out. It is your right and it is right to do so.