The Heroes of the Hour - Article about Pharmacists in South Africa

Professor Angeni Bheekie is calm and gentle in manner but her passion for pharmacy brings out a fired-up lecturer who aims to change the face of pharmacy.

“People generally don’t know what a pharmacist is or does,” says Angeni Bheekie a Professor of Pharmacology. Her service learning programme and research is attempting to change the way in which society and pharmacology students view pharmacists.

Professor Bheekie is researching the most effective approach to motivate pharmacy students to become and be seen as “active members rather than dormant dispensers.”

She speaks about pharmacists with so much pride it makes you feel as if they are the superheroes of the medical field. Pharmacists seem to play the ‘mundane’ role which people see in every day encounters but then behind-the-scenes they are actually saving lives and changing the medical profession.

The curriculum which pharmacology students at the University of Western Cape (UWC) follow has become more practical and emphasises the major role which pharmacists could play in the medical field.  “The service learning has given us a platform on which we challenge the system in a dialogue. We ask, ‘Is this how you see yourself practising when you graduate?’”

She explains the new service learning technique which has been implemented at UWC in her article Service learning in Pharmacy: opportunities for student learning and service delivery, which can be found in the African Journal of Pharmacy and Pharmacology.

Professor Bheekie is small in stature and a first impression of her is one of a kind lady you would meet at a bakery who is buying cake and cookies for her children. Although, she explains there has been no time in her life for marriage or children.

However she soon settles in and starts talking about pharmacists and their diminished role in society and the pleasant lady is gone. She is replaced with an educator who will make any listener feel as if they need to pay close attention in case there is a test after.

Through the service learning programme the students are taken to hospitals, clinics and public sector pharmacies to experience the part which pharmacists fulfil every day. Professor Bheekie understands the disillusionment which students are faced with when they see the submissive attitude and role which pharmacists are playing in their field.

She practised for 5 years before moving into academia as she was not willing to accept that the rest of her life would be handing out medication to patients with little or no interaction.

“I just couldn’t, I couldn’t go on every day. I was burnt out; I was just seeing faces and handing things over. I wasn’t doing what I thought I would be doing.”

The general perception of pharmacists is of people who stand behind a counter and hand over the medication which the doctor prescribed; which means they do not have to do anything but follow the instructions given by the doctor.

“There is so much thinking behind everything. The thinking behind why am I giving this drug with this agent comes only to a pharmacist because we know what the drug interactions mean and we know what the toxic side-effects are.”

Professor Bheekie is a small woman with a very gentle manner. She serves a small glass of orange juice on a saucer; as etiquette rather than practical reasons.

However this gentleness is shattered as she becomes more enthusiastic in her explanations and suggestions about the importance of pharmacists. She has the power to make a person want to apply for pharmacy immediately and become an apprentice of this super-Pharmacist.

“We give students the real life exposure so that they can see what needs to be done before graduating. They need to take the bull by the horns and say, ‘okay as pharmacists what do we need to do?’ There are little pockets of opportunity to make changes,” explains Professor Bheekie in terms of the role which the future graduates will be able to play.

She describes the barriers which exist between the patients and pharmacists; physically it is the walls and counters, while the more challenging barrier is the gap between what the pharmacist can do for the patient and what they do in reality.

“Our young students go to the facilities and they see pharmacists who are not performing what we teach them in theory.”

South Africa needs saving

In 2003 the government did a survey of the medical personnel in South Africa in order to determine which sector had the greatest need. The public sector was identified as having a great need for medical personnel in general but the pharmacist-to-patient ratio was extremely low.

UWC and other universities offering pharmacy were asked to increase their student intake, “the government is helping by asking us to triple our intake of students; we are asked to graduate 100-120 students.”

However the need will not be eradicated without some challenges, “academia is now overloaded so I am concerned about the quality which we are sending out there,” says Professor Bheekie.

Other universities were not willing to adopt the service learning programme because it was deemed “too resource intensive” says Professor Bheekie with raised eyebrows.

However, she will not let a negative word hang too long in the air before she has snapped it back up with an explanation or positive angle.

In 2011 Professor Bheekie, in conjunction with other pharmacology lecturers, wrote the research paper Public Health: every pharmacist’s business! In the paper she looks at pharmacists in the public sector.

“We believe the role of the pharmacist is so under-utilised. People go to a public sector hospital and they only see this window and this pharmacist working there. So you just look at these people giving you packets which mean patients get frustrated and can’t understand what is going on because they think these people should just count the pills and give it to them.”

She is quick to point out that the service learning curriculum was not created by her but it is clear her enthusiasm is the reason she is now carrying this project forward.

Her enthusiasm rubs off in her lectures and makes her students feel like the world is in danger and they are the only ones with the ability to save it.

 “I didn’t start off wanting to be a pharmacist but now I do. The main reason why I want to is because after learning all the theory and what goes into being a pharmacist and seeing that none of it is being applied in practise. I saw that there is a need for us to be there,” says Marcus Legodi a student in Professor Bheekie’s class.

The public sector is the main focus of Professor Bheekie’s research; primarily because that is where you will find the helpless and defenceless. Just as a hero would save a seemingly hopeless situation; Bheekie hopes to improve the lives of all.

“The ideal role of a pharmacist is to make sure patients understand why they are taking their meds and the dangers of non-adherence, especially if they are on chronic meds. Highlighting the importance of exercise and good diet and ensuring the social/environment in which the communities are living is conducive to healthy living. We cannot detach ourselves from the violence, the injury and the drug abuse.

“Cape Town is the drug capital of the world. So if pharmacists were doing their job, why is drug use so high? Where is this drug expert, we need to get to know our clients, we don’t know them.”

It may seem a bit of a stretch to place all the blame and responsibility at the pharmacists’ doors but Professor Bheekie will be able to persuade even the toughest sceptics that they have the power.

“She makes you fall in love with pharmacy; she makes you see it does not only end with you obtaining your degree. They teach you all that a pharmacist is about.

“She also teaches you that your knowledge can make a difference,” says Lebogodi who started studying Pharmacy as a bridging course into medicine but never made the move.

Throughout the description of the influence which pharmacists should and could have she is completely composed. Professor Bheekie only breaks her motivational speech briefly to ensure you are keeping up and envisioning the same ideal society she sees before her – one in which pharmacists swoop in and save the ‘patient in pain’, rather than damsel in distress.

Her arch nemesis is “old school academia” which does not intermingle with students and the surrounding society. She calls it “teaching in silos” as she paints a picture of an ivory tower looming above the students and giving orders.

Her service learning is aiming to not only connect with the students but also “to become more involved and embedded in society.”

Biggest Conquest yet

Professor Bheekie has identified the rural areas in South Africa as the biggest challenge because in these communities pharmacists “might not have the drug and because there is not much health promotion.”

In these situations the nurses are usually overwhelmed and the pharmacists just want to get rid of the queue which is before them. But she will not be deterred.

“The creativity of our students needs to come in in situations like this because pharmacy students need to become resourceful. They know the ingredients so they can make alternative arrangements.”

She will often set great goals amongst realistic suggestions; she tells a story of a doctor at Red Cross who made an asthma pump for kids out of a 500ml Coke bottle; Bheekie expects no less from her students.

“It is about taking that leap and changing the environment. ‘I don’t have that’ should never be the answer because pharmacists should be able to identify alternatives.”