The Pharmaceutical Journal
Vol 270 No 7234 p167-168
1 February 2003

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Pharmacy in Lithuania: emerging from years of Soviet rule

Pamela Mason travelled to Lithuania recently. In this article, she reflects on her experience of the country and its capital Vilnius

Lithuania is the southernmost of the three Baltic States. With an area of 65,200 sq km, it is also the biggest. Unwillingly, it was part of the Soviet Union for half a century, and you would have found it until 1990 only in a pre-war atlas or perhaps on a stamp in a grandparent's collection. Twelve years on this proudly independent country has, like its northern neighbours Latvia and Estonia, shed much of its Soviet heritage, and it is hoping to join the European Union in 2005. Lithuania also owes much to the rich cultural heritage of Central Europe, particularly Poland with which it once shared an empire stretching from the Baltic Sea almost to the Black Sea, and it still shares the Roman Catholicism which sets it apart from it Baltic neighbours. Lithuanians account for 80 per cent of its 3.7 million people. Around 8 per cent are Russian and 7 per cent Polish.

Pharmacy's long tradition

History has had a strong influence on the development of pharmacy in Lithuania and pharmacists continue to share in the joys and pains of this tiny but remarkable country, which is experiencing such rapid change. Pharmacy has a long tradition in Lithuania and the first pharmacy was established in the 16th century in the capital city of Vilnius, whose Old Town is the largest in Eastern Europe. Strolling through the warren of winding, cobbled streets with my host, Professor Eduardas Tarasevicius (president of the Lithuanian Pharmaceutical Association), I was struck by the number of magnificent churches and cathedrals, many of which have been lovingly restored in muted colours of rose pink, pale yellow and cream. Stand outside a pharmacy and you are sure to be able to see a church spire.

Vilnius also has a 200-year history of pharmacy education — albeit chequered —with the university opening its doors to pharmacy students in 1785. During the 19th century, Vilnius became a refuge for Polish and Lithuanian gentry who had been dispossessed by the region's new Russian rulers. This made the city a focus of Polish national revival and the tsarist authorities closed the university. This resulted in the end of pharmacy education in Vilnius for a time as well as the curtailment in the publication of a pharmacy journal, which had become established in 1820. A pharmacy association, which had existed since 1819, continued its activities, but these were much reduced. No longer able to study near home, students went to Germany, Poland and Russia to qualify as pharmacists.

The University of Vilnius eventually re-opened, but during Lithuania's first period of independence between the 1914–18 and 1939–45 wars, students wishing to study in Lithuania went Kaunas. Kaunas (now Lithuania's second city) was the national capital at that time because Vilnius itself had been taken over by Poland. In 1940 when Lithuania was annexed to the Soviet Union, many of the pharmacy students who trained during the independence period were deported to Siberia, shot or emigrated to the west. Pharmacy education continued in both cities until 1950 when, six years after the full establishment of Soviet rule, the department in Vilnius closed and Kaunas became the sole school of pharmacy.

Five years to become a pharmacist

Professor Tarasevicius, who also lectures in pharmaceutical chemistry at Kaunas, edits the Lithuanian pharmacy journal and owns a pharmacy, would like to see the pharmacy department in Vilnius reopen. "We could probably attract around 30 to 40 students and it would introduce some healthy competition," he says. Qualifying as a pharmacist takes five years with practical training in a pharmacy given during the fifth year. Until now, university education has been free of charge, but from 2003 this will change and students will have to pay a fee of E350 a year. Not much by British standards and, nowadays, it is not a big burden for Lithuanian students either, according to the professor.

The Soviet period brought many changes for Lithuanian pharmacy, in particular a heavy emphasis on science — much heavier than there had been in Britain during the 1950s and '60s. This was reflected in the activities of the Pharmaceutical Association, which was also expected to propagate Soviet ideology in relation to pharmacy practice. Community pharmacies grew from small family-owned shops to state-run enterprises, often situated on two or three floors. To the Soviet authorities big was beautiful, and staff numbers of 30 or more were not exceptional in Lithuanian community pharmacies at that time.

How busy the staff were is difficult to tell, but the "front shop" was a small proportion of the working area. Every pharmacy had to have large stock rooms because there was one state wholesaler, which delivered once a month and some pharmacies were expected to stockpile in case of war. They all had large manufacturing rooms for extemporaneous preparations, both sterile and non-sterile, and a quality assurance laboratory. All four of the pharmacies I visited still had such rooms, still tiled from floor to ceiling in "regulation" yellow, white or pink tiles and furnished with apple-green topped benches, imported from Bulgaria which were used throughout the whole of the Soviet Union. Today, the massive, but robust and serviceable, Russian autoclaves, pH meters and fume cupboards, stand silent for more hours of the day than they are used, and in some cases have been replaced by smaller and neater counterparts, often donated from Denmark and Sweden.

Extemporaneous preparation

During the Soviet period, up to 15 per cent of dispensed items were prepared on site. Such was the importance of extemporaneous medicines that every pharmacy had a separate area not only for dispensing them, but also for giving them to the patient and some of the pharmacies I saw still had two identifiable hatches for this. Nowadays less than 1 per cent of medicines are prepared extemporaneously, although some community pharmacies prepare medicines such as eye-drops, creams and ointments for local hospitals. I was particularly interested to see a six-stage extraction of Siberian ginseng in a pharmacy in Kaunas. Given my exciting but exacting schedule, I wondered whether I might need a few drops from the 50ml bottle the pharmacist gave me as a gift!

Stunning interiors

Architecturally, some of the pharmacy interiors were stunning. One, the Cathedral Pharmacy in Vilnius, was quite literally a work of art, with faces gazing out from wall paintings above the medicine shelves. Another, situated in Electric City, half way between Vilnius and Kaunas, was a glorious example of late Soviet architecture. Refurbished just before Lithuania became independent, it is lined with marble from Belarus, and customers are served from behind gleaming white counters with ivy trailing from a low balcony. Understandably, the statues of Lenin have long been toppled from Lithuania's public places and the hammer and sickle emblems unscrewed, but I expect this pharmacy interior will be preserved for posterity.

Since independence, Lithuania's pharmacists have had to get to grips with many changes, beginning with privatisation, which began straight away in 1990. In the early days, pharmacies were quite profitable, resulting in a rush to open new ones. However, as the free market gathered pace, the restrictions on distance between pharmacies were lifted, and you no longer had to be a pharmacist to own a pharmacy, so chain pharmacies stepped in, some in supermarkets. Small independent pharmacies are therefore now beginning to founder.

The size of pharmacies has reduced dramatically. Some of the old state pharmacies have closed and new smaller pharmacies opened, sometimes next door. Five of the pharmacies I visited had previously been state pharmacies and therefore still seemed rather large, although the chief pharmacist in Electric City said her pharmacy had reduced from 1,800 to 800 square metres.

Self-selection is not common in Lithuanian pharmacies. Although many of them have a bright and modern appearance they tend to be fairly traditional in presentation, with most items for sale behind a large counter. One pharmacist told me she was concerned about shoplifting. When I explained that there was shoplifting in Britain, too, but that pharmacists could not afford to have so much empty space on the shop floor, she smiled and took the point.

Currently one of the greatest difficulties for Lithuanian pharmacists is getting paid. Long used to being salaried employees of the state, they now have to provide for their own income. State reimbursement for prescriptions is often delayed for several months, but wholesalers still have to be paid. Pharmacists feel the tension between their role as health care providers and as business people, which is not one they have been used to. "The government doesn't understand. We have no cash flow," said one pharmacist.

Medicines shortages

Shortages of medicines still exist. The need for good textbooks and reference sources remains enormous. But all the pharmacists I met were enthusiastic and justifiably proud of their pharmacies. The hospitality I received was outstanding. From a picnic of black bread and cold meat in the middle of a pine forest, to caviar on triangles of white bread in Electric City, Lithuanian sausage and Zeppelins in a restaurant on the edge of Vilnius. I was never hungry. I returned home with a plate depicting the Pharmacy Association of Lithuania, a pot of vitamin cream prepared extemporaneously in the University Pharmacy in Vilnius, a bottle of Lithuanian ginseng, but best of all — some unforgettable memories.

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