Sultan (SID) Dajani, MRPharmS, is a community pharmacist and member
of the Council of the Royal Pharmaceutical Society. He also serves
on the Pharmaceutical Services Negotiating Committee and the local
pharmaceutical committee for Lambeth, Southwark and Lewisham
|
According to legend, when a gazelle cried in the Abu Dhabi desert,
an oasis was born and this became known as Al-Ein |
Visitors to the Gulf who expect year round sunshine, white beaches, undulating
desert sands, world class shopping, diverse cuisines, live entertainment
and an unlimited range of recreational pursuits are rarely disappointed.
For those in love with carats of the gold variety, the Gulf is paradise.
This is where you will find 22-carat gold about a third cheaper than the
18-carat versions in the UK. And haggling in English is expected.
The United Arab Emirates (UAE) is a federation of seven states, which include
Abu Dhabi and Dubai. Dubai is cosmopolitan but Abu Dhabi is the only place
to be if you want to play golf in the footsteps of Faldo, Montgomery and
other golfing heroes — the World Golf Sand Championships were held
there recently. But do not expect to find any greens. There are only browns
and you need an artificial grass mat to tee off. However, no course is
without the requisite 19th hole!
Development
The federation was formed in 1971. Under the presidency of Sheikh Zayed
Bin Sultan Al Nahayan, the UAE has made gargantuan architectural, structural
and economic achievements, through ambitious vision and having the resources
to realise this. There have been similar unrelenting advances in societal
aspects, too. This includes a burgeoning health care system. When I visited
Abu Dhabi recently I hardly recognised the place. Admittedly, I had only
just started walking when my family left, but it would be just as unrecognisable
had we left only 10 years ago. I am glad to say that the place has changed
for the better.
Although Abu Dhabi is the capital of the federation, Dubai is considered
the commercial hot-bed of the Middle East. Served by more than 200 shipping
lines and with airline links to over 130 cities, it is the gateway to a
billion people whose annual market value is estimated at almost £70bn
per annum.
Here, the pharmaceutical market is about 4 per cent greater than the global
average and, because Dubai has an open market with no exchange controls,
quotas or trade barriers, it is easier to do business. The UAE is a launch-pad
to the Middle East and Africa so it is not surprising that a great deal
of importance is placed on the Middle Eastern health market. This is reflected
by the region playing host to one of the busiest and most comprehensive
health conferences in the world: the Arab Health Conference.
Now in its 28th year and held in Dubai, the Arab Health Conference is considered
to be a vital showcase for many new products and innovative services. Hosting
1,500 exhibitors and involving 25 countries it is no wonder that it has
become so renowned and is reputed to be the breaking ground for many new
companies. Furthermore, the conference acts as a forum for exchanging ideas
and facilitating the development of health care through five areas, namely “medlab” (clinical
testing), pharmaceuticals, dentistry, international health services and
hospital design and interiors.
In addition, work to build a health care city in Dubai is currently under
way. This is to become the region’s centre of excellence for specialist
medical services, medical education, life science research and technology
leveraged health care services. Dubai Healthcare City will have the capacity
to accommodate 15 million visitors each year and, all being well, should
be completed in five years. The first four buildings of phase I are to
be inaugurated on Christmas day this year.
Apart from having fewer resource problems than other countries, the main
advantage the UAE has is that, as a new country, it starts with a clean
slate — unlike the NHS in the UK, it does not have to make the best
out of an old system and is not embedded in any particular culture. Materials
are new and the processes are not over burdened. Ongoing expansion of hospitals,
laboratories, medical research centres and specialist medical facilities
will make the ideals of equity and choice attainable.
However, in a land of plenty sometimes logic can be in short supply. For
example, the health care available to the large migrant manual labour workforce
is expensive and choice is a luxury. So, many who fall ill are forced to
return to their place of origin for treatment — an anathema to any
civilisation that wishes to become a first class society. To overcome this
problem, a workable national health insurance scheme is being developed. Pharmacy, UAE style
The practice of pharmacy in hospitals, as in the UK, varies significantly
between institutions, especially in their relationships with the community
(eg, the services they commission from primary care). The American Hospital
in Dubai was the first hospital to be accredited by the American Society
of Health-system Pharmacists (ASHP) and the Joint Commission for International
Accreditation (JCIA). For example, all intravenous medicines are prepared
in accordance with the latest ASHP and JCIA standards. Medicines are
distributed to patients on the wards in “unit dose systems”.
This means that for each ward round the medicines for each patient are
individually packaged. The pharmacy staff at the American Hospital are
also responsible for preparing total parenteral nutrition.
Pharmacists deliver the required discharge medicines to patients, provide
medicines management information and answer any queries. Medication errors
and adverse drug reaction are all reported and all the necessary procedures
are in place relating to alerts, correcting errors and educating hospital
staff in order to prevent such incidents reoccurring. Other work includes
evaluation of antibiotic use, data collection, formulation, producing pharmacy
and therapeutic committee bulletins and the performance improvement committee
with recommendations for corrective action (eg, risk assessment). All these
activities are documented.
Many hospitals in the UAE work collaboratively with Ajman University’s
college of pharmacy, where education and training manuals are prepared
to ensure high quality training for preregistration trainees. Pharmacy
staff are requested to keep up to date with new information through continuing
education. Continuing professional development is not practised and long-distance
learning is not part of the educational landscape.
However, the American Hospital is one of the better examples of hospital
pharmacy. In the UAE, pharmacists are looked at in much the same sense
as technicians are in the UK because their skills remain untapped. There
is little consistency of service, no inspectors and no official ethical
guidance document. It is also surprising to learn that part-time postgraduate
qualifications are not as esteemed as the full-time equivalent. This is
reflected in terms of responsibilities given.
Nevertheless, progress is being made. The UAE may be a long way from pharmacist
prescribing, pharmacist-run medicines management clinics and electronic
patient records but, if as much energy is devoted to public health as it
is to engineering, it will catch up quickly and could soon become a world
leader.
The UAE’s open market (apart from Dubai, which opted out) is regulated
by the Directorate of Drug Control in co-operation with the General Secretariat
of Municipal-ities. This is a valuable measure because the market attracts
numerous pharmaceutical products and food supplements and, therefore, needs
to be regulated. Under the personal control of the director, Easa Bin Jakka
Al Mansoori, the drug control department issues guidance to protect patients
while also encouraging the highest quality pharmaceutical services in the
Emirates.
Future plans for pharmacy include:
· Developing a financially independent agency for the control of medicines
and medical devices
· A pharmacy board to oversee the professional side of pharmacy
· More resources for inspection and enforcement
· More UAE nationals to qualify and work as pharmacists
· A transparent legal mechanism for enforcing the powers given to drug
control in the 1983 law and, ideally, a modernised law and legislature
for medicines and pharmacy |
The
Pharmaceutical Journal