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07 Aug 2020
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Several strategies have been proposed to help manage the adverse events (AEs) that emerged during the BEACON CRC trial which assessed the effect of encorafenib plus cetuximab in patients with BRAF V600E mutant metastatic colorectal cancer (mCRC) who had progressed after one or two prior regimens.

How is the COVID-19 situation treating you?

Pank Jit Sin
17 Apr 2020

The Movement Control Order initiated on 18 March by the Malaysian government put a stop not only to our travels but also to much of the commercial transactions, too. Community pharmacies nationwide had to cope with the sudden change in environment. Some initiated a limited customer per entry rule, some only allowed customers to place their orders at the door, and others were status quo. MIMS Pharmacist reached out to community pharmacists around the nation to see how everyone is coping with the MCO.

Nadia Ibrahim, of Segamat
Nadia’s pharmacy serves all types of customers across most demographics­­—various household incomes, ages, etc. She feels the MCO has enhanced her establishment’s role and function. “I’m glad to be able to serve people in times of need—from health advice, to supply of masks and sanitizers, getting medicines, COVID-19 related queries and so on.”

She said more people know the role of pharmacists now, and are privy to the existence of pharmacies (not just as a place to buy supplements or medicines). In fact, her pharmacy has been busy with COVID-19 related queries and sales. As a testament to the importance of a pharmacy, her establishment remained open during the lunar new year period just to serve customers. Although working through the holidays is exhausting, she noted: “But we are really glad to contribute to our community in our own way.”

After the MCO was enacted, her pharmacy now only allows one person at a time into the shop. She is comfortable with this arrangement as it makes her feel safer and enables her to pay more attention to each customer compared to before, when a few people would be surrounding her or asking questions at the same time. “I prefer one-to-one consultation and to focus on service. I still have my blood pressure monitor and glucose monitor ready should they ask to get tested.” Before each customer enters the shop, they are screened for temperature and each staff who engages a customer or handles a transaction sanitizes his or her hands after every encounter. Regulars are encouraged to call or message to check for availability of product before dropping by so that they do not waste their trip.

Nadia has kept her pharmacy open for the duration of the MCO but shortened the opening hours slightly. She has also made it a point to have face masks and hand sanitizers available for sale most of the time and supply has been consistent since the lunar new year. “It is really hard to do so (maintain an uninterrupted supply of masks and sanitizers), and it involves chasing suppliers and factories, but we did it.”

As mentioned earlier, business has gone quite well in spite of the MCO, and she has not needed to cut down or reduce her staff count. However, one of her workers, a qualified nurse, was called to serve the Ministry of Health. “I will need to hire a replacement for her,” noted Nadia.

With regard to the recently announced economic stimulus, Nadia said it was beneficial to the citizenry and this indirectly benefits pharmacists as the customers are able to continue purchasing their medical necessities ie, insulin needles, and chronic disease medications. In other words, the stimulus package will benefit the pharmacy sector, too.

To help out further, the government could encourage the public to get their masks and sanitizers from pharmacies. This isn’t just a commercial-driven suggestion, as pharmacists and the staff there are educated about the differences in types of sanitizers and masks. “I understand other people are trying to make a living, too, hence the use of the word ‘encourage,’” said Nadia.

Nadia also urged her fellow pharmacists to maintain a strong mind and healthy body. “For me, it’s a challenging but truly satisfying time. Let’s try our best to play our role as frontliners well. We must always think of how to benefit the community, how we can serve the people during this time. I like to think that we are helping to reduce the workload of clinics and hospitals in managing minor ailments (during this time).

On her part, Nadia is implementing all the necessary precautions suggested by the Malaysian Pharmaceutical Society ie, check staff temperature, sanitize hands after each transaction or encounter, among others.

Jacob, Kuala Terengganu
Jacob has been practicing as a community pharmacist in Kuala Terengganu for the past 27 years, serving to a clientele mostly coming from the lower- to middle-income groups. Having served for so many years in the same place, Jacob’s pharmacy caters to a multigenerational clientele, supplying daily necessities to chronic disease medications. Jacob often have to provide information and advice for illnesses and worries.

Having been a pharmacist for close to 3 decades, Jacob said he had been through a few tough eras. He said: “I have been through many crises before: from the economic crisis of 1997, to SARS, to H1N1. But never have we faced anything close to the MCO (and COVID-19 situation).”
 
From the beginning of MCO, his establishment decided to minimize the exposure of their staff by practicing a rotation system of working one day and resting one day. He noted that everyone is still on full salaries and benefits. Additionally, everyone practices social distancing. Waiting customer outside the shop are spaced 1.5 m apart and a cap of 5 customers are allowed in the store at any one time. All entrants are checked to ascertain their body temperature. Anyone with a temperature of over 37.5°C would be denied entry. Hand sanitizers are offered free to customers on the counters and they are encouraged to use them as often as needed. Jacob’s pharmacy has suspended all blood pressure and glucose testing for the immediate future. Additionally, all staff must wear face masks and gloves, which are provided by the establishment, at all times on the shop floor. They are also encouraged to change those at least once daily. Furthermore, soluble vitamin C is made available for the staff, and they are encouraged to drink as much water as possible to stay hydrated.  

Jacob said: “They are to distance themselves from customers at least one meter a part and at no circumstances should they touch customers with their hands. Our face shields are arriving tomorrow and will be used by our counter staffs.”

Interestingly, Jacob has not noticed a big difference in customers after the MCO. The only difference is of course the shorter opening hours. “We are to close by 6 pm as of the city ordinance. We do have a lot of new faces coming to us, including returning children, due to closures of some GPs and the avoidance of going to hospitals.”

So far, Jacob’s pharmacy has been able to keep everyone on payroll, with one staff resigning to take care of her mother, one refusing to come to work, and another working on alternate days only. Fortunately. because of the sustained business, Jacob’s pharmacy is exempt from the benefits declared by the government’s stimulus package for SMEs.

“Although we have our business hours, we are only slightly affected in terms of sales. But what I am most concerned about is the ’post viral’ effects on our economy. With the International Monetary Fund (IMF) already declaring the world is in recession, the post MCO period would continue to see more decline in sales. To make matters worse, most drug companies are increasing their prices between these few months (February to May), which will increase the inflationary pressure on our strained economies. In light of this, I would like to see a freeze on prices for all pharmaceuticals,” said Jacob. He added: “In addition I would like to see incentive given to pharmacies for improvements in infrastructure and equipment, in order to better serve patients.” With the weakening market in the retail sector, Jacob suggests that incentives should also be given to retailers to explore other platforms to increase revenues, such as online platforms.

With all the anxieties surrounding the virus and the economy, Jacob worries about the mental well-being of his fellow pharmacists. “The potential risk of exposure is a constant worry for all of us facing the multitude of sick patients, day in and day out. We need to be always vigilant to any danger to us, to our staff and our families. Beside all the precautionary steps we can take, I only wish to remind my brothers and sisters to take some time to exercise, to spend some time with your loved ones and to have a strong faith that will sustain your professional duties.”

Susan Tang, Kota Sentosa, Kuching

Tang runs a pharmacy in a somewhat suburban area of Kuching. Her shop is situated within 7th Mile Bazaar, and caters to customers from the surrounding village population and the 500 plus shops in the vicinity. As expected, her customers come from a mix of backgrounds—Chinese, Malay, Bidayuh, Ibans, and Indians, among others.

According to Tang, the MCO is a rather stressful and busy time for community pharmacy services as most GPs in the area have shortened their opening hours or do not open at all. At her practice, Tang has seen more people requiring counselling and others who come with questions pertaining to COVID-19. “We spend time explaining to customers about personal hygiene, which include regular hand washing, keeping personal distance from others, and wearing the face mask among others,” noted Tang. She said it is surprising that many still do not know how to wear a mask properly, thus the need to teach them. She and her staff also spend time to teach customers on ways to eat healthy, and advise them to stay at home as much as possible.

“We also advise customers to do some exercises at home, gargle their mouth, and sleep early and sufficiently every day,” said Tang.

The MCO and COVID-19 situation seems to be a blessing in disguise for Tang, as she has noted a pick up of customers during the MCO rather than normal times.

As she has only one fulltime staff, and with business picking up, Tang hasn’t had to make changes to her headcount. She has one other staff who is a part-timer, and both are still employed. Regarding the economic stimulus package, Tang said she had yet to go into the details of the package but would appreciate any benefit from it. As it is, she must cover the losses from selling face masks at RM1.50 per piece, which is lower than her cost price. Additional costs are also incurred from the extra safety precautions put into place eg, hand sanitizers and face masks while working.  

Tang believes the greatest challenge to all community pharmacists now is to avoid being infected by SARS-CoV-2. Hence, she calls upon all her peers to set up a system within their establishments to enable physical distancing, and to wear face masks of good quality to protect themselves whilst serving customers. Of importance is good air circulation. She said: “We also need to use extra things like infrared thermometers; gloves and sanitizers; and disinfectants to sanitize and clean our premise daily. These precautions will increase operating cost for us, and a government subsidy will be most appreciated.”

True to her own advice, Tang has initiated a few protocols at her pharmacy. She has closed the main door by barring it with a table and marked out the space for customers to maintain their distance while in her shop. Business at her establishment is strictly hands-off for customers. Tang said: “We do not allow customers to [freely] enter the premise but queue up outside the premise and to take turns to be served. We have also set up fans to blow the air outward. We mop the floor daily using disinfectant, and spray the tabletops and money with alcohol-based sanitizers. We wear gloves and face mask at all times. Customers will not handle any items on display in the pharmacy. We will bring the item to the customer instead and will disinfect all the items that they touched (especially those they did not purchase), before we place them back unto the shelves.”

Tang considers being able to stay open during the MCO as a privilege. She said: “I think many of us (pharmacies) will manage to pull through the MCO because unlike many others; we are privileged to be allowed to serve the people in need of our services while others could not.”

Ed: The different reactions and personal takes on the MCO and the government’s stimulus package from our panel of interviewees is reflective of each person’s individual background and experience. There is no right or wrong judgment that goes out among our peers. MIMS Pharmacist hopes our readers will find solace and comfort in reading each other’s experiences as we brave the MCO.

 

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Most Read Articles
07 Aug 2020
Concomitant treatment with a nonsteroidal anti-inflammatory drug (NSAID) following myocardial infarction (MI) is associated with a higher risk of cardiovascular and bleeding events, a study has shown.
Roshini Claire Anthony, 06 Oct 2020

Several strategies have been proposed to help manage the adverse events (AEs) that emerged during the BEACON CRC trial which assessed the effect of encorafenib plus cetuximab in patients with BRAF V600E mutant metastatic colorectal cancer (mCRC) who had progressed after one or two prior regimens.