BRIEF HISTORY OF HOW ASSISTANT PHARMACIST CAME INTO SERVICE

By Mr.Chong Kit Chee ( 1st Batch )
One of The Founder and Pro-Tem Secretary, National Union Of Government Dispensers 
(Kesatuan Pembancuh Ubat Kerajaan Semenanjung Malaysia- Now refered as
Kesatuan Kebangsaan Penolong Pegawai Farmasi Kerajaan Semenanjung Malaysia)


BRIEF HISTORY  OF PHARMACEUTICAL HISTORY OF HOW DISPENSERS CAME INTO THE SERVICE


Before the existence of Dispensers, the Dispensary was run by Hospital Assistant (now called Penolong Pegawai Perubatan) where training were purely Nursing. The Government decided to have specialize training in Dispensing and the scheme of Dispensers was introduce.

In 1957, the First (1st) Batch of Dispensers was formed and sent to Penang for Training. The scheme of service was RM137.50 x 7.50 / 178.00 / 422.00. (i.e after qualifying 3 years probationary, we get RM178.00 with COLA RM52.50. However for the Nurses and H.A the pay was RM238.00 - RM528.00. We find it difficult to accept th disparity and were making a lot of noise until some told us to form a "Union".

We have no knowledge of Trade Union activities. So we went to the Labour Department and got the advice and the procedure in forming a "UNION".

In the year 1959, we had our first meeting at : No.300, Macalister Road, Penang. The following are the members of the Union :

1. Chong Kit Chee (Pro-Tem Secretary)
2. R.Narayanan
3. Toh Hong Sang (1st President) - Founder Of UPHA Pharmaceutical
4. Lee Soon Thim
5. Dr.J.V Anandhan, Phd (1st Secretary) -  (Later become Lecturer & Pharmacist Specialist in USA)
6. Oon Peck Kee (1st Treasurer)
7. Bathasarithy
8. Lim Kok Lee
9. Miss Hooi Fong Yin
10. Miss Lim Yuet Yin
11. Shaharin Abdullah
12. Loke Chee Keong

We collected then RM2.00 per member to buy paper, stamps, etc to start the "ball rolling". I was (Chong Kit Chee) the first Pro-Tem Secretary and the late Toh Hong Sang was the 1st President. After 1960, all of us were posted to various state and the "Union" was finally started in Kota Bharu, Kelantan with J.V Anandan as the 1st Secretary of the "Kesatuan Pembancuh Ubat" with Toh Hong Sang the 1st President and Oon Peck Kee as the 1st Treasurer.

The membership then were RM2.00 per head. "For your information, the RM2.00 then is equavalent to more than RM10.00 now. We had no choice as we have no money.

We were look down by the H.A and Nurses and quite a number of Dispensers resigned and went to work in Private Pharmaceutical Company as salesman etc. Our President the late Mr.Toh Hong Sang successfully established the Pharmaceutical Factory which everyone know as "UPHA".

The Secretary J.V Anandan migrated to USA and is now Dr.J.V Anandan, lecturer in Pharmacology.

(J.V Anandan worked as Assoc Proffesor at Wayne State University, Pharmacy Specialist, Department of Pharmacy Services, Henry Ford Hospital, Detroit)

Our Union activities were first to enroll for members and the response was very encouraging. We started to make representation to the Minstry Of Health about our pay scheme and other related matters such as "Overtime" etc. We fought very hard but did not get much result. So we embarked on the "Work To Rule" to press for our duties to be duly rewarded.

"Work To Rule" means 8.00am - 4.00pm and no call duty. Because we were small in numbers and with the H.A blocking us, we had to proceed for quite some time before Ministry of Health called us for Negotiation.


Then came the "Suffian Report" and still we were left behind because the Nurses and H.A were placed after 3 years training their scheme were RM238.00 - RM750.00 whereas the Dispensers were given RM275.00 - RM600.00.

We continue to press for parity with all the medical staff. In the meantime the "Union" have some many changes in office bearers such as Thiruchelvam, Abd Ghaffar and Hj.Sabirin.

HJ.Sabirin is the longest and most efficient Secretary General of the Union. When I was the President he worked very hard to push for some much benefits for all members. The project to get Diplomas status he spent endless memorandum untill finally you all successfully got what we have today! He should NOT BE FORGOTTEN and is now residing in Sg Buloh, Selangor.

After so much about Kesatuan, we now come to the Persatuan. I dont quite remember the date of Persatuan formation but somehow after 1970. At the time the H.A got the Govenrment by Act of Parliment to gazette their H.A Union. We also decided to form our Association of Dispensers in Kuala Lumpur. (now called Persatuan Penolong Pegawai Farmasi Malaysia)

Because of lack of support from members, the Persatuan formed were not active. I also have no time to deal with the Persatuan. Eventually the Persatuan were transfered to Ipoh with Hj.Ismail is the President. In Ipoh the Persatuan also did not perform.

As a result i lost my membership because i was fully engaged in Kesatuan activities.

After few years in Ipoh, the Persatuan were transfered to Kota Bharu and the rest is History. I became a member again with the number 0090.

I must take this opportunity to congratulate you and your team for leading the Persatuan to this present day and to be known as "Persatuan Penolong Pegawai Farmasi". Carryon with the good work. I hope everyone must join the Persatuan to give the leaders sufficient negotiating power. The worse enemies in the "Penolong Pegawai Farmasi" will be those who only benefit from the sweat of their fellows members.

Best wishes to you and all members of Persatuan.

Chong Kit Chee
July 2011

The article above was posted to me on 15th July 2011 by Mr.Chong Kit Chee, the very 1st Batch of PPF (refered to Dispensers those years) and also Founder of our Union and Pro-Tem Secretary who prepare the Unions Constitution for Registration with Labour Department in 1959. 

PENJENAMAAN SEMULA PROFESION KE JURUTEKNOLOGI FARMASI

Salam sejahtera, Salam 1 Malaysia dan Salam Mesra kepada semua PPF Malaysia,

Pada tanggal 6 Mei 2015, semasa bengkel Pemurnian Senarai Tugas Pen.Pegawai Farmasi di BPF KKM Petaling Jaya,  Lembaga Farmasi Malaysia telah meminta kepada para ahli mesyuarat yang hadir (Gabungan Kesatuan dan Persatuan serta Think Thank kalangan PPF) mencadangkan Penjenamaan semula Gelaran Jawatan Penolong Pegawai Farmasi kepada satu nama baru yang sesuai dan boleh di guna pakai kepada semua sektor awam dalam KKM, Badan Berkanun, Swasta dan Industri.

Justeru itu Ketua Profesion telah meminta ahli-ahli Mesyuarat yang hadir memikirkan nama yang sesuai untuk di guna pakai. Beberapa Kumpulan telah di pecahkan dalam bengkel tersebut dan saya berada dalam Kumpulan yang menyediakan maklumat untuk penjenamaan semula. Kebetulan saya telah pun mempunyai maklumat yang di kumpul sejak 15 tahun dulu berkaitan Gelaran Jawatan PPF di serata dunia.

Penjenamaan semula Gelaran Jawatan adalah sesuatu yang di nanti-nantikan sejak sekian lama. Pada tahun 2006, saya dan Puan Faridah Saidi pernah menghadiri satu perjumpaan bersama Kesatuan dan Persatuan di Hotel IOI Marriot Putra Jaya semasa Kesatuan mengadakan mesyuarat Exco di sana di bawah pimpinan Arwah Hj.Sairin dan En.Rohin Daud. Saya bersama Puan Faridah Saidi (Timb.Ketua Profesion sekarang) telah mengambil inisiatif mengatur perjumpaan ini dan mengambil kesempatan menerangkan betapa pentingnya Gelaran Jawatan Juruteknologi Farmasi dalam fasa nama baru Penolong Pegawai Farmasi diproses untuk diluluskan ketika itu.

Cadangan yang kami beri tidak diambil kira walaupun telah beri penjelasan ia akan memberi kesan terhadap masa depan, Pendidikan dan Hala Tuju Profesion.

Sekarang perkara yang sama berulang lagi dan kita telah diberi peluang kedua untuk memastikan Profesion ini berada dalam landasan yang betul, Hala Tuju yang jelas, Senarai Tugas yang seiring dengan Gelaran, peluang pendidikan sehingga Ijazah dan kenaikkan pangkat dalam Jawatan yang sama serta Expanded dan Extended Role yang sesuai.

Rakan-rakan PPF yang dikasihi, amatlah penting kita mengambil sikap positif dan berupaya melihat jauh kehadapan perkembangan Profesion yang kita kasihi. Lihatlah semua Paramedik lain yang telah maju kehadapan jauh daripada kita. Jururawat, Pen.Pegawai Perubatan, JuruXray, Jurupulih Anggota / Cara Kerja, Pen.Pegawai Persekitaran, Juruteknik Pergigian dan Jururawat Pergigian semua telahpun menyediakan Silibus untuk Ijazah kecuali Pen.Pegawai Farmasi sahaja yang ketinggalan. Saya telah berjumpa beberapa Pegawai di Bhg Latihan termasuk Tuan Hj.Moideen Hasan yang menerangkan kita di dalam era yang sangat kritikal jika tidak mengambil sebarang inisiatif untuk menaikkan taraf atau memulihkan kelemahan sedia ada.

Menurut Pegawai Kanan Bhg Pengurusan Latihan KKM, di masa hadapan tidak ada lagi program bertaraf Diploma dan Pos Basik. Kesemuanya akan di ubah kepada Ijazah dan Advance Diploma (1 tahun menggantikan Pos Basik). Kemana kita akan pergi jika tidak ada peningkatan atau usaha. Kita akan ketinggalan dan JPA juga di fahamkan tidak akan lagi mengambil jawatan bertaraf Penolong dalam paramedik di masa hadapan. Ini disebabkan semua paramedik akan naik taraf ke Kumpulan  Profesional dengan Ijazah sama seperti di UK. PPF nak letak di mana? Apa hala tuju nanti ?

Bagi menangani masalah ini adalah amat penting barisan Exco Kesatuan Semenanjung, Sabah, Sarawak, Persatuan PPF Malaysia dan Persatuan PPF Sabah duduk semeja berunding dan mengadakan satu bengkel khas untuk menyediakan plan perancangan pembangunan profesion untuk jangka masa 10-30 tahun akan datang. Perkara ini tidak boleh dipandang ringan. Profesion ini dan Para Junior akan menerima kesan amat buruk sekiranya tidak dibendung lebih awal.

Untuk itu, pemilihan Gelaran Jawatan haruslah bermula dulu di ikuti dengan Hala Tuju, Senarai tugas, Expanded Role dan Extended Role (mengambil alih tugas di Stor Utama Unit Drug dll) ,         R & D, penglibatan Kualiti menyeluruh, penyeliaan oleh semua Gred Kanan secara total, Uniform yang sesuai, dll. Usaha ini harus dilakukan dengan serius dan perlu sokongan dari BPF KKM.

Ketua Profesion kita telah menjalankan usaha gigih dan dengan komitmen tinggi oleh beliau, saya percaya Profesion kita akan mampu maju lagi kehadapan dengan sokongan padu dari semua PPF Malaysia dan Organisasi dalam Kesatuan dan Persatuan. Ayuh kita bangun dan berusaha membentuk satu pasukan yang jitu demi Pembangunan Profesion yang di sayangi.

KEARAH TRANSFORMASI JURUTEKNOLOGI FARMASI YANG CEMERLANG !

PENJELASAN KP PPF BERHUBUNG PENJENAMAAN GELARAN PROFESION PPF UNTUK RUU FARMASI

Salam Sihat 1M untuk semua PPF Malaysia,

Pemimpin2 Kesatuan /Persatuan PPF Malaysia.

Hari ini saya dikejutkan lagi dengan gejala negatif Media Sosial (Whatsup/Messengers/Telegram) yang sepatutnya digunakan untuk penyaluran info penting bagi profesion tetapi digunakan untuk tujuan penyebaran maklumat yang belum sahih, pertelagahan dikalangan ahli group dan tuduh menuduh yang mencerminkan betapa kita TIDAK BERSATU dalam perjuangan Kesatuan/Persatuan dalam memartabatkan Profesion kita.

(PPF yang pernah menghadiri sesi jelajah ceramah saya di semua negeri di Malaysia tentunya masih ingat 'AMARAN' saya supaya berhemah dalam menggunakan media sosial jika ianya berkaitan dengan Profesion PPF)

Isu penjenamaan gelaran PPF untuk RUU Farmasi bukanlah perkara baru. Saya telah umumkan kepada PPF tertinggi Gred U40 dan sebilangan U38 pada 6 April 2015 semasa pihak BPF KKM mengadakan Bengkel Hala Tuju dan  Senarai Tugas PPF KKM. Saya telah berusaha sebaik mungkin untuk merungkai kekusutan ini dengan mengusahakan pembentukan MAJLIS GABUNGAN PPF MALAYSIA  pada 9 April 2015 (minggu yang sama Bengkel di adakan) dengan harapan semua pemimpin-peminpin dilantik dapat menjalankan amanah selaras dengan aspirasi semua ahli masing-masing.

Tambahan pula dengan desakan yang bertalu-talu dari Dr. Salmah Bahari (Pengarah Penguatkuasa Farmasi) yang bertanggungjawab dalam urusan pembentangan RUU di Parlimen, saya tidak ada pilihan melainkan terpaksa mengarahkan anggota saya untuk mengusahakan satu pungutan suara di kalangan PPF Msia melalui  ppfkkm.blogspot.com sebab pihak saya tidak menerima sebarang kenyataan/maklumbalas rasmi dari mana-mana Kesatuan/Persatuan PPF Malaysia melainkan kenyataan-kenyataan melalui whatsup group sahaja.

Hasil pungutan suara yang telah anggota saya jalankan, sekurang-kurangnya mencapai 25% dari jumlah PPF di Malaysia dan terdapat banyak cadangan penjenamaan yang memberikan gambaran tentang "suara hati" PPF di Malaysia.

Pihak Urusetia RUU Farmasi BPF KKM memberikan mandat kepada saya sebagai Ketua Profesion untuk menguruskan perkara ini dan saya mengambil keputusan untuk menyerahkan pencapaian keputusan ini melalui suara semua PPF di Malaysia yang berjumlah 4,000 ++.

Tidak ada cara lain selain dari memberikan mandat kepada Kesatuan dan Persatuan untuk mendapatkan cadangan dari ahli masing-masing. (Sila rujuk ppfkkm.blogspot bertarikh 25 Mei, 2015)

Pada 29 Jun yang lalu pihak Lembaga Farmasi Malaysia meminta saya senarai nama pemimpin Kesatuan/Persatuan untuk dijemput dalam sesi perjumpaan dengan Urusetia RUU Farmasi di BPF KKM untuk sesi perbincangan tentang penglibatan Profesion PPF dalam RUU Farmasi termasuklah penjenamaan gelaran, penglibatan dalam Akta Farmasi, senarai tugas baru dan isu pendaftaran PPF.

Sekali lagi saya terpaksa memaklumkan pihak pemimpin Kesatuan dan Persatuan berhubung perkara tersebut di atas untuk persediaan mereka berhadapan dengan Urusetia RUU Farmasi.

Saya telah berkali-kali memberitahu pihak Kesatuan/Persatuan bahawa sebarang keputusan adalah berpaksikan suara majoriti ahli masing-masing dan bukan keputusan Exco semata-mata. (Saya sendiri menghadiri Mesyuarat Exco Kesatuan Kebangsaan PPF Semenanjung Malaysia di Kota Bharu baru-baru ini dan menegaskan pihak Kesatuan/Persatuan perlu mendapatkan cadangan dari ahli kerana mereka yang memberikan mandat semasa Mesyuarat Agung Kesatuan dan Persatuan).

Pada 30 Jun (surat tersilap type 30 Julai) saya telah menghantar e-mail kepada semua ahli Majlis Gabungan Malaysia untuk TINDAKAN SEGERA dan cuma memberikan masa 3 hari untuk maklumbalas. KKM-55/BPF/305/002/17(31). Sehingga tarikh akhir 3hb Julai, pihak saya cuma menerima maklumbalas melalui whatsup dari  Kesatuan KPPFSM / Surat dari YDP Persatuan PPF Malaysia dan whatsup dari Setiausaha Persatuan PPF Sabah. Pihak SMSU Sarawak pula sempat mengadakan mesyuarat khas dan menghantar kertas kerja komprehensif lengkap dengan data cadangan dari 74% ahli-ahlinya.

Kertas Kerja Cadangan telah saya siapkan dan hantar kepada Dato' Pengarah Kanan, Pengarah Amalan dan Perkembangan, Pengarah Penguatkuasa Farmasi, Timbalan Pengarah Dasar & Pengurusan dan Ketua Penolong Pengarah Lembaga Farmasi Malaysia pada pagi Jumaat 3 Julai 2015.

Untuk makluman semua PPF Malaysia adalah tidak wajar untuk kita mengaitkan penjenamaan gelaran ini sebagai sesuatu yang terlalu penting berbanding dengan isu pengisian dan penambahan jawatan, kenaikan gred, penyelarasan senarau tugas dan penyelarasan PPF di Program 2,3 dan 6.

Halatuju profesion kita yang belum jelas pun menjadi satu halangan yang besar sekarang ini. Setakat ini kita hanya melihat 'perjuangan' melalui forum, media sosial dan kenyataan    yang tidak pernah sampai ke pengetahuan saya selaku Ketua Profesion dalam bentuk kertas kerja.

Saya telah menganjurkan Bengkel Halatuju dengan menjemput PPF yang dikenalpasti  sebagai "Thing Tanks" yang berupaya untuk mencapai sesuatu yang konkrit untuk profesion kita,tetapi saya beranggapan bahawa bengkel itu gagal tetapi berjaya pula dengan pemurnian Senarai Tugas yang lebih spesifik.

Selaku Ketua Profesion, saya sentiasa menghadapi CABARAN dari pelbagai pihak termasuk dari kalangan PPF sendiri. Tentunya tidak terkecuali dari pihak Pengurusan Tertinggi di BPF KKM dan juga Bahagian Sains Kesihatan Bersekutu, KKM.

Sebagai insan biasa saya juga tidak lari dari membuat kesalahan dan saya telah memaklumkan Y.Bhg. Dato' Pengarah Kanan pada hari pertama saya menjawat jawatan Ketua Profesion, jika saya tidak dapat menjalankan tugas saya dengan baik, saya rela menarik diri dan memberi laluan kepada yang lebih berkemampuan. Ini termasuk jika ada undi ketidakpercayaan Kesatuan dan Persatuan terhadap saya.

Sekian,

HJ. ABU BAKAR BIN IBRAHIM
Ketua Profesion Penolong Pegawai Farmasi
Unit Pembangunan Profesion
Bahagian Dasar dan Pengurusan
Bahagian PerkhidmatanFarmasi
Kementerian Kesihatan Malaysia

PERJAWATAN

Pen.Pegawai Farmasi kini masih menghadapi "tsunami" kemasukan Pegawai2 Farmasi (PRP)setiap tahun dan ini telah mengakibatkan kebanyakan post-post PPF yang kosong dikebanyakan Institusi samada Hospital atau Kesihatan tidak diisi oleh Pentadbiran Farmasi Jabatan  masing-masing.

Keadaan ini kelihatan sangat ketara. Jika dilihat dari sudut positif, Malaysia akan mempunyai cukup tenaga mahir dan profesional di barisan hadapan di kaunter dan dapat memberikan satu perkhidmatan yang cukup informatif kepada pelanggan khasnya.
Pen.Pegawai Farmasi juga seharusnya menerima fakta dan akur kepada perkembangan profesion Pegawai Farmasi dan juga pelan yang disediakan oleh KKM. PPF tidak seharusnya melawan dan 'demand' hak untuk dispen kerana tugas itu termaktub dalam undang-undang.

Pen.Pegawai Farmasi harus menitik beratkan kemajuan dalam aspek tugas-tugas teknikal
dan berjuang hak untuk mendapat tugas tersebut supaya ia boleh di gazetkan dalam akta dan dikawal oleh satu badan seperti di USA, UK dan Kanada.

Jika dilihat dari sudut sejarah keatas negara-negara maju, Profesion "Pharmacy Technician" di Amerika dan Eropah berkembang sangat pesat jika dibandingkan dengan lain-lain profesion. Di Amerika bilangan Pharmacy Technician telah melepasi angka 250,000 orang. Pada 1996,Jabatan Tenaga Buruh Amerika menjangka bilangan Pharmacy Technician adalah sekitar 150,000 pada tahun 2006 tetapi bilangan sebenar Pharmacy Technician pada 2006 ialah 285,000 ! Peningkatan adalah dianggarkan 32% sehingga 2016. (rujuk http://bls.gov/oco/ocos252.htm.)

Berdasarkan sejarah bidang Farmaseutikal, kita juga sebenarnya sedang mengikuti semua langkah-langkah dan kemajuan dalam aspek pembangunan "Pharmaceutical-care" dari negara-negara maju. Mereka telah lama meletakkan Pharmacist di barisan hadapan dikaunter-kaunter dan kita baru mengikuti langkah tersebut.

Apabila tiba pada satu tahap nanti, keperluan akan meningkat kepada Pegawai Farmasi terhadap perkhidmatan klinikal yang tinggi dan kepakaran. Mereka mungkin tiada masa lagi untuk kerja-kerja teknikal yang remeh mengikut tahap pendidikan tinggi profesion mereka. Itulah yang berlaku di Amerika dan United Kingdom. Kerana itulah ujudnya juga pendaftaran Pharmacy Technician di U.K oleh Royal Pharmaceutical Society of Great Britain yang mengawal Pharmacy Technician disana dan di Amerika pula oleh Negeri masing-masing seperti Texas State Pharmacy Board, California State Board of Pharmacy dll. Di Kanada juga mempunyai pendaftaran Pharmacy Technician iaitu Pharmacy Technician Board of Canada.

Daripada pengalaman-pengalaman di luar negara dalam bidang farmaseutikal yang berkembang pesat, tidakkah kita berfikir pada suatu hari nanti semua PPF juga akan menerima pengiktirafan ini? Adalah diharapkan pihak pengurusan lebih berfikiran terbuka dan menerima ahli-ahli dalam keluarga Farmasi demi kualiti dalam perkhidmatan farmaseutikal.

Kesilapan kita memilih nama gelaran juga mungkin menyebabkan rasa kurang senang di pihak pengurusan tertinggi oleh beberapa pegawai tinggi disana. Ini secara tidak langsung akan melambatkan sebarang proses tuntutan kepada perkembangan profesion kita.

Sekiranya kita memilih gelaran yang lebih bersifat teknikal(JuruTeknologi) dan bukan pentadbiran(Penolong Pegawai) iaitu seperti dalam post pertama saya- Pharmacy Technologist, kita mungkin dapat mendalami dalam bidang ini dengan usaha untuk mendapatkan hak kita dalam tugas-tugas teknikal. Pihak pengurusan tinggi Farmasi juga akan lebih lembut dan lebih berkerjasama dalam tuntutan kita.

Jika dalam bahasa melayu gelaran teknikal ini boleh disebut JuruTeknologi Farmasi (Pharmacy Technologist) samada Diploma atau selepas mendapat Ijazah Teknologi Farmasi (Degree in Pharmaceutical Technology) dan Ijazah Farmaseutikal Sains (Degree in Pharmaceutical Science).

Mungkin ada yang akan bertanya selepas mendapat Ijazah tersebut apa pula peranan PPF dan di letakkan diUnit mana? Pegawai-Pegawai Farmasi pula tidak harus rasa terancam sekiranya PPF melanjutkan pelajaran sehingga Ijazah kerana satu hala tuju dan peranan harus disediakan dahulu sebelum menerima Ijazah tersebut dalam perkhidmatan teknikal Farmasi. Kita tidak harus "cross over" dan tidak "overlap" dalam tugas harian perkhidmatan farmaseutikal dengan Pegawai.

Memang mudah untuk ditulis tetapi untuk praktikkannya dan menyediakan satu kertas kerja yang komprehensif, rasional dan cukup justifikasi, kita memerlukan satu Jawatankuasa PPF yang mantap, kreatif, dinamik, pintar, berpengalaman,sifat tidak berkira masa, pemikiran positif, fleksibel dan komited kepada perkembangan profesion.


Walau apapun memang ini kelihatan satu mimpi indah seperti dalam post saya sebelum ini.

- think positive and work towards profesionalism

NEW TITLE FOR ASSIST.PHARMACIST - PHARMACY TECHNOLOGIST

From my earlier post on 21st Sep 2008

To All Malaysian Assistant Pharmacist @ Technologist,
As we all know Public Service Department of Malaysia has  approved the title post of Pharmacy Assistant to Assistant Pharmacist (in Bahasa-Penolong Pegawai Farmasi) effective from 1st June 2008. Many are happy with the current development as it gives a better image of the profession but there are still others who question the rationale of using this term as it doesn't reflect our professional role and career developments in future.
I personally think that it is not a wise move to change the name of our post just because the Medical Assistants have changed theirs to Assistant Medical Officer (Penolong Pegawai Perubatan). Why are we always following others?
A Pharmacy Assistant’s job (in the west referred to as Pharmacy Technician) is a very technically-orientated post. We are involved in compounding, filling medicines, labelling, preparing mixtures, preparing extemporaneous preparations, TPN, TDM, CDR, procuring and purchasing, counter- patient management with or without supervision by a pharmacist in Health Centres. But we all know in Malaysia we still doing clinical work especially in community pharmacy setup in rural places where there is no Pharmacist.
Most of the duties of Assistant Pharmacist comprise a lot of technical undertakings nowdays while we still committed to clinical as well. Why do we choose to be known as 'Penolong Pegawai Farmasi'(Assistant Pharmacist) when we are really technical and part clinical staff(pharmacist cant deny we actually is still doing the clinical work). I have spoken to one of the higher officers in Pharmacy Services Division, Ministry Of Health and he agrees with my view.

I have also discussed this matter with Malaysian Pharmacy Assistant Association Committee Members, Health Ministry Training Division Staff, Lecturers from Allied Health Science College Sg.Buloh, Assistant Pharmacist from National Pharmaceutical Bureau and many dynamic seniors. They all agree that our post should not be changed to Assistant Pharmacist (Penolong Pegawai Farmasi).
So what is the most suitable name or title then?

After some research on Pharmacy Titles across the world in USA, UK, Ireland, Australia, New Zealand and Canada, I found that the most suitable name for Malaysian Pharmacy Assistant is Pharmacy Technologist. Why? Because in Malaysia our curriculum syllabus is one of the best in the world compared to other country. In UK, the course is only for 1 year with on job training. In USA the course for Pharmacy Technician is from 7 mnt-1 year with exam for certification(PTCB). But they also have a degree course in Pharmaceutical Technology and Pharmaceutical science which can lead to the post of Pharmacy Technologist! The Republic of Ireland is also running a similar course. Malaysia only offers a course that covers 3 years leading to a DIPLOMA!

The syllabus is indeed very comprehensive and tight with a total of 98 credit points. (To become a Pharmacist, one must complete 120 credit points in a Malaysian University). Hence our diploma course is close to a Degree in Pharmacy. That is about studies. How about the job description and the workload of the Assistant Pharmacist? In many places all the duties supposedly carried out by a Pharmacist is done by the Assistant Pharmacist.

Previously many Pharmacists prefer to be at the desk than to tackle technical or clinical duties. Only recently were there changes whereby the new Pharmacist is placed at the main counter and the Pharmacist Assistant doing the filling work and other technical duties. The role as front liner has been taken over by the Pharmacist nowadays as it should rightly be.

But the issue now is what are the prospects of a Assistant Pharmacist in the new era and in future? After 50 years, only now there is one professional Post Basic course conducted which is very limited chances to all Assistant Pharmacist!. Assistant Pharmacist feel they are treated as second class Paramedics because we are not respected and taken care of by some of the immediate officers. At the present there is a big gap between the Pharmacist and the Assistant in most institutions. But there is also a new generation of Pharmacists who really care and understand our problems.

Now back to the main topic. Choosing the right title. The staff from National Pharmaceutical Bureau very much awaited and fought the title to be changed to Pharmacy Technologist as they are fully doing technical duties there. Duties such as carrying out Microbiology Test, Quality Control, drug performance test etc is a technical job. For a Assistant Pharmacist (Penolong Pegawai Farmasi) to do this kind of job is ridiculous!

Every profession needs developments in its career. Therefore, the closest degree (apart from Deg.In Pharmacy) that we can apply now is Degree in Pharmaceutical Technology, Degree in Pharmaceutical Science and Pharmacology. It is very appropriate if our title is changed to Pharmacy Technologist in order to further our studies in Pharmaceutical Technology or Science. Don't you all agree with this? We can concentrate in our technical duties fully without interfering the clinical work which is the Pharmacists’ job.
At present we are sealed in our progress by being given the title of an Assistant which does not give us the chance to be a professional in the related category. To all concerned, think carefully. The change is still there to be made.

Warfarin and OTCs: An Unrecognized Risky Combination

Medscape Internal Medicine > Adverse Drug Events: Case Challenge Series

Douglas S. Paauw, MD

January 15, 2015

Warfarin and Acetaminophen

The interaction between warfarin and acetaminophen has been a well-kept secret for 30 years. Roughly every 10 years, there's another study that shows this important interaction between acetaminophen and warfarin. Each study may lead to a brief flurry of attention in the popular press that then fades away.

To begin 30 years ago, the first study published in 1984 was a double-blind crossover trial of 15 healthy volunteers who were first anticoagulated on warfarin and then treated with acetaminophen 4 g/day—the maximum recommended dose noted on bottles sold OTC—or placebo. After 2 weeks, an INR was obtained. Patients were then crossed over, and those initially given acetaminophen were now given placebo and vice versa. After an additional 2 weeks, INR measurement was repeated. On average, the INR was 1.75 times higher—almost double—when patients were taking 4 g of acetaminophen daily.

The second study was published 14 years later, in JAMA in 1998.^[2] It was conducted at an anticoagulant therapy unit, in patients who had a target INR of 2.0 to 3.0. An INR was obtained 4 weeks after initiation of warfarin therapy. There were 93 patients with an INR of more than 6.0 (range, 6.1 to 30). Control patients were chosen whose INR was close to the target range (actual values were between 1.7 and 3.3).

Cases and controls were similar in age (mean, 70 years), sex (50% women), race (97% white), duration of warfarin therapy, and reason for anticoagulation. All participants were interviewed and asked about medicines, including any newly prescribed or OTC medications, alcohol consumption, and prescribed and consumed warfarin doses. They were also queried about dietary habits, including recent changes and specifically about intake of foods with high vitamin K content.

Although a range of factors were identified that contributed to an increase in INR, acetaminophen ingestion was independently associated in a dose-dependent manner with having an INR greater than 6.0 (P for trend < .001). Patients taking more than 9 g of acetaminophen per week (eighteen 500-mg tablets) had an odds ratio 0 of 10 (95% confidence interval, 2.6-37.9) for an INR greater than 6.0. Even one half of that dose—nine 500-mg tablets per week—gave an odds ratio of 7.

Another 9 years, and a third study.^[3] A total of 36 patients with stable INRs who were seen at an anticoagulation clinic were randomly assigned to receive acetaminophen 1 g twice daily, acetaminophen 1 g four times daily, or placebo four times daily (12 patients per group) for 4 weeks. The study was terminated early after it was determined that 15 patients experienced an elevation in INR. Just over one half (54%) of the patients receiving acetaminophen exceeded their INR therapeutic range by 0.3 or greater, vs 17% of those taking placebo.

Finally, a study published in 2011 examined 45 patients on stable warfarin therapy.^[4] Patients in this prospective, randomized, parallel (three arms), placebo-controlled study received either 2 or 3 g of acetaminophen daily for 10 days or placebo. The mean maximal increases in INR were 0.70 ± 0.49 and 0.67 ± 0.62 in patients receiving acetaminophen at 2 g/day and 3 g/day, respectively (P = .01). The INR increase became significant on day 3.

So this is real. The take-home message is that the INR should be obtained after 3-5 days in patients taking daily acetaminophen for pain relief. This is not necessary in patients taking an occasional 1-g dose for a headache or another intermittent concern.

Although the bleeding risks of nonsteroidal anti-inflammatory medications and aspirin are well appreciated, leading to a common recommendation for use of acetaminophen as an alternative, acetaminophen must also be recognized as having some degree of risk. In patients using acetaminophen for chronic pain relief, this is an important interaction that should lead to a change in monitoring strategies.

References

1. Rubin RN, Mentzer RL, Budzynski AZ. Potentiation of anticoagulant effect of warfarin by acetaminophen [abstract]. Clin Res. 1984;32:698A.
2. Hylek EM, Heiman H, Skates SJ, Sheehan MA, Singer DE. Acetaminophen and other risk factors for excessive warfarin anticoagulation. JAMA. 1998;279:657-662. Abstract
3. Parra D, Beckey NP, Stevens GR. The effect of acetaminophen on the international normalized ratio in patients stabilized on warfarin therapy. Pharmacotherapy. 2007;27:675-683. Abstract
4. Zhang Q, Bal-dit-Sollier C, Drouet L, et al. Interaction between acetaminophen and warfarin in adults receiving long-term oral anticoagulants: a randomized controlled trial. Eur J Clin Pharmacol. 2011;67:309-314. Abstract

Common Sense Ebola Measures Save Lives in Africa, Teach US

Medscape Medical News from:

• CHEST 2014: American College of Chest Physicians Meeting
• Jim Kling
• October 28 2014
• 
  

There are things healthcare workers are doing in Africa that professionals here in the United States are not when dealing with Ebola, and that is encouraging infection, warned a physician speaking here at CHEST 2014.

Lewis Rubinson, MD, from the University of Maryland School of Medicine in Baltimore, described the setup at an Ebola treatment center in Kenema, Sierra Leone, where he worked.

Conditions at the center were chaotic and unpredictable, Dr Rubinson explained. The situation required healthcare workers to be consistent and vigilant in their approach because patients who seemed to be faring well could suddenly vomit.

Thirty healthcare workers at the site have already contracted the Ebola virus, and nearly 20 have died. Yet there are healthcare workers who have performed in these conditions and remained uninfected.

Dr Rubinson talked about professionals, including a nurse at Kenema, who remained virus-free after 6 weeks of treating patients. "They have the skills to teach you," he said.

There has been much discussion about using observers to ensure the proper donning and doffing of personal protective suits. In Africa, things have been taken a step further. "We had people who commanded you," said Dr Rubinson.

"You're tired and at risk of making mistakes, so even if you've done the process day in and day out, you're not allowed to do anything without someone ordering you where to stand, how to put your arms out," he said. "They're not passive observers," Dr Rubinson emphasized. "Someone actively takes over safety for you."

With Military Precision

This is a critical measure, Dr Rubinson said, but "that message has been lost in the United States."

"I could never predict when someone was about to vomit on me," he reflected. "You need to do procedures the same way every single time. Everything needs to be choreographed."

This discipline can be very difficult to maintain. "You can get very distracted. If you see a young kid dying, you might want to risk your safety to help, but the rest of the patients will be harmed" if you fall ill and can't contribute to their care, he pointed out.

In a separate presentation, Michael Connor Jr., MD, from Emory University School of Medicine in Atlanta, who treated Ebola patients at his hospital, suggested that the traditional ethics of the doctor–patient relationship is challenged by Ebola. This can take a terrible toll on healthcare workers.

"I will step out on a limb ethically and say it might be that healthcare worker safety supersedes patient outcome because, ultimately, we have to care for other patients, and if we can't, that's a problem," he said.

Another critical issue in the United States is identifying which patients in an emergency department setting are at high risk for Ebola. It is important to be vigilant looking for infections, but there is a risk for overexuberance. For example, a patient arriving from a country like Sierra Leone presenting with stroke symptoms could get flagged for concern about Ebola, even if that patient had no contact with anyone who was ill.

In the United States, "the hospital community, together with the public health community, has to figure out how to manage people so we don't have inadvertent injuries due to withheld treatment because we were isolating someone for Ebola," said Dr Rubinson.

Improvements to diagnostic guidelines would help, he said. The public health system is designed to rule in patients who have a specific illness like Ebola, rather than rule out patients who don't and who need to be treated for something else.

"The more important thing for American hospitals is to identify the person we don't think has Ebola and get confirmation that they don't have it," said Dr Rubinson, "so we can go back to giving them usual care."

The Quandary of Quarantines

Quarantines that have been implemented in New York and New Jersey could create more problems than they solve, said Josh Mugele, MD, from Indiana University School of Medicine in Indianapolis. "I worry that it's going to affect people's willingness to travel to Africa and take care of those patients," he told Medscape Medical News.

A quarantine could also drain resources. Any effort to quarantine doctors and nurses takes them temporarily out of circulation. "They cannot do their critical care jobs, they cannot do their emergency department jobs; it could put stress on the system," said Dr Mugele.

Influenza season could complicate efforts to identify and rule out Ebola cases because symptoms can overlap. "The fortunate thing about Ebola is that upper respiratory symptoms are not the predominant feature," said Dr Rubinson. More worrisome would be if this year's influenza epidemic has a strong gastrointestinal component. In that case, "it'll be really hard to differentiate" Ebola from influenza, he said.

It would be helpful if Ebola screening guidelines included duration of symptoms. Ebola is an acute disease with short-duration symptoms. Diarrhea or vomiting that has been happening for weeks is very unlikely to be Ebola, Dr Rubinson explained.

"The CDC guidelines get the conversation started, but they aren't constructed in a way that reflects how clinicians manage patients," he said. "We're using epidemiologic criteria to make clinical decisions. We need to modify these criteria to reflect how clinicians think, to make them useful to move someone up or down the scale in terms of the likelihood of having Ebola."

Dr Connor and Dr Rubinson have disclosed no relevant financial relationships. Dr Mugele is a consultant to the Indiana State Department of Health.

CHEST 2014: the American College of Chest Physicians Meeting: Presented October 27, 2010.

Tiotropium Showing Promise in Pediatric Asthma

Medscape Medical News from:

• CHEST 2014: American College of Chest Physicians Meeting

JIM KLING
October 31st 2014

AUSTIN — In children with poorly controlled asthma, once-daily tiotropium delivered with the Respimat inhaler improves lung function when added to inhaled corticosteroids, with no apparent change in adverse effects, new research has shown.

The drug and device combination is approved for the treatment of chronic obstructive pulmonary disease (COPD), and the manufacturer, Boehringer Ingelheim, is exploring US Food and Drug Administration approval for asthma.

Anticholinergic medications have long been used to treat acute asthma attacks, but recent evidence suggests that they could be useful as maintenance therapy in refractory patients.

"That got Boehringer Ingelheim interested in looking at the asthma part of this, not just COPD," said Mark Vandewalker, MD, principal investigator for clinical research at The Ozarks in Columbia, Missouri. He presented the research here at CHEST 2014.

In adults with asthma, the combination is an effective add-on to inhaled corticosteroids (N Engl J Med. 2012;367:1198-1207), so this study looked specifically at a pediatric population.

The 48-week phase 3 trial involved adolescents who had asthma for at least 3 months, a forced expiratory volume in 1 second (FEV₁) predicted of 60% to 90%, and a score of at least 1.5 on the Asthma Control Questionnaire 6-point scale.

The age range was 12 to 17 years, 65% of the cohort was male, mean asthma duration was 7.86 years, and mean baseline FEV₁% predicted was 82.8.

Participants had not smoked in the previous year or had never smoked. They were randomized to receive once-daily tiotropium, either 5 μg or 2.5 μg, or placebo, all delivered with the Respimat inhaler. The drug was given as an add-on to inhaled corticosteroids, in doses of budesonide 200 to 400 µg or equivalent for 12- to 14-years-olds and 400 to 800 µg for 14- to 17-years-olds.

The primary end point was peak FEV₁ in the 3 hours after dosing at week 24. The secondary end point was trough (predose) FEV₁ at week 24, which was measured 10 minutes before receiving that day's dose. FEV₁ peak in the 3 hours after the dosing and trough responses were also measured at week 48.

Table 1. Peak FEV₁ for Tiotropium Compared With Placebo

Variable	Adjusted Mean Difference (mL)	P Value
Tiotropium 5 μg
Week 24 FEV₁ area under the curve	174	.0005
Week 48 FEV₁ 3 hours after dosing	174	.0006
Tiotropium 2.5 μg
Week 24 FEV₁ area under the curve	134	.0085
Week 48 FEV₁ 3 hours after dosing	176	.0007

able 2. Trough FEV₁ for Tiotropium Compared With Placebo

Trough FEV₁	Adjusted Mean Difference (mL)	P Value
Tiotropium 5 μg
Week 24	117	.0320
Week 48	157	.0044
Tiotropium 2.5 μg
Week 24	—	ns
Week 48	137	.0154

The adverse-event profile was similar in all three groups, except there were some differences in drug-related adverse events and headache.

"You might think dry mouth would be a concern, and so far it hasn't been," said Dr Vandewalker. "My thought is that that's due to the Respimat device. We do see dry mouth with the older HandiHaler device."

Table 3. Incidence of Adverse Events

Adverse Events	Tiotropium 5 μg (n = 134), %	Tiotropium 2.5 μg (n = 125), %	Placebo (n = 138), %
One or more	62.7	63.2	59.4
Severe	1.5	1.6	2.2
Drug-related	3.0	0.8	0.7
Headache	6.7	5.6	1.4

For children whose asthma is not under control, the drug could be a useful option. "It looks like it was a beneficial treatment. So far, the teenagers are responding in a manner similar to adults — in fact more robustly — which we kind of expect because they haven't had asthma quite as long, so have less damage to their airways. The safety profile has been as good as, if not better than, that seen in adults," Dr Vandewalker added.

The drug would be a welcome addition to pediatric asthma care, according to Chris Carroll, MD, from the University of Connecticut in Hartford, who attended the poster presentation.

"For children with refractory asthma who are on moderate steroids and not well controlled, it would be really nice to have other options. It's great that they're doing pediatric studies because for a lot of medications, they don't bother," he told Medscape Medical News.

He said he finds the data reassuring. "I don't have any specific concerns about safety for this medication," Dr Carroll said.

This study was funded by Boehringer Ingelheim. Dr Vandewalker has received research report from the company. Dr Carroll disclosed no relevant financial relationships.

CHEST 2014: American College of Chest Physicians Meeting: Abstract 1994584. Presented October 29, 2014.