With just a few hundred registered pharmacists—including academicians and industrial staff—for a total of 1.7 million Malaysians in their state, a unique spirit of cooperation between the pharmacists of Kelantan has developed over the years. MIMS Pharmacist spoke to Khaled bin Ghazali, assistant treasurer of the Malaysian Pharmaceutical Society (MPS), and Nik Nurma Nik Yahya, vice-president of the Kelantan Malaysian Community Pharmacy Guild (MCPG) to find out more about their experiences with the collaboration.

Tell us about Kelantan’s arrangement.

Khaled (K): In Kelantan pharmacy, we tend to group together, do things together. Every program we want to do, we meet first, and we do it as a group. Even the Timbalan Pengarah Kesihatan Negeri (TPKN/Deputy Director of State Health) can get in touch with ordinary community pharmacists (CPs). There’s no MPS, no MCPG, no government sector, nor private—the Jawatankuasa Bersama Farmasi Negeri Kelantan is our highest authority, headed by the TPKN, and we’re all under him.

We have a Kelantan state pharmacists’ [social media] group. The MCPG, MPS, the industrial pharmacists, each have their own group, but we all connect in one as well, thanks to technology. We couldn’t do it last time, but social media has changed things.

Does the group consist of every pharmacist in the state?

K: We have over 300 people; the ceiling is about 400 I think, if you include everyone from every sector. If the Kelantan State Health Department (Jabatan Kesihatan Negeri Kelantan) has the budget, maybe they can recruit more pharmacists into the state. There’s also a growing number of CPs.

But whoever comes in as a pharmacist in Kelantan, we make sure we keep in touch with them. It doesn’t matter if they’re from another state, we also approach them; when [the big chain pharmacies] come in, we find a key person to stay in touch with. Every time there’s a transfer on the government side too. “Come, be in the Kelantan family. We have a group, and we do this and we do that. Come and join us.”

How do you normally know when new people come in?

K: We have a person in charge for everything who goes to get their info, introduce them to the group. If it’s in CP, we have En Azian or Pn Rozaida from the MCPG; in hospitals we have En Rizuan or Pn Munisah. In industry, we have En Fikri. In academia, we have a whole group of Hospital Universiti Sains Malaya (HUSM) people for that.

We cultured that [environment] in Kelantan, so that when pharmacists come in, we know about each other. Of course, we cannot obtain 100%, but definitely we manage 90% and above. Not even places like Klinik Kesihatan Gua Musang, the Orang Asli posts are left out—where the internet can go, we go.

HMR Kelantan 1

Pharmacists through the state network collaborate on Home Medication Review (HMR) in rural villages.

Pharmacists through the state network collaborate on Home Medication Review (HMR) in rural villages.

What does the group do?

K: For every issue that comes up—whatever happens in government [pharmacies], the CPs know, the industrials know, the academicians know. Whatever happens in a CP, the government knows, etc. And then we can help each other. For example, if a hospital pharmacy is out of stock for a drug—they can very easily ask the CPs for help. Likewise, if the CPs have anything they need, they can just ask. We’ve made the network very extensive.

Nik Nurma (NN): With that network, we’re able to do a lot of home medication review (HMR). In 2016, we did HMR in 2 kampungs; one in Tanah Merah and another in Kampung Gaung Kiat in Pasir Mas. And then in collaboration with Hospital Raja Perempuan Zainab II (HRPZ), the most recent was in 2017 in Kampung Air Chanal in Jeli. We’ve also collaborated with HRPZ—the major hospital of Kota Bharu—in doing HMR in seniors’ homes in Pengkalan Chepa. We ourselves went together on these excursions.

What are common problems you’ve seen in HMR?

NN: Well, we targeted the low-income patients; particular those who cannot travel to the hospitals because of their poverty. When we reviewed all their medications and found that they were not only all mixed up, but the counselling [they had received] on how to use the medication was very lacking.

K: There are people that cannot read the labels.

NN: Some of them stay alone, they’re sick, or their spouses are also sick. They cannot move, let alone move out [to a hospital].

How do you find the patients in need?

NN: We engage with the ketua kampung (village head, KK), or another person of authority in that kampung first to identify which house we should go to.

K: The KK knows who in their area who has diabetes, who has hypertension, who has difficulty in their daily living. Not all people… the hospital does a good job, the pharmacists tell them how to use this and this drug. But you know orang kampung (village people)—they listen, “okay okay”, and by the time they go home they’ve forgotten. Everything is dumped into one bag. All mixed up and then they have no system.

That’s why we go; we have a standard HMR procedure, and we help to teach them the simplest way to keep their medicine. We bring the box, and the labelling, and then we tell whoever the closest person is—if they have no children, we call a neighbour—to help take care of this.

And the HMR doesn’t stop there. When we have all the updated info, we refer the data to the hospital. For example, at Tanah Merah, we referred this data to the Hospital Tanah Merah, so that they and the CPs in the Tanah Merah Area can continue and look in on them. It’s all documented. And because people appreciate it, we keep doing it every year; at least two programs a year.

NN: We should have review trips, to go back there at least once a year, but because of time constraints it’s difficult.

How many homes do you cover?

K: In one day... We split into small groups. Let’s say we have 30 people, we’ll do 10 groups of three people. Ten groups can do about 60 homes; 30 in the morning, 30 in the afternoon. If more people come, we can cover up to 100 homes. Since we contact the ketua kampung ahead of time, they usually have a guide for us—(laughs) a Pak Cik Din, Pak Cik Mat, etc—who helps us find this person and that house.

NN: At the same time also, we give donations of basic things like rice and toiletries.

K: We don’t just go to talk about drugs, we also bring donations. We ask for donations from pharmacies, or any other companies—local wholesalers, local supermarkets, etc. When you go to rural areas you do need to bring buah tangan (host gifts) or something of the kind. It’s Malaysian culture.

Are you revisiting any location in 2018?

K: For 2018, because we had been doing it successfully for 2 years, our TPKN Tuan Shaik Nurudin made a task force to look into HMR during the annual planning meeting. First, we’re going to revisit all the previous kampung; then hopefully if we have the manpower, we can adopt other kampung as “kampung angkat” (adopted villages). Then each kampung will be observed by a klinik kesihatan (health clinic) or a hospital in the area. So it’s in the budget and the programme Tun Shaik planned.

Banjir 1

The network has helped organize teams for disaster relief work, including the 2014 Kelantan floods.

The network has helped organize teams for disaster relief work, including the 2014 Kelantan floods.

How did this collaboration start?

NN: It actually started once the MCPG was introduced in Kelantan. In 2015, we registered the MCPG as a society and collaborated with MPS first. Before that, the MPS was already established in Kelantan. So once we started collaborating and combined together, we became big. (laughs) That’s it.

K: We think that as pharmacists [in Kelantan], we are not that big a professional community… Luckily, everybody shared the same idea to get together and to be united. Nowadays it’s easier. Let’s say a PhD student wants to do data collection—just tell us, we have everything. Let’s say our pharmacy gets involved in IMARET (Islamic Medical Association of Malaysia) efforts, or Rohingya or Palestine [aid work], or even mosque or temple donations—all can be done.

NN: Even floods.

K: Except for politics. That one we can’t. We cut. Politics kacau (get in the way). (both laugh)

What was the flood work like?

NN: It was during the 2014 floods. We collaborated with the government, we all went to see the flood victims together… Everything was destroyed. Everything was mud, everything was contaminated. Some of the houses were completely flattened. You couldn’t tell there were houses there.

K: The most memorable story I remember from that was—we talked to a pak cik in Dabong. It was so dangerous there, the water was so high. He said that it took him—it was very dangerous for him to go from his house to the pusat banjir (flood evacuation centre), because from his house to there, they had to ride a raft, holding on by a ‘rope’. The flood is so high, do you know what that ‘rope’ was? It was the power cables running beside the roads. They used the cables to guide their way to the centre.