KUALA LUMPUR, August 13 — The Covid-19 pandemic exposed many defects in the health system that pushed hospitals and frontline medical workers to the brink.
The upward trend of brought-in-dead (BID) cases with coronavirus this year shows that patients are struggling at home as hospitals choke, forcing many facilities to refuse admission.
As medics burn out, beds run out, and systems cave in, it is clear that Malaysia’s health service is unprepared for the surge of Covid-19 patients.
Given the current reality, there is an urgent need to think ahead and consider the potential for the health system to be overwhelmed again – not only due to another global disease outbreak, but as Malaysia becomes an ageing population.
A recent report by the Economist Intelligence Unit (EIU), commissioned by the Pharmaceutical Association of Malaysia (PhAMA), stated that between 2018 and 2040, the number of people aged over 65 in Malaysia is expected to almost triple, rising from about two million to six million.
As the number of older people increases, the proportion of working-age people will decline, resulting in a dependency ratio (the proportion of people not of working age – either aged 14 years and below or 65 and over) of 49.5 per cent.
The burden of non-communicable diseases (NCDs) will also shift as ageing and dependency rise, moving from acute to chronic conditions and from single to multiple disease burden – which is expected to inflate health expenditure to US$80 billion (RM338 billion) by 2040.
In other words, the country needs to consider practical alternatives that are more self-sustaining beyond traditional doctor-patient interaction if the health system is to cope with the demographic change. This is where self-care comes in.
The World Health Organization (WHO) defines self-care as “the ability of individuals, families and communities to promote health, prevent disease, and maintain health and cope with illness and disability with or without the support of a health care provider”.
The Covid-19 pandemic not only made it clear that anyone could become sick and become hospitalised, but it has also shown that simple preventive measures like hand-washing and sanitising do help minimise the risk of infection. The same applies to face masks.
These are fine examples of simple, doable steps that anyone and everyone can do to reduce the risk of contracting Covid-19, and this is what self-care is about.
If Malaysia can develop a culture of self-care through better personal health practices, health supplements, and wider access and responsible usage of non-prescription medicines, it could ease the pressure on the country’s health care system in the long run.
While policymakers and health care experts play a crucial role in promoting self-care in public policy, a key enabler of self-care culture is the community pharmacist.
Self-Care Literacy Begins With Community Pharmacists
Community pharmacists do more than just dispense medicines. They often dispense advice and services related to healthy living – an essential part of public education and awareness.
Pharmacists serve as an early point of contact for patients, offer counsel on their medication regimens, screen them, and refer them to further care when necessary.
Today, even as digital technologies continue to advance – offering access to a wide range of information and products online – over-the-counter (OTC) counselling remains invaluable.
“Trust me, they (patients) will talk to you (the pharmacist) first, then they’ll ask ‘Dr Google’, their aunties, uncles and friends, and then they’ll come back to you again,” Lovy Beh, president of the Malaysian Community Pharmacy Guild (MCPG), said at a recent webinar co-organised by PhAMA and the Galen Centre for Health and Social Policy.
“We (pharmacists) will always have to bring them (patients) back to evidence-based practice, so we have to be bold and confident in explaining it to them,” Beh added. “It’s all about trust.”
According to Malaysian Pharmacists Society (MPS) president Amrahi Buang, pharmacists have long acted as gatekeepers to health misinformation as they are the most accessible health care professionals in a community, making them one of the most trusted professions in health care.
“Patients are coming to community pharmacists with questions about their health and health issues, which means we’re not talking about selling products, but we are educating the public,” Amrahi said. “We want community pharmacies to become the health hub of the community.”
Therefore, he said it is important for pharmacists to have a good network and relationships with other health care professionals like doctors, dietitians and optometrists, as go-to referrals and be well-informed of various aspects of health, diseases, and intervention.
“It is important for pharmacists to build trust via positive relationships. They must have the competency, expertise, and be consistent (in their views). So, if we’re going to move our practice from product-based to patient-based, this is what we need to do,” Amrahi said.
Panic Buys And Unregulated Products
Amrahi said partnerships between community pharmacies and online platforms are equally important so that consumers can recognise verified products and sellers on the internet.
Such collaborations also allow pharmacies to have continued relationships with consumers through medication delivery services and follow-up consultation via teleconference.
“What I’m trying to say is that you can see now how, because of the pandemic, the role of the pharmacist has changed, and they have to make sure they are able to adapt to the new normal,” he said.
The presence of many online platforms offering a wide range of medical products has, to a large extent, contributed to health misinformation in the country – derailing consumers not only from certified goods but also items they actually need.
The start of the Covid-19 epidemic in Malaysia last year saw panic-buying of disinfectants and personal protective equipment (PPE) as people stockpiled on hand sanitisers, wipes, as well as face masks, resulting in supply shortages of the latter.
There was also an increase in the purchase of vitamins to boost up immunity, cough medicine, and nasal spray during that time, Beh recalled.
“Of course, the trend now is the Lianhua Qingwen capsule and ivermectin – these are the latest craze. I personally do not sell them yet until and unless the government approves them for treatment and prevention of Covid-19. But (the problem is) you’re already hearing about people taking and stocking these products up,” she said.
Health-related advertisements in Malaysia, either about medicines or health care services, are subject to approval from MOH’s Medicine Advertisements Board (MAB). Once approved, the advertiser will have to strictly follow the approved advertisement format. Amendments are not allowed without consent from the MAB.
Authorised advertisements – either in print, electronic or new media formats such as the internet and social media platforms – must also display their approval number so that the general public can check their validity at www.pharmacy.gov.my.
However, Beh noted that despite MCPG’s complaints against portals that sell counterfeit medicine and vaccines, enforcement work has been limited.
“Some portals said they will delist such sellers but our members say they are still there. We hope the MOH and the Malaysian Communications and Multimedia Commission (MCMC) will take more serious action, not just against the sellers but the platforms as well.
“These online portals should be able to afford to hire pharmacists or enforcement officers to check and screen through the kind of pharmaceutical products that people are selling online.
“We need to protect the interest and safety of consumers, especially those that are vulnerable. Many have been scammed and conned, unfortunately, so they need to buy from authorised licensed pharmacies like us,” Beh said.
The Way Forward
The United Nations’ (UN) Sustainable Development Goals (SDG), which Malaysia has pledged to fulfil, is centred around the principle of “leaving no one behind”.
In developing a functioning self-care system in Malaysia, Beh said it is important that vulnerable communities like the elderly are taken into account. A survey by MCPG members found many elderly being left behind, with those living alone feeling isolated and lonely.
Beh said there are many practical solutions with regards to self-care that the government, health experts and the public can consider and implement.
Firstly, she said community pharmacies can build better rapport with their patients and carers via social media platforms like WhatsApp or via teleconference consultation. “Of course, during these times you need to be a bit more patient and spend extra time engaging with patients, as most of them will be more anxious.”
Secondly, collaborations between community pharmacies and the MOH or NGOs can be done to create mobile pharmacies that would make consultation and access to medication a lot more reachable for vulnerable communities.
Thirdly, community pharmacies can help alleviate the burden on health care professionals in the public sector by dispensing chronic medication for stable patients.
This can be done via public-private partnerships between community pharmacies and the MOH.
“The MOH just needs to reimburse community pharmacies at very affordable rates, and we can do all the dispensing on the distribution of medicine to these patients,” Beh said.
Additionally, MOH can collaborate with the Ministry of Education to embed self-care modules into the curriculum in schools, colleges, and universities to help the public be better equipped and to make self-care a habit and an accepted culture.
MOH deputy director for NCDs Dr Feisul Idzwan Mustapha’s message is simple: to be a positive role model.
“I think this is something that all of us can do. It’s not just a matter of knowing, and talking about it, but actually walking the talk,” he said.
“All of us have that role to play, to be a positive role model to our family members, colleagues at work, and those of you interacting with patients or clients need to be that example for self-care, and that’s something that is doable, and that’s something we can start today.”