NUSWhispers – Confession #80916

**warning long post ahead** I’m a pharmacist in a public hospital heavily affected by COVID-19. Today I would like to share with you some of the efforts of my pharmacy colleagues during this trying time. For those of you who have no idea what a pharmacist does, or those of you who think you do, please, read on. First let’s begin with Community Pharmacies such as Guardian, Watsons and Unity. These are our front liners first hit by the Covid effect. They fended off hundreds who came on a daily basis to demand masks, sanitizers and soap that simply wasn’t available. They provided these products, without even sparing any for themselves. They had to deal with enquiries and panic from the public on a virus that wasn’t well researched at the time. They dealt with anger, and frustration, all the while still having to keep calm about their own fears. While the fight for masks seems to have settled, these pharmacists are now also affected by closures of some stores, dwindling product sales, and perhaps manpower cuts as well. To my friends in the community, thank you for being the first defenders, hang in there. From the start of the new year, pharmacists were in meetings planning and predicting the onslaught of this virus and what we can do to effectively tide through. When NCID started opening its doors to screen, an urgent call for volunteer pharmacists, and pharmacy technicians was made, to open a new pharmacy to serve potential COVID patients at the screening centre over the Chinese New Year period. Many colleagues willingly volunteered their services, even though they were only given a day’s notice because of the urgency of the developing situation. These pharmacists continue to serve, and are usually the last step before patients are inadvertently are either sent home, or sent up to the wards. They don PPE for hours, work overnight, and eat luke warm meals, for your sake. (STAY HOME!!) The situation is constantly evolving, and so are the languages. In the COVID wards, pharmacists had to quickly become familiar with all kinds of terms in all sorts of languages. In the beginning, with many chinese patients being admitted, they became adept in the Chinese language - if differentiating Ceftazidime and Cefuroxime is a struggle for you, imagine doing that in chinese!! FYI we need to talk to patients and find out things like their past medications or allergies, cos if you’re allergic to a medication and if our medical teams give it to you without knowing, you could possibly die from that sooner than COVID-19 could ever kill you. Also, if you’ve ever spoken to your parents or grandparents about their medications, you’d know they probably describe them as like the small white round pill, the yellow long capsule without knowing what it’s for. Now try doing that with a foreigner, who has no idea what his meds are for. In a language you don’t understand LOL (most!! intense!! guessing!! game!! ever!!) Guess wrong, and your patient could have a seizure, start having palpitations, break out into rashes, or... die. Kudos to our pharmacists who do this on a daily basis in their wards with 40+ patients, not just during covid, but EVERY DAY. Thank you!! Just today, Singapore has had our highest spike in Covid-19 cases, and that means emergency measures to MAKE SPACE in the wards. The concept of decantment started early on from weeks ago, where patients who were relatively more stable would be “decanted” to off site facilities such as community hospitals. This protects the patients as well so that we can reduce their potential risk of exposure to the virus. By closing off some wards, this means patients are admitted, and often “discharged” from their original wards much faster than before. Pharmacists battle with the rapid transfers as each patient’s medications needs to be reviewed for accuracy, safety and efficacy prior to transfer, and of course provided with a new bag of medications to bring with them to the new hospital. To put this in perspective, it’s like trying your best to get to know a person you just met RAPIDLY, so that you can give them a great gift basket of all the things they need, accurately, a few days or hours later. To those fighting to decant our patients safely, thank you!! As more and more data about covid-19 comes up, im sure you’ve heard about people dying from Chloroquine etc. Pharmacists are the drug experts, and we are proud of that. Expert pharmacists are scouring medical journals for evidence on new treatment options, possible vaccinations being developed. They summarise the information for our medical teams in the hospitals to be able to make appropriate decisions at the point of patient care. Pharmacists in the wards are involved in the monitoring of these patients put on experimental drugs. We review the safety and efficacy of such medications, as well as deciding doses based on important monitoring parameters such as patient renal function, liver function, past medical history and current condition. You may have seen news on medications you may need to avoid e.g. Ibuprofen from unverified sources, well pharmacists have had a role in helping debunk that too! We study the mechanisms behind interactions, we rationalise if such things are possible, we justify them if they are, and we do this every day!! Yay Pharmacists! Behind the scenes, as more countries close their borders, our store and procurement pharmacists fight battles on a daily basis to ensure we have enough medications to tide through however long this crisis may last. While you are worried about whether you can bake your cake tonight with all the flour gone from the shelves, our pharmacists worry that in time, a patient in a pain crisis will not get their opioids because we don’t have any to spare. We are worried patients will have a heart attack or stroke because our hospitals have run out of blood thinners. Pharmacists are looking at data on how we can prolong the use of each vial of medication so that we can conserve for the future, but all these have their limits. And this is why, we need help from you at home to be understanding that we cannot give you 6 months of medications now. We can only give you what you need, because we NEED TO ENSURE THERE IS ENOUGH for other patients (seems like a recurrent theme from our supermarkets and government etcetc. Please lah, tolong don’t hoard... ). Also, FYI we don’t offer exchange or refund. Please: the argument is always the same, that you kept it well in a pristine condition. Well... what if you were the one who recieved the refunded meds, are you ok knowing that it sat for 2 months in someone else’s home??? If you’re not ok, then are pharmacists or the healthcare sector supposed to absorb the cost of the returned meds when you were the one who insisted you wanted a year’s supply? To all of you pharmacists, technicians and friends who have had a patient scream at you because they cannot get what they want, when they want it, stay strong, thank you. Your grandparents, or parents may have had their appointments rescheduled, so what about their medications? Home delivery services have been extended to all patients, you don’t even have to contact us first, we trace the patients that need a top up, and call YOU instead. This has increased the workload significantly!! With healthcare, it’s not like your Taobao delivery. They deliver wrong, at some inconvenience, you can usually get a return, refund. If pharmacies deliver the wrong meds to the wrong patient, that’s a nightmare. What if the other patient missed their meds because of that? Or what if our elderly frail giddy patient who is illiterate takes the medication meant for a 25 year old with terrible hypertension, causing his blood pressure to drop? So much could go wrong. In some hospitals, even patients discharged will have their medications delivered to them to reduce unnecessary contact. Let me just tell you - explaining medications to a patient in person can be very difficult. Explaining medications to a patient who is xxx km away from you who does not know what you are talking about is nearly impossible. This has increased the time we take to do things significantly!!! But pharmacists remain patient, remain calm, and keep going. Because that is the professionalism we continue to show as a healthcare professional. Thank you! I know many of us in the pharmacy profession often feel forgotten, but seeing how dynamic our profession is during times of crisis, I hope this is a good reminder of why we serve. There are so many roles of the pharmacist which I have not been able to share, because I am not the best person to, but to our researchers, regulatory pharmacists, IT pharmacists, and so many more, thank you. For all of us (even other healthcare professionals too!) who feel you are not directly at Screening Centre, NCID, TTSH, etc - no matter what, be proud to call yourself a COVID-19 Frontliner, because you are. Each and every one of us is necessary to keep this healthcare system going. Stay positive, Stay motivated, we are in this for the long run. - A.