Briefly introduce yourself (The person and your academic qualifications so far)
My name is Dr. Njoroge Peter. I possess a Bachelor of Pharmacy Degree from the University of Nairobi with over eight years of experience in hospital pharmacy. I have a passion for pharmacotherapeutics and a knowledge base in cardiovascular pharmacology, infectious diseases, and oncology.
Where are you currently working, and what does your job entail?
I currently work at M.P Shah Hospital Nairobi. My work primarily focuses on the in-patient section of the main pharmacy. My job entails screening treatment plans for pharmaceutical appropriateness and intervening where needed. I serve as a reference point for the pharmacy in cases of queries concerning treatment options available in the hospital formulary. I am also a member of the hospital antimicrobial stewardship committee, in addition to standing in for the resident oncology pharmacist in the chemotherapy unit now and then.
How did you end up at your current working place?
I ended up in MP Shah immediately after my government internship. I was part of the first batch of medics not posted after internship. After completing my internship at Moi Teaching and Referral Hospital in 2017, I applied for a job post at MP Shah. I got the post and have been there since then.
Looking at your curriculum vitae, you were the valedictorian during your graduation. How has this achievement benefited you in your career as a pharmacist? Have you had other achievements since then?
Being the valedictorian of the University of Nairobi Class of 2015 culminated my educational journey up to that point. I have always been a bright student. I was the index one student in primary and high school, and I remember always believing that if you put me in any class in the world, gave us access to the same information and decided to examine us, I could hold my own. When I got a call from the Dean of the School of Pharmacy at the time, Prof. Guantai, that I had emerged as the valedictorian of the entire University, it was a dream come true. Moving on to the competitive job market, having a cutting edge over similarly qualified colleagues is crucial in securing a job. So, besides the clinical pharmacy understanding I had obtained in MTRH, my transcripts were one of the key elements that made me secure the MP Shah job.
Having worked as an oncology pharmacist, what challenges did you initially face as you started working in this space, and how did you overcome them?
Oncology is quite an exciting field. Of all the fields in clinical pharmacy, oncology is where the pharmacist’s role is clearly defined and does not infringe on the roles/tasks of other medical specialities. Safe handling and aseptic reconstitution of cytotoxics are critical skills prospective oncology pharmacists ought to master. The fundamental principles of aseptic technique are taught in school. However, the practical experience, especially while working in a Class 3 biosafety cabinet, can be quite challenging, but with proper training and practice, it gets easier with time. The other challenge in oncology is keeping up to date with treatment regimens. Oncology is an evolving field, especially regarding targeted therapies, new data, and approvals/withdrawal of approvals. Guidelines keep changing, and as a pharmacist in oncology, one needs to constantly check Up to Date to be able to answer any queries from oncologists or patients.
It is evident that the world is moving more towards precision medicine and evidence-based medicine; are we embracing these new approaches well as a profession? How can we improve these aspects of practice?
I don’t know if the undergraduate curriculum has changed, but the concept of evidence-based medicine (EBM) was not emphasised at the University. During my MTRH internship, the idea of EBM was drilled in effectively as standard practice. I recall rotating in the Cardiac Care Unit under the resident cardiology pharmacist, Dr. Benson Njuguna, who seemed to have all the cardiovascular trials at the back of his hand. His interjections during clinical rounds to give supporting trials were a sight to behold. This fueled my passion for cardiology, where, with the absence of Cath Lab procedures, all the interventions were pharmacotherapeutic. In such an environment, a knowledgeable pharmacist with excellent recall can thrive. Interacting with other pharmacists over the years post-internship made me realise that pharmacists usually focus on seeking information from drug indexes rather than looking at where the data informing the drug index indication and specification comes from. On a side note, I usually recommend Lexicomp as the drug index of choice because it often gives you the trial data that informs you of the specifications for a particular drug. These concepts must be taught from the undergraduate level so the upcoming pharmacist can excel in the clinical field.
Have you had the privilege of participating in clinical trials at your workplace? If yes, what was the experience like? What steps do you think nations in the Sub-Saharan region can take to increase their accessibility of clinical trials?
We haven’t had any clinical trials in MP SHAH, but I know the Aga Khan University Hospital (AKUH) is involved in several clinical trials. We need trials conducted on our population to inform of medical information that is suited for our population. Clinical trials are expensive ventures, and I believe that increasing accessibility of clinical trials in Sub-Saharan Africa requires efforts from all stakeholders, including the government, regulatory bodies, ethics committees, big pharma companies, institutions, and medical professionals.
Having done some research, I read somewhere that you intended to be a Professor of Pharmacotherapeutics at some point; do you still have this vision?
It’s funny that my nickname at work is “Prof”. I have a passion for therapeutics. I believe that as a pharmacist, without referring, if given an accurate diagnosis, I should be able at any moment in time to come up with a treatment plan and how to objectively assess if the plan is working or not and what is the probable second line option if option one fails. Concerning a doctorate in therapeutics, that dream seems way further now than when I was a young pharmacist fresh from school.
Did you receive any mentorship from senior colleagues earlier as an early career pharmacist? How can mentorship be improved in the pharmacy profession?
Unfortunately, I can’t say I had a mentor in my early pharmacy career. However, interacting with clinical pharmacists in MTRH and shadowing them during their daily activities gave me the first clear picture of an ideal clinical pharmacist.
Senior pharmacists can improve mentorship by engaging young pharmacists in societies such as the Hospital Pharmacists Association of Kenya (HOPAK) and the Pharmaceutical Society of Kenya (PSK). Societies should make it easier for young pharmacists to join and engage in societal activities through lower subscription and participation levies.
As a pharmacist, have you been tasked with any leadership and management roles at your place of work? How would you advise young pharmacists to go about imposter syndrome when tasked with leadership and management roles when they are yet to gain prior experience as leaders?
I have participated in several teams and projects involving other healthcare personnel. The value of a pharmacist in such multidisciplinary teams is invaluable in that there are questions only a pharmacist can answer. Countering imposter syndrome is all about confidence in one’s ability. Pharmacists should know they are beacons of specific knowledge unique to them. If given a leadership role, be conversant with the issues; there is no reason to feel out of place.
Supply chain management is becoming an increasingly popular specialisation area among pharmacists; what roles and challenges have you faced as a pharmacist in supply chain management? How have you managed to overcome these obstacles?
“O/S” is a term that does not sit well with me and MP Shah in general. As a hospital, we try as much as possible to ensure the pharmacy is adequately stocked and patients do not miss any medications. When certain drugs are unavailable from our suppliers, we usually try to procure them from other hospitals. If that is not possible, then as a pharmacist, it is my job to look at the patient parameters and, with all factors considered, try to liaise with the prescriber and devise an alternative available in the hospital. We ensure the patient does not miss any treatment, no matter the situation.
What advice would you give to any young pharmacist passionate about pharmacotherapeutics but doesn’t know where or how to start?
My idea of pharmacotherapeutics is being a master of diseases and the treatment options to manage them. From the onset, you need to always think from the prescriber’s side and not just confine your thought process to the pharmacy side. Why did they choose this option over the other available options? Is there a contraindication in the patient that I might have missed? Engage clinicians as much as possible during ward rounds/on prescriptions. Ask questions and do your research. You remember the patients you assisted in managing for specific ailments, and recalling is easy when faced with a similar challenge. This, combined with much reading and up-to-date knowledge of clinical guidelines, births a brilliant pharmacotherapist.