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The Tincture Press Official Newsletter of the Pharmaceutical Society of South Africa (CWP) Branch Amptelike Nuusbrief van die Aptekersvereniging van Suid-Afrika (KWP) Tak TEL 021 683 7313 § FAX 021 683 5759 § EMAIL admin@pssacwp.co.za § P O BOX 375, CAPE TOWN, 8000 The opinions expressed in this magazine are those of the writers and not necessarily of the editor or the official view of the CWP Branch of the Pharmaceutical Society of South Africa. Vol 45 December 2017 Senate Dinner 2017 Photo Tracey Adams Seated, l–r: Dr N Finkelstein, Prof SF Malan (President of the PSSA and guest speaker), Ms A Patel (Senate Chairman), Mr W Bannatyne, Mr J Morris Middle, l–r: Ms L Turner, Mr R Volks, Mrs J Maimin, Ms A Wege, Mr PJ le Roux, Ms C de Beer, Mr M Lester-Olivier, Prof N Butler, Mr D Mader Back, l–r: Mr M Ackermann, Mr SP White, Mr E Smit-Wright, Mr GS Black, Ms R Boshoff, Mr G Malan, Mr L Röntgen
TP Noticeboard Dates to Diarise Season’s Greetings On behalf of all of us at the Branch Office, I would like to wish all members a peace- ful, joyful festive season and a successful 2018. We hope that you will be able to take some time out of your busy schedule to enjoy with family and friends. Thank you for all the good wishes and encouragement we have received. We trust you will continue to make use of the services we offer. Be assured that we will strive to assist you in every way possible. May you enjoy every success, peace and happi- ness in 2018. We remain ‘The PSSA, your Society, working for you’. Dankie vir jul ondersteuning deur die jaar. Ons sien uit daarna om julle van diens te wees in die nuwe jaar. Gary S Black and staff OFFICE CLOSURE Please note that the office will be closed from Friday 22 December 2017 and will re-open on Tuesday 2 January 2018. Mr Black, the Director, will be contactable on his cell phone 082 895 6064.
The Tincture Press Official Newsletter of the Pharmaceutical Society of South Africa (CWP) Branch Amptelike Nuusbrief van die Aptekersvereniging van Suid-Afrika (KWP) Tak TEL 021 683 7313 § FAX 021 683 5759 § EMAIL admin@pssacwp.co.za § P O BOX 375, CAPE TOWN, 8000 The opinions expressed in this magazine are those of the writers and not necessarily of the editor or the official view of the CWP Branch of the Pharmaceutical Society of South Africa. Vol 45 December 2017 CONTENTS 1. Editorial Bill Bannatyne Is pharmacy in South Africa sitting on a time bomb that will explode anytime now? 3. Season’s Greetings Sarel Malan Joggie Hattingh Ivan Kotzé Aleta Wege Donald Black 4. Pharmacist Interns Research Day 2017 5. I am the very model of a modern pharmacologist James Parry Attendance: FIP World Congress in Seoul 6. Reportback from FIP Aleta Wege 12. PSSA CWP & SAACP combined AGM 2017 12. Notice of Meeting 13. 2017 Annual Report on the Activities of the PSSA (CWP) Branch 20. Minutes of a Combined PSSA and CPS AGM editor Billy Bannatyne § executive editor Gary S Black § classifieds Elize Fick typesetting User Friendly
Editorial Bill Bannatyne Is pharmacy in South Africa sitting on a time bomb that will explode anytime now? How much to tell patients This board was constituted in terms of the Medical, Let me start by repeating an anecdote which I wrote Dental and Pharmacy Act of 1928. In 1928, the fast- in a previous TP. But, as the late Bertie Stewart est means of transport was by passenger train. This would have put it, ‘it was before the coming of the meant that it took approximately two days travel rinderpest.’ If anyone reads it this time round it will between the major cities. For this reason, the Board probably be for the first time. The story is about a did not work through specialist sub-committees as meeting of the CWP branch in a community hall in the Pharmacy Council operates but everything, in- Vredehoek. At the end of the meeting a pharmacist cluding formal inquiries, was done at a full board remarked that when he dispensed a prescription in meeting. his pharmacy, his customers often asked a lot of ques- This procedure continued after World War 2 so tions about it. His problem was that he was uncertain this was when I first came across the members of about how much information about the medicine he the legal profession who specialised in defending should give to the relevant customer and whether pharmacists accused of malpractice. Knowing how the prescribing doctor might object. careless the average person is in answering questions, The late Mr Hymie Barnett, the doyen of local how poor our memory of the finer details of previous pharmacy, stood up and, in a rather haughty voice, incidents can be, and how our memories of these stated that he was only prepared to explain to the events become infused with ideas and comments customer what the doctor’s directions for the medi- of others, they are particularly skilled in destroying cine were and if there were any other questions, he the evidence of anyone who opposes them as being would inform the customer that he or she should unreliable and unacceptable. discuss them with the doctor who prescribed the medicine. US doctors’ fear of malpractice Immediately, a young lady pharmacist stood up They are particularly active in the USA. There are and in a sweet tone that a caring mother would use numerous incidents of their work in this regard. One when dealing with a stubborn child, said ‘No, Mr of them, who was later a candidate for the US presi- Barnett, you are wrong. A modern-day pharmacist dency, argued that a child born with a malformed must answer every question that a customer asks brain would not have been so damaged had the baby about a prescribed medicine and ensure that the cus- been born by caesarean section. The entire obstet- tomer fully understands what it is all about and feels ric profession of the country disagreed with him but quite comfortable about taking the medicine.’ Mr he had this contention accepted by the courts. For Barnett, who could be devastating in public debate, many years thereafter, obstetricians were reluctant never said a word but sat quietly with a slightly per- to attend the birth of an infant unless it was by the plexed if not amused look on his face. I have always caesarean method. felt that if this young lady ever got bored with phar- I think it was a Readers Digest report that recorded macy she could have a most enjoyable and successful an incident where a passenger plane, travelling be- career in the Diplomatic Corps. tween the UK and USA carried a large number of US medical doctors returning from a conference in Legal challenges Europe. High over the Atlantic, the pilot, through Before I was elected to the Pharmacy Council, I was the public address system, enquired whether there elected in a by-election to serve the last two-and- was a doctor on board who could assist the cabin crew a-half years as a member of the Pharmacy Board. in dealing with a passenger who had taken ill. Not 1
Editorial continued a single US doctor responded. They were all afraid members dispensed each prescription, separately on of possible malpractice charges. A doctor from Paki- their own. It would also ensure that all the details stan assisted the crew. A fairly recent Carte Blanche were attended to. programme had a story about a South African ob- stetrician who was attending his last confinement Avoiding potential malpractice as the premium for an insurance policy providing There is an additional item which I think cannot be support against malpractice charges was going to be found in a normal patient’s medical details. That is over a million rand for the following year. One of their immunity-building ability and their resistance my daughters who resides in Gauteng tells me that to adverse drug reactions. The Merck Manual classi- her gynaecologist will not accept anyone as a patient fies adverse drug reactions as being either mild or who is below the age of 40 years. moderate or severe or lethal. Whilst the mild variety can often be accepted and even ignored, moderate South Africa at risk can often be rectified by change of medicine or dos- This brings me to the title and subject of this edito- age; severe can be serious often resulting in hospital- rial. My concern is that pharmacy in South Africa, isation, and lethal is the end of the line but is often particularly at community and hospital out-patient hidden in its origins by the resulting disease which dispensary level, is at risk of malpractice charges. I does not respond to treatment. think we may find the profession in a Ford Kuga situ- A further complication is that our lifestyle encour- ation. The Kuga was not an isolated incident. It only ages and recommends that we should always try hard hit the headlines when the driver of the car was un- in our life’s endeavours and should not be defeated able to get out of the car fast enough and was killed. by setbacks but should always try again. Very often From some personal observations and a discussion people who start out in life with very healthy bod- I had with our executive director, there is a concern ies lose their resistance through hard work and con- that some pharmacists are more interested in the stant endeavour as well as resurrecting themselves number of scripts they dispense and counselling is from setbacks. Because of modern medicine they are something of a forgotten art. able to survive despite their minimal resistance to At a previous Senate Dinner, much to the audi- adverse reactions and suchlike emergencies. ence’s apparent disapproval, I delivered a speech, I think this is an unexplored area of research. We based on some time and motion principles that should be able to identify high-risk patients. I think dispensing a prescription should not be the sole re- we can avoid possible malpractice charges if patients sponsibility of a single pharmacist but should be a who are at high risk as a result of hard work, con- team effort. I believe that in a busy pharmacy with stantly facing adverse situations, and recovering and the public crowded around the open dispensary, surviving adverse setbacks are known to us so that usually all of whom are in a hurry, attending to all they can receive the additional care and considera- the detail required to dispense a prescription that tion to avoid situations which have the potential for is safe for the patient to use is far too much for a malpractice charges. It could be the less expensive, single person to continuously perform. A team effort less traumatic and less worrying route. would accomplish more dispensing than if the team —oOo— 2
Season’s Greetings Dear friends and colleagues To all our members It is that time of the year again where we look back Thank you for your loyal support and your commit- at what has been accomplished, what we still wanted ment to our profession. At this time of the year we to do and what we neglected to do. We always strive should remind ourselves of the purpose of life and for more, but within our changing environment and fill our hearts with joy and happiness, thankful for limitations, the achievements for pharmacy in South friends and families. May 2018 bring you all success Africa outweigh the failures, moving the profession and satisfaction. ever forwards. I trust that this is true for all of us IVAN KOTZÉ individually as well, and that looking back on the Executive Director PSSA year, the triumphs and good experiences are what’s remembered. For me a highlight was surely the com- ing together of all spheres and practice settings of pharmacy to work together on defining the place and value of pharmacy in the current and future What an amazing year 2017 was! healthcare system of our country. Our future is in Please take a moment to reflect on all the blessings our hands. you experienced over the course of the year. This I would like to wish you a blessed festive season was the year of my first FIP World Congress. It was and a 2018 full of achievements and highlights. a wonderful experience and I urge you to add FIP SAREL MALAN World Congress to your bucket list. I hope you all PSSA President have a blessed Festive Season and are able to spend valuable time with family and friends. Come back in January re-energised and ready for the year that lies ahead. Expect to be amazed in 2018. Colleagues and Friends ALETA WEGE With the festive season and end of the year upon SAAHIP WC Chair us, I want to extend my heartfelt thanks tone and all who contributed to make 2017 a memorable year, through membership, through contributions and through service to the people of our wonderful country. May we all enjoy life to the fullest with fam- ily and friends and may we always have a thankful Dear Colleagues heart. All too soon Christmas is here with us again and we To those who are privileged to take a holiday, may see the end of another year. you enjoy your well-earned rest and return to work Thank you to those of you who unselfishly gave of rejuvenated. To those who hold the fort, thanks for your time and commitment to our Profession. giving your colleagues the opportunity to take a Christmas is a very precious time to spend and break and when your turn comes, make the best of it. enjoy with family and friends and I wish you a fruit- I want to extend my best wishes to our colleagues ful and prosperous New Year. May the year that who observe Christmas. May you have a blessed fes- lies ahead be filled with good health, peace and tive season in Christ our Lord. happiness! I wish all of you a wonderfully blessed New Year If you are going to be travelling at this time, may with good health, wealth and happiness. you return home safely! JOGGIE HATTINGH DONALD BLACK SAAHIP President PSSA/ SAACP Chairman *********** 3
Pharmacist Interns Research Day 2017 An important highlight of the year for the interns working for the Western Cape DoH is an opportunity to present their research projects to their colleagues and peers at Pharmacist Interns Research Day. Sincere thanks to, in particular, Denise Frieslaar and her team for organising this event. Aleta Wege, Chairperson of SAAHIP, was one of the adjudicators and presented the prizes to the winners. The prizes are sponsored by the Branch and SAAHIP. The winner receives free membership of PSSA for one year, attendance of the next SAAHIP Conference where she will present her work again, a book voucher and a Winner Lee-Anne Andrews (Bishop Lavis commemorative plaque. Community Health Centre) with Aleta Wege and Denise Frieslaar This year the winner was Lee-Anne Andrews from Results Bishop Lavis Community Health Centre. We pub- A total of 1558 folders were included for review in lish here a synopsis of her winning project. this study. In April 2017, 16 of 271 people that were screened were diagnosed with diabetes. In May and A retrospective study to determine the necessity June 2017, 271 and 203 people were screened with of the H65/2016 health circular to screen non- only six and seven people being diagnosed respec- diabetic patients for diabetes at Bishop Lavis Com- tively. After the H65/2016 circular was emphasised munity Health Centre to the clinical nurse practitioners and doctors, 471 Andrews L,1 Champanis E,1 Bedeker W,1 & Sayed F1 patients were screened but only five patients were diagnosed which amounts to only 3.45%. In August Introduction 2017, 332 patients were screened for diabetes; how- Hyperglycaemia is a common, serious and costly ever, only 13 patients were diagnosed. This amounts healthcare problem. Glucose testing has become to 3.92% which is a fraction of patients seen at standard procedure in many primary healthcare BLCDC. facilities and is often unnecessary. An investigation regarding the frequency of Accu-Chek strips used Conclusion and Recommendations for non-diabetic screening and the rationale for this Adhering to the H65/2016 health circular does not screening was compared to the criteria as stated in have a drastic effect on the number of patients being the H65/2016 circular. Based on this we can investi- diagnosed with diabetes. The results indicated that gate whether adhering to this circular is a necessity adhering to the circular is not a necessity and can and if it is beneficial to our practice as healthcare save time and resources. To save time, money and professionals working for the benefit of the patient. resources that have been proven to be limited in the public sector, the Society for Endocrinology, Metab- Objectives olism and Diabetes of South Africa Type 2 Diabetes To establish if adhering to the H65/2016 circular is a Guidelines are recommended. necessity and is beneficial to our practice as health- care providers and make recommendations based on The other winners were: results. • 1st Runner-up: Zaahid Parker of Lady Michaelis Community Health Centre Methods Topic: Medicine use evaluation of methylpheni- The study was a quantitative, retrospective folder date at Lady Michaelis Community Health Centre review investigation conducted at Bishop Lavis CDC • 2nd Runner-up: Mawande Golozana of Eerste between April 2017 and August 2017. Only non- River Hospital diabetic adult patients (~18 years old) of varying Topic: Mapping evidence- based application to the characteristics folders were retrieved and reviewed at Provincial Pharmacy and Therapeutic Committee the pharmacy; data collected, captured and analysed. (PPTTC) for the inclusion of phenylephrine minims and fibrin sealant injection on the 1 Bishop Lavis Community Health Centre provincial code list. 4
I AM THE VERY MODEL OF A MODERN Attendance: FIP World PHARMACOLOGIST Congress in Seoul (With apologies to W.S. Gilbert) I am the very model of a modern pharmacologist. The scope of practice in my head would surely Congratulations to Aleta Wege, SAAHIP (WC) stun an alchemist Chairperson who earlier this year had the opportu- I am very well acquainted with the tenets of the nity to present her poster, ‘Paracetamol Poisoning: formulary Rational use of N-Acetylcysteine’ at the FIP Con- But often seek the counsel of my colleagues in gress in Seoul. dispensary The Branch assisted in making it possible for her Klarithran and Aspavor, Glucophage and to attend the Congress and she writes as follows: Atropine Madopar and Noortropil, Glycomin and Stelazine I herewith would like to convey my gratitude for the PSSA But oh, in matters medicinal, ethical, and CWP Branch’s contribution towards my attendance of the pertinent FIP World Congress during September 2017. I am the very model of a modern pharmacologist! This was an amazing experience and I learned such a lot. As I was listening to colleagues from around the world I’m very well acquainted, too, with the constant I realised that pharmacists all face similar challenges, all quest for Methadone go the extra mile for their patients and work around those And often asked for doctor’s calls upon the obstacles in resource limited environments – all of this for dispensary telephone. the best interest of our patients. We are truly a borderless Allergic rashes, hammer toes, aches and pains profession. are stock in trade I want to recommend attendance of the FIP World Con- As is a great appreciation of methods how the gress to all our members. The 2018 conference will be held meds are made in Glasgow, 2019 in Abu Dhabi and 2020 in Seville, But oh, in these and other matters medicinal and Spain. Just go and be blown away. pertinent Regards I am the very model of a modern pharmacologist! Aleta Wege I have a goodly knowledge of stomach cramps See report below. and diarrhoea And have an understanding of coughs and colds and panacea I’m very good at formulas, both liquid and encapsulated I know the Latin names of all the medicinals intabulated; Side effects and interactions, claiming things and telephones Interruptions, counselling, dispensing meds and other clones In short, in matters medicinal, ethical, and pertinent I am the very model of a modern pharmacologist! For my pharmaceutics knowledge, though I have a goodly memory, It has only been about from the beginning of the century; But still in matters medicinal, ethical, and pertinent I am the very model of a modern pharmacologist! © 2017 James Parry Dip.Pharm. (S.A.) 5
It was with great excitement that I boarded my • Paracetamol poisoning: Rational use of Emirates flight to Seoul, South Korea. I have never N-Acetylcysteine – A Wege, Helderberg Hospital travelled that far East. After crossing seven timelines • Clostridium difficile: infection, risk factor and during my 19 hours flying from Cape Town to management among hospitalised patients in South Incheon Airport, Seoul via Dubai, I arrived at my hotel Africa – Laurel Legenza, University of Wisconsin on Saturday, 9 September, at 1 am in the morning. It was only Friday, 8 September, 6 pm in South Africa. I It was difficult to decide which of the sessions to was ready for FIP 2017: attend, but I chose as best I could. Here follows feedback on those sessions I attended. Medicines and beyond! The Soul of Pharmacy 1. First Timers Meeting The Opening Ceremony on 10 September was impressive. The Korean hosts did themselves proud. First Timers were introduced to FIP. Who is FIP and We were entertained by, amongst others, students what does FIP do. FIP (International Pharmaceutical from the different Korean Pharmacy Schools. Of Federation) is an NGO with an official relationship course they performed the popular hit Gangnam with World Health Organization (WHO). Style, much to the delight of the audience. A famous The three pillars of FIP are: Korean group, Red Velvet, also performed and I was • Pharmacy practice sections introduced to K-Pop. • Special interest groups The theme of the congress referred to the new • Pharmaceutical sciences challenges and changes the pharmacy profession is facing worldwide. The soul of pharmacy has to 2. Plenary Session: The Soul of Pharmacy be nurtured and preserved, based on tradition, 2.1 The soul of pharmacy and its core purpose in education, innovation and dedication. In her healthcare address, the President of FIP, Señor Carmen Peña, William Zellner (USA) spoke about the values of the reminded the delegates that education should no profession and the principles underlying professional longer be considered a burden, but must be seen as an practice. Pharmacy practice is in the process of investment. Education is essential because we need a transforming from primarily a supply function to a healthcare workforce that can provide the necessary patient-care function. services as the world moves toward universal healthcare. 2.2 Pharmacy in a world of limited The sessions were divided in five resources streams: Leonila Ocampo (Philippines) de • Nurturing the soul of pharmacy scribed the situation in her country. • Precision pharmacotherapy It is a low income country, geo • Pharmacy services: Going beyond graphically an archipelago with prescription village clinics to provide healthcare • Smart pharmacy to the population in these • Targeting special interests remote areas. I could relate to the challenges the pharmacists in the The Hospital Sector Poster Session Philippines have to deal with as we took place over two days: Monday have similar challenges in South 11 and Tuesday 12 September. African healthcare. Western Cape Government Health featured in two posters: 6
FIP: Medicines and beyond! The Soul of Pharmacy … continued 2.3 Pharmaceutical science and innovation Leslie Benet (USA) reminded us from where we have come. Through innovation we have moved from manufacturing emulsions and poultices to controlled and extended release formulations, to nano-medication and bio-equivalent and bio-similar drugs and lately to precision medication. The profession is now changing from product- orientated training to patient-orientated training. 2.4 Pharmacy caring for patients Warren Meek (Canada) reminded us that every patient has a story and we need to listen better. He reported on pharmacists caring for patients in East Africa, Tanzania, Lebanon and Iran. In 2015, 1.28 Speakers from Korea, Australia (2) and Canada million people were displaced and these people are discussed the global challenge of non-adherence in need of assistance and humanitarian support. His to treatment. In 2003 the WHO reported 50% non- closing message was: ‘Say what you do, Do what you adherence rate by patients with chronic diseases. Say and Do it well’. Research shows a non-linear relationship between health literacy and adherence. The consequences of 2.5 Educating pharmacists for the future non-adherence are: William Charman (Australia). Pharmacy is a highly • Clinical – poor outcomes regulated competency-based profession. The focus • Humanistic – poor quality of life is on WHAT is taught rather than WHY and HOW. To • Economic – $500 million wasted fulfil our role with regard to the WHO Sustainable Developmental Goals 3, 4 and 9, to attain universal Pharmacists are part of the solution. We need to healthcare we need to develop a healthcare work understand the difference between, and reasons force – by educating future pharmacists and by for, intentional and non-intentional non-adherence. enabling the current workforce. Research done shows five categories of reasons why Without a healthcare workforce there will be no patients are non-adherent: healthcare. • Socioeconomic, e.g. affordable treatment As Carmen Peña, FIP President, stated in her • Healthcare professional, e.g. trust, language opening address, education is not a burden, but an barriers investment. • Condition, e.g. severity of illness • Therapy, e.g. side effects, complicated regimes • Patient, e.g. health literacy $500 million could be saved annually if responsible use of medicines is achieved. We, the pharmacists of the world, must adapt to our new role. The focus is on patient care and we must hand over the supply function to the pharmacy technicians and other support personnel. 4. How to deal with low health literacy Speakers from Australia, Korea and the Netherlands 3. Improved Outcomes, Better Health discussed health literacy and its impact on health The WHO defines adherence as outcomes. Patient characteristics were associated with their level of health literacy. Patients do not The extent to which a person’s behaviour – taking want to show their ignorance by asking questions. medicine, following a diet, or making healthy Pharmacy is an environment where we use specialised lifestyle changes – corresponds with agreed upon skills and equipment and have our own language. recommendations from a healthcare provider. This is an intimidating environment to the patient. 7
FIP: Medicines and beyond! The Soul of Pharmacy … continued When we consider maternal mortality figures we find that worldwide 830 women die every day from preventable diseases. Even in countries with a high literacy rate the level of health literacy can be low. In Korea, 32.7% of highly literate individuals could not understand medicine directions. Pharmacists should be aware of the consequences of low health literacy and should endeavour to ensure their patients understand the doctor’s and the pharmacist’s instructions. We should not assume that the patient understands, but should use different methods of communication to ensure we communicate in a way that the patient understands. Ask the patient to explain to you how he or she would be taking the medicine. Use pictograms to explain to the patients. Carmen Peña reminded the audience that health literacy is a basic human right and pharmacists have an important role to play to improve health literacy. 5. Hot Topic – The Refugee Crisis and the role of pharmacy Pharmacists from Lebanon and Jordan shared their challenges when caring for Syrian refugees. The influx of refugees to Lebanon places an parents. This no longer is the case. At the beginning increased demand on the healthcare system. Twenty- of the 1960s Korea was one of the poorest countries seven per cent of Lebanese already live below the in the world. Life expectancy of Koreans has increase poverty line. The population has now doubled. due to: This has a great impact on the host community. • Improved nutrition Pharmacists are seeing new diseases emerging in • Expanded access to healthcare their country, e.g. leishmaniasis. • New medical technology Language barriers and cultural differences are also • Lower health inequalities challenges pharmacists have to deal with. Refugees suffer from post-traumatic stress disorder and social The projection is that life expectancy of Korean exclusion. Children can’t attend schools as they are people in 2030 will be the highest in 35 industrialised not legal residents of the host country. countries with women 90.8 years and men 84.9 Sweden, a high income country, integrated refugee years. The Korean government would like to improve pharmacists from Bosnia, Syria and Romania into income security for retired persons and wants to their healthcare system. These pharmacists boosted provide expanded medical cover for these citizens. the Swedish healthcare system and they are able to The challenges are: assist refugee patients. • How to fund the extended cover and income This once again confirms that pharmacy is a security borderless profession. • How to ensure sustainability in the long term 6. Healthy Ageing Alpana Mair (Scotland) reminded the audience Healthy ageing is well-being in older age, enjoying that our systems are not designed to care for the health and happiness; it is not only the absence of elderly. However 50% of the world population is disease. over 50 years of age. We need systems to allow the Heung-Bong Cha (Korea), former Korean Minister retired person to maintain his or her ability to live of Social Development, spoke on population ageing independently. The public health challenge of ageing in Korea and a new vision of health ageing. Korea requires development and design of: is developing a new policy to enable people over • Health systems for the population we serve 65 years to continue living independently. In a pre- • Systems of long-term care industrial age children used to look after ageing • Age friendly environments 8
FIP: Medicines and beyond! The Soul of Pharmacy … continued She also spoke on polypharmacy in elderly patients. We must utilise communication skills and tools Due to co-morbidities elderly patients take more available, e.g. pictograms, with patients with low than one type of medication. literacy and low health literacy to improve health • Adverse drug reactions and drug interactions due communication with patients. However, first we have to polypharmacy results in 8.6 million unplanned to learn to listen better. We must be aware of the non- hospital admissions in Europe every year verbal communications and factors that contribute to • 50% of hospital admissions due to ADR are non-adherence. During this period of change, where preventable the profession is moving from a supply function to a • 70% of these ADR are in patients >65 years of age patient-care function, pharmacists must listen better who are taking five or more medicines and talk better to improve adherence and ultimately • This has a tremendous impact on the healthcare result in better health outcomes. budget of a country 9. Ethics Pharmacists must be equipped to better serve the 9.1 Healthcare Reform in Taiwan ageing population and to intervene to decrease Fei-Lin Wu (Taiwan) spoke about the reform of adverse events. Pharmacy staffing models also need healthcare systems in Taiwan. Previously, due to poor to be such that pharmacists have the capacity to deal policy and poor control, they had to deal with highly with polypharmacy. unethical practices in Taiwan. All aspects of their healthcare system went through a period of reform, 7. Hospital Pharmacy Sector Meeting which also included reform of pharmacy education I attended the sector meeting where feedback on a and educating the public. The key to reform was number of projects was given: to improve the quality of pharmacy practice in • Antimicrobial stewardship and global solutions the community through collaboration between • Medication shortages government, pharmacies, hospital pharmacists • Counterfeit medication and community pharmacists. Today the healthcare • Opioid abuse system in Taiwan is of high quality and adhering to • Lack of access to analgesics in certain parts of the ethical standards. world • Basel statements 2015 on the future of hospital 9.2 Ethical issues related to intellectual property pharmacy practice. and personalised therapy See www.fig.org/baselstatements Wilma Göttgens (Netherlands) spoke about Per- • Biologicals sonalised Pharmacotherapy where standard dosage regimes are no longer applicable, A number of 8. Listen Better, Talk Better – Skills to improve ethical questions arises: medicines taking • Is this patient-centred care or is it technology? Parisa Aslani (Australia), Ash Soni (UK) and Marion • Who owns the data? Schaefer (Germany) spoke on communication and • What about patient confidentiality? its influence on medicine taking. Non-adherence to • Who may use the data? treatment remains a worldwide challenge. In the UK • Limiting access to data hampers continuity of £400 million worth of medication is wasted annually. pharmaceutical care As much as 30%–50% of medicines are not taken as • Which ethical rules, and which legal rules, are prescribed. We must identify where we have done applicable? well and also what we can improve on. Can we improve adherence by improving our listening skills and our communication skills? As Warren Meek said earlier in the conference: ‘Every patient has a story’. We must differentiate between: • Intentional non-adherence • Non-intentional non-adherence • Patients’ knowledge (or lack of knowledge) and perception of safety and risk • Information contributes to intentional non-adherence 9
FIP: Medicines and beyond! The Soul of Pharmacy … continued • Access to BIG DATA is in the best 10. Closing Ceremony/Dinner interest of progress in treatment Then The closing event was the formal we have another ethical dilemma: dinner on Thursday night. Our hosts, Two pharmacists, same situation and The Pharmaceutical Society of Korea different interpretation of ethical (PSK) and the Korean Pharmaceutical standards, different behaviours and Association (KPA) once again treated different routes of action – who is their guests to a spectacular show and right? Is one wrong and one right? a delicious meal. It was time to greet our colleagues 9.3 Emergency contraception from all over the world. South Africa is Arijana Meštrovič (Croatia) spoke on one of the bidders for FIP 2021 and we the moral dilemma of emergency invited our colleagues to join us in Cape contraception in a country with 75% Town should our bid be successful. of the population Roman Catholic. The Korean hosts handed over the What about patient care? Do you sell baton to the organising committee for the morning after pill, but not an IUD, FIP 2018, which will be held in Glasgow. because of different modes of action? Do you base your decision on when you believe life 11. In Closure begins? Is it when two cells fuse or when these fused Attending the conference was an amazing experience. cells are implanted in the uterus? I have learned so much! It was terrific to see how Are you, as a pharmacist, entitled to conscientious Western Cape Government Health Healthcare 2030 refusal? Your conduct should not be a danger to the is aligned with WHO vision for universal healthcare, health, welfare or safety of a patient. as is FIP. I want to recommend that WCG Health allows 9.4 Ethical dimensions of pharmacogenetics and candidates to attend the annual FIP World Congress. personalise therapy FIP 2019 will be held in Abu Dhabi and FIP 2020 in Farshad Shirazi (Iran) once again had a discussion on Spain. the BIG DATA issue, intellectual property and patient To learn from pharmacists around the world and confidentiality. He is of the opinion that it is in the realise that they have similar or bigger challenges than best interest of the patient to share the information. us, and that we all share the same vision of patient- Human life in the 21st century is becoming more centred care, renewed my energy to contribute to and more impersonalised. To share the data is for the process of change, the benefit of the patients. To discover each patient’s allowing pharmacists to genetic code and treat him/her accordingly is the step into the new roles ultimate goal. The patient could carry the data on expected of them. a flash drive (USB) and decide who to share the information with. Thank you for your Careful observation and control of the present support! This has been a transitional phase of extensive personalised life changing experience! information disclosure for scientific purposes is mandatory. International regulations and laws are Aleta Wege required to prevent any use of personal data for Pharmacy Supervisor unethical purposes. Helderberg Hospital 10
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NOTICE OF AN ANNUAL GENERAL MEETING Notice is hereby given of the combined Annual General Meeting of the Cape Western Province Branch of the Pharmaceutical Society of South Africa and the SA Association of Community Pharmacists (CWP) Branch to be held at Pharmacy House, ‘S’ Block, Greenford Office Estate, Punters Way, Kenilworth on Wednesday, 7 February 2018 at 7:00 pm for 8:00 pm The meeting will be preceded by a finger supper. Wives, husbands and partners are most welcome, but to facilitate catering, kindly RSVP by Friday 2 February 2018 ELIZE/BAHIA – TELEPHONE 021 683 7313 KENNISGEWING VAN ’N ALGEMENE JAARVERGADERING Hiermee word kennis gegee van die gekombineerde Algemene Jaar vergadering van die Kaap Westelike Provinsie Tak van die Aptekers vereniging van Suid-Afrika en die Gemeenskapsaptekers Sektor (KWP) Tak wat gehou sal word te Farmasiehuis, ‘S’ Block, Greenford Office Estate, Puntersweg, Kenilworth op Woensdag, 7 Februarie 2018 om 7:00 nm vir 8:00 nm Die vergadering sal deur ’n vinger ete voorafgegaan word. Gades en metgeselle is baie welkom, maar om verversings te voorsien sal ’n antwoord waardeer word. RSVP teen Vrydag, 2 Februarie 2018 ELIZE/BAHIA – TELEFOON 021 683 7313 12
2017 ANNUAL REPORT ON THE ACTIVITIES OF THE PSSA (CWP) BRANCH Introduction Young Pharmacist’s Sub-committee This serves as a brief summary of the many activities of The Young Pharmacist’s sub-committee was chaired by the Branch and its Committees. Gawie Malan. Activities included the following: • The Branch facilities were used by the Western Cape 2017 PSSA Branch Committee DoH for orientation of their interns (30 January) and The following members served on the Committee: community service pharmacists (13 and 14 February). Chairperson Mr DG Black On both occasions the Society was afforded an Vice-Chairman Mrs J Maimin opportunity to address these young pharmacists. Treasurer Dr N Finkelstein Colleen Whitelaw, Chairperson of SAAHIP WC Elected Committee members Branch spoke to the interns about the benefits of Ms C de Beer Mr KA Johnson membership of the PSSA. Mr PJ le Roux Mr GG Malan • Membership application forms and the leaflet Ms B Macauley Mr PW Meissenheimer explaining the Vision and Mission of the Society were Mr MS Sattar Mr HHD van Dyk distributed on both occasions. Interns were asked to pay just R100 towards their membership for the year Immediate Past Chairperson Ms A Patel with the balance being sponsored by the Branch. • The Young Pharmacist Group, with assistance from PSSA National Executive Members UWC, has launched a new initiative. They are currently Ms R Boshoff, Prof NC Butler, Ms A Patel setting up their own version of an app called ‘Quiz Up’ which can be downloaded on mobile phones. PSSA president Prof SF Malan This is a game whereby pharmacists can test their Sector representatives knowledge of pharmacy practice, latest treatments Academy Dr K Ward and guidelines. SAACP chairman Mr DG Black • Other planned activities for the year included SAACP vice-chairman Mr K Patel assistance to the interns on submitting their CPD SAAHIP chairman Ms C Whitelaw portfolios and a tutorial in preparation of the intern SAAHIP vice-chairman Ms A Wege exams. Unfortunately, due to lack of response, the SAAPI Ms A Patel tutorial was not held. • A call for applications for the PSSA Young Pharmacists’ In attendance Mr GS Black (CWP) Branch Director Group (YPG) Professional Innovation Project 2017 was sent out by e-newsletter and nationally by news The following Committee meetings were held: letter, the website and Facebook. 25 January, 8 February (AGM), • The SAPC held a tutor/intern information seminar on 1 March, 14 June, 17 March. 28 November • A number of young pharmacists serve as elected members on the PSSA, SAACP and SAAHIP Branch Financial Advisory Committee committees. This Committee consisted of the Treasurer, Dr N Finkel stein, Mr DG Black, Mr KA Johnson and Mr K Patel. This PSSA National Executive Committee Committee was tasked to oversee and control the Branch Committee members serve on the PSSA National finances of the Branch. Executive Committee as follows: Whilst the Treasurer will deliver a full report at the • Prof Sarel Malan was re-elected President of the PSSA annual general meeting, we can report that certain • Mr Joggie Hattingh, President of SAAHIP, serves as a changes to the investment portfolio were made to Vice-President of the PSSA secure better investments and more income for the • Current elected members are: Ms A Patel, Mr DG Black running of the Branch. Mr Gawie Malan and Ms R Boshoff 13
2017 ANNUAL REPORT ON THE ACTIVITIES OF THE PSSA (CWP) BRANCH continued Mr Hattingh and Ms Patel serve on the NHI Portfolio • Practice information, promotional material, guide Committee. lines and patient information leaflets The Director, Mr Black is the nominated Director • Assistance to members with submissions to and serving the Constitution Portfolio Committee. Having liaison with SAPC and DoH scrutinised the Constitution, Mr Black submitted • Liaison with SAPC on behalf of members regarding proposals for amendments and commented on the registration numbers, correspondence, etc. proposed articles of association for the YPG group. He also assisted SAACP, SAAHIP and the other Branches Labour Relations with constitutional matters The Branch continues to pay the retainer for our Labour Relations consultant, Mr Gerald Jacobs. This service is Honours provided by the Branch to all members nationwide. Members of our Branch have achieved high honours Queries are regularly referred to Mr Jacobs. Matters within the profession during the past year and d eserve addressed included: our congratulations and support. • Workman’s Compensation for pharmacists • Prof Sarel Malan, re-elected as President of the PSSA • Sick certificates for pharmacists • Members of the SAPC: • Tax deductions —— Mr JA Raats • Dismissal due to incapacity —— Mrs J Maimin, chairman of the Practice • Working conditions of RP (2) Committee • Locum pharmacist – salary issues —— Mr D Defty, Vice-President of SAPC • Disciplinary issues —— Ms H Hayes • Rights of pharmacists re working hours • Numerous Branch members won awards at the • Employment contracts SAAHIP National Conference as noted in the SAAHIP report below. We congratulate them all. Gerald also presented a CPD workshop titled ‘Handling Grievances at Work’’. Membership We welcomed 106 new members from 1 October Legal Advice 2016 to date. The Branch sponsored 20 interns as new After consultation with the Director, Mr Black, and on members of the Society and 10 CSPs also joined as advice by the Peer Review Committee, legal assistance members. on practice or ethical issues is made available to members. In these instances, the Branch pays for the Membership statistics first consultation with our legal advisers. These matters Academy 66 are kept strictly confidential. General 215 SAACP 601 Confidential Ethical Matters SAAHIP 460 Members are encouraged to consult confidentially with SAAPI 119 the Director, Mr Black, regarding confidential matters Total membership 1467 such as disputes with the public, colleagues or other healthcare professionals, charges by the SAPC, ethical Membership Support dilemmas, etc. Many members have been assisted and General Services disputes resolved. Through the Branch offices, many pharmacy practice requirements are made available to members including: Professional Practice Matters • Preferentially priced reference books An important aspect of the work of the Director, Mr • Professional Indemnity insurance Black, is to assist members with professional practice • Notification of stolen/fraudulent prescriptions matters. Telephonic and emailed queries are followed • Labour relations consultancy – provided nationally by written confirmation which includes reference • Legal assistance on practice or ethical issues sources and relevant guidelines. The topics of these • Intervention in patient/pharmacist disputes queries vary greatly. • General information such as contact details, registra We list here some of the approximate 100 different tion of doctors, etc. topics that were covered in the past year. 14
2017 ANNUAL REPORT ON THE ACTIVITIES OF THE PSSA (CWP) BRANCH continued • Absence from pharmacy • Info generic substitution • Reference sources • Abuse of medicines • Inspections – grade C pharmacy • Regulations regarding CDU • Administration of injections • Labelling • Repeat prescriptions • Advertising • Labour law (3) and incompetent • Re-use of medicines • Anti-inflammatories pharmacist due to sickness • S6 medicines • Authorised prescribers • Licensing of pharmacy • Salary scales • Cold chain management • Locums • Sale of S1 & S2 medicines • Confidentiality • Logistics of a down referral process • Schedule 3 without script • Consultant pharmacy for Schedule 6 items • Scope of practice PA • Dentist prescribing • Medicine distribution • Ships’ medicine • Destruction of medical waste • Medicine schedules – glucosamine • Sick certificates by pharmacist • Dispensing fee • Nurse prescribing • SOPs • Dispensing of scripts from Vets • PA working in PHC • Specified S5 register • Doctors dispensing • Payment collection of medicines at • Substances requiring special • Doctors prescribing for family and till point handling himself • Personal tax query • Temperature monitoring • Doctors’ prescriptions deteriorating • Pharmacist signature • Travel medicine rapidly • Pharmacist’s assistant • Tryptophan • Electronic – faxed prescriptions • Pharmacy licence • Website advertising • Expired stock • PPIs and H2 antagonists • Wholesale distribution of medicine • Fraudulent prescriptions • Prescription processing protocols • Workmen’s compensation – • ICSP online system for mid-year • Professional fees pharmacists registration • Recommending of Schedule 2s by • Immunisation Clinic Sister Community Service Pharmacists • 02/11/2016 – ‘Understanding Professional Indemnity The Director, Mr Black also dealt with a number of Insurance’ by Dr Jessica Wiggill enquiries regarding Community Service. • 09/03/2017 – ‘Handling Grievances at Work’ by Gerald A document regarding Community Service Pharma Jacobs, labour lawyer and consultant to cists was prepared and forwarded to the National Office. the Society This document details the legal process required for the • 06/04/2017 – ‘Accidental Poisoning’ by Linda Curling MOH to amend Regulations in order to enable those • 23/05/2017 – Five SAAHIP Conference Presentations pharmacists who have not been placed in a CSP post, • 20/07/2017 – ‘Antibiotic Stewardship – Who Cares?’ to register and work as pharmacists. It emphasises the by Dr Helen van der Plas right for such pharmacists to practise their profession. • 23/08/2017 – ‘Maternal Depression and Infant Mental Health’ by Dr Anusha Lachman PSSA Website • 19/09/2017 – ‘Vaccines and Cold Chain Management’ A number of the articles first published in My Little Black by Sisanda Mtatambi and Sonia Botha Book of Pharmacy Practice by the Director are available • 23/10/2017– ‘Accidental Poisoning’ by Linda Curling in the Practice Info section on the PSSA website, www. – in George pssa.org.za. Recently all these articles were reviewed and updated in the light of the latest legislative changes. All members who participated in the programmes were issued with certificates of attendance. These were Continuous Professional Development emailed to all attendees after each lecture. The following CPD functions were held: • 01/11/2016 – CPD evening was heldin George for all Communication and Liaison PSSA members: Communication ‘Understanding Professional Indemnity Communication with members was maintained through Insurance’ by Dr Jessica Wiggill The Tincture Press, the PSSA website, faxing/emailing, 15
2017 ANNUAL REPORT ON THE ACTIVITIES OF THE PSSA (CWP) BRANCH continued e-newsletters and broadcast SMSs. Members receive • a Pharmacist’s Oath-taking Ceremony for graduates an electronic version of The Tincture Press, including a and sponsorship of membership of FIP. number of members living overseas. Oath-taking Ceremony Liaison Mrs E Fick assisted in organising a successful • Aadila Patel (immediate Past Chairperson of the Pharmacist’s Oath-Taking Ceremony on 7 April 2017. In Branch) represents the PSSA on the Board of taking the Oath, the graduates were led by Mr Donald Directors of MedicAlert who use our boardroom for Black, Chairperson of the CWP Branch. The Deputy their quarterly Board meetings. Dean (Teaching and Learning), Faculty of Science, Prof • The Director attends the Public Private Health Forum David Holgate addressed the Graduands. The Academy meetings called by the Provincial DoH, all PSSA medals were presented by Dr Kim Ward and the Branch Nat Exco meetings and serves on the Constitution Student Awards by the Chairperson, Mr Donald Black. Sub-committee. The Director represents the PSSA National office at various meetings/events in Cape UWCAPS Town when called upon to do so. The Branch again sponsored UWCAPS to attend the SAPSF Conference. Special Interest Groups The Director has also been involved in assisting the YP School of Pharmacy, University of Western Cape group and the PCDT group. • The Branch continued to work closely with UWC. • Profs Malan, Butler and Dr Kim Ward serve on the Student and Academic Support Branch Committee and Dr Renier Coetzee on the Students SAAHIP committee. Involvement with UWC Pharmacy School included: • The Branch assisted in sponsoring membership of FIP • student loans (CPPSA Student Loan Fund), for the School of Pharmacy • two FPE bursaries, • The Director was invited to address the final year • prizes for deserving students, and students on the topic of professionalism. SA ASSOCIATION OF COMMUNITY PHARMACISTS OF THE PSSA (CWP) BRANCH Introduction Elected Committee members The CWP Branch of SAACP continues to make an Mr KA Johnson Mr J Kariem important contribution to the affairs of the Society. A Mr PJ le Roux Mr HHD van Dyk number of our members play important leadership Immediate Past Chairman Mr J Raats roles in the Society at a National level and in various In attendance Mr GS Black, Director CWP Branch business forums. During the year a number of joint meetings were held Activities with the PSSA (CWP) Branch Committee. This enabled National projects us to arrive at consensus on many issues and to prepare Through our representatives on the National Executive a balanced viewpoint on matters such as legislative of the SAACP and the Director, Mr Black, the Branch changes and motions to Conference. continues to have an influence at a national level. The Branch Director continues to assist the SAACP Director, SAACP (CWP) Branch Committee Mr Jan du Toit, whenever necessary. Chairman Mr DG Black The Director and members of the Committee have Vice-Chairman Mr K Patel given input on a number of matters, including strategic Treasurer Dr N Finkelstein planning and restructuring, Constitution, professional Secretary Mr GG Malan fees, and professional practice. 16
2017 ANNUAL REPORT ON THE ACTIVITIES OF THE PSSA (CWP) BRANCH continued SOUTH AFRICAN ASSOCIATION OF PHARMACISTS IN THE ACADEMY OF INDUSTRY PHARMACEUTICAL SCIENCES Most activities of SAAPI are organised at a National The Academy is represented on the Branch Committee level and take place in Gauteng, which has the by Dr Kim Ward who keeps the Branch well informed largest concentration of SAAPI members. Aadila Patel about the activities of the Academy. The Academy had represents SAAPI on the Branch Committee and keeps their annual conference in 6–9 July 2017. members well informed of all matters affecting the industry. SAAHIP WESTERN CAPE BRANCH SAAHIP (WC) Branch Committee (2016/2017) Presentations: Chairman Colleen Whitelaw There were 15 presentations from the Western Cape: Vice Chair Aleta Wege 1. Renier Coetzee (Podium Presentation)** Treasurer Bhavna Harribhai What if students could be transformational Secretary Carrie de Beer resources for pharmacy practice? Elected Committee members 2. Carrie de Beer (Podium Presentation) Ronel Boshoff Patient care experience student rotation at Kleinvlei Dr Renier Coetzee Community Day Clinic (CDC): A novice preceptor’s Joggie Hattingh reflection Mahmooda Mohamed 3. Renier Coetzee (Podium Presentation)** Mthabisi Ncube International clinical pharmacy rotation at the Dr Paul Voigt University of the Western Cape 4. Mthabisi Ncube (Podium Presentation) Immediate Past Chairperson Mrs Shani Dames A case for pharmacy business process re- engineered at a primary health care centre Sean Honeyborne (Southern Cape representative) 5. Jacqui Jooste (Podium Presentation) In attendance PSSA Director Mr GS Black Systems and experience gained in managing the non-communicable disease load of the Eden The activities of SAAHIP Western Cape were com District, Western Cape Province prehensively reported on in the Chairperson’s Report 6. Nicole Hoffman (Podium Presentation)** which was distributed to all SAAHIP members prior to Medicine use evaluation: Nystatin oral drops their Annual General Meeting. 7. Laurel Legenza (Podium Presentation)** A number of highlights of activities in 2017 include Qualitative assessment of Clostridium difficile the following: infection treatment barriers and facilitators in South Africa SAAHIP Conference 2017 8. Daniel Ekar (Poster Presentation) A full delegation of the Branch attended the 31st SAAHIP Antibiotic stewardship in a level 1 rural setting National Conference held at the Champagne Sports hospital Resort in March 2017, which was most successful. 9. Wendy Wilson (Podium Presentation) Twenty-four delegates, one observer, three guests Medication service delivery for chronic non- and the SAAHIP President attended from the Western communicable diseases: The Albertina Clinic story Cape. from diagnosis through to parcel collection 17
2017 ANNUAL REPORT ON THE ACTIVITIES OF THE PSSA (CWP) BRANCH continued 10. Aleta Wege (Podium Presentation)** Paracetamol poisoning: Rationale use of N-acetylcysteine 11. Jacqui Jooste (Poster Presentation) Applying a ‘4-pillar’ gatekeeping model to drive antimicrobial stewardship by pharmacists at regional and district level hospitals in the Eden District 12. Aleta Wege (Pearl Presentation) Attack! Kill that virus! 13. Carrie de Beer (Pearl Presentation) The Interns group 2017 Breaking the mold 14. Wendy Wilson (Pearl Presentation) Death by prescription! On this occasion, the SAAHIP Chairperson, Aleta Wege 15. Colleen Whitelaw (Pearl Presentation) attended and acted as one of the judges. Perfect packs for pill poppers SAAHIP WC Branch would like to thank PGWC and the PSSA CWP Committee for their continued support **These five presentations were accepted for presenta in this endeavour. tion at the FIP conference in Seoul in September 2017. Social Responsibility Awards The Committee decided to support Leliebloem House • Nicole Hoffman won the prize for the best podium this year by means of donating school stationery, presentation. toiletries and school clothes. The house provides a • Renier Coetzee was co-recipient (with Andy Gray) of home away from home to 60 children from troubled the best academic presentation award. families. These children are in need of specialist care • Western Cape Branch won the Spirit Trophy. and intervention as they experience trauma, abuse and • Keaton Harris and Saajida Momath had won the neglect at home. SAPSF Clinical Skills Competition. Their prize included They collected stationery as well as R1000 at the attendance to SAAHIP Conference. Combined PSSA & SAACP (CWP) Branch AGM. The money will be used to buy additional stationery for The Western Cape Branch was again responsible for the children. R1810 was donated to Leliebloem House organising the 2017 conference. for their Fair and R800 towards their High Tea function. Conference organising committee members Other donations included cakes to the home, knitted Convener Ronel Boshoff beanies, scarves and gloves for children, goody bags for Committee Renier Coetzee, Carrie de Beer, Bhavna their Sports Day and their children’s Christmas party. Harribhai, Joggie Hattingh, Sean Honeyborne, Aleta SAAHIP continues to Support Operation Smile. At Wege, Colleen Whitelaw conference this year R49 500 (enough to pay for nine smiles!) was raised for Operation Smile. On 23 August, A very big thank-you must be said to Gary Black and Western Cape Branch (as conference organisers) Elize Fick for their valuable support. handed over the money to Operation Smile on behalf of SAAHIP National. SAAHIP / PGWC Intern Award The 12th Annual SAAHIP / PGWC Intern Research Award Public Relations and Communication event took place on 8 November 2017. The winning Activities included: presentations were: • Regular communications to members via email, newsletters and Facebook Winner Lee-Anne Andrews, Bishop Lavis Community • Contributions to Tincture Press Health Centre • Communication to non-SAAHIP members to inform 1st Runner-up Zaahid Parker, Lady Michaelis Community them of the benefits of being a member and to Health Centre encourage interest in SAAHIP activities 2nd Runner-up Mawande Golozana, Eerste River Hospital 18
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