Pharmacy in Baghdad
The Pharmaceutical Journal Vol 265 No 7110p273-274
August 19, 2000 Articles
Pharmacy in Baghdad
By S. A. Jafar, PhD, MRPharmS
This article describes a recent visit to Baghdad, where the author, who has family in Iraq, found that despite ongoing difficulties pharmacy practice, including clinical pharmacy, and pharmacy education was thriving
Recently I visited Iraq, mainly for social purposes, but also to acquaint myself with the current pharmaceutical climate in the country. Most of my family is in Iraq, and so a lot of time on my visit was spent catching up with them. However, I did my pharmacy training there, and I was keen also to meet up with past lecturers and colleagues to get an understanding of pharmacy practice, training and education and also the regulatory system in Iraq today.
Iraq shares its border with Iran, Jordan, Kuwait, Saudi Arabia, Syria and Turkey and occupies an area nearly twice that of the United Kingdom. Baghdad, the capital city, has a population of five million, which is nearly a quarter of the whole population of Iraq.
Iraq has the second largest oil reserve in the world. Therefore, it has a great potential to be a wealthy country if its circumstances were to normalise. Two great rivers - the Euphrates and the Tigris - flow through the country, the land between them being known historically as Mesopotamia, the cradle of civilisation. Civilisation originated in Mesopotamia 9,000 years ago, with pharmacy and medicine in the region dating from this time, too.
According to Dr M. Al-Hiti, a local pharmacist, scientist, and historian, the first pharmacy in the world - as we know pharmacy today - was established in Baghdad in 774AD. This was soon after Baghdad was built as the capital of the Abbasid and Islamic empire by Abu-Jafar Al-Mansour. The pharmacy was owned and managed by a pharmacist named Isaac Abu Quraysh, who also worked as the private pharmacist to the Abbasid caliph (the ruler) "Al-Mahdi". The Abbasids established the first public hospital and even then doctors and pharmacists were subject to systematic government inspection.
Abu-Jafar's reign as the second Abbasid caliph lasted more than two decades from 753 to 774 and brought great modernisation and scientific advancement to the land, making Baghdad a great centre for science and knowledge. The Abbasids introduced algebra, chemistry, logarithms, and plain and spherical geometry, and also discovered the zero. They computed accurately the circumference of the earth 600 years before the rest of the world was prepared to admit that it was not flat. Of course, the history of nations goes through turbulent cycles and all too often the past is either forgotten or ignored.
There are three colleges of pharmacy in Iraq and a plan exists to increase the number to five. I visited the largest of the three, the college of pharmacy at the University of Baghdad, from which I graduated in 1972.
There are about 1,540 students at this college - more than double its proper capacity. The main reason for this is the high demand for pharmacists as a result of the introduction of the rotation procedure (see below) after graduation, as well as the fact that there are no longer any restrictions on opening pharmacies.
The duration of the pharmacy course is five years. During the summer holidays at the end of the third and fourth years, students train in community pharmacy. Graduates then spend a compulsory period of over three years serving as resident pharmacists in rotation within the three main branches of pharmacy, which are clinical pharmacy, industry and clinical and drug analysis. This training is a prerequisite for working in community pharmacy.
I was impressed with the standard of education in the college at Baghdad, especially the level of clinical pharmacy. There is a well established department of clinical pharmacy run by academics, almost all of whom hold PhDs from United States or UK universities. The pharmaceutical knowledge of final-year students in Baghdad appears to be as good as that of any final-year pharmacy student in the UK.
United Nations sanctions imposed on Iraq after the Gulf War have severely affected the availability of chemical reagents, glassware and equipment needed by the college's laboratories. This shortage is forcing simple processes, such as titration, to be conducted by 10 students using one pipette and one burette. For the demonstrator, this is visibly frustrating as he or she can only do some experiments in front of 20 students. I could not help contrasting this with the time of my own study at the same college 30 years ago, when every student would carry out an experiment separately and independently.
Moreover, the sanctions have forced some of the academic staff to emigrate, mainly to escape from the high inflation in Iraq. The Iraqi dinar (ID) was equivalent to $3.333 before the sanctions; the current exchange rate is ID2,000 to $1. There is only one computer in the college of pharmacy, which is in the dean's office and used for word processing. No educational institutes in Iraq have internet connections and most students and academic staff have never used the internet, although they do know about it.
Sanctions have severely affected access to information resources, such as books and journals, and scientific communication. There are no up-to-date pharmaceutical publications available and the latest British National Formulary dates from the early 1990s. There is no drug information centre.
Syndicate of Iraqi Pharmacists
All practising pharmacists have to be registered with their governing body, the Syndicate of Iraqi Pharmacists, which was established in 1967 after pharmacists took control of their profession from the ministry of health. All registered pharmacists must hold a university degree from an approved Iraqi college of pharmacy. Registration of overseas pharmacists is subject to approval from the syndicate through an adjudicating committee.
The council of the syndicate consists of eight members, who are elected every year, plus a chairman who is elected by the members of the syndicate and not by the council. In addition, there are three vice-chairmen. The council, through its committees, has a powerful influence on the supervision of pharmacy practice. It also has 14 regional representatives throughout Iraq in a structure that is similar to the Royal Pharmaceutical Society's branch network. The syndicate also issues a journal covering pharmacy activities.
Moreover, the syndicate arranges a successful continuing professional development programme for pharmacists and participation is compulsory. The syndicate is a member of the International Pharmaceutical Federation (FIP) but, sadly, because of the sanctions, it cannot pay the retention fees and members have not been able to attend any recent FIP congresses.
The vice-chairman of the syndicate, Mrs Ilham Al-Jubouri, reassured me that the syndicate was endeavouring to raise the standard of pharmacy premises and practice. She also told me that there is a plan to unify the sign for pharmacy premises to the familiar green cross.
In contrast to the situation in the UK, each pharmacy in Iraq can only be owned by a pharmacist, and a pharmacist can own only one pharmacy. The presence of the pharmacist manager is compulsory as long as the premises are open to the public.
A pharmacist's career can be in education in the medical colleges, in community pharmacy, in a drug store or in one of the scientific offices for drugs (private agencies run by pharmacists which represent foreign drug companies in Iraq). Indeed it is a government requirement that all foreign drug companies marketing their products in Iraq have an Iraqi pharmacist as the manager of the scientific office for drugs.
There are no multiples and no restrictions on opening a pharmacy - even next door to an existing pharmacy. This is because the original geographic restriction of a 50-metre distance from the next pharmacy has been abolished, something which has greatly benefited the public. Any one who is against abolishing the UK restrictions should go to Baghdad and see the huge benefit such deregulation has given to patients.
Availability of medicines
The recent application of the memorandum of understanding (MOU) between the UN and the Iraqi government under the "Oil for food" programme has reduced the shortage of drugs. Many items still become unavailable temporarily, and this is due to complex bureaucratic procedures between the Iraqi government and the sanctions committee of the UN.
All drugs entering Iraq have to go through a complex procedure. Payment for imported drugs is agreed by the sanctions committee and is subject to approval and submission of a credit letter from the Iraqi central bank. Added to this, the poor telecommunications in Iraq since the Gulf War do not help matters.
Every drug from abroad must undergo a thorough and intensive examination, including all the procedures and protocols used during production and manufacturing by the exporting company. Furthermore, the Iraqi licensing authority requires accelerated stability testing to be performed at a temperature higher than the highest temperature set according to the official methods followed in other countries. Drugs have to pass all applicable tests through the protocol of testing imported drugs.
In conclusion . . .
Despite the sanctions, which have crippled almost all activities in Iraq, I found a very good pharmaceutical infrastructure - from education to practice. The Syndicate of Iraqi Pharmacists is developing well and is having a positive influence on the profession. Customers in community pharmacies are happy with having improved access to pharmacies as a result of the deregulation.
I was impressed that new graduates undergo a compulsory year as residents in hospitals, so becoming important members of the health care team. Clinical pharmacy is thriving and the council members of the syndicate are enthusiastic to contribute to the advancement of pharmacy.
Mrs Al-Joubori told me that the syndicate is interested in developing relationships with other pharmaceutical governing bodies, such as our own Royal Pharmaceutical Society. In particular, an initiative such as that in Indonesia1 where an academic department in the UK has contributed to the establishment of a drug information centre would be valuable and would help to take pharmacy out of the political realm.
Dr Jafar is a community pharmacist in Manchester
|1.Tan CK, Aslam M. The development of clinical pharmacy in Indonesia. Pharm J 2000;264:817-9.|
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