Newsletter of the Southern Gauteng Branch of the Pharmaceutical Society of South

Africa and Associated Sectors Edition 6/October 2019

The Golden Mortar 6/2019 1

CONTENT PAGE

PSSA Mini Symposium 1 - 4

SAAPI - What’s Coming 4

It’s Time to Quit Smoking 5 - 7

Wits Pharmacy Student Council Executive 7 - 8

Trinity Health Services Experience 8 - 9

Antibiotic Resistance 10 - 11

Mental Health in the Workplace 12

Insomnia and its Treatment 13 - 16

National Pharmacy Museum 16

Happy Secretary’s Day 17

Glenhove Events Hub 18

ICPA Conference Report 19 - 21

SAACP Activities Report 21 - 22

Pharmacy Month Poster 22

PSSA SG October CPD 23

CONTENT PAGE

SAAHIP Amazing Race 23

Tributes to Max Katz 24

An Introduction to Ethical Theories 25

Success 26

Pharmintercom 26 - 28

New Course from Wits Pharmacy 28

SAAPI Cold Chain 29

National Pharmacy Museum Website 30

National Pharmacy Museum Tour Information 30

Trinity Toiletry Drive 31

SAAHIP Antibiotic Awareness Park Run 32

Professional Indemnity Insurance 32

3rd National Pharmacy Conference 33

PSSA Book Department 34

Mini Symposium Photos 34 - 35

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“A big thank you to the organisers of the PSSA Mini Symposium held on 31 August

2019. It has been such a busy time in the industry with all the changes at SAHPRA

that I really “ummed and aahed” about attending the symposium as weekends

have become precious for vegetating on the couch and watching TV. But then I

reminded myself that the opportunity to interact and learn new things can be just

as rejuvenating as “relaxing at home.” Attending this symposium not only rejuve-

nated me, but it was an inspirational day that really allowed me for that short time

to put all the stress and current negativity aside and reframe my thinking to a more

positive pattern. I found the wide variety of talks and topics and the fact that they

were not directly about pharmacy topics but focused more on subjects we do not

often hear about, very refreshing. A very big thank you for “dragging” me to

Glenhove on that chilly Saturday – I can’t wait for the next one!” Katrin Stülpner

“I would like to congratulate you on a very enjoyable Mini-symposium and your excellent choice of speakers. It was

a pity that no time was allocated to questions – maybe next time? The time just flew by. Thank you once again.”

Regards Linda Crawford

The Golden Mortar 6/2019 2

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It was stunning to be a part of such a

well-organised and thought provoking

industry event which clearly delivered

fantastic value to its members. The

great snacks and delicious coffee also

kept us going!

Candice De Carvalho

Thank you once again. It was

a truly interesting morning.

Thank you for the

slides ...very helpful.

I am Hanaa the Pharmacist from Mauritius.

I am loving all these CPDs. The Mini Symposium was excellent

and very informative.

It was a very interesting topic, it was a glimpse of what we

should gear ourselves up for the future in our career and be on

top of our game. Thank you very much for the time and effort

for organising them. I wish I knew about you guys from the

time I was registered as a community service Pharmacist.

Regards Hanaa with a BPharm from Rhodes University

Mini Symposium Presenters L - R: Hilary Stiss, Candice de Carvalho, Shelley McGee, Judy Coates,

Reinhard Hiller & Mavis Mazhura

Angela Conway

The Golden Mortar 5/2009 3 The Golden Mortar 6/2019

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Fun Quotes from Presenters

“Emotional Intelligence - You are the valuer, the deter-

miner and the meaning maker”

“Emotional intelligence - Train your advisor (self-talk)”

“Sport is an area where gender discrimination

is “acceptable”

“Chat bots are not intended to replace the

personal care but to be a continuum of care

Patients coming in are so far more empowered”

“Biotechnology is changing the world. Agricultural biotechnology is

helping to feed the world. Biofuels are contributing to the reduction

of greenhouse gas emissions. Applications of biotechnology pro-

mote responsible consumption and production. Biotechnology can

contribute to the preservation of marine ecosystems. Biotechnology

plays a critical role in saving lives and improving the quality of life for

people across the globe.”

Mavis Mazhura

Shelley McGee

Candice de Carvalho

Hilary Stiss

Reinhard Hiller

“Driving deep into Personalized / Precision /

Deep Medicine—what is next?”

The Golden Mortar 6/2019 4

…/Mini Symposium continued

“Have more fun… spend

more time with family and

friends … all this improves

one’s intelligence”

Chris Smith The Naked Scientist

To review the full slide decks shared, and to see fun networking photos visit https://glenhove.co.za/gallery/

Words of Thanks Thank you to the members and friends that joined us and made the day a success.

A special thank you to the awesome PSSA SG Staff and amazing Glenhove Events Hub Team that work before

and behind the scenes ensuring all in attendance have an excellent experience in the home of the PSSA SG.

Thank you to all our exhibitors that took time to share their offerings with our members.

We wish to once again thank our sponsors for investing in this year’s symposium.

More Mini Symposium photos on page 34 & 35

The Golden Mortar 5/2009 5 The Golden Mortar 6/2019

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It’s Time to Quit

Don’t let tobacco take your breath away

Introduction

Tobacco smoke is harmful to both smokers and non-smokers. It contains more than 4 000 chemicals, of which

more than 50 are known to cause cancer and at least 250 are known to be hazardous. Cigarette smoking reduces

health in general, harms almost every organ of the body and has been linked to many diseases including cancer,

heart disease and respiratory disorders. Indeed, smoking is a leading cause of premature, preventable death.

“There is no safe level of smoking– smoking even just one cigarette per day over a lifetime can cause smoking-

related cancers and premature death.”

The START approach to quitting

Besides the money saved, there are numerous health benefits associated with quitting, ranging from improvements

in smell, taste, circulation and lung function, a reduction in coughing and shortness of breath to reducing the risk of

dying prematurely from smoking-related diseases such as coronary heart disease (e.g. heart attack), lung disease as

well as cancer.

The first and most important step for a smoker is to decide that he/she wants to quit smoking and then to START.

• Set a quit date (a date to stop smoking completely), ideally within the next two

weeks. Alternatively, a special date e.g. birthday or anniversary may be selected. The number of cigarettes smoked should be reduced prior to the quit date.

• Tell family, friends and co-workers that you are planning to quit smoking and ask

them for their support.

• Anticipate and plan ahead for challenges. Be prepared to deal with episodic cravings

and other nicotine withdrawal symptoms. Avoid situations that may trigger smoking e.g. stressful situations and drinking alcohol or coffee. Consider asking smokers not to smoke in your house, car or at the office.

• Remove cigarettes, lighters and ashtrays from the home, workplace and car on the

night before quit day - “Out of sight, out of mind.”

• Talk to a doctor or pharmacist - smokers are more likely to quit when different ap-

proaches such as changing behaviour and taking medication are combined.

START

Be prepared to deal with cravings and nicotine withdrawal symptoms

Quitting can be challenging. Nicotine is as addictive as cocaine or heroin and in the absence of nicotine, a smoker

develops nicotine withdrawal symptoms and cravings for cigarettes. Although the intensity of withdrawal symptoms

varies from person to person, symptoms are usually stronger in heavier smokers.

Other withdrawal symptoms include, but are not limited to:

• Difficulty sleeping

• Restlessness, irritability, anxiety, frustration or anger

• Difficulty in thinking clearly or concentrating

• Temporary depression

The Golden Mortar 6/2019 6

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Withdrawal symptoms usually peak in the first three days after stopping smoking. Symptoms generally subside over the next three to four weeks. However, a smoker’s cravings for cigarettes may persist for months to years.

Stop-smoking medication may reduce or make withdrawal symptoms more tolerable; for example:

• Nicotine replacement therapies (available in different forms including gum, patches or sprays)

eases withdrawal and reduces the craving for nicotine

• Bupropion* reduces the desire to smoke and

• Varenicline* reduces withdrawal symptoms and cigarette cravings

* (Bupropion and varenicline are available only with a prescription).

In addition, it is important to exercise, follow a healthy diet, drink plenty of water, change habits especially

those associated with smoking, and to remember that any single craving will go away in a few minutes if a per-

son distracts himself/herself by doing something else. Some people also find it helpful to join a support group.

Don’t give up after a relapse

Cravings for cigarettes may be intense and are a common reason for ex-smokers to start smoking again. How-

ever, a relapse should not be viewed as a failure. Smokers should keep on trying, if not successful with the first

attempt.

Reassess – What worked? What did not work? What contributed to the relapse? It is important to understand

why it happened so that the next attempt will be more successful.

In a nutshell:

• It is never too late to quit. Smokers, regardless of their age,

can reduce their risk of developing or dying from smoking-

related illnesses, by quitting.

• People who have already developed tobacco-related health

problems such as coronary heart disease or chronic obstruc-

tive pulmonary disease can still benefit from quitting – A smok-

er who stops smoking after he/she had a heart attack can re-

duce his/her likelihood of having another heart attack by 50%.

Helpful links

• Centers for Disease Control and Prevention (CDC): Quitting smoking: https://www.cdc.gov/

tobacco/data_statistics/fact_sheets/cessation/quitting/index.htm

• The Cancer Association of South Africa (CANSA): How to quit smoking: https://www.cansa.org.za/

how-to-quit-smoking-and-why/

• Western Cape Government: Tobacco and your health: https://www.westerncape.gov.za/general-

publication/tobacco-and-your-health

Bibliography

1. World Health Organization (WHO). Tobacco [Updated 29 May 2019]. Available from: https://www.who.int/

news-room/fact-sheets/detail/tobacco (Accessed 2 July 2019)

2. National Cancer Institute at the National Institute of Health. Harms of cigarette smoking and health bene-

fits of quitting. Available from: https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/

cessation-fact-sheet (Accessed 2 July 2019)

3. CDC Centers for Disease Control and Prevention (CDC). Smoking and tobacco. Health effects of cigarette

smoking. Available from: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/

effects_cig_smoking/index.htm

4. Rigotti NA. Benefits and risks of smoking cessation. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.

https://www.uptodate.com (Accessed 5 July 2019)

5. World Health Organization (WHO). Tobacco Free Initiative (TFI). Fact sheet about health benefits of smok-

ing cessation. Available from: https://www.who.int/tobacco/quitting/benefits/en/ (Accessed 2 July 2019)

6. American cancer association. Benefits of quitting smoking over time. Available from: https://

www.cancer.org/healthy/stay-away-from-tobacco/benefits-of-quitting-smoking-over-time.html (Accessed 5

July 2019)

7. UpToDate (ed). Patient education: Quitting smoking (The basics). Post TW, ed. UpToDate. Waltham, MA:

UpToDate Inc. https://www.uptodate.com (Accessed 2 July 2019)

Copies of the Quit Smoking CPD Chart will be available

The Golden Mortar 5/2009 7 The Golden Mortar 6/2019

…/ Quit Smoking continued

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8. National Council Against Smoking (NCAS). Make a fresh start. Available from: https://www.cansa.org.za/

files/2018/05/NCAS-Quit-Smoking-Guideline-ENG-web-2018.pdf (Accessed 2 July 2019)

9. Rigotti NA. Patient education: Quitting smoking (Beyond the basics). Post TW, ed. UpToDate. Waltham, MA: Up-

ToDate Inc. https://www.uptodate.com (Accessed 2 July 2019)

Wits Pharmacy Student Council (WPSC) Executive Office Bearers

WPSC Chairman 2019/2020

My name is Sthandekile Ncube and I am a 3rd year pharmacy

student at Wits University. I am passionate about serving and

community outreach. I am keen on reaching out to students and

ensuring that their voices are heard. I believe that as the young

generation we have potential to bring about a positive impact to

our communities if we work together. I am proud to be part of

the pharmacy community as it’s a profession that makes a dif-

ference in other peoples’ lives and brings about a positive im-

pact to the society. It is my desire to see the society become a

better place and also to be part of the people who will make it a

better place.

“The will to win, the desire to succeed, the urge to reach your full

potential…these are the keys that will unlock the door to person-

al excellence” ~ Confucius Sthandekile Ncube

WPSC Vice–Chairman 2019/2020

Hi there, my name is Nomsa Molefe, and I am the WPSC Vice-

Chairman for the year 2019/20. I ran for the Student Council as I

strongly believe the future of any profession or country is dependent

on the youth and the ideas that they have. I want to be a part of that

process and assist my fellow colleagues (both young and old) in real-

ising their full potential and have full confidence in the pharmacy

profession.

I chose to study pharmacy as I believe it is one of the most critical

health professions and is highly underestimated in terms of its po-

tential to make a larger health impact. Being once let down by a

pharmacist, I believe all patients deserve the best and that we have

so much more to offer from various aspects and afford care.

I am a hard-working, passionate, fun and caring individual who

strives to do her best always and to be appreciative of the little gifts

handed to me. I also tend to dream big and don’t believe in such a

thing as “the sky is the limit”. I am also vocal about my opinion and

being heard about my concerns or someone else’s concerns. I would

like to see myself as a psychiatric clinical pharmacist and be more

Nomsa Molefe

The Golden Mortar 6/2019 8

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involved in the mental health of patients and to improve the positioning of pharmacy within the mental health

space. Working, prior to applying to Wits, for a company as big as Discovery, and having the opportunity to learn

the business environment, allowed me to see how management works and not only gain work experience; it al-

lowed me to grow as a person and to see what reality looks like and be exposed to people from various back-

grounds. It also exposed me to a work environment and what it entails.

Apart from having so much love for the pharmacy profession, but most importantly our patients, I have various

hobbies and likes that I partake in; these include reading, listening to music, writing poetry and short stories, and

playing video games.

Siviwe Ngalo

WPSC Treasurer 2019/2020

My name is Siviwe Ngalo and I am the Treasurer of the Wits Pharmacy

Student Council (WPSC). I am originally from Port Elizabeth, Eastern Cape,

where I made the decision to become a pharmacist. Since grade 10, I al-

ways saw myself working in the healthcare sector simply because giving

and helping other people came naturally to me. It did help that I was

raised by a mother who is a nurse.

I chose pharmacy as a career because of a few reasons. I have an interest

in business and I like how all the sectors of the profession are business

orientated without discarding the healthcare aspect. I like the diversity

within the profession which allows for many opportunities to grow as an

individual. But most importantly, I like the massive positive impact that the

profession has in so many peoples’ lives especially when working in the

manufacturing sector.

I decided to run for Council because I wanted to improve the lives of my fellow pharmacy students. I believe that

this can be achieved by working closely with students and other individuals who have already established them-

selves within the profession.

The field in pharmacy that interests me the most is the manufacturing sector, specifically the regulatory affairs

field in the sector. Hopefully in the next few years, I will get the opportunity to prove myself within the regulatory

affairs field. Although this is my dream job, starting my own manufacturing pharmaceutical company which be-

comes the next Aspen or Austell would be a dream come true for me.

Chigomezyo Kawonga

WPSC Secretary 2019/2020

My name is Chigomezyo Kawonga. I am the current Secretary of the Wits

Pharmacy Student Council. I am extremely honoured to be serving on

Council in my current capacity. Having this opportunity affords me the

chance to be part of a Council that believes in making a difference in the

lives of the Wits pharmacy students and the pharmacy community at

large. I believe that having a positive impact on the people around you

creates a lasting legacy that inspires even more people to go out into

their world and drive positive change. I am really excited to be playing a

part in what the Council has in store for the 2019/2020 term.

TRINITY HEALTH SERVICES EXPERIENCE

On Thursday 22nd August 2019, we were given an opportunity to serve at Trinity Clinic, were we served food and

donated blankets to underprivileged people.

I was accompanied by Dr. Judy Coates and delegates from BDO and Liberty. As we entered the Trinity Clinic build-

ing, a long queue already began to form where the feeding table was. The queue was filled with a variety of peo-

ple, young and old, male and female.

Virginia Mashike (PSSA)

The Golden Mortar 5/2009 9 The Golden Mortar 6/2019

…/Trinity Experience continued

On that day, I saw that those people are just like all of us, full of dreams, hopes and ambitions. I have learnt that

we people who have shelter and food are blessed and need to appreciate what we have and be thankful.

The environment was charged with love and care. I realise how those people appreciate the little we were giving

them, they were so grateful.

I felt amazed to connect with people who are constantly ignored and neglected by our society.

I pray that God raise more men and women to be involved in fighting and reducing the alarming rate of poverty in

our country.

I have learnt that love is not what you say but what you do.

The Golden Mortar 5/2019 10

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Sumari Davis (Bpharm) Amayeza Information Services

Introduction

Antimicrobial resistance occurs when micro-

organisms such as bacteria, fungi, viruses and para-

sites become resistant to certain antimicrobials used

to treat infections with these micro-organisms. Anti-

microbial resistance, arguably currently represents

the greatest threat to global health, food security and

development. Antibiotic resistance to bacteria occurs

naturally, but misuse of antibiotics in humans and

animals is accelerating the process, resulting in inef-

fective treatment, persistent infection, longer hospital

stays, higher medical costs, an increase in the

spread of resistant infection and increased mortality.

In 2016, 490 000 people developed multi-drug re-

sistant tuberculosis (MDRTB) globally and drug re-

sistance is starting to complicate the fight against

HIV and malaria as well. Klebsiella pneumoniae is a

major cause of hospital-acquired infections such as

pneumonia, bloodstream infections, and infections in

new-borns and intensive-care unit patients. Re-

sistance of this common intestinal bacterium to car-

bapenems (last resort of treatment) has now spread

to all regions of the world and carbapenems are inef-

fective in half of the patients treated for K. pneu-

moniae infections.

Causes of antibiotic resistance

Several factors play a role in the development and

acceleration of global antibiotic resistance and some

of the plausible causes include:

• Excessive and inappropriate use of anti-

biotics in animals (food, pets) and hu-

mans such as:

Incorrect choice of antibiotic

Suboptimal doses

Not observing the optimal dura-

tion of treatment (due to cost or

lack of knowledge)

Use of broad-spectrum instead

of narrow-spectrum antibiotics

Inappropriate use of antibiotics

e.g. for treatment of viral infec-

tions

• Antibiotics sold over-the-counter

• Poor sanitation/hygiene

• Release of non-metabolised antibiotics

or their residues into the environment

through manure/faeces.

• Increased international travel

These factors contribute towards the global emer-

gence of multidrug resistant infections. Global antibi-

otic resistance is reaching a tipping point towards a

post-antibiotic era, where common infections that

were previously easily treated, now require antibiotics

of last resort, or are untreatable. This begs the urgent

question of how to limit these effects and who is re-

sponsible?

Reducing antibiotic resistance

Although antibiotic resistance cannot be stopped,

steps can be taken at all levels of society to reduce

the impact and limit the spread of resistance.

Individuals

Individuals can reduce and prevent the spread of

antibiotic resistance in the following ways:

• Use antibiotics only when prescribed by

a health professional

• Do not demand antibiotics when a

healthcare worker says it is not neces-

sary

• Follow instructions for antibiotic use

properly and complete courses without

skipping doses

• Never share or use leftover antibiotics

for subsequent infections

• Prevent infections by practising good

hygiene measures (washing of hands),

covering the nose and mouth when

sneezing, practising safe sex and avoid-

ing close contact with sick people who

may be contagious

• Maintain adequate ventilation in the

home and working environments

• Prepare food hygienically by keeping

utensils clean, using safe water, sepa-

rating cooked and raw foods, cooking

food thoroughly, keeping food at safe

temperatures and choosing foods that

have been produced without the use of

antibiotics for growth promotion or dis-

ease prevention in healthy animals

• Ensure that vaccinations are up to date

Health professionals

Pharmacists can play a role in reducing antibiotic

The Golden Mortar 5/2009 11 The Golden Mortar 6/2019

…/Antibiotic Resistance continued

resistance in the following ways:

• Prevent infections by maintaining high

standards of hygiene, keeping hands,

equipment and the working environment

clean

• Promote age-appropriate vaccination in

order to prevent infections

• Prescribe and dispense antibiotics when

only they are needed, according to current

guidelines

• Recommend alternative treatment for mi-

nor infections and educate patients on the

inappropriateness of antibiotic treatment

for viral infections

• Report antibiotic resistant infections to

surveillance teams

• Educate patients on the correct use of anti-

biotics, antibiotic resistance and the dan-

gers of antibiotic misuse.

Although media campaigns are more successful in dis-

seminating information, professionals are more suc-

cessful in changing the behaviour of patients by dis-

cussing the risks of antibiotic overuse, and addressing

their concerns around the consequences of the doctor

not prescribing an antibiotic.

Vaccination reduces the need for antibiotics by provid-

ing direct protection from bacterial disease, regardless

of whether the organism is resistant to antimicrobials or

not. Introduction of pneumococcal vaccination in 2009

reduced the incidence of pneumococcal resistance to

penicillin by 82%, ceftriaxone resistance by 85% and

multidrug resistant disease by 84% within a period of 4

years. Vaccination may also reduce the carriage and

colonisation of bacteria to reduce the spread of dis-

ease. Vaccination, especially against influenza, also

reduces the incidence of viral infections and therefore

avoids the indiscriminate use of antibiotics.

Conclusion

The success of modern medicine such as organ trans-

plantation, cancer therapy, management of preterm

babies and advanced major surgeries often depend on

the availability of effective antibiotics for treatment of

infections. If the spread of antibiotic resistance is not

contained through the rational use of antibiotics, we

might encounter the situation where 10 million people

die annually from antibiotic-resistant infections by

2050. This is only preventable if prescribers and public

alike join the international community in change to pre-

serve this precious health resource.

Health care workers may access links to courses and educational material on the

Federation of Infectious Diseases Societies of Southern Africa (fidssa) website at

https://www.fidssa.co.za/SAASP/Edu_Material

Bibliography:

1. World Health Organization Antimicrobial resistance 15 February 2018 available from: https://www.who.int/en/

news-room/fact-sheets/detail/antimicrobial-resistance

2. Goff DA, Kullar R, Goldstein EJ, Gilchrist M, Nathwani D, Cheng AC, et al. A global call from five countries to col-

laborate in antibiotic stewardship: united we succeed, divided we might fail. The Lancet Infectious Diseases.

2017 Feb 1;17(2):e56-63.

3. World Health Organization Antibiotic resistance 5 February 2018. Available from: https://www.who.int/en/news-

room/fact-sheets/detail/antibiotic-resistance

4. Aslam B, Wang W, Arshad MI, Khurshid M, Muzammil S, Rasool MH, et al. Antibiotic resistance: a rundown of a

global crisis. Infection and Drug Resistance. 2018;11:1645-1658

5. Mendelson M. Role of antibiotic stewardship in extending the age of modern medicine. South African Medical

Journal. 2015;105(5):414-9.

6. Meyer HJ, Sibanda M. Appropriate use of antimicrobials: An ongoing and coordinated effort. SA Pharmaceutical

Journal. Jan 2016; 83(9):41-7.

7. Brink AJ, Richards GA. Use of vaccines as a key antimicrobial stewardship strategy. S Afr Med J 2015;105

(5):421.

APOLOGY

In Edition 5 of The Golden Mortar, (page 2)

the Surname of the mother should be Ndoro not Ndlovu.

The Golden Mortar 6/2019 12

The Golden Mortar 5/2009 13 The Golden Mortar 6/2019

…/ continued on page 14

Still awake?

Take this…

An overview of insomnia and its

treatment Nicole Twala

BPharm Student (Wits)

Grant McDonald BPharm Student (Wits)

Introduction

We all have that friend who ‘gets up at the crack of dawn’ or is ‘a night owl’. What is the fuss over sleep anyway?

Well, ‘beauty sleep’ (the notion that enough sleep will keep one young and beautiful) is not such a far-fetched

concept after all. Quality sleep is mandatory for learning and recall, emotional stability, cardiovascular and meta-

bolic processes1. Ultimately, quality sleep improves quality of life (QOL)1. On the opposite spectrum, people with

insomnia suffer from decreased QOL and are more likely to suffer from psychiatric, metabolic and cardiovascular

diseases2.

Insomnia is difficulty in falling asleep, staying asleep or poor-quality sleep that occurs in spite of ample time and

opportunity for sleep. Insomnia may result in the following daytime effects3:

• Fatigue*

• Memory impairment

• Lack of energy

• Low irritability threshold

• Reduced work performance

• Difficulty concentrating

* note that people with insomnia do not suffer from excessive daytime sleepiness (EDS).

Insomnia occurs more frequently in females, the older person, and individuals with other medical and psychiatric

conditions1. There are higher rates of insomnia in individuals experiencing physical and social stressors (e.g.

unemployment, physical disability, divorce)1. Insomnia is often associated with substance use disorder (SUD)1.

Normal sleep has three main components4:

• Quiet sleep - also termed deep sleep and advances from stages 1-4

• Rapid Eye Movement (REM) sleep - dreams occur in this stage; the body is relaxed and eyes move

rapidly due to increased brain activity

• Wake periods - which are brief and last 1 to 2 minutes. People do not usually remember wake peri-

ods unless they last longer due to distractions (excessive noise and light).

In insomnia, there is increased brain arousal, suggested by EEG readings that show brain activity during quiet

sleep3. The Spielman Model of Chronic Insomnia suggests that chronic insomnia results from the interaction

between predisposing (genes, such as the ones implicated in sensitivity to caffeine), precipitating (stressors) and

perpetuating (misconceptions of normal sleep that lead to anxiety and dysfunctional sleep behaviours) factors3 .

Classification of insomnia

Primary insomnia: occurs in the absence of comorbidities.

Secondary insomnia: is a symptom of another condition or SUD.

The Golden Mortar 6/2019 14

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Classification of insomnia

Primary insomnia: occurs in the absence of comorbidities.

Secondary insomnia: is a symptom of another condition or SUD.

Types of insomnia

Acute insomnia: lasts less than 3 months.

Chronic insomnia: lasts for longer than 3 months.

Categories of insomnia according to ICSD-23

The International Classification of Sleep Disorders, 2nd Edition (ICSD-2) is a system used to classify sleep disor-

ders.1

Adjustment Insomnia:

Is either stress-related (exams) or due to environmental factors (temperature extremes, uncomfortable bed).

Insomnia resolves with adaptation or when the stressor is no longer present.

Psychophysiological insomnia: Is when a person with insomnia starts to worry excessively about daytime effects,

developing a vicious cycle of chronic insomnia reinforced by dysfunctional behaviours (daytime naps, clock-

watching).

Paradoxical insomnia:

Extreme sleep deprivation coupled with less severe daytime effects than expected for that degree of sleep depri-

vation or compared to other insomnia subtypes.

Insomnia due to a medical condition:

• Chronic pain states (cancer, arthritis)

• Fibromyalgia

• Chronic Obstructive Pulmonary Disease (emphysema)

• Chronic Fatigue Syndrome

• Neurological disorders (Parkinson’s disease)

Insomnia due to mental disorders:

• Depression

• Schizophrenia

• Bipolar mood disorder

• Generalised anxiety disorder

Insomnia due to drugs or SUD (Substance Use Disorder):

Is associated with the use of depressants (alcohol), stimulants (caffeine, cocaine) and medication

(corticosteroids, beta-blockers)

Unspecified insomnia:

Is not associated with any known pathology or substance use, does not fit into other subtypes.

Insomnia due to inadequate sleep hygiene:

Is characterised by poor sleep habits such as:

• Irregular sleep schedule

• Regular use of alcohol and caffeine before bed

• Mental activity, exercise and engaging in activities that cause emotional turbulence before bed

• Using the bed for other activities other than sleep (watching television, studying, thinking, planning)

• Inability to maintain an environment conducive for sleep

Idiopathic insomnia:

Persistent insomnia with a slow onset in childhood or infancy and with no precipitating or identifiable cause.

Behavioural insomnia of childhood:

Where the child refuses to sleep, has difficulty maintaining and initiating sleep or falling asleep. Causes of in-

somnia in children include enuresis, nightmares and fear of the dark2

Primary sleep disorders causing insomnia:

• Restless leg syndrome

• Obstructive sleep apnoea

The Golden Mortar 5/2009 15 The Golden Mortar 6/2019

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Questions the pharmacist assistant should ask

At what time do you go to bed and wake up in the morning?

How do you function during the day?

Is there anything in your environment keeping you from falling asleep?

Is there a body experience that keeps you from falling asleep?

Is there a life event that occurred at the same time as your sleeping problem?

What do you do before bed?

Non-pharmacological treatment

• Cognitive Behavioural Therapy (CBT) aims to eliminate perpetuating factors and is recommended for

treating chronic insomnia1. Components of CBT include1:

• Sleep hygiene education

• Cognitive therapy - eliminates negative thoughts associated with sleep and alleviates the anxiety associ-

ated with chronic insomnia

• Relaxation therapy - includes step-wise relaxation techniques that target each muscle group until the

whole body is relaxed

• Sleep restriction therapy - ensures that maximum time in bed is spent on sleeping

Good Sleep Hygiene Habits3

Regulate your sleep habits. Schedule bedtime and sleep duration

Avoid catching up on sleep in the morning

Avoid daytime naps

Do not read, write, study, watch television or eat in bed

Avoid coffee after lunch, alcohol within 6 hours of bedtime and nicotine before bed

Do not go to bed hungry or eat a big meal within four hours of going to bed

Relax before bedtime and have a bedtime routine (change into nightwear, listen to relaxing music)

Avoid exercise within four hours of bedtime

Keep the bedroom dark, quiet and at a regulated temperature

If you are unable to sleep within 30 minutes of getting into bed, get up and do something relaxing until you feel

sleepy. Avoid activities that increase anxiety like clock-watching

OTC Pharmacological treatment5

Drug Dosage Side Effects

Diphenhydramine (Sleepeze®, Betasleep®)

25-50 mg at night Anticholinergic side effects that

include dry mouth, urinary reten-tion, constipation, tachycardia, diz-

ziness and drowsiness Doxylamine (Somnil®) 25-50 mg at night

Conclusion

Sleep is important for memory, learning, emotional stability and physiological processes. People with insomnia suffer

from decreased QOL. Insomnia can be acute or chronic and can occur in the absence of or concurrently with another

condition. Insomnia develops from hyperarousal of the brain during deep sleep and is the result of the interaction

between genetic, precipitating and perpetuating factors.

• Circadian rhythm disorders (shift-work sleep disorder)

Treatment of insomnia

The table below lists questions that the pharmacist can ask the patient with insomnia in order to evaluate a person’s

sleep habits and need for counselling or referral to a doctor. The elderly and children who present with insomnia

should be referred. People with secondary insomnia should be referred for a physical assessment before the insom-

nia is treated.2

The Golden Mortar 6/2019 16

…/Insomnia continued

Risk factors to insomnia include chronic pain, SUD, sleep apnoea and poor sleep hygiene. Good sleep hygiene is

a means to prevent insomnia. A good sleep history must be obtained to evaluate the type and classification of

insomnia and to establish whether counselling or referral is necessary. CBT is a non-pharmacological interven-

tion. OTC medications are centred around sedative antihistamines.

References

1. Chigome A, Meyer J, Nhira S. An overview of insomnia and its management. South African Pharmacy Jour-

nal. 2018; 85(2):32-38.

2. Selwood L. Insomnia. South African Pharmacy Journal. 2014; 81(9):24-26.

3. Chawla J. Insomnia: Practice Essentials, Background, Anatomy [Internet].

4. Emedicine.medscape.com. 2019 [cited 7 May 2019]. Available from: https://emedicine.medscape.com/

article/1187829-overview

5. Knott L. Insomnia [Internet]. Patient.info. 2019 [cited 4 May 2019]. Available from: https://patient.info/

mental-health/insomnia-poor-sleep

6. South African Medicines Formulary, 12th edition

NATIONAL PHARMACY MUSEUM

The Golden Mortar 5/2009 17 The Golden Mortar 6/2019

Happy Secretary’s Day!

4 September 2019

The PSSA SG Office wishes to honour and thank the lovely ladies that support

behind the scenes on a daily basis. We appreciate all you do.

Cecile Ramonyane PSSA SG Branch Secretary

Virginia Mashike Glenhove Events Hub Reception & Museum

Secretary

Alison Blackhurst SAAPI Office Administrator

The Golden Mortar 6/2019 18

Home of the SA National Pharmacy Museum

The Golden Mortar 5/2009 19 The Golden Mortar 6/2019

…/ continued on page 20

A COMMUNITY PHARMACY PERSPECTIVE

I attended the recent ICPA Conference held on the 17th

and 18th of August at EMPERORS PALACE. I found the

conference very informative and in addressing various

relevant issues faced by community pharmacists as

well as CPD and marketing and information systems to

be beneficial to the community pharmacy.

The highlight of the conference and the AGM was the

attendance of the newly appointed Minister of Health,

Dr. Zwelini Mkhize who was appointed on the 29th of

May 2019. The Minister did a presentation of the im-

plementation of the NHI and urged the meeting and the

profession to support the NHI: ‘Friends of NHI’. The

Minister was very supportive of the pharmacists and

community pharmacy’s role in the delivery of the NHI.

The Minister returned the next day to endorse a joint

media release which was compiled at the AGM and

released to the media reflecting the support to Univer-

sal Health Coverage and the availability of the 1200

ICPA pharmacies, 3000 pharmacists and twenty thou-

sand support personnel to NHI, with their primary

health clinics. ICPA will form an NHI Committee chaired

by NHI Committee Director Mogologolo Pasha.

The Minister highlighted the following:

• He paid a tribute to women in pharmacy;

• Made the statement that the implementa-

tion of the Bill on NHI was the biggest

change since the new democracy;

• That the implementation of the NHI is con-

stitutionally sound, based on the constitu-

tional right of all the people in South Afri-

ca; and

• The establishment of the NHI fund.

The Chairman of the ICPA Board, Mr. Sham Moodley,

addressed the following:

• Ownership (Clicks Unicorn matter);

• The recognition of pharmacy;

• Advancing technology; and

• Access to patients’ records.

The CEO’s report highlighted the following important

issues and relevant information:

The licensing of pharmacy premises.

ICPA have also identified the collusion between land-

lord and corporates to oust independent pharmacies

and to cancel their leases. The Helen Suzman Founda-

tion also identified this activity and suggested in their

report that this matter be addressed.

The NDoH (National Department of Healthhave agreed

to publish all license applications on their web-site and

then allow comment for pharmacy owners affected and

to lodge objections to the new licenses being granted.

New licensing guidelines based on need, will be pub-

lished before the end of the year.

Clicks unicorn vertical integration matter

Reported on the progress with the Clicks Unicorn mat-

ter: The ownership of pharmaceutical manufacturing

companies by retail pharmacy and the benefits corpo-

rate pharmacy derives from full vertical integration...

Regulation 6 of the Pharmacy Act specifically prohibits

manufacturers of medicine to have a direct or indirect

interest in retail pharmacy.

The case lodged with the Appeals Committee was lost

as well as the subsequent appeal, and notwithstanding,

the ICPA is still challenging the outcome. ICPA has now

taken the Appeals Committee decision on review to the

High Court and they have asked and received R1 mil-

lion rand from the Community Pharmacy Legal Trust

[CPLT] for funding.

ICPA will continue opposing and challenging perverse

vertically integrated and anti-competitive business

models that directly threaten patient health and profes-

sional autonomy.

Targeted discrimination and profiling of black profes-

sional pharmacists and pharmacies on racial and eth-

nic criteria.

The CMS (Council for Medical Schemes) invited stake-

holders to provide comments on the Fraud, Waste and

Abuse Charter as well as the unfair and abusive treat-

ment by medical schemes and administrators. In this

regard CMS established a Section 59 investigation of

unfair treatment of healthcare professionals and the

withholding of claim payments based on race and eth-

nicity. ICPA submitted a detailed report on the blatant

profiling of independent pharmacy owners within the

ICPA member base.

Section 59 of the Medical Schemes Act addressed by

ICPA to expose the unfair treatment and investigation

of fraud into outlying pharmacy profiles resulting in sus-

pension of medical scheme claim payments. Bias by

medical scheme Medscheme demanding purchase

invoices specifically targeting black owned pharmacies.

Forcing an acknowledgement of debt to be signed be-

fore the matter is fully investigated in a formal manner,

and disallowing pharmacists the right to the ‘Audi al-

teram partem rule’: no person should be judged without

a fair hearing and each party be given an opportunity to

respond to the evidence against them.

Gary Kohn

The Golden Mortar 6/2019 20

…/ ICPA continued

…/ continued on page 21

ICPA has also lodged an appeal with the CMS com-

plaining about the continued victimisation by

schemes of independent pharmacists labeling them

as fraudsters without any convictions and CMS sup-

porting the interest of schemes and not protecting the

rights of the scheme beneficiaries.

Chronic medicine supply and specific NAPPI

code dispensing

Schemes also insist that chronic medicines be sup-

plied by courier pharmacies. NAPPI-specific formular-

ies determined medicine doctors must prescribe and

pharmacists dispense. Profits from house brands and

staff appraisals dictate generic substitute choices

rather than patient preference and value.

‘Allegations of serious maladministration, improper

and unlawful conduct of CMS employees and officials

and conduct of CMS employees/officials and conduct

that could be interpreted as corrupt and could cause

serious harm to the interest of the public’ was raised.

Reacting to the above serious matter on the 5th of

July 2019, President Ramaphosa announced in a

Government gazette that CMS is under investiga-

tion by SIU (Special Investigating Unit) to address the

above. Notwithstanding the declaration by the Com-

petition Commission that the penalty co-payment by

medical schemes on non-DSP [Designated Service

Provider] is an undesirable business practice.

The amended Medical Schemes Act specifically ad-

dresses the penalty co-payment but the legislation

has not been implemented and non-DSP providers

are still being charged.

ICPA is still attempting to have the practice of closed

DSPs enforcing penalty co-payments declared an un-

desirable business practice. The last communication

from the CMS indicated that they have decided not to

make a decision regarding DSPs.

The proposed Medical Schemes Amendment has

banned DSPs and co-payments but has not been

promulgated.

The pharmacist’s involvement with PreP (Pre-

Exposure Prophylaxis), PEP (Post-Exposure Prophylax-

is) and pharmacist-initiated management of ART.

ICPA together with the HIV Clinicians Society [SAHCS]

has awarded funding of short courses on HIV treat-

ment protocols including PEP, and Pharmacist initiat-

ed HIV/ART treatment offer Family Planning and treat

syndromic STI’s.

Expanding the pharmacist’s scope of practice such as

PCDT will always require additional training and a

section 22A [15] permit from NDPoH and registration

with SAPC.

Update on regulations by Vincent Tlala, the Chief Op-

erating Officer from SAPC:

CPD will now become a requirement for tutors, RPs

and registered pharmacists as published on the 17th

of May.

The SAPC registered RPs must always be present in

the relevant pharmacy and cannot register as a dis-

tant or not present RP. Fronting as a RP and non-

adherence can result in a 2-year suspension and a

fine of R25 000.

New inspection assessment for regular self-

assessment of the pharmacy by the RP will be availa-

ble in OCT/NOV 2019. Compliance will be weighed

per section. Each requirement will now be backed up

by the relevant clause in the Act and the regula-

tions. Non-compliance can result in schedule C sta-

tus. Only 5% of pharmacies inspected attain sched-

ule C status.

The following can result in a pharmacy attaining a C

status:

• RP not active and present in the specific

pharmacy;

• Fridge does not comply;

• Schedule 6 must be stored in the correct

manner and be balanced every three

months: March, June, September and

December; and

• Pharmacist is not present in the pharma-

cy.

RPs, tutors and pharmacists will then have to make a

declaration of training completed or attended during

the year.

Things to avoid that could get you C-status during an

inspection:

• Pharmacist is not present in the pharma-

cy;

• Selling counterfeit medicine or having

counterfeit medicines in stock;

• Trading without a valid licence;

• Moving the pharmacy premises without

complying with the necessary require-

ments; and

• Not using the registered name of the

pharmacy.

“Chronic pain and the Opioid dilemma” presented by

Dr. Shaquir Salduker:

He explained the negative feedback loop of tolerance,

reduced effect of the body's own endorphins, the re-

duction of the pain threshold, and the danger of res-

piratory depression. He also highlighted the Serotonin

Syndrome that may include the following symptoms:

Confusion, disorientation, irritability, anxiety, muscle

spasms, muscle rigidity, tremors, shivering, diarrhoea,

rapid heartbeat or tachycardia, high blood pressure,

nausea, hallucinations, overactive reflexes, or hyper-

reflexia and dilated pupils.

In more severe cases the symptoms may include:

Unresponsiveness, coma, seizures and irregular

heartbeat.

He reported that a panel of ten psychiatrists had

The Golden Mortar 5/2009 21 The Golden Mortar 6/2019

…/ ICPA continued

…/continued on page 22

drawn up a document that will be made available on

the Opioid dilemma. As pharmacists we are very aware

of prescription Codeine addiction as well as the dra-

matic increased addiction of the OTC pain and cough

medicines containing Codeine. There has definitely

been an increase in the unauthorised and false de-

mand, escalating into aggressive and threatening de-

mands.

We as pharmacists cannot in any way allow excessive

selling of these medicines to support a habit which is

detrimental to the patient’s health and supports their

addiction, and in conflict with our role in the control and

ethical supply of medicine. Purchases and recorded or

not recorded sales of these products will be matched

and investigated by Pharmacy Council on the receipt of

a complaint.

The control and restriction of the maximum of forty tab-

lets and one hundred millilitres should be adhered to

and not exceeded per patient supply and sale, not even

on demand or request by the patient for additional sup-

ply.

Sales and supplies of these scheduled medicines

should be done in the dispensary by the pharmacist or

authorised personnel and must be properly recorded by

taking the patient's address and recording their identity

number. Unqualified and unauthorised personnel

should not be used in the sales transaction.

We are all collectively responsible for the sale of Co-

deine-containing medicines whether on prescription or

sold over the counter.

The Codeine Care Program was a positive endeavour to

control and record national sales, so that pharmacists

could access patient sales and possible abuse.

Adcock Ingram HA Codeine Academy has an infor-

mation drive that has four goals

To educate the consumer about codeine, to under-

stand the pharmacokinetics, pharmacodynamics,

dosages, use, and combinations.

To understand the impact of the current codeine

‘crisis’ and how to identify people at risk.

To take responsibility of this which is affordable

and is helping so many people in acute and chronic

pain who cannot afford anything else.

To come up with possible solutions to manage this

problem. This includes initiatives like Codeine Care

project and much more.

Important comment:

Codeine is a narcotic drug under international control on the Yellow List by the International Narcotics Control Board

of which South Africa is a member.

Control is exercised over 130 narcotic drugs , mainly natural products, such as opium and its derivatives, morphine,

codeine and heroin, but also synthetic drugs, such as methadone and pethidine, as well as cannabis and coca leaf.

Parties to the 1961 Convention undertake to limit the production, manufacture, export, import, distribution and

stocks of, trade in, and use and possession of the controlled drugs so that they are used exclusively for medical and

scientific purposes. The production and distribution of controlled substances must be licensed and supervised, and

Governments must provide estimates and statistical returns to INCB on the forms supplied for that purpose , on the

quantities of drugs required, manufactured and utilized and the quantities seized by police and customs officers.

The control system established under the 1961 Convention functions well, and the system of estimates first intro-

duced by the 1931 Convention is considered to be the key to that success. The system of estimates covers all

States, regardless of whether or not they are parties to the 1961 Convention. Each year, INCB publishes in a tech-

nical publication information about the licit movement of the internationally controlled narcotic drugs.

References: The above report contains information extracted from the ICPA conference brochure and the presentations, as well as my

interpretation and input

SAACP SG ACTIVITIES REPORT – GM/2019

The Southern Gauteng Branch of the SA Association of Community Pharmacists (SAACP SG) Commit-

tee reports the following recent activities :-

The PSSA SG Branch Mini Symposium, held on 31st August at the Glenhove Events Hub (GEH), was

attended by Frans Landman (Chairman) and Gary Kohn, and found it very informative, with interesting

topics and presenters, and well organised.

Thanks and appreciation are expressed to the PSSA SG Branch for arranging this event, as well as to

the sponsors.

Dave Sieff

The Golden Mortar 6/2019 22

…/SAACP SG Activities continued

At a recent SG Branch monthly meeting, it was decided to sponsor 7 Branch Committee members, as well as 2

Pharmacy students/Interns – as part of a mentorship programme – to attend the SA Pharmacy Council Confer-

ence, from 3rd to 5th October, with wide a choice of many presentations and workshops.

Plans are in place for a Sector Workshop/CPD session to take place on Tuesday 29th October, at the PSSA GEH,

where Ms Luyanda Lokwe, from the Health and Welfare SETA, will make a presentation on “Funding for Work-

Based Learning, and Additional Funding for Pharmacy Personnel.”

This promises to be of interest to Pharmacists in all Sectors, who are invited to attend.

A successful SARCDA “XMAS” Trade Exhibition was held from 22nd to 25th August at the Gallagher Estate Conven-

tion Centre, attended by many trade buyers, both local and from abroad.

The 6-weekly meetings of the Editorial Board of The Golden Mortar - Newsletter of the PSSA SG and associated

Sectors - are attended by the SAACP SG representative, Gary Kohn, planning of future issues takes place, and he

also regularly contributes articles and reports.

The Golden Mortar 5/2009 23 The Golden Mortar 6/2019

The Golden Mortar 6/2019 24

I recently received the sad news of the passing of a stalwart of Pharmacy in South Africa, Max Katz.

For those who remember Max, and for the readers of The Golden Mortar, I would like to recall his sterling service

to the profession, having served on many Pharmacy Committees, at local and national levels, being voted Branch

Chairman and National President, respectively.

He was also awarded Honorary Life Membership of these organisations, and his name appears on all the Hon-

ours Boards in the SA Association of Community Pharmacists, Southern Gauteng (SAACP SG) Branch boardroom,

as does his Presidential photo.

Max is probably best remembered for his initiative, together with a few colleagues, of creating the SAPDC Phar-

macy Trade Show, as it was initially known, and was later taken over by the SA Retail Chemists' and Druggists

Association, which expanded it into the current, very successful, SARCDA Trade Exhibitions, a division of the

SAACP SG Branch.

He will also be remembered, particularly by his Committee colleagues, as a gentle man, in the true sense of the

description; he was an erudite and knowledgeable speaker, and a clear thinker, which helped to clarify many

discussions and debates, and important decisions.

Those who knew and respected Max will share our sincere condolences to his wife Shel and their family in Aus-

tralia.

Dave Sieff

For the SAACP SG Branch Committee

TRIBUTES

TO

MAX KATZ

Max Katz sadly passed away recently in Sydney, Australia.

Max was a colleague devoted to his fellow pharmacists, specially those in retail/community pharmacy.

He was an Honorary Life Member of both the National Committee and Southern Transvaal (Gauteng) Committee

of SAARP/ Community Pharmacists Association, having served many terms as Branch Chairman and as National

President. He also served for some years on the S.Tvl Branch Committee of the PSSA.

He was Chairman of the Board of Directors of SAPDC Ltd. for many years, until its sale to Premier Milling.

Max was a very avid squash player, and this took precedence, before all his other activities outside of running

McCauley’s Pharmacy in Jules Street, Malvern.

Max retired to Sydney, to be with his children and grandchildren.

We extend our sincerest condolences to his wife, Shel, and his two daughters and son, and all their family, on the

loss of dear Max.

Bernard Lapidus

Toronto,Canada

The Golden Mortar 5/2009 25 The Golden Mortar 6/2019

Welcome to a new series on medical ethics, that will be presented over five is-

sues of the Golden Mortar! Together, the series will deliver an introduction to

medical ethics - a foundation that will serve you in your future reading. The four

bioethical principles that will be covered in the future include:

i. Respect for Autonomy,

ii. Non-maleficence,

iii. Beneficence, and

iv. Justice.

You are challenged by a moral dilemma. After some deliberation, you choose a

particular course of action, which you must now explain. You are required to ar-

gue for your decision and describe how you arrived at your conclusion.

The skills and knowledge that will help you with that process - the philosophical

deliberation and the construction of a sound, logical argument for a position - are

what you learn when you study normative ethics. A worthwhile endeavour, partic-

ularly when it comes to the noble professions of healthcare.

Ethics is the study of what is good, right or moral. Medical ethics is a sub-branch

of ethics called ‘applied ethics’. However, before we can apply ethical theories to

medicine (as we shall be doing in future articles), let us first understand the theo-

ries we shall be applying!

Theory 1: Utilitarian Ethics (Teleological)

The principle of utility states that actions are right in so far as they promote happi-

ness or pleasure. It is thus consequence, outcomes oriented.

Among others, there are three key thinkers who contribute to this theory: Epicu-

rus, Jeremy Bentham, and John Stuart Mill.

“Do no harm”: John Stuart Mill (1806 - 1873) built on the principle of utility as

well as the harm principle which states that “the only purpose for which power

can be rightfully exercised over any member of a civilised community, against his

will, is to prevent harm to others.” Other than this, he argued that one should

never interfere with another person’s liberty.

Theory 2: Acts and rules-based Ethics (Deontological)

Immanuel Kant (1724 - 1804) was a key thinker here and ideas that are central

to his thesis are “respect for persons” and “human dignity”. He saw that rational

human beings’ capacity to act autonomously is the basis for strict moral duties.

Deontology (the study of duty) is focussed on the motivation of the actor and not

on the outcomes of the actions.

One of the most important arguments made by Kant is that one should “act in

such a way that you treat humanity, whether in your own person or in the person

of any other, never merely as a means to an end, but always at the same time as

an end”. This is referred to as the second formula of Kant’s Categorical Impera-

tive.

Theory 3: Character Ethics: (Virtue-Based)

Teleological and deontological thinking may seem attractive due to their formulaic

nature but they neglects a subtle aspect of morals that includes a person’s own

character. This emphasises the person who is doing the acting, referred to in

ethics as the ‘moral agent’.

In character ethics, you examine the virtues of the person who acted. Is the per-

son generous, compassionate, fair, etc? This person would be praised as a moral

model.

In logical argumentation, which of these three theories appeals to you the most?

Do you focus on calculating the maximum benefit for the most number of people?

Are you strongly influenced by rational duties? Or do you focus on the goodness of

the person more than their ultimate actions? How would you argue your case?

HOW TO ARGUE FOR YOUR CHOICES:

An introduction to ethical theories

Candice De Carvalho MSc (Med) Human Genetics

MSc (Med) Bioethics and Health Law

The Golden Mortar 6/2019 26

…/ continued on page 27

SUCCESS

Dr Sybil Seoka - Chairman of PPS Board and first woman President of the PSSA, often refers to the Zulu proverb,

“Only the one that hunts catches”.

This proverb highlights the fact that women should level themselves on the playing field of life by not being afraid

to put themselves out there. Universal characteristics define success, diligence and ingenuity, determination and

vision - not gender.

INTERNATIONAL LIAISON:

PHARMINTERCOM, 18 – 22 AUGUST 2019

Pharmintercom consists of the Presidents and Executive Officers of the Community Pharmacy Associations of the

seven English-speaking countries namely, Australia, UK, USA, Canada, Ireland, New Zealand, and South Africa.

The Pharmintercom event takes place annually and this year (2019) it was the honour and privilege of the South

African Association of Community Pharmacists (SAACP), to host Pharmintercom in South Africa. The event took

place at the Shepherd’s Tree Game Lodge (Northwest Province) from 18 – 22 August 2019.

As can be seen from the photo included, the event was well attended. These participants are the decision-

makers in their various countries on matters relating to community pharmacy practice, remuneration models,

how to approach the implementation of new services and also to maintain services indispensable to the viability

of community pharmacy.

The business agenda for the event therefore included, a variety of old and new matters important to community

pharmacy and of course specifically for community pharmacy in South Africa which is on the brink of the imple-

mentation of a National Health Insurance financing system (or “one-payer” system). The remuneration models in

place in most of the countries represented are “one-payer systems”, such as the 6th Community Pharmacy Agree-

ment for community pharmacists in Australia and the current new five-year Community Pharmacy Contractual

Framework negotiated between the Pharmaceutical Services Negotiating Committee (PSNC), NHS England and

the Department of Health and Social Care (DH) in the UK

The full business agenda stretching over three days is available on request. The following very informative

presentations added further value to the event:

• Reducing health inequity – distribution of pharmacies in RSA (Prof M Lubbe, NWU);

• Training & scope of practice of pharmacy support personnel in RSA (Mrs C Venter, IPP);

• Development of Good Pharmacy Practice Standards (Mrs M Mokoena, SAPC); and

• Grading of pharmacies as a mechanism to improve compliance with GPP (Mr V Tlala, SAPC)

The Golden Mortar 5/2009 27 The Golden Mortar 6/2019

…/Pharmintercom continued

…/ continued on page 28

Participants: Front row (left to right): Mr D Connolly (President, Irish Pharmacy Union); Mrs C Hrudka (Chair, Cana-dian Pharmacists Association); Mr T Rabali (President, South African Association of Community Pharma-cists); Mrs C Venter (IPP, South African Association of Community Pharmacists); Mr J du Toit (Executive Director, South African Association of Community Pharmacists); Mr E Hanly (Vice-President, Irish Phar-macy Union) Back row (left to right): Mr H Chancy (Treasurer, National Community Pharmacists Association, USA);

Mr B Osborn (President, National Community Pharmacists Association, USA); Mr G Doucet (Chief Exec-utive Officer, Canadian Pharmacists Association); Mr D Hoey (Chief Executive Officer, National Commu-

nity Pharmacists Association, USA); Mr A Lane (Vice Chairman, National Pharmacy Association, UK); Mr M Lyonette (Chief Executive Officer, National Pharmacy Association, UK); Mr D O’Loughlin

(Secretary General, Irish Pharmacy Union); Mr A Gaudin (Chief Executive Officer, Pharmacy Guild of New Zealand); Mr T Twomey (Vice-President, Pharmacy Guild of Australia); Mr M Dent (Director of

Funding, PSNC, UK); Mr B Caswell (Incoming President, National Community Pharmacists Association, USA); Mr C Monteith (President, Pharmacy Guild of New Zealand); Mr G Tambassis (President, Pharma-cy Guild of Australia)

Much was also learnt from the implementation of the full scope of practice of pharmacists in Canada to the success-

es of the Pharmacy Guild of Australia in negotiating for the implementation and remuneration of new services in the

best interest of the public. However, what was evident is that none of the agreements reached and contracts negoti-

ated in these countries for community pharmacy was achieved overnight. Many years of negotiations with govern-

ments (as one-payer systems) were required to achieve what has been achieved to date. Of the utmost importance,

and highlighted again at Pharmintercom 2019, was the need for well-documented evidence on the added value of

community pharmacy to healthcare delivery. In most cases such evidence was a result of initiatives and resources

invested by the Community Pharmacy Associations in the future of their members.

The same would apply to how these countries dealt with the challenges such as the misuse /abuse of codeine con-

taining products, and/or sale of substances with abuse / misuse potential. It was emphasised that improved control

would only be achieved with real time monitoring of the use of these substances. Without such monitoring, it would

not be possible to implement workable mechanism and measure improvements.

The Golden Mortar 6/2019 28

…/ Pharmaintercom continued

We must take note and learn from their experiences and the information gathered will be used during discus-

sions regarding the way forward with this challenge in South Africa.

We also learnt that a Fee For Service was the most preferred method for remuneration of community pharmacy

in most of these countries. A “hybrid” system involving capitation is under investigation in New Zealand. We were

warned / advised to tread carefully with a capitation model for the remuneration of community pharmacy in

South Africa as part of NHI as it could result in the closure of many smaller (independently) owned community

pharmacies.

Amongst the emerging pharmacy practice matters discussed were the following:

• Is community pharmacy more than just dispensing;

• Negotiating for remuneration of (new) services – lessons learnt

• Electronic data capture systems / developments applicable to community pharmacy

• Promoting community pharmacy services to the public & payers

Of course, it was not all “work and no play” and our overseas guests were treated to the best that the Pilan-

esberg Game Reserve could offer. This contributed tremendously to a very successful Pharmintercom 2019

event.

Congratulatory messages, and expressions of gratitude and praise for a well organised Conference, were sent by

all the delegate teams representing their countries, with special mention of Jan du Toit, Tshif Rabali, and Chris-

tine Christensen, while the stay at the Shepherd’s Tree Game Lodge and the outing to the Pilanesberg Game

Reserve received special mention, with some even planning to return soon to the same Lodge and repeat their

game drives.

The next Pharmintercom event will be held in Killarney, Ireland, next year (2020)

Jan du Toit: Executive Director,

SA Association of Community Pharmacists

NEW COURSE FROM WITS PHARMACY

Introduction to Oncology Admixing

Oncology pharmacy is a growing field in the practice of pharmacy in South Africa. The skills and techniques re-

quired to perform basic oncology sterile admixing manipulations are crucial to the preparation of oncology chem-

otherapy. Quality assurance at every step is a prerequisite to delivering a safe product.

Wits Pharmacy is excited to introduce a new short course, An Introduc-

tion to Oncology Admixing. Our objective is to expose participants to the

basic theoretical and practical aspects of preparing sterile oncology

chemotherapy products for intravenous use. This includes developing a

basic understanding of the safe preparation of sterile products and

aseptic technique, working with biological safety cabinets, performing

basic manipulations and calculations, managing the safe disposal of

hazardous waste, and quality assurance.

The course is held over two days at Wits University Faculty of Health Sci-

ences campus. The first day covers theoretical aspects, and the second

day involves practical exposure to techniques. The course

costs R6000.00 per delegate. For more information and for

registration please visit the Wits Enterprise website: https://

wits-enterprise.co.za/c/introduction-to-oncology-admixture or

contact razeeya.khan@wits.ac.za.

The Golden Mortar 5/2009 29 The Golden Mortar 6/2019

Global health care industry is changing due to the manufacturing of more complex modern drugs i.e biologics and

specialty use drugs. The pharmaceutical cold chain market has been evolving and growing significantly in the past

few years and more growth can be anticipated in the future because of the new innovative product launches. In the

words of Sarantis ‘The result is, Smarter drugs = Smarter supply chain’.

As a pharmacist in Quality Assurance, our mandate is to ensure and assure that the products we distribute in the

market meet and exceed the quality standards and expectations set by the guidelines and the Regulations. This is

accomplished by ensuring the implementation of effective relevant processes of vouching for integrity of pharmaceu-

tical products to meet the standard for the proposed use. As much as the guidelines are being updated to becoming

clearer, the regulations are becoming stringent as well. In order to keep up with the continuous improvement, there

is need for collaborating with subject matter experts for better understanding.

The SAAPI workshop offered by Sarantis, from Strategnos, on Validation and Qualification in GDP/ GWP Environ-

ments, on the 3rd of July 2019, highlighted crucial and critical developments in the cold chain management ‘world’. I

was interested in a better understanding and interpretation of the available guidelines, not only for compliance’s

sake but also for the end-user patient benefit. This also helps in building knowledge-based rationale to assist in deci-

sion making, for instance when approaching the business world to implement some of the costly exercises.

Sarantis, a highly knowledgeable expert in the cold chain management field, took a deep dive into the Key elements

to look out for regarding the regulations and guidelines; particularly, one of the South African Regulatory require-

ments which was updated with in-depth content: South African Pharmacy Council, Good Pharmacy Practice (Board

Notice 50). He shared his expertise, experience and regulatory expectations regarding the Validation and Qualifica-

tion processes and concepts.

Validation and Qualification is one of the pillars which hold the foundation of the quality management system. The

topic is very sensitive and at times the interpretation of the requirements can be challenging, which in turn may af-

fect the compliance thereof. We got the opportunity to acquire a clearer understanding of firstly the definitions and

differences between Validation and Qualification, then the Validation concepts, Equipment Validation, System Vali-

dation, Process Validation including the Risk analysis associated with each concept.

I also appreciated that the learning included practical examples of day-to-day challenges and processes which as-

sisted to better understanding e.g. Process validation: insulated containers, routes, lanes, etc. We were also

equipped with the road map of how to plan and execute validation and/ or qualification tasks as well as the relevant

references.

This workshop was valuable and worthwhile, I gained a deeper understanding of the topics as well as an insight of

the Regulator’s expectations. I would highly recommend the workshop to any personnel in the pharmaceutical field,

in quality, distribution, supply chain and management. I look forward to more SAAPI workshops that promotes excel-

lence through continuous development and innovation.

Thank you.

Sandra Ruzive, SAAPI

The Golden Mortar 6/2019 30

Come Visit the Remarkable National Museum

The Golden Mortar 5/2009 31 The Golden Mortar 6/2019

The Golden Mortar 6/2019 32

The Golden Mortar 5/2009 33 The Golden Mortar 6/2019

The Golden Mortar 6/2019 34

The Golden Mortar 5/2009 35 The Golden Mortar 6/2019

The Chairman of the Editorial Board is David Sieff and the mem-bers are Judy Coates, Ray Pogir, Gary Köhn, Tammy Maitland-Stuart, Tabassum Chicktay, Stephanie De Rapper and Deanne Johnston. All articles and information contained in The Golden Mortar of whatsoever nature do not necessarily reflect the views or imply endorsement of the Editorial Board, the Branch Committee, the PSSA, its Branches or Sectors. The Editorial Board and the afore said cannot therefore be held liable. Every effort is made to ensure accurate reproduction and The Golden Mortar is not respon-sible for any errors, omissions or inaccuracies which may occur in the production process. The Editor reserves the right to amend punctuation or text for cor-rectness, and to summarise where necessary. We welcome all contributions and as space permits, these will be published.

The Golden Mortar

P O Box 2467, Houghton, 2041 Tel: 011 442 3615, Fax: 011 442 3661

pssa@pssasg.co.za Your PSSA SG Branch Chairman: Lynette Terblanche Your PSSA Southern Gauteng Branch Sector representatives are: Community Pharmacy: Tshifhiwa Rabali & Winny Ndlovu Hospital Pharmacy: Tabassum Chicktay & Thanushya Pillaye Industrial: Gina Partridge & Tammy Maitland-Stuart Academy: Prof. Yahya Choonara & Stephanie de Rapper

Contact them through the Branch Office: Tel: 011 442 3615

The Editorial Board acknowledges, with thanks, the contributions

made by the SAACP Southern Gauteng Branch to the production of this newsletter

The Golden Mortar 5/2009 36 The Golden Mortar 6/2019