Problems and challenges faced in consumer reporting of adverse drug reactions in developing countries A case study of Yemen, Nepal and Malaysia.

Background: Pharmacovigilance is the “science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problems”. The most commonly used adverse drug reaction (ADR) reporting system worldwide is spontaneous and voluntary reporting, which forms the backbone of reporting systems. Aims: To explore the current status of consumer involvement in the pharmacovigilance program in three developing countries, Yemen, Nepal and Malaysia. Method: An analysis was carried out for these three countries based on the current status of pharmacovigilance and involvement of consumers in their pharmacovigilance programs. Results: Malaysia has a good system for involving consumers in their national pharmacovigilance system, whereas Yemen still lacks the well-formed national drug policy. Lack of legislation and regulation which govern the import and distribution of drugs in Yemen is a limiting factor for development of consumer pharmacovigilance. Despite establishment of a pharmacovigilance centre, no reports have been released by the centre. The status of pharmacovigilance in Nepal is still in infancy. The regulatory body is assigned to be a national pharmacovigilance center, and coordinates with seven regional centers for pharmacovigilance activities. Nepal also lacks the involvement of consumers in the national pharmacovigilance program. Conclusion: Consumer reporting may be important for developing countries to implement a proper and effective pharmacovigilance program that can reduce morbidity and mortality rates, as well as reducing the economic burden of ADRs.

Predicted equations for pulmonary function in normal adolescent south indian population.

Pulmonary functions are affected by variables like age, sex, height, weight, and geographic location. Our study aims to establish predicted equations for pulmonary functions in normal South Indian adolescent population. 400 subjects were grouped into pre & peripubertal (10-14 years) and pubertal (15 to 18 years) age categories. Anthropometric data collected, PFT assessed using portable data logging Spirometer MIR II. Mean FVC and FEV1 values were 2.80 L, 2.49 L in boys and 2.34 L, 2.12 L in girls respectively. Predicted equations for both adolescent age groups were generated by using linear regression analysis. PFT were significantly different in both age categories in boys and girls. PFT increased with increasing age and significantly correlated with the anthropometric parameters. Region specific and age specific predicted equations for PFT are generated from this study.

Developing and sustaining a medical humanities program at KIST Medical College, Nepal.

The author conducted a voluntary Medical Humanities (MH) module at Pokhara, Nepal, in 2007 as a curriculum innovation project for a fellowship in health sciences education. He conducted a module for faculty members at KIST Medical College (KISTMC), Lalitpur, Nepal, in 2008. The modules used literature excerpts, case scenarios, role-plays, paintings and group activities to explore different aspects of MH. The module for faculty members had the objectives of introducing faculty to MH and also creating facilitators for the student modules. For the last four years the author has been facilitating an MH module for first-year medical students at KISTMC.

Small group facilitation skills in problem-based learning.

Medical schools are increasingly changing over to a problem-based system of learning. Students work in a small group to analyze a well-structured, clinically relevant patient case. Problem Based Learning (PBL) provides a logical approach in training students for practicing medicine in a complex environment by exposing them to simulated problems which may reflect real life situations. PBL requires a change in mindset on the part of both the learner and the teacher/facilitator. For tutors, metacognitive skills, i.e. the ability of active, positive, conscious monitoring and direction of activities carried out by the students who were confronted with a problem, clear communication, and awareness of the learning needs of the students are rated as important. The ‘knowledgeable’ teacher no longer dominates learning, and students and teachers became equal partners in the learning process. Teachers/facilitators are requested not to give answers but to provide students with more room for active self-learning. An effective PBL tutor has the ability to communicate informally with students and has an empathic attitude which creates an atmosphere in which open exchange of ideas is facilitated. Programmes to improve PBL facilitation skills have been carried out in various institutions in the South Asian region. The positive impact of these training programmes highlights the need for workshops to develop such facilitative skills among South Asian medical educators. Problem-based learning should gradually become the more important and more widely used method of learning compared to didactic lectures.

Impact of educational outreach visits by pharmacists on treatment of childhood diarrhoea - initial findings from Banke district, Nepal.

Diarrhoea is one of the most common causes of mortality and morbidity in children in developing countries. Oral rehydration salts (ORS) and zinc are the primary tools used to fight diarrhoea in children. Educational outreach visits or academic detailing has been practiced over a period of time to improve prescribing behaviour in the developed countries. However, educational outreach programmes are very uncommon in Nepal. We conducted a pilot study to see the impact of educational outreach visits on the management of diarrhoea in children among 10 prescribers in the Banke district of Nepal. Initial findings suggest that there is a marked improvement on the prescribing of ORS and zinc by the prescribers after our intervention. Therefore it is planned to conduct the same study among a large number of prescribers in the Banke district of Nepal.

Medical students and medical teachers learn together: preliminary experiences from Western Nepal.

Medical students and medical teachers learning together have not been widely reported in the literature. However, there have been reports of this collaborative learning from other areas of education. The Manipal College of Medical Sciences, Pokhara, Nepal admits students from Nepal, India, Sri Lanka and other countries to the undergraduate medical course. The department of Medical Education decided to offer a voluntary Medical Humanities module to the students. Faculty members also joined the module along with the fifth and sixth semester students. The facilitator conducted two focus group discussions (FGDs) with the faculty and the student participants separately. Various issues regarding the module were discussed but here I am only describing the issue of the faculty and the students learning together. The sessions were based on small group, activity-based learning and were held after regular college hours. The faculty participants acted as co facilitators and guided the dynamics of their groups. They added experience to the literature and art interpretation and to the role plays. In certain sessions, their professional experience added value. The faculty and the students bonded together well. The new topic, the informal and interactive nature of the sessions may be partly responsible. Future sessions can draw on this experience.

Basic sciences in South Asia now and then: A personal perspective.

The late 1980s was a period of change and continuity. The preclinical subjects of Anatomy, Physiology and Biochemistry were taught during the first one and half years of the course. Dissection, histology, osteology, animal experiments, hematology practicals, biochemistry practicals were the different exercises. The internet and computers were still in the future during my student days and traditional anatomical specimens were used to study the subject. These days a number of simulations and computer programs are available. Multimedia has made the learning of the subject easier and online support websites are a great help to both students and teachers. Animal experiments and pharmacy practicals were carried out in pharmacology during my student days. Pathology and Microbiology practicals were microscope based. Community Medicine was not taught in the community. Nepal is a relatively new entrant to medical education. In Nepal, the basic science subjects are taught in an integrated, organ system-based manner during the first four semesters. Teaching and learning rational use of medicines is emphasized in pharmacology in our institution. Assessment has become more structured and is carried out using checklists. Adult learning strategies are more commonly used and the student-teacher relationship is becoming more democratic and egalitarian. Technology has invaded the classroom. The number of private medical schools has increased and the importance of the undergraduate medical degree (MBBS) has decreased. The next twenty years will definitely see more changes and promises to be an exciting time in medical education. The late 1980s were a period of change and continuity. India was firmly wedded to socialist principles but a young prime minister was just beginning to initiate change. Medical schools were still traditional places of learning. Massive buildings, overcrowded hospitals, milling crowds.