ROLE OF PHARMACIST IN PUBLIC HEALTH IN INDIA

The profession of pharmacy has undergone a drastic change from just

dispensing to safe and effective use of medicine. Thus a pharmacist provides
pharmaceutical care to achieve best patient outcomes. Pharm D is the basic
educational requirement in all developed countries. Such pharmacists are clinical
pharmacists and are professionally qualified to practice. These pharmacists do have
a role in public health and is more patient oriented. Pharmacists are involved in
immunizations, smoking cessation, alcohol, tobacco and other drug use prevention
and family planning, Pharmacists also provide rehabilitation support to individuals
and communities by giving advice on the use and selection of various appliances
and equipment. Pharmacist are active in various health screening, sexually
transmitted disease control and contraception programs, providing health
education, and advising patients of OTC drug choice and use. In rural areas,
pharmacists have supported environmental programs such as water pollution
control, chemotherapeutic agents, sanitation, and waste disposal.
In hospitals clinical pharmacists manage drug therapy , thus reducing the
number of days of hospital admissions. They are also involved with doctors, nurses
and other health care professionals on various techniques of prescribing
medications and issues related to the drug use process. The pharmacist play a
unique role in the evaluation process to assure that medications are effectively
being utilized with better treatment regimens, identifying medication errors and
adverse drug events. Based upon analysis of epidemiologic and pharmaco-
economic data, medication use criteria, medication use review and risk reduction
strategies, Pharmacists develop specific drug management and disease
management protocols as well.
Pharmacists are much aware of the drug use, mechanism of action and their
toxicity. They also learn from, newsletters, seminars, courses in nursing and
medical schools, and continuing education. A small number of colleges of
pharmacy offer dual degree programs with PharmD/MPH options in US. Such
pharmacy schools incorporate public health and pharmacoepidemiology courses
into their curriculum and train pharmacists as public health professionals.
So pharmacists play a key role in prevention of disease and also provide
pharmaceutical care. Thus clinical pharmacists are recognized well in public health
care in developed countries.
Though health screenings and health education by pharmacists is not
practiced in India, they provide medication during emergency for common
conditions such as, over-the-counter (OTC) drugs and also simple advices. Patients
are relieved of visiting doctors many times with these medications. Pharmacist
helps in pain control by providing NSAIDS. Provide medicines for common cold,
gastric problems and fever. Sometime even antibiotics are dispensed. They also
provide information on self-management of diseases like hypertension and
asthma,

A clinical pharmacist with Pharm D qualification in India can currently

contribute to patient care through hospitals, home care, long-term care, community
pharmacy or other health care systems. These pharmacists must be allowed for the
provisional prescribing of medications in collaboration with a physician within
some jurisdictions. This practice is needed in areas where there may be a shortage
of physicians or other qualified health care professionals. They may be engaged in
public health program such as

 Disaster management like recent 2018 kerala flood (Level 3

calamity), 2014 Jammu flood, 2008 Kosi flood, or similar situation
where outbreak of epidemic prone disease is common. Education to
public, mass medication need is to be taken care.
 Family planning control by distributing contraceptives and educating
public
 Prevention and control of disease such as dengue and diarrhea.
 Promotion of healthy life styles
 Immunization programs such as polio drops.
 Patient counselling for drug management.

India is a vast country with more rural population. Pharmacists can

definitely fill the void. The local pharmacist can offer a much needed source of
clinical expertise. Pharmacists are particularly valuable assets in these
disenfranchised sub-sectors of the community, because the pharmacist acts as an
easily accessible resource for health information and screening. In order to achieve
compliance with therapeutic regimens and to assure medication are taken properly,
need of patient counselling is required. Maximum population is suffering from
chronic disease (hypertension and diabetes) and infectious diseases (HIV and
tuberculosis) where they require lengthy medication treatment. Pharmacists are
best to counsel such patients.

The pharmacist has excellent health knowledge including drug information

and therefore can provide public health services to the community. In India
pharmacist work in hospitals, nursing homes and retail stores. Pharmacists are in
direct contact with the public, thus a wide opportunity to provide public health
services is available. They are at their best to provide information on lifestyle
changes that can influence healthy outcomes. Pharmacists are the best information
providers on drugs, its use , management and adverse reactions and therefore
involves in patient health care and prevention of diseases.

As the population in India is more, health care professionals such as clinical

pharmacists are very much needed. These pharmacists have to be recognized at
national level. Clinical pharmacists are definitely going to be the major support to
the Indian healthcare system. Pharmacists should seize the opportunity and take
their place. As the pharmacists have excellent knowledge on drug use and
management, they must be the integral part of the healthcare system. Knowledge,
skill, confidence level of pharmacist can be improved with proper training and
involvement. Recognition of pharmacist and their services, adequate policies can
contribute to the public health services. Pharmacists are easily available as most of
the retail stores can be directly contacted without any appointment.

In order to contribute properly in community, the curriculum can be

upgraded with the clear objectives and role of the pharmacists. One of the main
agenda set by the World Health Organization (WHO) for the future of public
health is to form accessible, multidisciplinary networks of public health
professionals who actively engage within communities and provide key public
health services in order to ultimately improve the life expectancy of the population.
The public health role of the pharmacist is yet to be clearly defined in India.
Clinical pharmacists must be allowed to have a role in health camps, patient
counselling, drug and poison information centre, all kind of awareness programs,
pharmacovigilance centre and in policy framing under health ministry. Thus
clinical pharmacist with Pharm D qualification can play a valuable role in public
health care.

13 Divya Desams in ancient Kerala

A Divya Desam or Vaishnava Divya Desam[1] is one of the 108
Vishnu temples that are mentioned in the works of the Alvars
(saints). Of the 108 temples, 105 are in India, one is in Nepal,
and last two are believed to be outside the Earthly realms. In
India, they are spread over states of Tamil Nadu (85), Kerala
(11), Andhra Pradesh (2), Gujarat (1), Uttar Pradesh (4),
Uttarakhand (3). The last two are Thirupalkadal and
Paramapadam. Tirupalkaddal is the ocean of milk and
paramapadam is the Vaikuntha where Lord Vishnu presides.
The Divya Desams are revered by the 12 Alvars in the Divya
Prabandha, a collection of 4,000 Tamil verses
There are 13 Divya Desams based on Malai nadu the ancient
Kerala. But now 2 of them are in Kanyakumari district of Tamil
Nadu. Kerala has the largest no of divya desams (11) next to
Tamil Nadu. Brief description about these 13 temples -
Thirupatisaram, Thiruvattar, Thiruvananthapuram, Thiruvalla,
Thiruvaranmula, Thrichitat, Thiruvanvandoor, Thiruppuliyoor,
Thrikkodithanam, Thrikkakara, Thirumoozhikkalam,
Thirumittakkode and Thirunavaya - are presented here.

The rabidly fanatic Tipu Sultan destroyed more than two

thousand temples in the Malabar and Cochin region of Kerala to
establish Islam. Thirunavaya, Thirumittakkode,
Thirumoozhikkalam and Thrikkakara Divya Desams were
destroyed as a result of Tipu Sultan's military operations. They
were reconstructed by the kings of Calicut and Cochin after the
defeat of Tipu Sultan in Sreerangapatanam and the Treaty of
1792 A.D.

Thrichitat, Thiruppuliyoor, Thiruvaranmula, Thiruvanvandoor

and Thrikkodithanam temples were collectively called Pancha
Pandava Temples and are believed to have been built by
Dharmaputra, Bheema, Arjuna, Nakula and Sahadeva
respectively. It is believed that worship at all these five temples
on the same day is especially meritorious.
Pancha Pandava Temples are the five temples in Chengannur area (Kerala) which
are built by Pandavas.The temples are Thrichittatt Maha Vishnu Temple by
Yudhishthira (the eldest of the Pandava princes, who never uttered a lie, lied in one
instant to defeat his Guru, Dronacharya. To overcome the sin of the lie, he
underwent penance worshiping the lord Imayavarappa Perumal here) Puliyur
Mahavishnu Temple by Bheema (deity is Mahavishnu with four hands holding in
each Sankhu, Chakra, Gada and Padma. Sreekovil is Conical in shape. Lord sent
Indira in the form of tiger and killed the evil spirit. The Gatha, used by Bheema is
present in the temple), Aranmula Parthasarathy Temple by Arjuna (the pandava
prince, built this temple for the sin of killing Karna in Nilakkal which is a dense
forest, so the idol was brought here in a raft made of six pieces of bambooand
hence the name. The sacred jewels, Thiruvabharanam of Ayyappan are taken in
procession to Sabarimala from Pandalam, and Aranmula Temple is one of the stops
on the way. The Thanka Anki, golden attire of Ayyappa, is stored here and taken to
Sabarimala during the Mandala season.Aranmula is also known for snake boat race
during Onam at the Pampa River).Thiruvanvandoor Mahavishnu Temple by
Nakula (The famous Pamba river is near the temple and hence the name of the
deity is Paambanaiappan.) and Thrikodithanam Mahavishnu Temple by Sahadeva
(The deity in the temple is Athpudha Narayanan.Kazhuvetti Kallu – The strange
statue outside is a stern reminder that bribery, cheating and dishonesty cannot be
tolerated.Anybody who goes after these evils will be met with the capital
punishment).Worship at all these five temples on the same day is especially
meritorious. These temples are considered very sacred and are included in the 108
Divyadesams.

Notes

Puliyur Mahavishnu Temple by Bheema

.
Thirupatisaram Kuralappa Perumal Temple
Thiruvattar Sree Adikesava Perumal Temple
Thiruvananthapuram Sree Padmanabhaswamy Temple
Thiruvalla Sree Vallabha Temple
Thiruchitat Maha Vishnu Temple
Thiruppuliyoor Maha Vishnu Temple
Thiruvaranmula Sree Parthasaradhi Temple
Thiruvanvandoor Maha Vishnu Temple
Thrikkodithanam Maha Vishnu Temple
Thrikkakara Vamana Moorthy Temple
Thirumoozhikkalam Lakshmana Perumal Temple
Thirumittakkod Anchumoorthy Mangalam Temple
Thirunavaya Nava Mukunda Temple