Graduate / 'I can get easier access to HIV treatment' - Statement for Masters of Public Health [4]

Hi everyone. My name is Melissa Chew and i am a pharmacist working in Malaysia. I am hoping to pursue graduate studies in a renowned American Public Health School. I have a written a personal statement based on the guides provided by the school. I've actually written more than what was recommended and need to cut down my essay by 1 page but i am having problem deciding on what to leave out. I truly appreciate any feedback that i can get. Thank you very much. Cheers!

"The reason i moved to Johor Bahru is so that I can get easier access to HIV treatment for both myself and my daughter."

The words uttered by this particular patient, Patient X, during a Retroviral Disease (RVD) Medication Therapy Adherence Clinic (MTAC) session was an eye-opener for me and it made me take a good look at the accessibility and standard of healthcare services in Malaysia. It made me question the accessibility of health services in Malaysia. Are the treatments affordable? Are the treatment given in the best interest of the patients or are they profit-oriented? Are the healthcare professionals adequately trained and are they following best practices guidelines? Do the patients understand what is being done for them? Can we do more in terms of disease prevention and patient education? And more importantly, what can i do to make an impact on public health in Malaysia?

The scope of public health is far-reaching and numerous public health issues resonate with me. However, the first issue close to my heart is the fair and affordable provision of healthcare, specifically primary healthcare, to my nation, Malaysia, and other developing nations. I believe primary healthcare is where preventive actions could be practised as the outreach is great and the rewards significant. The second issue involves patient safety, with an emphasis on promoting medication safety via patient education. These are the issues that i encounter daily during work. I strongly believe that by taking up the Masters of Public Health offered by XXX, with a concentration in Health Leadership & Management, i will develop the skills and competencies that will enable me to address these important public health issues. The courses offered by the Health Leadership & Management Concentration are both essential and practical for the progression of my career.

I am currently a pharmacist working in a Ministry of Health (MOH), Malaysia primary healthcare facility- Kempas Health Clinic. Pharmacist roles are traditionally confined to dealings in the pharmacy, be it the community pharmacy or the various departments in a hospital. The public health management roles are usually undertaken by more senior members of the staff who were posted to the Pharmaceutical Services Department due to promotion in ranking. However, i believe that i can step out of the stereotypical role of pharmacists working only in the pharmacy and empower myself on issues regarding public health by pursuing further studies.

Having worked with the MOH, Malaysia for 5 years, i have a comprehensive insight on the workings of the healthcare system in Malaysia. The healthcare system in Malaysia can be loosely classified into two categories - healthcare facilities under the Ministry of Health (MOH) Malaysia, or healthcare facilities established by private healthcare entities. Cost of treatment at MOH facilities are heavily subsidized by the government and patients generally only pay One Ringgit Malaysia (RM) (USD 1 = RM3.50) for consultation, laboratory tests and medicine whereas the cost of treatment at private healthcare facilities are patient-borne. The MOH Malaysia offers universal coverage for its citizens; however, as evident by Patient X's predicament, services offered are not always uniform. As with many of the developing nations in the world, the issues faced by the healthcare system in Malaysia includes facility location proximity, shortage of trained healthcare professionals and in particular with the MOH, budget and policy constraints.

The Malaysian Government is heeding the World Health Organization's call on providing universal health coverage and reducing exclusion and social disparity in health. Therefore, the Malaysian Government is now embarking on an ambitious National Health Financing scheme called 1 Care that will see all patients pay the same amount of money for the type of treatment they receive, irrespective of whether they seek treatment at MOH healthcare facility or at a private healthcare facility. When this scheme is launched, the healthcare facilities currently under MOH will be autonomous healthcare facilities. As such, a Masters of Public Health concentrating on Health Leadership & Management will give me the skills necessary to make a smooth transition while providing me with the fundamental grasp of public health issues.

In my daily duties as the managing pharmacist of Kempas Health Clinic, i encounter endless public health opportunities. However, when i first started my career as a pharmacist, public health wasn't exactly what i had in mind. My interest back then was primarily clinical pharmacy. Due to my track record of excellence and diligence, i was given the opportunity to be the first houseman pharmacist to be attached to the Retroviral (RVD) disease clinic, under the supervision of the clinical pharmacist. It was at the RVD clinic that i became aware of the fact that HIV/AIDS was something that can be prevented with the right education and treatment. It put what i had learned about public health in pharmacy school, into perspective.

My year at the hospital gave me practical insight on the running and functions of the various pharmacy departments. But it was at my second posting to Kempas Health Clinic that i found my niche. Being a primary care pharmacist was a self discovery and self learning process for me, as i was the pioneer pharmacist at Kempas Health Clinic and the first few primary care pharmacists in the district and state. Due to the lack of pharmacists at that time, i was also the pharmacist in charge of 3 other MOH health clinics in the district. I quickly realised that my job wasn't merely to dispense medication to patients but that i played a pivotal role in providing the patients with the best healthcare service available. What made the work even more challenging was to work within the constraints of the MOH policy, budget and drug formulary. However i was able to assume a leadership and managerial role in the pharmacies and establish an inventory system that made the order and supply of medicine systematic and efficient to ensure the smooth running of the pharmacies and clinics.

One public health role that i am fortunate to have and cherish is the role of an educator. Being involved in operational duties has enabled me to have close contact with my patients. I am able to educate patients on their medication, diseases or medical devices on a daily basis. The patients at Kempas Health Clinic come from a diverse background of different races, cultures, faiths and education levels. As such, there was a need to adapt the counselling and education sessions to meet the different needs of the patients. I have also been fortunate to be involved in the multidisciplinary effort to educate the diabetic patients in the clinic. In 2008, along with the Family Medicine Specialist, the Diabetic Team Staff Nurse and I established a monthly Diabetes Education Class in Kempas Health Clinic. I was responsible for creating the education curriculum for the patients in the class to educate them on their medication and treatment. The curriculum was subsequently adopted by the Johor Bahru Health District Pharmacy Department as the standard patient curriculum. The Diabetes Education Class is still ongoing in Kempas Health Clinic and i still deliver lectures to the patients on a monthly basis.

Unfortunately, in my four years as a primary care pharmacist, i have come across many patients who were unable to read the name of their medication or understand what the healthcare provider was explaining to them. What comes naturally their more educated counterparts, is a struggle for these patients because they were unable to understand Malay or English language. These patients predominantly belong to the elderly group who did not receive formal education. This breakdown in communication between the provider and the patient became a public health issue that i felt strongly about, especially when it comes to the patient's inability to identify their own medication via the name of the drug or inability to read the dosing instructions on the medication labels.

I felt compelled to act. I knew that there was a limit to what one person could do to educate the patients, so i brought up the importance of educating patients to prevent medication error to the Johor state Pharmaceutical Services Clinical Pharmacy Committee, in which i was a committee member. As a result, i successfully developed and implemented a 'Know Your Medicine and Pharmacy Counselling Day' campaign at Kempas Health Clinic. The campaign, done in collaboration with the Pharmaceutical Services Enforcement Department and Pharmaceutical Services Clinical Pharmacy Committee, aimed at creating awareness for patients on counterfeit and unregistered medicine, as well as educating patient about proper medication usage. For patients who were on chronic medication, we were able to provide detailed and lengthy explanations on their own medication in a counselling session that was not suited for normal working days due to lack of staffing and the need to adhere to a maximum waiting time of 30 minutes. More importantly, we were able to create awareness of identifying the medication via the name of the drug instead of shapes, colours or sizes. The campaign was a success and was subsequently incorporated into district health office's annual strategic plans. I believe the Health Leadership & Management curriculum in the Master of Public Health offered by XXX will enable me to address patient safety issues, in particular medication safety, on an even wider scale.

My operational duties so far has unfortunately limited the amount of research work that can be actively pursued. However, in 2010, i was appointed the head data collection coordinator for Kempas Health Clinic in a nationwide, multicentre study. The study was conducted in two phases. The first phase focused primarily on the utilization of medications and cost for the treatment of Diabetes Mellitus (DM) in MOH healthcare facilities. The objectives of the research was to determine the utilization pattern of medication used in the treatment of Type 2 DM, to assess the adherence of Type 2 DM patients towards medication and to determine the direct and indirect cost for the treatment and management of Type 2 DM. The currently ongoing second phase of the study involves following selected Type 2 DM patients on a 6 months diary entry to better determine all the direct and indirect cost of treatment and management of the disease. The findings from the research will be used for policy-making for Type 2 DM management and treatment in MOH.

In my daily duties, i encounter a wealth of information suitable for public health or clinical research. These data can be translated into findings that will help the MOH make sound decisions on clinical, financial or policy issues. I hope that by enrolling in Masters of Public Health, i would be able to polish my research skills and translate the abundant information available into significant data that can be used for policy-making. Having co-authored a handbook on Teleprimary Care Pharmacy Module, i also hope to further enhance my skills on writing operational guidebooks.

I have been an effective communicator and have held leadership roles since my schooling days. I was the Leo Club, English Language Society and Fire Brigade Club President as well as the assistant Head Prefect in school. In college, i was the class representative. Throughout my life, the leadership roles have continued, with increasingly more important roles at work. Perhaps my most significant achievement and challenging leadership role to date has been my role as the pharmacy head module for Teleprimary Care (TPC). In 2009, despite the fact that i was a junior member of staff, i was appointed the Head of Pharmacy Module for TPC due to my track record of excellence and diligence. Furthermore, i was a vocal and effective speaker who was not afraid to voice my opinions on the shortcomings of the system and the problems faced by the end-users of the system.

TPC is a clinical and health management information system that was developed by the Family Health Division of MOH. TPC was specifically designed for primary care usage and integrates the various functions of the clinic or hospital such as registration, note taking, prescription and stock management. It is noteworthy to mention that a study involving TPC was done in collaboration with the Johns Hopkins Bloomberg School of Public Health back in October 2007. The study entitled 'Using Teleprimary Care (TPC) Data Set for Predicting Utilization of Health Services in Malaysia, Through Use of Johns Hopkins ACG (Adjusted Clinical Groups)' looked at the possibility of using TPC data with case mix system. As the Pharmacy Module Head, i am largely responsible for coordinating and collaborating with the National Pharmaceutical Services Department, Family Health Division and IT Vendor to correct and improve the pharmacy module of TPC. In addition, i provide feedback and consultation to the IT Vendors for system design and troubleshooting. In line with the MOH's policy of clinical information system, TPC is in the works to integrate with the national level Pharmacy Information System (PhIS) and i provide consultation to the working committee on behalf of TPC. TPC is already a significant tool in data collection and has the potential to strengthen the MOH's primary healthcare services when implemented in all MOH primary healthcare facilities nationwide.

During my tenure as the pharmacy module head for TPC, i have been able to highlight the issues faced by the pharmacy module of the system to the Pharmaceutical Services Department and set up a TPC working committee within the MOH to better address these issues. I have also co-authored the TPC Pharmacy Module Handbook to provide a guideline for the pharmacy staff. Additionally, i am working with the Pharmaceutical Services Department and Family Health Division to fight for the provision of external data source that will provide, maintain and update the clinical information within the system to provide information such as drug-interactions, medication indication and dosing guidelines. More importantly, i have managed to liaise with the IT vendor to make minor adjustments to the system by changing the dosing instruction on the self generated drug label from showing 1/4, 1/2 or 3/4 tablet to showing ź, ˝ or ž tablet. This resulted in a significant improvement in the patient safety index.

I strongly believe that i am a healthcare professional that has the right intellectual capacity, relevant experience, maturity and commitment to excel at the Masters of Public Health programme. I am ready to step out of the box and challenge the traditional perceptions that a pharmacist is limited to duties in a pharmacy setting and leadership and management roles are reserved only for the senior member of staff. Having shown the relevant public health and healthcare experiences in my career so far, i hope to further my career prospects and contribute to health care on a wider, population based level either in Malaysia or in other healthcare organizations in the world. Master of Public Health at XXX will provide me with the skills and platform necessary to take the next step in my career.