Empowering pharmacists in antimicrobial stewardship: A conversation with Ivan

During the recent in-country launches of the CwPAMS 2 programme we spoke to Ivan, who is co-leading the Antimicrobial Stewardship Committee at Connaught Hospital in Sierra Leone.  

As part of the CwPAMS programme, Ivan supports the training of 12 pharmacists as AMS champions through “Strengthening Pharmacy Leadership on Antimicrobial Stewardship”. As the lead for the training, he delivers joint preparation and delivery of the AMS Champion programme to a new cohort of pharmacists, and supports the new AMS Committees to set up appropriate governance and surveillance structures.

Could you tell us how you developed an interest in antimicrobial resistance (AMR)?  

I became interested in AMR during my fourth year of pharmacy school. At that time, I developed a passion for infectious disease control. This passion continued to grow throughout my studies, and upon graduating as a pharmacist, it became even stronger. Antimicrobial resistance has posed a significant threat worldwide, with over 500 million people affected by drug-resistant infections. In Sierra Leone, a cross-sectional study assessing national antibiotic consumption between 2017-2019 revealed that 98.4% was oral antibiotic use, while parenteral antibiotics made up 1.6% (Joseph Sam Kanu et al, 2021). Another cross-sectional study on antibiotic use among hospitalised adult patients at Connaught Hospital in Freetown, Sierra Leone revealed that of 920 patients interviewed, 753 (81.8%) had antibiotic use without laboratory evidence (Sulaiman Lakoh et al, 2019). The impact is not only on human health but also the financial burden, as treating these infections costs millions of dollars. Considering these factors, I developed a deep passion for addressing AMR. During pharmacy school, I served as the public health chairperson for my association and was involved in organising events like World Antimicrobial Awareness Week in Sierra Leone. We partnered with various organisations to raise AMR awareness in schools, educating students about antibiotics, resistance, and contributing factors. This experience further fueled my passion, and I continued my AMR work as a pharmacist, particularly on the AMS subcommittee. 

 Can you tell us more about your pathway to becoming a pharmacist in Sierra Leone and explain the steps involved in becoming a pharmacist?  

 The journey to becoming a pharmacist begins during high school. Students must have a strong background in sciences and must pass the West African Senior School Examination with a minimum of five credits, including subjects like maths, chemistry, biology, physics, and mathematics. After meeting these requirements, one can apply to the College of Medicine to pursue a pharmacy degree. The program consists of six years of study, including one year of pre-pharmacy for those coming directly from high school. Following graduation, a 12-month internship is mandatory and after completing the internship, aspiring pharmacists must pass their licensing exams to become licensed pharmacists in Sierra Leone. The entire process takes approximately seven years. 

Are there any barriers that individuals commonly encounter during this journey? 

Several barriers can hinder the learning experience. One significant barrier is the availability of well-equipped laboratories, particularly for practical learning in pharmacy and other scientific disciplines. Another notable barrier is the lack of awareness among doctors and other healthcare professionals regarding the role of pharmacists. Initially, when I started working, it was a new concept for them as they were accustomed to viewing pharmacists solely as dispensers. However, the profession has evolved, and pharmacists now play a crucial role in patient care. Overcoming these misconceptions and increasing awareness is essential.  

What would you like to achieve through CwPAMS?  

One of the things I have found crucial is the opportunity to develop my leadership skills, especially in managing antimicrobial stewardship. As we all know, antimicrobial stewardship involves the responsible use of antimicrobials, and to take responsibility, I believe I need to enhance my leadership skills. Another aspect I aim to focus on is quality improvement. My ultimate goal is to become a proficient pharmacist in the field, and CwPAMS training plays a vital role in achieving that. By being part of the champions in training, I hope to develop my leadership skills and effectively manage antimicrobial stewardship in this hospital. 

Why has the AMS Subcommittee been established here at Connaught? 

Since 2019, we wanted to have an AMS committee in the hospital. There already existed as WASH committee, infection prevention control, environmental unit, but an AMS component was missing With the support from the CwPAMS 1, we were able to establish the AMS subcommittee. We conducted a baseline assessment, GPPS survey, and an end-of-project assessment to determine the progress. The AMS subcommittee was launched, and we developed an action plan. The CwPAMS 1 project supported fully us in establishing the AMS subcommittee, enabling us to address areas like education, awareness, surveillance, and training. 

 Why has the GPPS survey been so important? 

The GPPS survey was significant because it was conducted by us, the pharmacists, as members of the team and the champions. It provided valuable information about antibiotic use in the hospital, such as the reasons behind doctors prescribing specific antibiotics and whether they adhered to the antibiotic guidelines. Understanding this information is crucial for effective antimicrobial stewardship. 

What are your ambitions for the next couple of years? 

Our ambitions for the next couple of years revolve around becoming a highly functional AMS committee with full support from the management and the National Antimicrobial Stewardship Team. We aim to share our knowledge and best practices through training, turning our hospital into a centre of excellence that can support other hospitals nationwide. Together as a team, we strive to promote the judicious use of antimicrobials to ensure better patient outcomes.