Some photos: Top left, one day Erdem decides to change the look of the pharmacy. He's always buzzing with some little project. He hardly ever sits still.
Top right there is a photo of this little street place by Katabash station, where we returned from Prince's Island. That night we ate here, it was excellent.
Middle is a typical residence on Prince's Island. You see them walking by the streets. Most owned by people of wealth and influence, some retired.
At the bottom a photo of "boza". Boza is a thick drink served with a splash of cinnamon on top. Almost something between an egg nogg and a rice pudding without the rice. It's made from bulgar wheat and most popular in the winter.
I notice something the other night that I think speaks a lot about the relationship between culture and how the profession is practiced. I think this is important…
An Arabic couple comes in. They are speaking broken English. The woman is entirely cloaked in the black garment according to their religion. She has a skin problem of some sort. They must take her in the back to examine the situation.
What follows… Erdem explains very clearly and precisely what he believes the problem may be, what he can prepare for this problem, and the option they have to seek a doctor. I believe it was some kind of steroid plus anti-inflammatory but that’s not the point. The point was as he was trying to begin to prepare the medicine they kept bombarding him with question after question after question. I thought this was rude and disrespectful. I didn’t say anything that night.
The next morning I spoke with him about it to get his thoughts. I told him in the United States most pharmacists would find this behaviour very rude and disrespectful, it would not be tolerated in many cases. I told him, from the majority of my experience, yes, it is customary to be clear with the patient what exactly we will do for them, however questions and counseling come after the medicine is prepared. We kindly inform the patient to sit and wait patiently as we work to prepare their product. Never will the patient come behind the counter.
Erdem agrees, this is the way it should be. He agrees these patients frustrate him. Not only that but it can increase the chance for error if you’re not giving enough attention to what it is you are preparing.
Yes it frustrates him, but as we will discuss soon, such is the culture of Pharmacy in Turkey.
And not just Turkey. These patients come from one of the Arabic nations. It is very typical, Erdem will tell me, that they will demand a lot of the pharmacist.
He says, quite insightfully, that the concept of a pharmacist as a health professional is not understood in the Turkish community. Not ready to accept them as health professional. But at the same time they will go to them for access for the most common illnesses. I want to get him on video explaining this because he has a compelling way of telling the story.
Anyway, to a great extent, this began a long time ago where pharmacies were a place people would go to get treatments. People knew the pharmacist, they knew their families, it was very personal, very intimate. It still is. However, despite the large number of patients seen, and the intimate contact the pharmacist has with the patient, they cannot prescribe medicine even though they are recommending medicines just the same.
Erdem believes there could be a solution. There are items that require a prescription, there are items that should not require a prescription, and there should be a 3rd category where, because of the volume of cases they see over and over for the same common illnesses, pharmacists can prescribe. The skin rashes are a good example. It’s something he sees over and over again day in and day out. This would be something he could manage. He knows the medicines better than the doctors. We agree the doctor should be for diagnosis, this is his training. The pharmacist should be for treatment and applying the right medicine. One of the surprising things about primary care in this country is the time spent with patients. To make an appointment, patients either call or book online a 4-minute time slot running from about 9am to 3pm. I found that very interesting. This tells you how much a priority primary care is around here.
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