Samim Hasham knows what it means to become part of a community. She has owned and operated Morrish Pharmacy in Scarborough, Ont. for 19 years.
By donalee Moulton
Before that, however, the native of Kenya was on the move. In the 1970s, she emigrated from her native country with her family; went on to graduate in pharmacy from the Robert Gordon University in Aberdeen, Scotland; moved halfway across the world to Kingston, Ont., meeting her husband along the way; and then pulled up stakes once more and headed to Toronto. Along the way Hasham discovered what it is about pharmacy that compels her to get up in the morning, and she built a philosophy that defines her work today.
For Hasham, who has her Master’s in International Health Leadership from McGill University and her Doctorate in Pharmacy from the University of Colorado, understanding the kind of pharmacy she wanted to establish started with a realization of what she did not want. “I really felt constrained in what I could do if patients couldn’t pay for medications. Many of those people had mental health problems,” she says of her time as a staff pharmacist.
“We’re a culturally competent healthcare province,” she notes, “but I wanted to do more to improve health outcomes. I wanted to be a full member of the healthcare team.”
A focus on mental health issues
With those tenets as a foundation, Hasham opened her own pharmacy, perhaps the first in Canada with a focus on mental health. “Running my store gave me greater freedom to concentrate on mental health. They were the forgotten people at the time.”
In an era before cellphones, Hasham would follow up faithfully with patients to see how they were doing and if there were any issues. She also stepped outside her store boundaries to become active in the community, working in particular with homeless people. “I had a responsibility,” says Hasham. “The stigma that surrounded and continues to surround mental health has no role in the provision of healthcare. I believe in global citizenship. We must share our knowledge.”
As a new pharmacist in the community, Hasham recognized that her outreach to physicians and other healthcare professionals had to be deliberate and targeted. The focus was on collectively helping to identify mental health issues early and improving adherence. “I pounded the pavement,” Hasham says. “I made everyone aware of what I could do for them. I never forgot to be humble. People want their care and their relationships to be individualized.”
Hasham also introduced a three-month medication review, and very new concept at the time. She points out that patients with mental health issues have shorter lifespans. They have increased rates of malnutrition and heart disease as well as a greater risk of drug interactions. As well, Hasham talked with her patients about broader issues, everything from housing to caffeine intake. Then she reached out once again to the health community. “I spoke to whoever would listen to me and whoever the patient gave me permission to speak with,” says Hasham, the only pharmacist in Ontario to co-chair a Human Services Justice Coordinating Committee.
In those conversations, the emphasis was on offering solutions. “I took on the aspect of what we would call today de-prescribing as well as identifying drug problems and options. That created credibility with psychiatrists. They were calling me asking about how to taper a patient off a medication or stop one altogether,” says Hasham.
Educating herself was equally as important to the Ontario pharmacist, who learned more about smoking cessation and diabetes, for example, with weekly clinics offered for patients with mental health issues. “This means I see people regularly,” says Hasham. “We connect.”
Hasham’s commitment to helping her patients with mental health issues has actually resulted in her helping many others with these health issues. She reached out, for example, to psychiatrists with information about the relationship between clozapine and constipation when case reports were described. “They started prescribing stool softeners with the prescription.”
Reaching out to others in her chosen profession is also part of the work Hasham does on behalf of individuals with mental health issues. Screening for depression is an important service pharmacists can provide, and Hasham has helped to develop a toolkit for her colleagues across the country and beyond. “We’re in a unique position as pharmacists to take on this role,” she notes.
That role, she stresses, is fundamental. Hasham urges pharmacists to get more involved in mental health issues by learning more. “Educate yourself on what mental health really means. It’s not just about medication. It’s a moving sidewalk. There is no one size fits all.”
Helping patients with mental health issues is a mixture of art, craft, and science, says the pharmacist. “It’s evidence and experience. And it is always about the patient. Make it possible for the patient to come to you. And be there when they do.”