The incident last year of dispensers at a government clinic giving children mouthwash instead of anti-fever syrup called attention to outdated practices that have negative consequences for public health. The question is: how could such an inexcusable mix-up happen at a publicly-run clinic? From a report released last week, we now know that the dispensers in charge, when they realised the mistake, lied to parents about it. A whole host of other problems came to light, such as poor labelling, insufficient supervision, and lax record keeping. The standard of professionalism at that clinic left much to be desired and those responsible for overview at the Department of Health must also take responsibility. Disciplining those at fault is one thing, but the public must be assured that such a shocking mistake cannot happen again. That incident has resulted in a special panel being set up to review practices at all government clinics. It is time to look at the fundamentals, and for top officials to make it their personal responsibility to reform the system. There are 250 private dispensaries and about 80 Department of Health clinics that dispense medicine in Hong Kong. Private sector dispensaries are required to have a pharmacist on duty for at least two thirds of the opening hours to supervise the work of trained dispensers, who mix and handle drugs and communicate with the public. However, in accordance with regulations drafted at a time when Hong Kong was short of resources and trained professionals, dispensers in government clinics are not required to operate under the supervision of a pharmacist. Why has Hong Kong failed to bring these regulations up to date? And why was it only two years ago that medicines dispensed in public clinics were required to be labelled with their contents? Perhaps both situations indicate a broader issue of insufficient appreciation within our medical profession and the Government that good medical services include professional dispensing of medicines. Dispensers are skilled technical workers who must complete three years of education and internship before receiving their licence. Pharmacists are highly trained professionals, who must understand the technical aspects of mixing and compounding drugs as well as being able to plan and direct their provision and supply. The public relies on pharmacists and dispensers to communicate the details about medicines, including any complicated instructions or precautionary measures. In fact, it has become clear from the recent incident, after which several government-employed dispensers revealed that their job entails more explanations and thus takes more time than it did in the past, that the public now demands more communication about medicines they are given. This indicates a growing sense of responsibility and accountability about public health, and should be acknowledged and encouraged by the Government and the medical profession. Simply put, times have changed, and the Government must meet the challenge. The limited resources and less stringent regulations of the past are out of date today, when Hong Kong is wealthy and its people expect the Government to make public health a priority. With due consideration for the complexity of manpower decisions, it seems a rather basic commitment to extend the requirement of a pharmacist's presence to all government clinics, and to consider hiring more dispensers to decrease the potential for human error. But more importantly, this incident should encourage a change in attitude, and a greater appreciation for the part of the health-care system that deals directly with the public.
