Working in a community pharmacy, especially in low-income estates, exposes you to situations that are not in the textbook. Not every problem that walks through that door has a clean, clinical solution. Some are financial, some are social, and some force you to make decisions that go beyond protocols. This is the side of pharmacy that is rarely talked about.
When you work in a community pharmacy in low-income estates, you will come across many problems that can’t be solved. There are cases that sometimes force the pharmacist to dig into their pockets.
Take for example, a patient comes to the pharmacy feeling unwell. They tell you their symptoms — cough with phlegm, fever, chills, shortness of breath, chest pain that worsens with breathing or coughing, and fatigue. Before you even respond, the patient hands you Ksh 50 and says, “doctor, this is all I have, see how you can assist me please.” Then they add that they don’t even have food at home.
That amount is not enough to buy medicine that will help them. When you explain the least amount needed for something meaningful, they get shocked.
After going back and forth trying to help them understand, they finally say, “just give me a painkiller for that amount.”
But with those symptoms and how they present, it is clear the condition will only get worse. The painkillers will only mask the pain — the underlying problem remains untreated.
This leaves the pharmacy professional with a decision to make:
Do I help this patient, or let them go and suffer?
It becomes even more emotional when the patient is a child.
The more you think about it, the more you realize — you are the only person who can help. There is nowhere to refer them, even public facilities are out of reach. It is you.
So, there are three ways to go about this:
You can give the client painkillers and let them go sort out their financial problems.
You can pay for the medicine yourself.
Or you can allow them to take the medicine and pay later.
The reality is, this is not how you want to run a business. A pharmacy, like any other business, needs to make profit to sustain itself. If you turn it into a charity, chances are high you will be out of business in no time.
However, there is a reason it is called a community pharmacy. People walk in with all kinds of problems — sometimes not even medicine-related — and somehow, you are expected to help.
From what I have seen, experienced pharmacies handle this in a few practical ways.
If you are in a position to pay, do it. Let the patient see that you are actually paying from your own pocket. Give them the receipt together with the medicine — it builds trust and shows transparency.
Alternatively, take the client’s details, give them the medicine, and agree on when they will pay. This works better for clients who have some source of income, even if it is inconsistent. You must set clear timelines and follow up if they don’t honor the agreement.
This applies to both walk-in clients and those with prescriptions.
For prescription clients, there are also ways to work within their budget without compromising outcomes too much.
You can give generic brands that are equivalent in efficacy but more affordable.
You can partially dispense the prescription — for example, a 30-day course can be given in 7- or 15-day installments.
You can also prioritize the most important drugs in the prescription. Antibiotics, for instance, may be necessary, while painkillers or supplements can be left out. This should be done carefully — either in consultation with the prescriber or after properly assessing the patient.
Conclusion
Community pharmacy is not always about making money. It is about adjusting your service to fit the patient in front of you without compromising their health outcome. The balance is not easy — between empathy and sustainability, between helping and staying in business. But that balance is what defines a good community pharmacist.