MEDICAL AFFAIRS IN SUB-SAHARA AFRICA: 10 LESSONS FROM MY 10 YEARS SO FAR - PART ONE

Today 1st May 2023 marks 10 years since I joined the life sciences industry in the then emerging role of medical affairs in Sub-Saharan Africa. I remember walking into the Kenyan office of Novartis Pharmaceuticals on the second floor of Africa Re Centre in Nairobi to begin my new job of Medical Science Liaison (popularly abbreviated as MSL). In the elevator silence, I remember asking myself if I had made the right decision because the company and more so the role were both novelty. This was especially so to me, a medical doctor whose experience had hitherto only been in hospitals and clinical research settings. I further reflected pensively on the questions that had been posed to me by colleagues, friends and family “What are you thinking? Joining the Pharma industry?” “Are you now going to sell drugs instead of treating patients”? “Isn’t this a risky career move”?

The journey to Novartis had started just over two months earlier when I accepted to attend an interview that seemed to have come out of the blue. In fact, it felt like more of an unscheduled stopover than a well-planned interlude in my then career journey of just over four years. During my time at the University of Nairobi medical school, I had begun shaping my career around clinical research and had envisioned myself having a long career in this field. I had been inspired by the quest to bring new knowledge into the field of medicine to change patient outcomes. This mission was borne out of the challenges I saw in day-to-day clinical practice such as the dilapidated infrastructure and poor working conditions of Kenyan healthcare practitioners. There was absolutely no plan to join the life sciences industry by the time I graduated in December 2008. In fact, for most medical students at that time, our main interaction with this industry was from sales and marketing representatives who came to sponsor continuous medical education (CME) events, some school activities and graduation dinners. I never foresaw what was to come just over fifty months later. So, how did this shift from future medical researcher to pharmaceutical medical affairs professional happen?

Well, this the story of “How I met Pharma!” After completing my mandatory one-year post-graduation internship in 2009, I was posted as Medical Officer in charge of a small hospital called? Olenguruone sub-district Hospital in Nakuru County. This job further stimulated my yearning to join the world of clinical research as I came to terms with the dire situation of our public healthcare system. As I viewed it those days, the system was in wretched shambles, distressing to patients, healthcare workers, payors and other stakeholders. This was particularly in the rural areas. I remember continuously applying to many research-related organisations and attending a couple of interviews without success. Days turned into weeks and then finally to seven months when I finally received an offer to join the KEMRI-Wellcome Trust Programme as a Research Medical Doctor based at their hub in Kilifi County on 1st October 2010. This opened up an exciting chapter in my career where I enjoyed working in a world class clinical research hospital and participated in some research projects. I enjoyed every bit of it, and I then made plans to further my studies by enrolling in a clinical or research master’s programme to further develop potentially into a Senior Research Officer or even a Principal Investigator.?

However, that was not to be because by 2012, I noted a few pharmaceutical companies had started to hire medical doctors as medical affairs associates who went by various titles including Medical Science Liaison, Medical Manager and Medical Advisor. I was intrigued by this development and engaged with some of them. “What exactly is this role about”? I asked. Many of them responded with the textbook definition of “a function that generates and communicates data to help healthcare professionals (HCPs), payors, policy makers and other stakeholders make informed decisions that ensure the best use of treatments to benefit patients”. Initially I was sceptical as I really didn’t get what that meant on an everyday basis. However, I slowly started to see some parallels between my current job and medical affairs as they both seemed to involve communication of scientific evidence to appropriately change clinical practice. But at that time, I perceived joining the pharmaceutical industry in a role that was relatively new as a risk, as did many of my colleagues and friends. I asked myself if I could really gamble my career plans on this new but arguably exciting position. I had at this point even planned to go for a clinical specialisation, for which I had settled for Clinical Pathology. So why apply for some unclear position in the pharmaceutical industry? In fact, at that time many of these companies did not really advertise the jobs but worked with existing employees to reach out to those who would be interested. Nevertheless, I’ll admit that at this point, my sense of adventure kicked in and a little voice whispered in my head “what’s the worst that could happen by trying something new?” “I could always try and if it didn’t work out, I’d go back for my clinical specialisation and have a story to tell”. That was the moment I expressed interest through my network of medical doctors who had joined the industry and thus begun a pivotal point in my career.??

Lesson 1: Treading the untrodden path

In late February 2013, I got a call from a recruitment firm asking me if I would be interested in an interview at Novartis for the position of MSL. As I was in Kilifi at that time, this would entail travelling to Nairobi for the interview. I agreed and decided to put my adventure to the test and after two rounds of interviews over two weeks, I emerged as one of two successful candidates. I remember receiving the offer letter and wondering “okay this is actually happening!” By this time, I took it a little more seriously and final decision making was a fusion of my own introspection as well as discussions with my close network of family, friends and colleagues. Part of me was very keen to try something new even if I didn’t fully understand it while another was extremely anxious that I was making a huge mistake. The apprehension was nerve-wracking! This is the first important lesson that I would later appreciate in my career. When it comes to expanding and developing any career, sometimes you must tread the untrodden path. So, after much thought and reflection, I accepted the offer to join Novartis in May 2013 amid the doubts from both myself and naysayers. Interestingly, in April, something happened that reduced my doubts significantly. I attended the British HIV Society Conference in Manchester as part of an Exchange Scholarship sponsored by AbbVie Pharmaceuticals which was one of my last activities at KEMRI Wellcome Trust. During the conference I met and briefly interacted with the Medical Director of AbbVie who happened to have been a practicing Obstetrician & Gynecologist before his current role and right there and then, I felt a sense of relief in meeting someone who had actually transitioned from clinical practice and research to the pharmaceutical industry. I thought, “this may not be a bad career move after all”. Perhaps the moment was also epiphanic – “was this a new direction that a medical doctor can shape their career?” I left the UK confident that I can try and make the best of my time when I started my new role.

Lesson 2: Accepting the good, the bad and the ugly?

My career at Novartis began with mixed fortunes. On the negative side, the learning curve was quite steep and there were moments when I questioned my decision. For instance, my role involved meeting and engaging medical experts in Oncology, Ophthalmology and Haematology. Some of these experts were quite busy and many times I had to sit patiently for hours waiting to meet them only for me to be asked to come another day. Of course, as someone who had practiced before, I understood how busy clinicians are, but at the same time, I was very frustrated that I was unable to meet one of my key work objectives. Furthermore, when I did get to meet the specialists, some of them would spend most of the time questioning my decision to join this industry as a medical doctor rather than allowing the meeting to proceed to points of mutual benefit. The questions continued “how can a medical doctor join the pharmaceutical industry? Such jobs are for pharmacists”. To add insult to injury, there were some trying times with some healthcare professionals. I remember two such healthcare professionals, one who kicked me out of his office because the company had not sponsored the society conference the previous year. He demanded that I give an explanation even though it happened prior to my joining the company. Another was rude to me when I tried to present scientific data on one of the products.

On the positive side, I must at this point appreciate the support of my manager Dr. Eric Mate who was the Medical Advisor in charge of Specialty and Oncology who understood the challenges of transitioning into the pharmaceutical industry and of understanding the job. He had enjoyed success in the pharmaceutical industry having started at a Kenyan-based pharmaceutical company before joining Novartis ten months prior as MSL and subsequently being promoted to Medical Advisor in early 2013. Therefore, he was one of the few people I knew who understood what was going on. He was firm but understanding and, a few months later, I began to get a better grip of what the role entailed. In fact, I remember a wonderful moment where one of the leading ophthalmologists had commented that he was happy to have me on board to complement the interactions between him and the company particularly in non-commercial matters such as medical and scientific projects. I was extremely delighted to be recognized as a key internal stakeholder for some of the healthcare practitioners. Still, there had started to be questions especially among internal stakeholders on how exactly to measure success in a role that seemed to have no measurable metrics linked directly to commercial success of the company. I’ll tackle the issue of “measuring medical affairs” a little more later in the story. As I went about the job, I realized how easy it was to quit a job because of the stuff we may not like. My first year on the job gave me a valuable lesson on how to gauge a job. I always ask myself “do the pros outweigh the cons?” We must learn to accept that every job, role or company comes as a mixed bag and we need to determine how much our tolerance bandwidth is being stretched for us to know what the next move should be. For me, more and more, the pros began to outweigh the cons and I guess that’s why I persevered and stayed on.

Lesson 3: Knowing yourself – what “issues” can you solve?

I began 2014 full of enthusiasm as my time in pharma no longer appeared to be an accidental stopover but a career path that was now setting out towards a clearer and more pleasant direction. I had settled down well and was beginning to grow into my own. The icing on the cake at this point came in April when I received the “Quarter 1 Make Things Happen” award because of always going the extra mile to collaborate across various functions and ensure collective success in key projects. The anxiety and uncertainty that had clouded this career change barely a year earlier were now long gone. Furthermore, it was important to be recognized for something I felt I did effortlessly, supporting the commercial teams in scientific training and collaborating on key educational projects, something I remain passionate about to date. Later in the year, I was also appointed the Africa Region Brand Medical Expert in Oncology whereby I was tasked with supporting cross-functional teams across the continent in scientific training and brand messaging. I was able to work with teams beyond my region and again this began to show me my strengths on the job. Indeed 2014 ended with yet another huge milestone when the company reorganized the departments with Specialty and Oncology medicines being separated and Dr. Mate maintaining his role of Medical Advisor for Specialty and I being offered the role of Medical Advisor Oncology commencing January 2015. What a year to not only receive an award and recognition but also to be promoted! I was in dreamland! This vindicated me from any further reservations that medical affairs was a wonderful career for me at the time…and perhaps for a very long time to come!