Contents Editorial Editor Lutendo B. Makgopo sapsf.editor@gmail.com Tel: +27 (0) 849701440
Editor’s Internship programme The programme to be formed under the auspices of SAPSF and PSSA
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Editorial committee
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SAPSF going Green Cindy Hayward 21633274@nwu.ac.za Tel: +27(0)834539486
Global warming! Many of us know and understand the concept of global warming…….
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G3R Makhema Ofhani omakhema@hotmail.com Tel: +27(0)722941869
Pharmacy House, 6 de Veer Lane, Arcadia, 0083. , South Africa
The future of pharmacy By Dr Jesslee du Plessis
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Are we going somewhere or going nowhere slowly, catch an exclusive about the future of the profession
PO Box 26039, Arcadia, 0007, South Africa
South Africa, 2012
59th SAPSF CONFERENCE AT WITS UNIVERSITY FROM THE 1-6TH OF JULY
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A winter warmer not to miss.
…. and more
Editor’s note After a successful pharmacy week 2011, the office of the editor adopted the title ‘towards quality Antidote together’ following the inspiring theme of the pharmacy week 2011 ‘towards quality care together. The Antidote magazine Project unfolds after massive work done by the Presidential committee 2011/2012 and all the stake holders of the South African Pharmaceutical student’s Federation. The presidential committee 2010/2011 is to be given a credit for opening the platform for young Pharmacists to take the profession and the federation to the next level. This version of the magazine “I believe” will open doors for future and professional publications for the federation. This is after a great work done by the president of the federation and the editor of the Pharmaceutical Society South Africa in establishing a mentorship program in which the Editor of SAPSF will be guided on professional publication (more in the article). Special thanks to the following people and organizations for their commitment, guidance and leadership. Cindy Hayward from PASV, Makhema Ofhani from ULAPS, SAPSF presidential committee and the Pharmaceutical Society of South Africa.
Editorial Committee.
Cindy Hayward
Ofhani Makhema
Lutendo… Lutendo. B Makgopo SAPSF Editor 2011/2012 The views expressed in this publication are those of the authors and not necessarily those of the sponsors or publishers. Whilst every effort has been made to ensure that the contents of this magazine are both accurate and truthful, the publisher and editor accept no responsibility for inaccurate or misleading information that may be contained herein.
SAPSF ANTIDOTE /June 2012
Dear Pharmacy Students It is with much excitement that I am able to address you as the current President of your beloved Federation. The Pharmacy Profession is currently at an axis, an axis that pivots around the current decisions that you as the future of the Profession will make when you graduate. It is our choices as the future to decide whether we will become leaders in our areas and spheres of influence or add our lot to the apathetic. The Profession is a noble one, one where we are custodians, a role given to us by society to serve the society. Our roles are healthcare providers, not script pushers nor financial margin achievers, albeit those are important, that is not our core business. Our business and mandate is to serve the centre of the healthcare profession, together as a team, not serving a particular professional or seeing ourselves as lesser, but serving our patients and owning our space in the healthcare profession I urge you as the future to own your Profession, own it with your entire being and serve your patients, for we are educated specialists and it is time we rise up and take up our vocation and calling and start shaping our profession. Thomas Jefferson said “every generation needs a new revolution.�, may this become your revolution.
Aluta Continua, viva le Pharmacie
SAPSF ANTIDOTE /June 2012
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Danelia postgraduate from PASV I loved Pharmaceutics and all of the clinical subjects like Pathology, as well as Pharmacology! I least liked Management and Communication – all the small subjects. It felt as though they were wasting my time – I can communicate!
If you had to do it over again, what changes would you make? Om ‘n onderhoud te doen met iemand saam met wie ek gereeld Kilojoules verbrand by Virgin Active was interessant, aangesien ek hierdie dinamiese, energieke en doelgerigte persoon op ‘n ander vlak leer ken het. Daarom was dit nie vir my vreemd om sommer na ‘n tawwe oefensessie, Woensdag 22 Februarie 2012, ‘n paar vragies vir Danélia Botes te vra nie. Danélia describes herself as an energetic person, who absorbs her energy from people around her. Motivated, and also motivating others, she loves challenges and also to start projects and see them through. She says that she gets bored easily, but from experience I also know that she can change a situation to make it interesting again. Her love for her course is shared by one for people, adventure and the beach. In her free time, Danélia goes on roadtrips, boattrips. paragliding, micro lighting and anything adrenaline based. She says that what makes her a unique pharmacist is the fact she does not drink medicine, “I have to be in my deathbed before you will convince me to take medicine!” A few questions were asked in English and Afrikaans… Danélia tells us about her educational experience:
How did you balance your academic life with social life? By working during the day and partying at night time!
What subjects did you enjoy most [or least] in pharmacy school?
My class attendance would be a lot lower and I would prepare for practical sessions… I would study harder. And I would be nicer to my lecturers, because as I got to know them better, I could see that they are nice people. Moving on to her career development…
What would you like to accomplish during the next five years? I would like to marry a rich man (laughs) but if that doesn’t work out, I would like to be involved in pharmaceutical or cosmetic formulation. I’ve worked with people from Nimue and Vichy. The manager is in France and treats his people really well.
Who made you choose pharmacy as a career? I decided for myself because I wanted to have a professional and relevant career. Being assured to have a job after studying was also a key component in my decision.
Who had the greatest influence on your choice of pharmacy as a career path? My father made me think a lot and helped me with the grown up decision and I brother studied pharmacy as well – I could buy his textbooks. This made sense financially! SAPSF ANTIDOTE /June 2012
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Describe the ideal position based on your long-term career plan. On the long term I would like to work for a cosmetic company, where I want to do product development, or I would like to finish my PhD and stay in research, where I can still be involved in research and development of products, or medicine.
I am part of the Unit of Drug Research and Development – Pharmaceutics. We formultae topical products and then test transdermal delivery. This covers anything from cosmetics to pharmaceutical products. My project focuses on the optimization of transdermal delivery of ketaconazole and asiklovir in the treatment of HIV-related infections. We are mainly doing research on the treatment of Herpes infections during the course of HIV. We want to develop ‘n wider spectrum treatment.
Why did you choose such a topic? Wat is die mees interessante projek wat jy al aangepak het? Tummy Tuck vel-voorbereiding. Ek samel tummy tuck velle in na ‘n operasie, sny, die vet af en berei dit voor vir transdermale afleweringstudies van ons produkte. Ek werk saam met dokters en sal nog baie graag in die teater wil gaan kyk hoe hulle ‘n tummy tuck doen. Tydsbeplanning Hoe organiseer jy jou daaglikse take en aktiwiteite? Aan die begin van jou Meesters word ‘n deeglike jaarbeplanning gedoen, maar met navorsing is dit moeilik, want as jou goed nie werk nie, gooi dit jou skedule omver en die geheim is om aan te pas. Die grootste ding is om seker te maak dat jy darem elke dag ietsie doen en nie agter raak nie - dan sal jy bo bly! ‘n Voorbeeld van hoe jy onlangs beplan het? Ek is nie baie georganiseerd wat sulke goed aanbetref nie, maar kyk na afsnydatums – dit wat eerste moet in, word eerste gedoen. As jy sukkel met ‘n deel van ‘n eksperiment of prosedure, dan tik jy solank aan literatuur of so, want dit kan baie tyd vat. Research focus
I never really chose it – we select a topic from a list made available. I have always been fascinated by Herpes, since it is a complex disease that cannot be cured. There is a lot of research on this topic, but with lots of room for improvement – that is mainly what got my attention. Also the lack of available combination products of asiklovir and ketakonazole drew my attention. I want to achieve this. I chose transdermal, because skin diseases are always interesting, and I like investigating and understanding skin problems when a patient comes into the pharmacy with one and I have to figure out the diagnosis, etc. And face it, every girl likes cosmetics!
How do you think it will benefit the future generation? I feel that the opportunities are endless in my research and that it can be taking further than just a Masters. Patient compliance is better with transdermal preparations than with oral ones, and with certain disease states, quality of life can be improved by these transdermal products. Also, Pharmaceutics is the one subject that distinguishes us from other careers and research will thus always be there!
Take us through your topic of study. ## Cindy Hayward
SAPSF ANTIDOTE /June 2012
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Editor Internship Programme: Introduction The editor internship programme is to be formed under the auspices of the South African Pharmaceutical Students’ Federation and the Pharmaceutical Society of South Africa in a collaborative relationship. The programme is to be established to ensure that the South African Pharmaceutical Students’ Federation and its respective Editor gain the necessary skills required to produce quality, informative and relevant publications, namely the Antidote and the SAPSF Monthly. The foundation of the programme is through a relationship between the two bodies namely through each body’s publication arms, namely the Antidote (SAPSF) and the South African Pharmacy Journal (PSSA) and their respective Editors The objectives of the programme are: •To understand the planning processes behind a publication •To see the logistical components to produce a publication •To learn any processes regarding a publication including software used •To be mentored under a knowledgeable and experienced person •To produce top quality publications for the Federation •To understand the multipurpose of a publication i.e. advertising etc The programme will take place as agreed upon between the Editor of SAPSF and the Editor of the PSSA and a relevant date will be set for the programme to commence. The editor of SAPSF will spend 1-2 days under the guidance of the PSSA Editor (Lorraine Osman) and glean any skills they can in the pursuit of quality. ## Raydon Juta SAPSF ANTIDOTE /June 2012
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Interview 2: PhD student Riaan from PASV
If you had to do it over again, what changes would you make?
I would definitely be more social and other than that I’ll change nothing.
Moving on to his career development
What would you like to accomplish during the next five years?
So on Monday 13 February 2012 I set out to our library’s coffee shop, Ferdi’s, to meet a post-grad student, Riaan Reay. Riaan is currently doing his PhD in Pharmacology and after asking him to tell me a bit more about himself, it was easy to see that his passion in life is rather Pharmacology! Riaan does not like to talk about himself, but if he had to describe himself, he would use the words “dynamic, ready for any challenge” which he had learnt during his studies. He feels that he easily motivates other people – I fully agree as I wanted to go post graduate after talking to him!
Firstly, I have to finish my PhD, then do community service whereafter I would like to redefine, or should I rather say, add muscle to the skeleton of consulting pharmacy in South Africa.
Who made you choose pharmacy as a career? My mom.
Who had the greatest influence on your choice of pharmacy as a career path?
Riaan told me about his educational experience:
Dries Gouws at Medi-Park pharmacy in Kempton Park, where I worked as a student and intern. He was a real mentor and his passion for pharmacy lies far beyond just counting tablets. Prof. Douglas Oliver is also a visionary man that triggered in me a search for alternative ways in re-establishing professional pharmacy as a profession in South Africa.
How did you balance your academic life with
Describe the ideal position based on your
social life?
long-term career plan.
I believe in the saying, a healthy body houses a healthy mind. After class I usually did some sort of physical activity such as jogging, cycling etc. before attempting any form of academic work. I also worked in a pharmacy twice a month so that I could implement knowledge to practice.
Managing my own consultant pharmacy as well as serving the country and her health needs that specifically include the public sector. I would also like to create a program to give greater exposure to our profession that is specifically focused on the youth.
What subjects did you enjoy most [or least] in
Creativity
pharmacy school?
If you were to be a drug, what would you be?
I enjoyed pharmacology and pharmaceutical chemistry the most, and honestly there is no subject that I did not enjoy. However my friends would say that I really did not enjoy pathology.
I would be Thalidomide, because not until I have tried all my options in life, will I fully know the limit of my potential, however negative the connection to this drug might be.
His favourite Bible verse, by which he lives, is Phillipians 4:13 I can do all things through Christ who strengthens me.
SAPSF ANTIDOTE /June 2012
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How would you like to be remembered? I would like to be remembered as a man that made a positive lasting impact on someone’s life.
I went back and performed stage one. During off periods (i.e. the time one spends waiting upon receiving of reagents) I prepare to determine the statistics that need to be used in the study and read a lot of new literature to keep updated.
Research focus
What is the most interesting work assignment that you have done? I would say that one should see oneself as a work assignment, and if I look back on the years that have passed since I left school, there was definitely an interesting development or two. Other than that it has to be our fourth year pharmaceutical chemistry project where we had to create a pro-drug for amlodipine. It was interesting and intellectually stimulating. Time management skills
How do you organize your daily assignments and activities? By listing them in order of importance and the systematically working through them until they are complete, and it always ends with a reward for the day. Motivation to complete tasks is one of the most important steps in organization and that is something you don’t learn in text books.
Give me examples of how you prioritized work assignments in your most recent position: It is important to have a routine, especially if you do research. My current study comprises of two stages. One, to determine the three SNP’s in a population where inter-individual variation in drug response is highly prevalent and the second is to determine the base-line frequency of pharmacogenetically relevant SNP’s in a population. What I did was to determine the timeframe in which these stages needed to be completed. Urgency lied with the second stage first since there is such a large amount of work and preparation that needed to be done, because it is a broad term and there are many SNP’s influencing inter-individual variation in drug levels. After selecting the SNP’s for stage two,
Take us through your topic of study. The title of my study is; the baseline frequencies of pharmacogenetically relevant genes in a Black South African population. We will set out to determine what genes play a role in ADME in specifically ARV drugs. Thereafter we will present data that indicates the frequency of these genes in our population and its relevance. We will also look at four SNP’s on the CYP2B6 gene and its effect on the inter-individual variation in drug response in a population of HIV-infected children.
Why did you choose such a topic? Because of the current relevance in our country and that it really touches the lives of at least one person that each and every one of us knows or came to know. This project also has the potential to be put into practice and the skills of other highly competent researchers that cannot by law be registered as the HPCSA as clinicians, be put to us. The project, if it reaches its full potential, has the potential to redefine the private partnerships in the medical industry in South Africa.
How do you think it will benefit the future generation? This project will help us to better our understanding of the inter-individual variation in drug levels in our Black South African population. It also gives us a chance to contribute to the limited date available on the pharmacogenetically relevant genes in our Black population. We also need to increase our future study participants so that the contribution of diversity among the Black South African population is reflected more accurately. Because our country is the leaders, according to me, in how a country should celebrate its divers cultures, this project will also celebrate unity in diversity. ##Cindy
SAPSF ANTIDOTE /June 2012
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SAPSF
GOING GREEN
Global warming! Many of us know and understand the concept of global warming; on a daily basis we are reminded about the Earth’s destruction due to increased temperatures and how this adversely affects all human beings animals and plants. With all the knowledge mankind has regarding global warming, working together as the inhabitants of the earth has been shown to be the only chance we have to survive. Climate change disasters like the Tsunamis and earthquakes which have claimed millions of lives have resulted in a global movement to ensure the earth’s survival. Ideas on how to better treat the earth have been shared and implemented in many parts of the world. With the recent hosting of the Congress of the Parties (COP) 17 in Durban, South Africa is at the forefront of this global movement.
As a national organisation the South African Pharmaceutical Students Federation (SAPSF) has proposed that we become part of the solution and help save the earth that provides for us. As health care professionals pharmacists have obligation to promote health. The concept of health promotion does not end through the interaction with the patient over the counter but it goes beyond that and incorporates other concepts like environmental health. Environmental health may be directly linked to disease and climate change. Looking at the public health facilities of our country one may notice that almost all facilities have posters or at least documents written words like “Save” or “Going-green” but the question of whether these concepts are put into practice or not always rises as soon as one takes a detailed look at the facility.
What can we as SAPSF do? Well there are a lot of organizations that provide free information on how to energy efficiently and effectively without wasting. These organizations can also help provide information on the correct methods of disposal of used materials that can also help promote health. We have the power to impact positive change on our sphere of influence as young/upcoming pharmacists and we can do this through teaching our peers and fellow health care professionals about the importance of recycling, reusing and reducing unnecessary consumption. Good habits towards our world can help our future generations.
Lastly in the words of Wendell Berry I would like us to remember that “The Earth is what we all have in common”
United in Pharmacy
## Thulasizwe N Shelembe
SAPSF ANTIDOTE /June 2012
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Pharmacy my Profession Pharmacy is a profession that goes beyond receptors and chemical structures that would give NASA astronauts a launch to the moon any other day. It is a career path for which some discover by coincidence for a lack of a better word, but needless how as a student you have arrived to that choice I will be the first amongst many students who spend their endless nights with a loading dose of caffeine studying their Pharmacology to admit that you have made the right choice. According to the United Nations, the Global Illicit Drug Trade is estimated to be worth over 300 Billion U.S. Dollars, makes you think what important role pharmacists have in correct and rational drug usage in a world that is drunk of ignorance to cook some of this highly toxic compounds in their own kitchens. As a student it would still be your responsibility to deal with drug abuse issues and that’s one of the moral packages that come with the profession. Surely one would pick up drug abuse traits with medicines that contain ephedrine and codeine-something to look out for. In your undergraduate you will be filled with lots of Latin medical words you won’t probably be able to pronounce after few weeks but that is fine you don’t need a dental procedure. The existence of mentorship programs will really help and you should take advantage of that, allow senior students to walk you through something less not comparable to a lion’s den. Always attend your classes is something that they told you at home because at varsity the only alarm is the voice of sense and schizophrenic schedule that keeps you ahead. The first time you will break a flask in the laboratory you will feel horrible, and lessons should be learnt quickly before you lit the whole Lab with a Bunsen burner. Reports are to be submitted on time. The best time to be a student is when you receive your clinical coat and you know there is no going back. Time will pass and you will have hospital and clinic visits where you meet a lot of people seeking
.
your advice on medicines. Some will call you a Doctor and some will shout at you for they have been given the same eye drop for three months and still no changes. Some will come back to collect their repeats earlier than the word because “they were in the neighbourhood”. The fascinations of being a student whilst being exposed will help a lot. You will learn to receive stock, procurement and distribution of medicines, cold chain management which generally is a scope of practice of a pharmacist or under which he/she will supervise you on.
Excellence is the finest guide in this career when you don’t become ignorant to the world around you. Try to avoid the usual out of the bush sentence we all quote for a lazy pleasure to not study other things none related to pharmacy. You might be an “A” student who knows all this drugs, but what are you when scenarios become real people with real problems? You are the last person who sees most patients in a hospital environment, surely to excel you would need to fine tune your interpersonal skills and how you communicate. So the best way to excel is to know who you are and what you are able to do to help you choose in a pool of different pharmacy sectors where you would be best suited to work at.
Nothing says it more in this profession than the huge smiles at the end of a prescription from your patients. “ASK YOUR PHARMACIST”….we take those words for an excuse to perfect our egos sometimes, make no mistake, it is about saving lives and for the better purpose of the profession we must own up to the challenges and technical prospects of what pharmacy is. Go out there and represent; for greater notions in the little we do we change lives, we instill hope and sustain something more valuable than a transition metal (Gold) that they probably didn’t let you experiment on in Chemistry –quality of life. ## Makhema Ofhani
SAPSF ANTIDOTE /June 2012
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i SAPSF
IHEART INITIATITVE
.
iHeart by definition asks us as future health care providers to extend our hearts to those who are less fortunate. To not only treat symptoms and conditions, but to treat a patients humanity. Each year the initiative will be mandated by the Presidential Committee with a particular theme and focus for that particular year.
This year the theme is “Teddy Bear Hospital” and focuses around the collection of teddy bears or plush toys to be donated to sick children in either a paediatric ward or children’s hospital. We believe that healing does not only arise from medicines but from an emotional component in one’s own being, whereby if we can recognise their humanity, we can influence and aid their healing.
We, as the Presidential Committee urge all branches to be on board with this initiative and to give a little more this September/October to those who have not. Often the smallest thing like a hug or some love can mean the difference between recovery and ill health for many persons.
W
e are called to give of ourselves to our patients, never to make unlawful and immoral gains from their sufferings and to ensure that we provide a form of care that goes beyond the norms of plain pharmaceutical care. As future professionals of this beautiful land we call our home, we serve not only in the halls of healthcare, but we serve beyond these halls in ways we do not yet understand the full future impact of.
In the words of a great thinker Charles H. Spurgeon, “A good character is the best tombstone. Those who loved you and were helped by you will remember you when forget-menots have withered. Carve your name on hearts, not on marble.” May we as professionals aim to carve our names on the hearts of these children. ## Raydon S. Juta
SAPSF plans to fulfil this call at a local level by all branches associated with the Federation by mandating the iHeart initiative. This initiative was started with the vision of all branches representing all pharmacy students in South Africa, to make a difference in the sphere of influence in their local communities during September/October of each year.
SAPSF ANTIDOTE /June 2012
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Abednigo Bheki “AJ” Nkosi UWCAPS President A Van Niekerk PASV chairperson If you were a drug, what would you be? Histamine. I love my sleep
If you were a drug, what would you be? Multivitamin I’m the one who fills the gaps
M. Ncube RUPSA Chairperson If you were a drug, what would you be? Mefenamic acid
S. Inderjith
UKNAPS chairperson If you were a drug, what would you be? Prednisone
S. Sifo PEPSA chairperson If you were a drug, what would you be? Adcodol Makes people calm and less stressful
D. Mpanda TUTULAPS Acting Chairperson If you were a drug, what would you be? Digoxin Have magnificent potency in a low concentration
M. Mohale ULAPS Chairperson If you were a drug, what would you be? Aspirin
JC. Shaikjee WPSC Chairperson If you were a drug, what would you be? Methylphenidate
The future Pharmacy
of
After mentioning the phrase “Future of Pharmacy” the first thing that came to Dr Jesslee’s mind was “Clinical Pharmacy,” a topic which certainly intrigued me as a student. Everything regarding pharmacy is being taken over by this concept. Dr Jesslee participated in a group that investigated this phenomenon in Western Countries which is rapidly spreading worldwide. Currently, the enthusiasm for becoming a clinical pharmacist is overwhelming. The government, the private sector and universities see the need for clinical pharmacists. The pharmacists and pharmacy students are enticed by this concept which will lead to a lot of disappointment due to limited vacancies and enthusiastic subscriptions to short courses among normal pharmacists, as this specialized training will be limited to a fortunate few. Another problem is that these vacancies are already filled with pharmacists who are not all qualified as clinical pharmacists.
What separates these terms are the clinical pharmacist’s scope of practice regarding the interpretation of lab results as well as knowledge of dosages and blood levels. Currently not all B.Pharm Curriculums cover these areas sufficiently. Thus, changes to the curriculums are being made. As far as National Health Insurance is concerned, Dr Jesslee emphasized the clinical pharmacist’s scope of practice. When placing it in perspective, the clinical pharmacist is at the top of the heap. He/she can help manage changes in protocols (evidence-based), focus on drug resistance patterns and Public Health, which goes hand in hand with the NHI. On other interesting subjects, Dr Jesslee, expressed the following opinions: PDs: Upon portfolios during internship being replaced by CPDs, Dr Jesslee felt that Continual Professional Development is an excellent process, but portfolios shouldn’t be completely abolished. Students should be taught to still keep them, documenting everything they do for future reference. If you don’t write down everything you do, you tend to forget important things until you see someone else writing them down.
negative influence on students, which has necessitated implementation of an extra module to first years’ curriculums to teach them how to read and write Afrikaans and English correctly, as well as getting rid of text language and etiquette. Students struggle when using reference material such as books or reviews, as they tend to do research on their smartphones. Chaos arises when network signal is off. Social networking is useful in keeping contact between professionals, as well as spreading information and marketing events. She feels that it is easier to keep up to date with a social network group, than to read and reply to e-mails. Most of us use social networking on a regular basis and information being uploaded is instantaneously available to read and share. Tablets make it easier to access work while mobile, and notifications via SMS or IM make it easy to follow up on the latest updates in the health profession. Search engines can be positively connected to pharmacy care, and negatively connected to patients. It is easy to quickly search drug properties on the internet, as the latest information is regularly updated. Research
hand, patients tend to search drugs and diseases and diagnose themselves, which leads to incorrect self medication, without the pharmacists consent and knowledge. But all in all Dr Jesslee feels that communication is very important. It is the backbone of any degree and will also form an integral role in the training of our Master- and exchange students. You can’t study and obtain knowledge, but not know how to transfer it in a multidisciplinary occupation such as ours, where we have continual internal liaison among assistants and technicians, as well as external with physicians, nurses, therapists etc. and of course the patients. After completion of this interview, it was made clear that the future of a pharmacist (or even one in training,) looks bright! We may face a lot of challenges, but we certainly have the appropriate resources, solutions and motivation to rightfully make our marks in healthcare provision! Nora Roberts said, “If you don't go after what you want, you'll never have it. If you don't ask, the answer is always no. If you don't step forward, you're always in the same echnology: Dr.Jesslee place.” says that the use of projects and data, drug I think that the time has come cellphones and instant reviews and updates, for us as pharmacists to step messaging has definitely had a newsletters etc. are regularly forward and be the change. published online. On the other ##Cindy Hayward
C
T
SAPSF ANTIDOTE /June 2012
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59th Annual SAPSF Conference 1-6 July 2012
Pharming the Future: Beyond the Counter
A man cannot sit down alone and plan for prosperity. African Proverb A man can’t ride your back unless it is bent. Martin Luther King Jr. Even a fish wouldn’t get into trouble if it keeps its mouth shut. Proverb