ASHP InterSections ASHP InterSections

April 6, 2016

International Pharmacy Residency a Challenging, Inspiring Experience

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Ishmael Qawiy, Pharm.D., BCACP

Editor’s Note: Author Ishmael Qawiy, Pharm.D., BCACP, is a public health resident with Bristol-Myers Squibb Foundation and Rutgers University.

ONE OF THE MOST EXCITING OPPORTUNITIES available to practitioners today is the chance to be a part of the evolution of pharmacists’ patient care roles in other countries.

I was lucky enough recently to do an international Bristol-Myers Squibb Foundation & Rutgers University public health residency.

I wanted to improve public health and explore how economic and cultural factors impact health outcomes. Community-centered pharmacy, in particular, appealed to me because of its reliance on a comprehensive approach to tackling healthcare disparities.

Beginning in July 2015, I worked in sub-Saharan Africa for six months as part of the foundation’s Secure the Future initiative. This cross-cultural program is an immersive experience in which participants address health inequities by working with indigenous people and their healthcare systems.

A Professional Shift

I arrived in Johannesburg, South Africa, excited and optimistic about making my mark in community healthcare. After being trained on the position’s scope of work, I traveled to Ethiopia, Swaziland, and Lesotho to work with grantees who are trying to reduce the incidence of cancer in women and lower the transmission of HIV.

This residency posed quite a professional shift for me, as I had previously been more comfortable doing medication management and health education. But the work was particularly exciting given the new focus on chronic disease management generally, and oncology in particular, that is currently taking place in Africa.

Dr. Qawiy poses with nurse Birhanu Moges.

Dr. Qawiy poses with nurse Birhanu Moges.

I was lucky enough to be able to work directly with the leaders of several community-based health organizations, including the African Medical and Relief Foundation (AMREF) and the Mathiwos Wondu-Ye Ethiopian Cancer Society (MWECS). These groups are on the front lines of providing care to underserved populations throughout Ethiopia.

In Ethiopia, I developed educational health materials for patients that were translated into the local language and distributed at community mobilization events. During my residency, I also created medication safety protocols and medication-handling procedures, and I developed an electronic patient database to collect and streamline reporting and improve operational efficiency.

The Reality of Healthcare in Developing Nations

During my time in Africa, I learned that it’s important to be realistic about the kinds of care you can provide when working in a developing nation with limited resources. For example, I found that standards of pharmacy practice vary from country to country. I also witnessed the fact that clinical and regulatory guidelines developed in the U.S. or in Europe weren’t well-suited for a low- or middle-income country with limited numbers of specialists and patient access to resources.

In Lesotho, for example, pharmacy technicians and nurses have the ability to dispense medications without the supervision of a pharmacist. This may raise some red flags in wealthier countries, but in low-resourced communities, building healthcare capacity by educating and training available personnel is often the most viable option. In many sub-Saharan countries, access to drugs — particularly, chemotherapy agents and pain medicines — is limited. Clearly, this negatively impacts patients’ quality of care and survivorship.

11809902_433888716818578_1803379262_nAs a public health resident, I worked on a number of different projects. For instance, I gave presentations to medical staff and hospital administrators on drug interactions and developed a framework for a drug and therapeutics committee.

I also helped create a protocol used to assess baseline awareness of cancer and met with officials with the local Ministries of Health to discuss their goals for combatting HIV and other communicable diseases.

The work was so inspiring because it made me challenge my own biases and begin to look at the world through a more culturally sensitive lens.

The Vital Role of Pharmacists

It’s important to know that if you choose to do a public health residency such as this one, it can be both professionally gratifying and emotionally taxing. During my time in Africa, I saw that health disparities can be systemic and embedded deeply in a society’s very fabric due to failed health policies, poor governance, or both. Creating equity in healthcare requires contributions from every part of society, including policymakers, healthcare providers, and the community.

I was fortunate during my residency to meet people from different walks of life and enjoy the local culture. I also found that pharmacists can contribute in significant ways to ensuring that the disadvantaged receive appropriate healthcare. Now that I’m back in the United States, I look forward to using this life-changing residency experience to explore the difference I can make in the lives of my patients.

–By Ishmael Qawiy, Pharm.D., BCACP

September 28, 2010

What I Learned: Reaching Patients In Central America

William P. Albanese is a Pharm. D. candidate, class of 2011, University of Maryland School of Pharmacy

When a friend invited University of Maryland pharmacy student William Albanese to travel to Honduras to help run a mobile medical clinic with Global Medical Brigades, a student-run non-governmental service organization, Albanese jumped at the opportunity. He thought it would be a chance to use his pharmacy education to help those with limited access to care, and he looked forward to getting practical experience counseling patients on the finer points of their medications. He didn’t think he would be talking about shampoo.

“It was a rural situation where roads are the exception and not the norm, and over half the population is more than 20 miles away from a medical professional,” Albanese said. “That takes it beyond medicine into basic health, and I did a lot of things that I didn’t expect to do. I wasn’t titrating drugs and getting labs. It was more like, ‘Here’s how to brush your teeth, and here’s how you use shampoo.’”

Facilitating Patient Care

That’s not to say that Albanese didn’t get the practical experience he craved. Quite the opposite. “From a pharmacy perspective, we became facilitators of the whole mission,” he said. “The physicians relied on us for a lot of things—assessments, therapeutic interchanges when drugs ran out, and just thinking on our feet. We had to be quick, yet precise.”

In one case, student input changed a diagnosis. A patient had come to the clinic with what physicians thought was asthma. “But when he described his situation, it sounded more like chronic obstructive pulmonary disease (COPD),” said Albanese. “We spent an extra five minutes going over his symptoms, and we learned that he’d been smoking for 60 years. When we spoke with the physician about it, he changed the prescription on the spot, and the patient walked away with three months of COPD meds.”

Events like that made getting up at 5:30 each morning, trucking for two hours over rough terrain, and getting back to the campsite at 6 or 7 p.m. well worth the effort, he added.

“Here in the U.S., students are often taught how to do physical exams and be more of a primary provider, yet we never get to actually experience it in person,” he said. “My first experience with an actual patient was in Honduras. After just three or four screenings, I felt so much better about being able to do exams properly.”

Realizing One’s Potential

Albanese feels that student opportunities like the one he experienced are all about realizing potential. “In an international setting, physicians wanted to see what we could do,” he said. “It was all under the supervision of a Honduran doctor, but we were given a chance to make things happen.”

%%sidebar%%The interdisciplinary interactions were priceless, he said. “The physicians asked a lot of questions, and allowed us to ask questions in return,” Albanese said. “Our input was an important part of the morning meetings.”

The experience taught Albanese something about himself, as well. “It made me realize that I need to interact with patients to be happy in the profession and in my career,” he said. “That’s what I crave. I can’t be a pharmacist who works from a remote location or behind a counter. It made my career take a different turn.”

Albanese plans to return to Honduras with Global Medical Brigades this winter. He will pack a suitcase of clothes and one of supplies and medications provided by the organization. While many students will be enjoying the holidays with their families, Albanese will be deep in a Central American jungle, keeping formulary records, educating patients about their medications, checking blood pressure—and explaining shampoo.

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