Pharmacists can make a significant contribution to an overseas medical mission. In fact, the participation of a pharmacist on a recent mission to rural Kenya led by a California-based hospital proved to be so invaluable that all future missions to that region plan to have a pharmacist onboard.
Bhavi Shah, PharmD, clinical pharmacist and pharmacy educator at Hoag Memorial Hospital Presbyterian in Newport Beach, said, "My pharmacy training allowed me to work as a clinician, educator, and dispenser."
For the past few years, the Hoag Hospital has been involved in an outreach program that provides medical resources to underserved communities both locally and internationally.
The medical personnel initially participating in the rural Kenya program included physicians and registered nurses. However, the decision to include a dispensary as part of the services provided by the mission meant that a pharmacist was needed. "The dispensary serves as a laboratory, a clinic, and a pharmacy all rolled into one, and the first team visiting Kenya realized that they couldn't set up a dispensary properly without the expertise of a pharmacist," Shah said.
Her responsibilities during the 10-day program were highly varied. Following meetings with team members to assess medical supply needs and determine dispensary conditions, she set up a complete formulary and worked alongside local pharmacists completing and dispensing prescriptions with assistance from Swahili interpreters.
She also helped develop lectures and handouts on topics that had been identified during prior missions as needing pharmacy education. Her "students" were pharmacists, nurses, and "clinical officers," who are the equivalent of physicians assistants.
"Sometimes we had to teach them really simple things," Shah noted. "For example, they would prescribe a baby aspirin for a child," she said. "They didn't understand that the 'baby' in 'baby aspirin' did not mean that the product is intended for a baby."
Medical personnel in rural Kenya also tended to overprescribe antibiotics and were unable to distinguish between viral and bacterial infections.
Shah also noted that she occasionally found herself working as a clinician. "I felt that with my clinical background, I was more credentialed than some of the local clinical officers," she said.
She cited the case of a young girl whose eczema she diagnosed. "The local medical personnel had not been able to diagnose her and had kept throwing [sic] antibacterials and antibiotics at her when all she needed was hydrocortisone and a moisturizer," she said.
Shah acknowledged that the program was fraught with some insurmountable challenges. For example, most of the Kenyans in the area where they were working could not read or write so they were unlikely to retain what was explained to them by medical personnel. "So this made it difficult to deliver quality care," she said.
Polygamy also led to potential problems, she observed. "Men had multiple wives who had multiple kids," she said. "And when we give out antibiotics in varying doses to multiple family members who are all illiterate, it's easy to see how problems may result," she said.
Another problem is that antibiotic and antimalarial medications are available over-the-counter, which has led to overuse and escalating resistance. Finally, Shah said that although her responsibilities included teaching, she also had the opportunity to learn firsthand about clinical problems she had never encountered, including brucellosis, typhoid fever, and malaria.