Providing Pharmacy Services Abroad
The goal of medical mission trips is to reach out to people who are less fortunate than most Americans and help them by providing culturally competent patient care. As pharmacists, we are trained to provide clinical pharmacy services within our areas of expertise, taking into consideration the needs of the local population and the available resources. Thus, researching and understanding local health needs and preparing to address a wide array of health problems—acute and chronic, rare and common—are important steps in the planning process, as the needs of the population served will vary from mission to mission.
For example, on the previously mentioned mission to Belle Glade, Florida, the most pronounced needs related to the management of chronic conditions such as hypertension, type 2 diabetes mellitus, dyslipidemia, heart failure, asthma, chronic obstructive pulmonary disease, HIV disease, and AIDS. On another mission, in the Juan Dolio area of the Dominican Republic, the greatest needs related to acute infections such as dermatophytosis, vulvovaginal candidiasis, urinary tract infections, respiratory tract infections, gastroenteritis, and parasitic infections. In Zambia, the areas of greatest need involved HIV disease, AIDS, opportunistic infections, tuberculosis, malaria and other parasitic infections, gastroenteritis, and superficial fungal infections. Pharmacists are well trained to work with other health care professionals to manage all of these conditions and ensure the judicious and appropriate use of medications.
During the mission trips organized by our school, pharmacists were available to support and coordinate the efforts of local physicians, physician assistants, and nurses. The pharmacists played an important role by reminding the team to avoid the use of certain medications without first assessing a patient's renal function (e.g., metformin), ensuring the availability of laboratory monitoring (e.g., warfarin), or ensuring the continuous availability of a given drug or drug class (e.g., β-blockers). The mission team recommended treatment options based on the limited medication formulary, checked and dispensed prescriptions, counseled patients, and supervised students.
Delegating responsibilities to students and local staff facilitates the workflow. With supervision provided as appropriate, students can assist in triaging patients, influencing prescribing behaviors, filling prescriptions, compounding, and counseling patients about their medications. Local staff can assist in advertising, spreading the word about mission-coordinated clinic days, organizing the workspace before opening the clinic, and serving as interpreters. They can also provide transportation and food services.
A typical clinic day usually starts with an early breakfast at which a faculty member or a student shares inspirational thoughts to energize the team. Both faculty and students then gather the supplies needed for the day. Categorizing the medications according to classes (e.g., antimicrobials, gastrointestinal products, analgesics and antipyretics, antihistamines and cough products, topical preparations, multivitamins) may facilitate the prescribing and dispensing process.
On clinic days, transportation is provided from the lodging site to the clinic site. On arrival at the designated town or other clinic site, the workspace is prepared by dividing it into four sections: a patient waiting area, a triage area, a diagnosing and prescribing area, and a pharmacy area. Mission teams usually see 50–100 patients per day, including pediatric patients and adults with various medical conditions, giving the students ample opportunity to apply what they have learned in pharmacy school.
At the end of the day, the team typically gathers in the evening around the dinner table for fellowship and a de-briefing session. Since clinic days can be exhausting, scheduling some free days to explore the hosting country and the culture of its people is good for bonding among team members and creating memorable experiences.