Tomorrow's Pharmacist October 1999 p78-80
Edited by Pamela Mason

Student exchanges

A summer in Zimbabwe; trading places ...

By Lindsay McClure, MPharm, MPharmS

Working overseas can be a rewarding experience, and for many people means receiving far more than they can ever give. Here, the author describes one such experience in Zimbabwe on an IPSF student exchange.

Falls "Life's an adventure!" and I guess that's what I got when I went on an International Pharmaceutical Students' Federation (IPSF) student exchange to Zimbabwe a few summers ago. I found out that I had been accepted about six weeks before I was due to go - just enough time to get my injections. Well, it had not really been part of the plan to have a bad reaction to them and end up in bed for a fortnight waiting for it to wear off.
I finally made it to Harare airport and was picked up (an hour late!) by three second year students from the University of Zimbabwe, with whom I became good friends. We went back to the university just as the students had finished rioting over student grants, all of the grass land was black from being set on fire, and most of the lecturers had gone home in fear so the place was deadly silent.

Community pharmacy

After the "character building" start, things soon settled down a bit. Most of the time I was staying with the owner of a city centre pharmacy, Debbie Peters, and for the rest of the time I stayed with the chairman of the school of pharmacy, Farai Chinyanganya and his family. My interests lie in community pharmacy so I was based at Debbie's pharmacy, Drug-Tech. It was pretty different from what you see in Britain - no tablet counting machines, a balance that had a minimum measure of 1g, tablets packed in plastic bags and a South African computer programme, Easy Scripts, which turned out to be far from easy!
On one of the first days I was working there, a man came in with a prescription for his daughter who had malaria but he could not afford it so she got no medicine. The next day a man came in with a bad skin infection, but he could not afford to go to the doctor so he ended up buying aqueous cream and calamine lotion to heal the open sores that he had all over his body. After that I stopped getting shocked and remembered the real reason that I had chosen to do pharmacy - not for the fast car or the big house (although that would be nice!) but to be part of the community and to help people.
It was suggested that as many as 40 per cent of the population could to be HIV positive, and at one clinic in a high density suburb beside Harare, 95 per cent of babies being randomly tested were found to be HIV positive. Poverty is evident everywhere; 60 per cent of the population are unemployed, the government is pretty much bankrupt and the Zimbabwe dollar is falling faster than ever before, but Zimbabwe did have some amazingly good points. While they no machines, they had community - people who worked together to do the same jobs and people who would go out of their way to make you feel welcome. I spent the weekend at a mission hospital about seven hours from Harare where, although the rest of the country was on strike, the staff there worked on. The nurses had made their own uniforms and the community - who lived in mud huts - from the surrounding area, chopped down trees and built a fence so that the hospital could grow vegetables in a small patch of garden. The facilities were very basic, but the work that they were doing and the difference that they were making was unbelievable.
Pharmacy students from the University of Zimbabwe's Hindu society had made enough money to provide a mattress, pillow case, blanket and two sheets for every bed in the 110-bed hospital so I took them up in the Zimbabwe essential drugs action programme truck. We nearly did not make it after problems caused by the strike, but when we finally arrived it all became worth it. One of the government ministers had come to see the handing over ceremony so our trip ended up being covered on Zimbabwe television's 8 o'clock news.
It was one of the first times that I've ever been speechless in my life. All of the staff that worked there stood up and started singing a song to say thank you to us; it was in Matabele, so I did not understand any of the words, but I understood exactly what was meant. Just the looks on the people's faces when they first saw the new mattresses and that of the medical registrar when she got her first baby resuscitator, is something I will never forget.

Hospitals

I also got to spend time at Harare's two main hospitals. Parientyatwa, the private hospital, was well equipped, with some counting machines, many laminar air flow cabinets and plenty of staff. It was very easy to forget where you were. However, Harare hospital, which was the government hospital, was another story. Due to the critical shortage of drugs, only patients with rheumatoid arthritis, diabetes and hypertension were given medicine (this was where patients came who could not afford anything else). A skin specialist visited once a week, and if any patient wanted a cream made up they had to wait until that afternoon. The pharmacy was so understaffed, there was simply no time on any other day. Queues of about 50 people waiting for the two pharmacists to dispense their medicine were about average for out-patients, where there was no time for introductions, and everyone simply had to work together in an effort to give patients their medicines.
Harare hospital had counting machines, but the problem was that they did not work, and there was no money to fix them. I got the chance to make up magnesium trislicate in bulk and package it into used bottles, washed by hand because of the high cost of glass. I made injectables in their single laminar flow cabinet, not even wearing sterile gloves, because they could not afford them. I had never thought about the real value of money before - not when I had never had to worry about having a roof over my head, or where my next meal was coming from. I have never had to worry about who is going to help me when I get sick and I have not got enough money to buy the medicine that could save my life. I guess being in Zimbabwe really changed my outlook on life.

A wedding

But it was not all work! I befriended a medical student from London who happened to be President Mugabe's niece. She was visiting Zimbabwe for the President's wedding. I think I got lucky! After receiving a normal invitation to the wedding, I met the uncle of a second year pharmacy student who happened to be a member of parliament. He took me into the VIP tent where I got to meet some of the other guests, including Nelson Mandela and the presidents of Mozambique and Namibia.

On safari

on safari There were some American students over at the same time, visiting the university with their lecturer, so I went to see a bit of the country with them. I also spent a long weekend at Victoria Falls (on the Zambian border) where I took part in a canoe safari. It started off with a game drive through the national park to the Zambian border where we saw all of the main animals. We then camped out in the national park. After spending a few hours telling horror stories in the dark around the campfire, it was time for bed. In the distance I could hear the sound of running impallas, grunting hippos and monkeys in the trees above the tents. But what worried me more was that there was a mouse in my tent!
After a while, tiredness took over and I fell asleep. However, I managed to get some great photos of sunrise the next morning. At least if you are going to be eaten, you can see what by after daybreak! There were hyena tracks all around the camp next morning but that was the least of our worries. There were hippos everywhere but they are vegetarians, and the most they will do is capsize your canoe.
Nearer the end of the trip I visited a Shona village, and in one of the mud huts was a N'anga - a traditional healer and fortune teller. To gain entry to the hut, everybody had to take off their shoes and watches to show respect to the spirits. She predicted that because of the experience I had had that summer, I would one day return to Zimbabwe for a much longer visit. She might have been right in her prediction. I had a brilliant summer and would really recommend the IPSF student exchange programme. I have learned a lot about pharmacy, and about myself. Yes, I do want to return to Zimbabwe, so maybe the N'anga was right. However, it did worry me a bit that despite all of her traditional beliefs and values, she tried to convince me that the spirits would give a better prediction if I paid in Smirnoff vodka!

For more information on the IPSF student exchange programme or other opportunities to work abroad including the Neema Project, which is building a dispensary in Tanzania, contact BPSA at BPSAUK@aol.com or check out the BPSA web page - http://members.aol.com/BPSAUK.

Ms McClure is a locum community pharmacist in Hertfordshire

Tomorrow's Pharmacist October 1999 p78-80 Edited by Pamela Mason