Inside Tomorrow's Pharmacist (2001)

Home > Students > Tomorrow's Pharmacist >
A prescription for travel

A prescription for travel by Paul D Spivey

Web sites

Every second another person in the world is exposed to the tuberculosis bacillus and of these one in five will develop TB. Annually there are 11m deaths among the under-five population, of which 70 per cent are caused by five common diseases. There were nearly three million deaths from AIDS in 1999. We've all heard the figures. But the thing is they could be reduced. Dramatically reduced. Many of these deaths are preventable.

Now, let's think about a meeting in the World Trade Organisation — a meeting on access to pharmaceuticals and intellectual property rights. Access to essential medicines is a current focus of the world's media, frequently making the headlines in America, Europe and South Africa. There is world-wide concern about the existence of counterfeit products of patent medicines as well as poor quality production of medicines with generic labels. Travel to Russia, for example, and you'll see for yourself.

Then there is the World Health Organisation, Médecins Sans Frontières, Oxfam and others who are campaigning very strongly to ensure that public health issues and not commercial incentives motivate the provision of health care.

All this before we even begin to discuss the issue of the safe supply and rational prescribing and use of medicines! Just four years ago I came across a village health worker in Nigeria — which involves just a three-week training — using phenylbutazone and indomethacin as the preferred options for "body pain".

I hope the message is clear. The challenge for pharmacists in international health and especially in health systems in developing and least developed countries is enormous. The question is how can you get involved?

As I sit writing this in my hotel room in Pretoria, South Africa I have just finished watching a question and answer programme on CNN television about access to essential medicines, particularly for the care of AIDS patients. A hot topic in today's world, but as I celebrate 35 years on the register, access to essential medicines has been the focus of my career. A career that has been a privilege and that has taken me to work in 24 different countries — some more than once. Later this year I anticipate working in Hanoi, Istanbul and Lilongwe, perhaps also back in Pretoria, maybe in Sarajevo. What about Kosovo, you ask? Yes, been there, done that.

What are your hopes and expectations as you think ahead to your pharmacy career? You could have some surprises ahead! I hope so anyway. But maybe I am moving ahead too quickly. Recognising the needs in health care in developing countries is one thing, but doing something about it is another. And how can you, as a pharmacist, do something about it?

Learn to do your job well in the UK

Before thinking about working overseas, learn to be an effective pharmacist in the UK. You would be very presumptuous to think you could contribute elsewhere before working in your own environment. It's a bit like sending used tea bags to those in desperate need of a good cup of tea on the basis that it is better than nothing! If you plan to work overseas, you need to have gained a good grasp of your profession, of the broader principles that drive some of the practice activities, and of the structures necessary to ensure the safe supply of quality medicines within the resources available. I was advised to get a minimum of two years working experience as a registered pharmacist. It was good advice too.

Don't immediately expect to be a highly paid international expert

Working overseas is one of those "chicken and egg" situations. International agencies are looking for people with experience so how can you get experience working in developing countries if they won't provide it? The answer lies in contacting non-government organisations (NGOs) that are involved in health care work. There are many of them, both religious and secular, including Voluntary Service Overseas (VSO) and also a specific NGO for pharmacists (Pharmaciens Sans Frontières). In some cases the organisations may not realise that they need a pharmacist! You might want to persuade them otherwise. There are also "junior" posts within many government and international aid agencies for professional officers (eg, the United Nations volunteers programme). They may not be pharmacist posts but the important thing is to get in-country experience in the health care environment, and pharmacists know a lot more about the broader health care environment than they realise.

Learn to be creative

My first job was in a small 160-bed hospital in Kathmandu in 1969. Clinical pharmacy and pharmaceutical care had not been invented! My fellow professionals in the UK were dipping their toes into ward pharmacy and I still have the PJ article that inspired me to do the same when challenged to improve drug supply management and control in the hospital. In Kathmandu we had no cardexes, no fancy ready-made drug trolleys, so we designed our own medication charts, our own trolleys, and our own system of prepacks and checking on the ward. What we took from the UK were the underlying principles and we adapted them. In fact, we were ahead of the UK at one stage in that no solid dose medication was allowed as ward stock.

Learn to be flexible

In the early months I found myself quickly drawn into teaching, hospital management and running a joint supply store for several other hospitals as well as being the only pharmacist around! One of the challenges in working overseas is to adapt to the working environment and find a way to get a job done. This will probably require you to move beyond the normal boundaries of a pharmacist's role and apply your knowledge to broader areas of public health. It will also cause you to re-think your priorities. How would you react if you found all outpatient prescriptions were dispensed in used newspaper? And what about IV fluids filtered using two filter papers in funnels one below the other?

Become a trainer of others

A crucial aspect of working overseas is to be able to pass on your knowledge, skills and attitudes — the good ones of course — to others in order to build capacity and ensure sustainability of a programme. There are opportunities in formal education in some countries, particularly those that train their own support staff to supplement the limited number of pharmacists. As well as training people to do the basics of dispensing and supply in the hospital in Kathmandu, I was asked by the government to share in the development and delivery of a course to train pharmacy technicians. Some knowledge of educational techniques and curriculum development will always prove to be useful.

Postgraduate studies

If you plan a career in international pharmacy, it is a good move to get a postgraduate qualification in public health, health management, health economics or in international development studies. There are a number of courses in the UK in all these areas and such study is probably best done after at least one assignment overseas. Having a postgraduate qualification in a broader aspect of health or development can be an advantage and is particularly useful when applying for posts with the international agencies.

Opportunities with the major agencies

Three of the main international agencies have pharmaceuticals programmes. As you would expect, the World Health Organisation is one of them, but there is also the United Nations Children's Education Fund (UNICEF), and the World Bank. Except for very short-term research assistant work, these agencies are usually looking for people with a proven track record with five to ten years of experience in developing countries.

Given some working experience there are a number of posts on projects varying from six months to three years. This is particularly true in the area of pharmaceutical policy, regulation and registration and in quality assurance. In the coming years there will inevitably be an increasing number of programmes focusing on improving access to essential medicines that will have international financing.

If you don't, others will!

One of the realities in the field of pharmaceuticals globally is that medical doctors are ahead of the game, simply because they have been quick to recognise the opportunities. There are very few pharmacists who are regarded as leaders in the area of international pharmaceuticals policy. What is more, the added value of pharmacist participation in health care planning and delivery is rarely acknowledged. We need more pharmacists willing to take up the challenge of working overseas. So, why not you?

Web sites

Catholic Agency for Overseas Development (CAFOD) www.cafod.org.uk

Christian Aid www.christian-aid.org.uk

Department for International Development (DFID) www.dfid.gov.uk

Oxfam www.oxfam.org.uk

Pharmaciens Sans Frontières www.psfci.org.

Save the Children www.savethechildren.org.uk

Tear Fund www.tearfund.org

UNICEF www.unicef.org.uk

Voluntary Service Overseas (VSO) www.vso.org.uk

World Bank worldbank.org

World Health Organisation www.who.int

WHO (employment) www.who.int/employment

WHO Europe http://www.who.dk (not working in November 2001)

Mr Spivey is an independent pharmacist consultant with more than 25 years experience of working overseas