Pharmacists Have Important Role in Developing World Medicine

Alumna Jennifer Boyd (Pharm.D. '03) is Making a Difference

"I can breathe!" - Outreach in Kenya, January 2009
One afternoon in Mombasa, Kenya the doctor sent a man to my make-shift pharmacy for an albuterol nebulizer treatment. I didn't have a translator so I'm sure I looked pretty funny as I hooked up the nebulizer through a power adapter and converter, then pantomimed how to hold the nebulizer mouthpiece. A few minutes into the treatment he pounded on the table to get my attention. Worried something was wrong, I quickly found a translator. "I can breathe!" he told me. This man struggled with a reactive airway disease his entire life and this was the first time he'd received proper treatment. I told him we would give him albuterol inhalers so he could give himself a similar treatment at home. He was so excited he had trouble relaxing his smile long enough to finish the treatment!
 

Since 2006, Jennifer Boyd has traveled as a member of medical missionary teams to rural and impoverished areas throughout the world providing medical care for people who have no access to doctors or healthcare. The teams she works with consist of doctors, nurses, nurse practitioners, dentists, and medical students. Boyd has worked in the Philippines, Cameroon, Zambia, Kenya, Bolivia, Peru, India, Siberia, and the Dominican Republic. Her example and message for students and fellow alumni is that pharmacists have an important role in developing world medicine.

When she is home in Boise, Idaho Boyd is a hospital pharmacist at Saint Alphonsus Regional Medical Center. She is currently helping to coordinate Mission Medics, a medical missions training program through the Vineyard Christian Fellowship of Boise.

Boyd shares her amazing experiences and provides information about the needs of people in impoverished areas on her Web site: www.prescriptionformercy.com. The following statistics about the developing world are posted on her site:

•Approximately 30,000 children die each DAY from preventable and/or easily treatable diseases (like diarrhea, malnutrition, and simple respiratory illnesses.)

•Between 70 and 80% of the world's population lives outside the reach of health services (more than 4 hours from medical care or prohibited by economic barriers)

•One out of every 10 babies born in developing countries will not survive to the age of five (and those are the babies who survive childbirth!)

Per Boyd, the biggest "percentage of global disease burden" is in Southeast Asia and Africa (>50%). Yet these areas have the smallest "percentage of global health care workforce" (<15%). World Health Organization, 2001

Amidst the challenges of steep terrains, hot, humid weather, possible tribal wars, illness, and lack of indoor plumbing and amenities, the medical missionary teams treat patients for everything from wounds and infections to serious illnesses. An excerpt from her Web site provides an idea of life as a medical missionary:

Bolivia - 2008 - A day in the life of a missionary pharmacist

After breakfast and morning devotions we crammed ourselves in small taxis and headed for that day's clinic site - about one hour from San Juan. The building we used in this village was a school building that had not been used for several weeks. Spiders, cockroaches, and moths had literally taken over the walls and floor of the room we used for a pharmacy. We worked with some local Bolivian ladies to sweep the floors and walls while the men located a large table somewhere down the road and carried it to the school.

Cathy and I started to set up the pharmacy, but we'd locked most of our medications and supplies in a building down the road the night before and our Bolivian teammates had trouble finding someone with a key to open it for us. So the doctors started seeing patients who didn't complain of fever (the thermometers were also locked away) and medication orders started piling up. After many medical outreaches in the developing world I'm used to problems like this. We took advantage of our forced free time to play with some kids and I wrote some notes in my journal.

Sometime after 9:30 a key was located and the pharmacy bags started arriving. By 9:40 the room was a bustle of activity as my 2 helpers counted pills, diluted liquid antibiotics, filled out labels and laid out piles of medications for me to check. Suddenly it was 12:30 and my growling stomach reminded me of the crackers in my backpack. Pain in my neck and back reminded me to give my helpers a break. We stopped to give each other quick back rubs, stuffed crackers in our mouths, and each took a 5 minute break to walk around the school yard and interact with people. Lunch finally arrived at 2pm, and after a short break to eat our rice and chicken we continued seeing patients until dark. That day I dispensed over 500 prescriptions, 200 of which needed a "pharmacist touch" (pediatric dosing calculation, therapeutic substitution, patient teaching, etc). Exhausting work (did I mention it is HOT in San Juan?) but also rewarding. One of my last patients was a child who had never used an inhaler before. The woman who was explaining most medications for me was busy, so I grabbed another translator and worked with this boy and his mother myself. There were no pediatric "spacers" available so we used a toilet paper roll. His breathing improved mere moments after using the inhaler, and his mother's grin will stay in my mind for a long time.

The end of a clinic day is often the most chaotic time of day for me. As doctors and team members finish their last patients, they arrive in the pharmacy to help. I feel like an air traffic controller - politely ordering everyone around while frantically checking our last prescriptions and mentally inventorying medications as they disappear into boxes so I know what to bring the next day. Today we loaded our boxes back into the locked building down the street (to be picked up on our way to a more distant village the tomorrow) and piled into vehicles to go back to San Juan.

When asked what prompted her to begin working with medical missions, Boyd responded "I had no plans to work with medical missions when I was in college. I had been overseas a few times, but assumed you had to be a doctor or nurse to serve on a medical team. However, I'm a big proponent of serving the underserved wherever you are. While in Laramie I volunteered with Big Brothers Big Sisters and supported the Laramie Downtown Free Clinic. After graduation I took a clinical position at a hospital in Boise. Two years later I paid off my school debt, paid off my car, purchased a house, and started asking "now what?" About that time a flyer from Christian Pharmacists Fellowship International (CPFI) came in the mail. At the top it said "Pharmacist needed for medical outreach to Cameroon." I signed up for the team, got out my World Atlas to figure out where Cameroon was, had an amazing experience, and the rest (as they say) is history."

"Jen was an outstanding student while in our program and has continued to be an outstanding pharmacist while practicing at home and in other countries. Through her work as a pharmacist she has provided invaluable help to destitute people living in impoverished areas of the world. She works with passion and compassion," comments Associate Professor M. Glaucia Teixeira, Ph.D. She adds, "We wish we had more students who would follow Jen's steps. Her professional work makes us proud of our profession and program."

Jennifer Boyd is an alum "who has taken a non-traditional path," says Associate Professor E. Kurt Dolence, Ph.D. "I gave her her first non-A grade ever. She will admit that she deserved a B grade. Her dad actually thanked me at graduation since it forced her to see that there is more to life than school."

Boyd suggests that there are two important ways pharmacists can help in developing world medicine. First, pharmacists are invaluable on short-term medical outreaches. Medication supplies are usually limited, so providers appreciate pharmacists' ability to "creatively" select treatment based on the medications they have on hand. Pharmacists offer patient counseling, basic health education, compounding skills... the list goes on and on. With a little experience, pharmacists can also help with trip preparation by setting up a cost-effective medication formulary, pre-printing medication labels, and preparing for patient education.

Second for long-term medical outreaches, full-time pharmacist positions in developing world settings are rare but they do exist. Clinical pharmacists work in mission hospitals, clinics, and outreach programs throughout the world. Boyd knows of pharmacists working for medical missions organizations here in the United States. One pharmacist works full-time for a medical mission organization in Florida, coordinating medications for their short-term and long-term projects throughout the world. Others work for medical missions drug distributors (Blessings International and MAP International).

Referring to the obstacles pharmacists confront in working with medical missions, Boyd says, "Working in developing world medicine usually doesn't pay. Anything. In fact, it will probably cost you (or people who support you). There are many rewards, but they are not monetary. Pharmacy education is very different in developing countries. Foreign pharmacists in these countries learn basic pharmacology, but are usually more business oriented. You will probably have to develop trust with local government officials and health care professionals before your advice will be taken seriously."

Her advice for students and other pharmacists is, "If you think you're interested in developing world medicine, join a short-term team (usually for 1 or 2 weeks). I've traveled with Global Health Outreach and Medical Ministry International. Both are great organizations that send numerous teams throughout the year, but there are hundreds of other organizations. One place to start is missionfinder.org (search for "pharmacist"). Or attend the Global Missions Health Conference (held each November in Louisville, KY)."

"If you're still in school, pay attention to obscure medications, disease states, and skills. Think you'll never need to know how to dose antimalarials, antihelminthics, or chloramphenicol? Think again! All are used routinely overseas. As a mission medic hiking into remote villages, I also make frequent use of physical assessment, basic laboratory, and compounding skills."

Boyd is continuing her work as a missionary pharmacist and leaves in November for India. She is making a difference in the lives of her patients and their family members in villages throughout the world. She is also setting an example for the role pharmacists can play in developing world medicine. For more information or to read about her medical missions, please visit her Web site at www.prescriptionformercy.com.

Posted on Monday, October 19, 2009