Rx Vietnam

Drake faculty and students research the prescription pipeline abroad

SARS. H1N1. Avian flu. Populations are more mobile than ever before and pandemic fears are raising the profile of health care issues in the United States and abroad.

“Any disease you can name is no more than a plane ride away,” says John Rovers, John R. Ellis distinguished chair of pharmacy practice. “It serves us well to ensure people are healthy in other countries. It also serves our market interests since healthy and wealthy countries are essential for American trade.”

The Drake pharmacy research team met with healthcare workers and ministers at all levels in Vietnam.

Because many of the world’s pharmaceutical companies are based in our proverbial backyards and with a field full of trained pharmacists available to explain treatments, finding a source for prescription medication isn’t a problem for most living in the continental U.S.

In developing countries, connecting patients with the drugs they need often isn’t as easy. But where lack of infrastructure and limited staffing are issues, Rovers travels in search of solutions. Rovers’ most recent research trip with Andrea Kjos, assistant professor of social and administrative sciences, and Vietnam-born student research assistant Van Le, explored pharmaceutical availability in Vietnam. There, the Drake contingent connected with representatives from the Hanoi University of Pharmacy and the country’s ministry of health.

Big questions, personal answers

How does a health system choose what drugs to buy? How much? How are they allocated?

Studying how to get medication distributed in underserved Vietnamese populations involved interviewing more than a dozen players in the prescription pipeline — from medical supply stock keepers to directors of pharmacy to members of district health boards. (Plans for even more interviews were disrupted by the Japanese earthquake and tsunami. The Drake team’s flight was 45 minutes outside of Tokyo when the earthquake hit this spring and they were diverted to far northern Japan — an unfortunate travel adventure detour that ate into research time.)

One of the most common challenges the team encountered in discussions with participants was staffing. At a 500-bed hospital they visited in Vietnam, there were four pharmacists, compared to a staff of perhaps 75 that one would see at a similarly sized hospital in the U.S. The Drake team’s research explored government-owned hospitals, so that results could be comparable to a study Rovers previously conducted on similar issues in the Australian Outback.

“Making policy decisions in those systems allows change to happen more quickly than getting hundreds or thousands of private organizations to comply,” Rovers said.

Kjos’ background in qualitative methodology helped ensure an objective, nonbiased assessment of questions asked and translated.

“The interview questions underwent four English-Vietnamese iterations to ensure integrity of meaning,” Kjos said. “Qualitative research presents many challenges when everything is in English and making the process bi-lingual amplifies those challenges.”

Students were essential to the trip’s success, too. Vietnam-born pharmacy student Van Le made integral contributions, serving as interpreter and ensuring complicated questions were properly translated. As one can imagine, industry-specific terms posed an extra struggle.

Third (now fourth)-year pharmacy student Elizabeth Tran also assisted from Des Moines.

“I never imagined that I would be able to get involved in such a unique and amazing opportunity and become a research assistant,” said Tran, whose parents are from Vietnam. “Being a research assistant in a project aimed at social and administrative pharmacy was well suited for me. When I tell people I am a research assistant at Drake, they always assume I am in my white coat and in a lab somewhere, so it has been great to explain that in pharmacy we are able to do other types of research.”

Rovers said collaborating with students in this project has been a mutually beneficial experience.

“It’s a great student-faculty partnership,” he said. “As faculty, we’d like to believe that we’re career mentors. It allows us to model a career students may not see and offers undergraduates research experience. It’s good to be able to get that exposure early on in an academic career.”

Their work was supported by the John R. Ellis Research Endowment in Drake’s College of Pharmacy and Health Sciences, and is a wonderful example of faculty and students living out Drake’s mission of providing opportunities for both collaborative learning and responsible global citizenship.

Partnering for solutions

The Drake study was descriptive rather than prescriptive, meaning Rovers’ team will provide Vietnamese colleagues with the results of the study and helping make policy recommendations instead of presenting step-by-step solutions.

Rovers and Kjos’ immediate goal is to publish in a national or international academic journal, but also to assist Vietnamese healthcare providers with developing their system and, in turn, to incorporate the scholarly work back into the classroom as a teachable experience.

“I was struck by the immense desire (of those we interviewed) to see improvements in their system,” Rovers said. “Both parties (Drake University and the Vietnamese health ministry) are happy to continue in working toward an ongoing relationship.”

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