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Reflecting on an International Rotation

Written by Erin Frazee

Erin Frazee was the first pharmacy student to participate in an innovative rotation at the Hillside Health Care International Clinic (http://www.hil in Belize . Upon returning, she shared these thoughts with DELTA Rx:

How was this rotation different from others you’ve completed?
I really enjoyed the amount of therapeutic decision making I was able to directly contribute to. This was a very unique experience to be involved in and I was able to play a part in about seventy-five percent or more of therapeutic decisions that were made. The approach to healthcare used by the pharmacy practitioners in Belize is much more proactive than the often reactive approach that occurs in the United States. A lot of this is due to the fact that the pharmacy students or staff members are only one of the few people who are aware of the medications that are available on a given day. Also, many members of the medical team are students and are still very new to medication prescribing and dosing. As a result, the pharmacy representatives becomes invaluable and are consulted to decide the best therapeutic choice and recommended dosage given the options available.

The relationship with the rest of the team also ended up being very educational for me. I worked with one of the medical students to put together a presentation on osteoarthritis and rheumatoid arthritis. This team-based approach allowed us each to focus on our areas of expertise while working together to comprehensively cover the topic, and enhanced the quality of the presentation.

What was your role as the first pharmacy student at this rotation site and how did this benefit the clinic?
I believe the overall role of the pharmacy student benefits both the patient and the other providers. I was a member of a very cohesive health care team that included two medical students, a physician assistant student, two medical residents, and an attending physician. The team was very welcoming and they were always interested in my input on therapeutic decisions and pharmacy practice in general.

There were a couple of facets of my professional relationships that were out of the ordinary when compared with experiences during other rotations. Because of scheduling, there was always another team member in the pharmacy with me. The first time I worked with someone, I spent time training them on the basics of filling prescriptions, documentation, inventory management, and general pharmacy orientation. After this initial session, they would be responsible for dispensing while I worked in the clinic. This approach offered the clinic a new perspective on medication distribution and gave me the opportunity to get away from the dispensing side of pharmacy, in which I have already had much experience.

I also appreciated the feeling of having a pharmacy “consult service.” In most situations, the medical students would come to me prior to presenting cases to residents or the attending physician. It allowed them to gain insight on dosing and therapy choices. I tried to encourage certain methods of dosing, particularly calculating weight-based doses in the pediatric population.

How did the clinic respond to the donations from your “Fill the Suitcase” campaign?
The impact of the donations was enormous. They all arrived while I was at the clinic, and it was truly extraordinary to see the items become integrated into common practice. We were able to do simple things like stock the beds with gowns and provide medications that were previously unavailable, and also improve the infrastructure of the clinic and facilities in general. It was incredible to see the appreciation of both patients and practitioners.

One of my favorite memories is watching the facilities manager use the power washer. As soon as he had it out of the box, he assembled it and was immediately making use of it to wash the steps, cars, or anything else that he could justify as moderately in need of a cleaning. Another rewarding experience was providing a donated knee compression sleeve for a young boy whose severe juvenile rheumatoid arthritis had become so debilitating that he would regularly fall down and couldn’t carry on the normal activities of daily living. Honestly, it kind of felt like Christmas.

What previously developed knowledge or skills did you use at this clinic?
In this setting in a developing country, reference tools were not always available so it is important to have a diverse team with adequate clinical knowledge. I have had a great deal of experience in the community pharmacy setting, and I definitely drew on these past experiences during this rotation. The basics of counseling and education were critical throughout the clerkship. One of the big roles that I had was to educate both patients and providers. Through previous opportunities and instruction I have learned to adapt the information that I provide to the audience with whom I am speaking. This was an invaluable skill during this rotation. Empathy, cultural sensitivity, and compassion are all attributes that were very useful and that pharmacy students should learn and practice if they have not already. This rotation reinforced the critical importance of previously learned skills and required students to practice them on a daily basis.

What skills/knowledge did you gain from this rotation since it is so unique? How will you apply it to other clinical sites or rotations?
Hillside Health Care International Clinic is an urgent/primary care practice setting that also manages chronic diseases for patients. They also see a lot of viral infections and dermatologic conditions. Because these areas affect so many patients in both the developed world and in currently developing countries, it was beneficial to review. I did learn more about pharmacology and pharmaceutical care in these areas.

One thing that was particularly interesting was the unique disease states of the developing world. In the United States, conditions such as leishmaniasis and malaria are not very common and thus are not given much attention so I appreciated the exposure and learning opportunity the experience in Belize offered.

Has this experience altered your views of the pharmacy profession?
It absolutely changed my view of pharmacy. Until this rotation, I did not have a good perspective on how pharmacy was practiced in countries outside of the United States. I was able to observe pharmacy in its most primitive sense, a traditional community practice experience adapted to meet needs in a developing country.

What challenges did you have to overcome during this rotation?
The biggest challenge in this type of experience is learning to be creative and flexible. The environment is constantly changing and there are different resources nearly every day. There are limited reference resources, and I was often without medications and supplies that are ordinarily used to practice in the United States. Changing with the practice setting is a must.

Another area that was challenging and required creativity was patient education. The level of health-literacy is very low, so it is important to be succinct and clear at a level the patients will understand. Often developing creative ways of setting up a schedule or providing them with both written and verbal information is critical to reinforcing the principals of therapy.

What advice do you have for other students who want to participate in a similar global service rotation?
This rotation was an extraordinary experience, and one I would advocate for in the future. It is important to enter into this type of activity with a positive attitude and enthusiastic mindset. Do not anticipate that you will change the world, but do strive to make a difference in whatever ways you can. Make sure that if you want to implement changes, communicate with the people who will be continuing with them upon your departure and consider their needs.

I would highly encourage any interested person to get involved with a philanthropic project like mine. It was a demanding project with respect to time and energy, but the personal and professional rewards are invaluable.