Pharmacists Who Go Global

Nearly everyone has heard of Doctors Without Borders — physicians from all over the world who travel to poor and war-torn areas to deliver care to people in need. But many other medical professionals also donate their time and skills to those in other countries, including, perhaps, your neighborhood pharmacist.

Healthline sat down with three American pharmacists to find out what they've learned from years of international service.

Paul Doering, a professor emeritus at the University of Florida College of Pharmacy, recently returned from the Stuttgart region of Germany, where for the past 19 summers, he and a team of colleagues have taught students a 20-hour course in clinical pharmacy. Doering has also traveled to Brazil four times to teach this course to pharmacy students.

“Sometimes we are so introspective, we think the entire world practices pharmacy the same way we do here. I've learned from my international travels that there’s a huge variation in the way pharmacy services are delivered,” said Doering.

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A Personal Touch in Germany

While traveling abroad, Doering has met many pharmacists who share a similar sense of pride and responsibility, but he has also seen many differences in the way pharmacists and patients interact. 

For one, Germans can’t buy over-the-counter medicines in a gas station or supermarket like we do in America. They have to go to a pharmacy and speak to the pharmacist. Although this increases pharmacists' role as counselors, Doering said they are not taught counseling skills in pharmacy school.

“There’s a hard-core emphasis on science, and they are astonished to learn that in teaching our pharmacy students we build in courses in communication. The professors in Germany sort of laughed at the concept of teaching communication skills in the university," Doering said. "When we first started doing case studies and interviewing and breaking students up into teams of three, which included a pharmacist, a patient, and an observer, we were all cautioned that this is not going to work in the German setting. We said, 'let’s try it,' and it was a huge success.”

"Change never comes easy. Sometimes it takes the urging of somebody with a different perspective to bring about that change." — Paul Doering

Doering is careful not to judge other countries' systems. “I feel very proud that we've been able to introduce the concept of the patient being at the center of what a pharmacist does. In Germany ... the big difference is their emphasis on science for the sake of science," Doering said. "We introduced the term 'patient-oriented practice of pharmacy,' and it has caught on. Among the young pharmacists, we now have a sizable cadre of believers in the concept of patient-oriented practice. I've seen such progress that it emboldens me to want to go back again and again."

And Doering welcomes a change in his own point of view. “It was Mark Twain who said, travel is the biggest enemy of bigotry. We can sit here half a world away and criticize this group of people, but it’s really hard to look into the eyes of your counterpart in another country and criticize that person. Change never comes easy. Sometimes it takes the urging of somebody with a different perspective to bring about that change," he said. "It’s like a glacier. You can’t look at a glacier and know it’s moving. But you check back a hundred or a thousand years, and say, 'holy cow, it’s moved.' It is a great feeling.” 

Fresh Water in Latin America

In addition to these professional trips, Doering has logged many miles visiting Guatemala, Honduras, and the Dominican Republic on medical mission trips. “I went to the highlands of Guatemala and that was eye-opening, because Americans tend to forget about the rest of the world and the woes that go along with poverty, hunger, crime, and political strife,” he said.

Doering, who travels with a group from his church, was pleased to counsel patients in Spanish. “In each of these areas we went out to distant villages where they hadn't seen a doctor in six or seven years. It was very rewarding," he said. "We would show up to set up the clinic 8 a.m. in the morning, and the line would wrap all the way around the building.

"We treated intestinal problems, diarrhea, parasites, worms, colds, and headaches. In Guatemala, ladies carry baskets on their heads and they have constant headaches and neck aches. They don’t have access to many medicines. They told me that generic aspirin tablets cost between 50 and 75 cents apiece, if you are able to get them at all," he said. "The people are eternally grateful. There are smiles and gratitude everywhere.”

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Paul Doering, left, and his partner Tim Rogers at a pharmacy clinic in the Dominican Republic. Image courtesy of Paul Doering.

One of Doering’s church’s outreach efforts was a partnership with Living Water International of Houston, which brought Doering to El Salvador. “That was my first well-digging trip. It was way up in the mountains, where the drinking water is perpetually polluted and causes all kinds of illness and suffering," he said. "It’s not a small drill, but a giant machine, and we assist the professional well diggers with manual labor. The trip lasts a week, and the day before we left we had fresh water up from the ground, 150 to 190 feet deep. That’s water so pure it tastes delicious compared to the river water or spring water they are used to drinking.”

Doering didn't mind the manual labor, which involved handling heavy pipes. In fact, he says, “This was four years ago. Since then we had the opportunity to go to Guatemala once again, this time for drilling a water well down on the Pacific Coast area ... That’s a healthcare improvement that will continue to reap benefits well into the years to come," he said. "In many countries around the world, young girls and women hike seven miles just to bring back a couple of buckets full of water, and that water is laden with dirt and bacteria.”

An HIV Clinic in Rwanda

When Joel Zive, Pharm.D., an adjunct professor also at the University of Florida College of Pharmacy, received a Fulbright scholarship to teach pharmacists in Africa, he had no idea that he would fall in love with the continent.

His humanitarian missions, which include designing a pharmacy and helping to build a clinic in Rwanda for women who have HIV and their families, date back to 2004. That year, he wrote an abstract that was accepted by the International AIDS conference in Bangkok. “I flew out there to present the poster and realized there was a real need for pharmacists to help out people in healthcare facilities in developing countries," Zive said. "I applied and didn't hear anything."

But while he was in Bangkok, Zive met Dr. Kathy Anastos. Later that year, Zive learned that Anastos had flown a colleague to Rwanda. He called her and was excited when she invited him to work in “a resource torn country” to design a pharmacy for a new clinic. "She asked, ‘are you really serious?’ I said, ‘absolutely,’" recalled Zive.

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Joel Zive in Rwanda. Image courtesy of Joel Zive.

Zive met with Anastos in January 2005 and they sketched out the plans for the pharmacy. "I literally went from the hospital to my doctor and got six shots to get inoculated for my trip, and I don’t like needles. But when you want something bad enough, you put up with this stuff. I went to Rwanda for two weeks and I was really hooked,” said Zive.

He brought computers and other equipment to Rwanda and showed the pharmacists there how to sort medications more efficiently and how to make drugs last longer so they don’t expire.

“In a small way, I was able to show them how to design a pharmacy," Zive said. "On my second trip, the pharmacy was built. I started a nonprofit and was able to raise money from family, friends, and colleagues to buy an extra generator ... I brought over 500 pounds of equipment from the United States to Rwanda."

Today, Zive, who has now been to Africa seven times, says the clinic he helped build has grown from a capacity of 41 to serving more than 1,100 HIV patients.

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A Training Network in Thailand

Janet P. Engle, Pharm.D., executive associate dean, professor, and head of the Department of Pharmacy Practice at the University of Illinois at Chicago (UIC) College of Pharmacy, started her global treks to Thailand in 1994.

"In Thailand, in the 1990s, they realized they did not have enough pharmacists for all of the patients that they had. The government was willing to start new colleges of pharmacy so they could train new pharmacists, but the faculty did not have enough capacity to teach. The government gave them money to form the United States-Thai Consortium for the Development of Pharmacy Education," Engle said. "I spent time in Thailand teaching week-long workshops on different clinical services. They also send pharmacists here who go back home fully trained."

Every time Engle goes back to Thailand to visit one of the practice sites, she says she sees the positive impact the training has had. "You can see we were making a difference. I went to one pharmacy and they were using the exact same monitoring forms we taught them about, which we were using in our clinics. Now all these years later, the faculty are making a big difference, not only in Thailand, but internationally as well," said Engle, who is planning another trip to Thailand at the end of August.

"We can share our expertise, but we get the benefit of learning from our colleagues in the other countries. It’s a two-way street. If we are going to be a forward-thinking college of pharmacy, we need to learn from others what they are doing and what their thought processes are." — Janet Engle

Engle said many countries in Asia realize there is a role for clinical pharmacy, but they need more resources. "A few years ago, I put together a clinical pharmacy workshop for the Western Pacific Region. There were pharmacists from nine different countries. We talked about how to start a drug information service and how to start parental nutritional services," she said. "The international commission has come up with criteria, similar to the standards we use in the United States, to accredit colleges of pharmacy, but these criteria have been written with a more global look, due to the fact that healthcare systems are different in other countries.

The idea is to help schools in other countries to look at their own programs, within their own cultural context, and put quality improvements in place. We just certified a number of schools, including one in India and a few in Saudi Arabia," Engle said.

Engle's pride is evident when she reveals that the Princess of Thailand presented her with an honorary Ph.D. in pharmaceutical sciences from Khon Kaen University in Thailand. But what's more important, she said, is for others to also go global.

"We can share our expertise, but we get the benefit of learning from our colleagues in the other countries. It’s a two-way street," she said. "If we are going to be a forward-thinking college of pharmacy and be a leader, we need to learn from others what they are doing and what their thought processes are — to be more global in our thinking and make sure our students are prepared for that and that they understand global health issues."

'We Are All Cut from the Same Cloth'

The three pharmacists traveled to different destinations, and had different reasons for their trips, but they all shared in the same benefits.

“When you can bring a smile to a young child’s face, or if you can help eradicate whatever illness or affliction they have, it’s really a great feeling," Doering said. "I’m semi-retired and I want to make full use of the knowledge and experience I’ve gained over these years, scientifically and professionally, but also from the standpoint of a sense of responsibility to my fellow human beings. When the day is done, we may differ in languages and culture, but we are all cut from the same cloth. If there is something I can do to bring a little bit of happiness and comfort to a person, I believe very strongly I have that obligation."

Zive saw the benefits of working abroad in terms of personal growth. “I became a better father, a better pharmacist, and more compassionate and more empathetic, and intolerant of waste and fraud," he said. "Now I’m a mentor and I teach students, and when they see what I've done, they say, 'if he could do it, I could do it.'”

Engle offered these words: “It’s worth looking for opportunities to work with international partners. You’ll get as much as you give. You’ll get that back multiple times over, in terms of what you learn and satisfaction to see things change, and you make friends, too. I was in awe of everything those pharmacists did with so few resources. They didn't have access to technology the way we had 20 years ago, but were doing so many innovative things. For me, it was just very inspiring."

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