Real-world skills on display during international outreach trip

By Nicole Perez, Darla Quevedo, and Leonard Deleon, PharmD

There are a variety of ways that students can bolster their professional backgrounds. The University of Florida (UF) provides unique opportunities that prepares students to be leaders in pharmacy when we go outside of our comfort zones and bring health care to other parts of the world. Since 2003, UF has worked directly with health professionals and students from the Universidad Autónoma de Yucatán (UADY) in Mérida, Mexico. The project, called “Hoy en tu Communidad,” is a program developed by UADY that targets disadvantaged villages and provides free health care services to patients. While UF students participate for 1 week in the spring, UADY frequently visits these same villages throughout the entire year.

Partaking in an international outreach trip offers several real-world skills that include adaptability, cultural sensitivity, and patient care combined into one experience. We accompanied an interdisciplinary team and traveled to Mexico to serve underprivileged populations this past March. We want to provide information to those considering similar travel programs or looking to set up one at their school.

Adaptability a key attribute

To begin, there is a vast array of different perspectives in culture and health care systems that even the U.S. demographic may not offer. In the program, most of our patient demographic have little to no access to health care nor affordability for medications because the majority of prescription medications are primarily paid out-of-pocket.

Our typical clinic day consisted of meeting with UADY students early in the morning, traveling for some hours via bus to the designated town, and quickly setting up makeshift clinics and work-up stations. We were surprised to find that a great deal of adaptability was required throughout the day. Were we going to be in-doors or outdoors? How much space did we have? How much inventory should we leave out? Who would be in charge of manually writing out proper medication use? At the official start of clinic, patients would be worked up and triaged appropriately prior to coming to our pharmacy. Our team was responsible for counting medications, manually writing directions, packaging in Ziploc bags, and finally, counseling patients with a UADY student serving as translator.

The most notable skills included calculating weight-based dosing for pediatric patients and checking appropriateness of antibiotic prescriptions. When we ran out of inventory of a medication, we identified an appropriate alternative to be verified by both pharmacist and provider.

Overcoming delivery of care differences

Yet, workflow was not the only nontraditional work environment. Patient communication was its own obstacle. While most patients spoke Spanish, only a few could understand the traditional language of Yucatec Maya. It lacks some direct translation of medical anatomy, which made a clinical work-up difficult.

In addition, the availability of some medications was different from that in the United States. For example, lisinopril dosed once daily is a commonly dispensed medication for high blood pressure in the U.S.; however, captopril dosed three times daily was more prevalent in the Yucatan Peninsula due to existing regional drug manufacturers. In fact, UADY students stated that adherence to taking a medication as often as three times a day was not so much an issue. It was instead affordability of the next refill that deterred adherence and left gaps in chronic care. Fortunately, more than 70% of our formulary was purchased in-country, and the rest consisted of donations of U.S.-based OTC products.

Rewarding experience for all participants

Finally, the relationship with patients was not overshadowed. Patients were simply grateful for care. Even after standing in line for hours to finally receive their medication and counseling, patients carried a grin and were receptive to education. Probably the most outstanding interventions included potentially life-saving work-up of patients who may not have visited a physician in years, directing these patients to a local and affordable primary care provider or specialist, and making the effort to explain the importance of chronic disease management in an easily understood manner. These accomplishments are significant, as we know that the most common chronic diseases may not denote symptoms in the moment until a severe episode or hospitalization occurs.

Global health trips, regardless of location or nature, can yield valuable experiences that students can take directly into rotations and eventually into practice. Higher roles of pharmacy may require the balance of learning that can’t be taught in school, and these trips service these attributes. Overall, it is the combination of these experiences that result in the variety of skill and success of student learning to becoming an independent, open-minded, and well-rounded clinician.