Practising pharmacy abroad is never easy. But when abroad is a third-world country that has only recently recognised pharmacy as a profession, things are even harder – as care homes pharmacist Sharon Maxted can testify.
It was earlier this year that the care homes lead at Coventry and Rugby clinical commissioning group (CCG) decided to venture to Malawi, where more than half of the population lives below the poverty line. Sharon’s interest was piqued by a talk from a trustee of Friends of Sick Children in Malawi, who reported on the experiences of an aspiring paediatric nurse in the country.
The nurse had been supported to complete her training by a group that Sharon volunteers for: the Kenilworth and District Soroptimists, which works to improve the lives of women and girls across the world. Listening to the nurse’s experiences, she was keen to gain an insight into healthcare in Malawi first hand.
“I had always wanted to do voluntary service overseas and see what it was like to work in pharmacy in an underdeveloped country,” she explains. Looking back, Sharon admits that she underestimated what was involved. Firstly, it took nine months to prepare for the visit. Sharon assumed this would be plenty of time to get everything ready for her stint in Malawi’s largest hospital – the Queen’s Elisabeth Central Hospital in Blantyre. But time flew by. The email system in Malawi was “hit and miss” and it took “a lot of to-ing and fro-ing” to establish the vital details. “It was a bit like Christmas – it seemed like a long way away and suddenly it was there,” Sharon remembers.
Luckily, Sharon managed to confirm her visit – and, crucially, what the hospital needed – before flying out with her husband in September. They ended up taking 92kg of medical supplies with them. “We used all our luggage allowance to take out medical goods including instruments and antibiotics,” she says. “We made sure that what we took was what they needed, not just what we had.”
“We used all our luggage allowance to take out medical goods including instruments and antibiotics... we made sure that what we took was what they needed, not just what we had”
Sharon Maxted, CCG pharmacist
Finally came the culmination of nine months’ work: Sharon’s arrival in Malawi. In some ways, it was what she expected. She had travelled to far-flung destinations before, so staying in basic accommodation “wasn’t too much of a shock to the system”. But she soon realised that her expectation to “roll up my sleeves and dispense” in the hospital pharmacy during her two-week stint were unlikely to be realised. “It was naive at best and pretty arrogant at worst,” she says.
The difficulty lay in the vast difference between pharmacy in Malawi and the UK. Pharmacy is an “incredibly new profession” in Malawi, she explains, and until recently there were no pharmacists – just technicians. It was only this millennium that a pharmacist training programme was established, and it produced its first crop of graduates in 2010. Sharon describes the hospital pharmacy in Blantyre as similar to her experience in UK hospitals “about 40 years ago”. “The biggest shock for me was the total lack of procedure,” she says – for example, there were no standard operating procedures (SOPs).
Quickly realising she would not be able to dispense, Sharon set about using her skills in a different way. She saw that pharmacists in Malawi were “very keen” to move beyond a supply role. As an independent prescriber, Sharon shared her experiences in a bid to help the profession realise that ambition. She gave a lecture on safe prescribing at the local school of pharmacy, attended meetings and made links with as many people as possible.
One common theme came through: despite the pharmacists being “very knowledgeable”, they were “frightened to talk to prescribers and correct their mistakes”. Sharon found they were “fascinated” that she was able to prescribe and advise GPs on their prescribing – and she hopes the profession could soon do the same in Malawi. “To get that respect, they need to earn it, but they’re so enthusiastic I don’t think it will take long,” she says.
On one hand, it was rewarding to see how the money had been spent to improve the lives of children. On the other hand, it was difficult to witness the continuing discrepancies in care between Malawi and the UK
Sharon soon found that working in Malawi presented other challenges. These were of the personal, rather than professional, nature. Her work centred around the children’s division of the Queen’s Elisabeth Central Hospital, which had been the recipient of funding from the Kenilworth and District Soroptimists.
On one hand, it was rewarding to see how the money had been spent to improve the lives of children. On the other hand, it was difficult to witness the continuing discrepancies in care between Malawi and the UK. Sharon saw wards of 80 children that had only two nurses on duty per shift. Two or three children would often share one bed. The limited funding meant many children missed out on potentially life-saving treatments, too.
“Perfectly preventable conditions” such as pneumonia and dehydration caused illness and, in some cases, death. For those with cancer, the only option available was palliative care. “That was hard,” she says.
But Sharon is quick to point out that her experience “wasn’t all doom and gloom”. She describes the “sheer enthusiasm” of the young pharmacists as a highlight of her two weeks in Malawi. The head of the hospital pharmacy – who only qualified in March and took charge during Sharon’s stay – was highly receptive to new ideas, she says. The two are still in contact and Sharon has put her in touch with Birmingham Children’s Hospital.
Sharon stresses that her objective was not to dictate how to practise pharmacy in Malawi, but to help the profession move in its chosen direction: “It’s really about supporting them to make the changes they feel need to be done.” And, in this way, Sharon hopes the impact of her work will live on far longer than her two-week stay.