Pharmacy life on board the Africa Mercy is just a liiiiitle bit different to what I do at home! How does each day start? By singing, playing music and dancing with the patients of course! You are greeted by everyone with ‘Bonsoir! Ça va?’ every time you walk down the hall, and frequently find a soccer ball being kicked in the corridor when walking from one ward to the next. There are so many amazing moments working on the Africa Mercy. It’s really hard to explain the sense of community.
There are three pharmacists volunteering on board the Africa Mercy. We work 8am-5pm, Monday to Friday and rotate weeks on call. Both my wonderful fellow pharmacists are from Canada. Sandy has been on board for two years and has extended for another two. Sharon is here for the whole Benin field service which is August until the end of May. The third pharmacist (me) is a short term rotational position of about 7 weeks. There are some communication barriers between myself and my friendly Canadians for some things including spelling of medications (‘estrogen’ versus ‘oestrogen’ etc), my Aussie slang and pronounciation of drug names – but they have been so welcoming and made settling in to my position and life on board the Africa Mercy very easy!
We have a small pharmacy located next to radiology and pathology departments, across from the hospital wards. As our pharmacy is not big enough to store everything we also have an air conditioned shipping container outside.
We participate on ward rounds each morning with the treating physicians and nursing team leader and provide advice on appropriate medications, doses and interactions as required. We also perform daily medication chart reviews.
We provide medications and fluids for the operating theatres, each wards imprest and all the crash carts / emergency bags. We dispense medications for patients during their hospital stay and on discharge, and medication required by crew.
Our pharmacy has 635 different medications on board, which is significantly less than my work at home. Since the field service began we have dispensed 823,644 units of medication (tablets, liquids etc) and given out more than 15,000 pre-packs. Pre-packs are individually packed medications in certain quantities which are labelled accordingly for clinics including dental, ophthalmology and outpatients to dispense to patients on discharge.
One of the less fun jobs to do is drug disposal. Our expired and returned medications need to be disposed of in particular ways which renders the active ingredient inactive – which is very time consuming.
Our medications come the USA, UK and Netherlands. The medications from the Netherlands come from two different foundations which supply essential medicines to low income countries for no profit. A donor pays for all medications purchased through one foundation, and the other supplies to us at cost. Medication from the USA come from a number of distributors that sell to Mercy Ships discounted. Medications are shipped mostly by container. From start to finish it takes about 3 to 4 months to order and receive medications. We generally order 2 to 3 times per year for most medications, and once per year for controlled drugs as they take even longer. Ordering controlled medications requires export licences from the UK, where the order comes from, and import licences in Benin. Both these licences must go through a government approval process which explains why it takes so long. It can be very tricky trying to predict annual requirements of each medication as each country has differing endemic disease states and each physician has their own preference on which medications they wish to use.
1. Patients often cannot be started on long term medications as they either cannot afford it post discharge or the medication is not available in Benin, and the patient may experience side effects if ceased suddenly. We ask one of our day crew members to call local pharmacies and ask in French whether they have particular medications available, the pack size and cost if long term medications are required to be commenced
2. Medications are shipped or flown to us from various locations so do not look the same as home and are in foreign languages including Dutch
3. Patients in Benin speak mostly French or Fon with minimal to no English. Many are also illiterate. Labels for medications are labelled in French, there is no google translator for English to Fon though! A translator is used for all counselling, for every patient. Some patients speak a local language no one can translate so symbols are especially important in this instance
4. We have limited medication resources, none of which I am familiar with as they aren’t Australian
5. Some medications which require level testing cannot be used as our laboratory is currently unable to run the required tests (e.g. Vancomycin)
7. West Africa has so much MRSA and resistant strains of bacteria! We are forever decolonising patients and treating infections with broad spectrum antibiotics
I have been very lucky having the opportunity to attend many clinics both on and off site to view different aspects of how Mercy Ships run. I cannot recommend highly enough that everyone should experience this at least once in their life! Although very different to home, it is such a rewarding experience.