Stephanie Johnston is a pharmacist and has worked in Cambodia, Uganda, Chad, Armenia and Bangladesh.
It is a long, long way from the daily routine of a Sydney community pharmacy to working in Cambodia via the West Nile region of northern Uganda, but interesting opportunities like this can unfold when you work with Médecins Sans Frontières. Just ask Australian pharmacist Stephanie Johnston because that is exactly what happened to her. She has always been interested in humanitarian work. ‘After 12 years’ working as a pharmacist in Sydney and the UK I decided to do a Masters of International Public Health. It linked my pharmacy experience in health promotion, disease management and rational use of medicines to a broader health qualification with a focus on disease control in developing countries and humanitarian emergencies’.
‘After graduating I applied to Médecins Sans Frontières as a pharmacist. I had been following the work of the organisation for several years and felt a strong connection to its aim to provide emergency medical assistance to those needing it most’. In April 2007 Stephanie went to Arua in the west Nile region of northern Uganda. ‘I was the field pharmacist working on a project to deliver comprehensive care for HIV/tuberculosis patients in partnership with the Ugandan Ministry of Health.
"Tuberculosis is the most common opportunistic infection in HIV patients in both Africa and Asia, so early diagnosis and an integrated treatment approach is crucial"
Tuberculosis is the most common opportunistic infection in HIV patients in both Africa and Asia, so early diagnosis and an integrated treatment approach is crucial. Médecins Sans Frontières also offers treatment for multi-drug resistant tuberculosis (MDR-TB) which is increasingly common in settings of high HIV prevalence. MDR-TB not only requires a rigorous 18–24 months treatment plan instead of the normal six months for regular TB but the limited availability and cost of these drugs prevents many people in developing countries from accessing them.’
Médecins Sans Frontières field pharmacists secure the drug supply for the project. This involves assessing the pharmaceutical needs of the project (including laboratory items and therapeutic food products) and determining whether teams are supplying each item or backing-up the drug supply in case of shortages from the Ministry of Health. Most drugs are procured internationally to minimise the risks from increasingly sophisticated counterfeit medicines, which are common in many local markets in Africa and Asia. However international procurement can have a delivery time of up to three months (except in emergencies) so orders need to be planned well in advance and drug consumption patterns followed closely in the field. The pharmacist also provides technical support to the team, particularly the logisticians, who are responsible for cold chain maintenance and customs clearance and transportation of medical orders, and medical staff.
They also have a role in following up the national drug supply. In a project, the pharmacist is responsible for liaising with the Ministry of Health and all the other actors concerned with the country’s drug supply. For HIV/TB medications, this can include WHO (Global Fund and Global Drug Facility), the US Government (via PEPFAR), the Clinton Foundation for paediatric ARVs and donation programs. The overall goal is to improve the capacity of the national supply drug chain to function effectively, and pharmacists can play a key role here.
"Many of the HIV/TB patients we have helped would otherwise not have lived long enough to see their children grow up. It is also a very rewarding to be able to prevent new HIV infections by reducing mother to child transmission"
‘The initial part of a placement is usually the hardest. This might be a few weeks on a short placement or a few months on a longer one. It’s a new job, there is often no one to show you the ropes, you’re in a country with a different culture and your patients and staff speak several languages. The best way to prepare is to read as much as you can about the country and project beforehand and then try to feel comfortable with being completely out of your comfort zone!’ ‘It takes time to understand the project but the best thing is you are part of a big team and you support each other. The national staff usually has years of experience working with Médecins Sans Frontières and they understand the local context and culture/customs. It’s really important to listen to them and not rush in trying to make too many changes as this can be very difficult for them to adjust to, with a continual rotation of expats, each with different ideas and ways of working’.
‘After 12 months in Uganda and a short break home, I went to Cambodia. Here I worked as the Pharmacist Coordinator on another HIV/TB project, with field sites in Phnom Penh and Kampong Cham (about three hours north of the capital)’. ‘On both placements I’ve helped people in urgent need access quality healthcare. Many of the HIV/TB patients we have helped would otherwise not have lived long enough to see their children grow up. It is also a very rewarding to be able to prevent new HIV infections by reducing mother to child transmission from 40% to <2% with improved ‘preventing mother-to-child transmission’ programs. As with any job the people you’re working with really make the difference – the combination of expats and national staff results in a great workplace dynamic with lots of energy and lively discussion’.
‘It is a privilege seeing the difference you have made to people’s lives. In Uganda I would walk into the Arua Hospital HIV Clinic each morning and see more than 200 patients (part of a current cohort of almost 8,000) who had access to free quality HIV/TB treatment and were able to remain living and working in their local communities’. Stephanie said that the hardest part is seeing people die from treatable diseases. ‘This may be because they can’t afford the cost of transport to the hospital. In other cases they have diseases such as meningitis or pneumonia for which vaccines are readily available in the West, but not in developing settings due to prohibitive costs’. ‘My next goal is to improve my French language skills. I would like to work as a pharmacist in a Francophone context, preferably back in Africa. Médecins Sans Frontières is also involved in other types of projects such as nutrition programs and immunisation campaigns, which I am interested in.’