Pharmacy students complete clinical rotation in Africa

Fourth-year pharmacy students Erin Dickert and Melissa Smisor completed their final clinical rotation in Cameroon, Africa this past April at Mbingo Baptist Hospital. Mbingo is a 270-bed facility nestled in the mountains of northern Cameroon offering some of the most specialized care and advanced surgical services in the developing country.

The hospital is site for World Medical Missions, a branch of Samaritan's Purse based in Boone, N.C., where physicians from the United States are sent to complete post-residencies and to train African physicians in an academic setting. Dickert and Smisor traveled through WMM to complete their rotation, and work alongside the physicians and pharmacy staff. There are currently 15 African physicians and seven physicians from the U.S. practicing at the facility who specialize in internal medicine and pediatrics.

Dickert and Smisor share below about their rotation abroad, and what they learned during their time in Cameroon.

Missions elective

During our third-year of pharmacy school, we had the opportunity to take the Pharmacy & Christian Missions Elective led by Dr. Larry Swanson, former chair of pharmacy practice, and Dr. Corey Furman, guest lecturer and 1995 PharmD graduate. It was a five-week course painting a picture of what pharmacy looks like in the world of medical missions.  Both of us had felt a calling to the mission field since early college and we jumped at the opportunity to make loving and serving people in a different country a reality.  

Through Dr. Furman and Dr. Swanson's leadership, we were led to World Medical Missions.  It was a year-long process to determine a location and plan the logistics of the trip. In August 2012, we were approved to travel to Cameroon for the month of April 2013.  And so began the planning, paperwork and preparing to leave.

Cameroon: The Armpit of Africa

We did not have any idea of what to expect when we arrived in Cameroon. We knew we were prepared in terms of pharmacy knowledge but we were completely clueless on to how to provide care in an African hospital. 

Our daily routine was interesting and always provided learning opportunities.  It started with chapel for the hospital staff at 6:40 a.m., morning report with the medical residents at 7 a.m., breakfast, rounds from 9:30-11:30 a.m., lunch, and work in the pharmacy dispensing and counseling until our lecture at 3 p.m.  

We had the opportunity to round on the men's, women’s and children's wards and spent a small amount of time in the newborn nursery. The medical teams were ecstatic to have pharmacy on rounds to help with dosing, disease state management, medication interactions, and determining drug availability.

We saw heart failure exacerbations, COPD exacerbations, pediatric Burkitts Lymphoma, and sickle cell crisis - to name only a few. The most prevalent disease states were miliary tuberculosis, cerebral malaria, and HIV opportunistic infections.  In HIV-positive patients, the highest CD4 count recorded was 480 cells/mm3 and the lowest was 4 cells/mm3.  We certainly had the opportunity to use critical thinking skills to provide medical care for each and every patient.

Cameroonian care

The hospitals in Cameroon share almost nothing in common to hospitals in the United States, with the exception of providing medical care. When a patient is considered for admission, they must have a caregiver present with them. The caregiver is responsible for staying with the patient at all times, providing and feeding the patient all meals, and assisting with activities of daily living (bathing, toileting, basic physical therapy). There are approximately 20 to 40 beds per ward with about one foot of space in between each bed and only a curtain for privacy (if you are lucky).

Many of the patients were diagnosed with severely advanced diseases and while there may not be much medical management available, the families were thankful for any diagnosis and treatment option offered to them. Dying with dignity is of utmost importance for patients and their families in Cameroonian culture.

It costs 2000 CFAs ($4) per night to stay in the hospital.  Payment for labs, diagnostic films (only ultrasound and x-ray available), and medications are tallied and kept on strict record in the patient’s medical book.  Upon discharge, if patients are unable to pay their complete hospital bill, they have the option to remain on the hospital grounds to complete construction and maintenance projects. Needless to say, the hospital is a beautiful place!

Mandara Mountains

One weekend, we traveled to the other side of the mountain (about a two-hour bumpy drive) to visit the Ndawara Tea Estate which provides all of the drinking tea for Cameroon and surrounding countries. They walked us through a step-by-step process of tea production and then took us to see exotic animals. We saw peacocks, ostriches, baboons, snakes and even got to hold a chimpanzee named Billy.

Around the hospital, there were beautiful hiking trails. One Sunday afternoon, we were able to climb up a trail to a waterfall and enjoy the view of the whole area while eating a picnic lunch. Afternoon plans had to be made carefully as it was rainy season and would pour rain from 2 to 4 p.m. almost every afternoon.  We certainly made the most of experiencing the culture!

A different way of looking at pharmacy

This is not a trip that will soon be forgotten. We learned a great deal in terms of medication name differences (ex: glybenclamide in Africa is glyburide in the U.S.), process of acquiring drugs in a developing country, communicating with patients of a completely different language and dialect, and medication safety and regulation.

The most valuable clinical experience we gained was learning to be creative with medication regimens when faced with extremely limited options, resources and lab tests. The treatment of tuberculosis, malaria, infectious diarrhea, and opportunistic infections were difficult to initiate and a patient's HIV status was always at the forefront of all medication decisions. 

During our three weeks at Mbingo, we learned creativity, flexibility and the importance of a smile. The patients we cared for, the caregivers we met, the physicians we worked with, and the pharmacists we learned from made this experience beyond incredible. 

The opportunity to serve is immense in Cameroon and they are always looking for volunteers of all specialties year-round.  We do not know when we will have the opportunity to go back, but we eagerly look forward to returning to Mbingo Baptist Hospital to love on people and introduce them to Jesus, the Great Physician.

Dickert and Smisor graduated with their doctor of pharmacy degrees on May 10, 2013. Dickert is completing a PGY1 residency at Palmetto Health Richland Memorial Hospital in Columbia, S.C., and Smisor matched for a PGY1 residency with Spartanburg Regional Medical Center in Spartanburg, S.C.

Photo: Pharmacy students Erin Dickert and Melissa Smisor with some of the pharmacy staff at Mbingo Baptist Hospital in Cameroon. They estimate the pharmacy had a max of 200 drugs to use hospital-wide.