UW News

February 18, 2010

Pharmacist’s role in patient care advanced in Ethiopia

UW Health Sciences/UW Medicine

As Peggy Odegard and Don Downing gave their presentation in the bright classroom in Jimma University in Ethiopia, they didn’t expect the Ethiopian pharmacy students, faculty and practitioners in the audience to be so rapt. The UW professors of pharmacy were just giving a basic overview of pharmaceutical care and pharmacy practice in other nations.

Specifically, they were explaining that Japan and Micronesia, like Ethiopia, are trying to move their pharmaceutical care model into one that focuses more on patient care, rather than primarily on dispensing medicines.

The Ethiopians leaned forward in their chairs. Many of their faces lit up during the discussion.

“It turned out a lot of them were self-conscious over the belief that their country’s pharmacy practice system was behind others in the world,” said Downing. “We didn’t realize how important it would be for them to understand that they weren’t so far behind other nations.”

Odegard and Downing were in Jimma, Ethiopia, with professor of public health Andy Stergachis in November, training the Ethiopians on patient-focused pharmaceutical care and pharmacovigilance (the science and application of drug safety).

Their weeklong trip was funded by the Strengthening Pharmaceutical Systems (SPS) project. Stergachis is a principal investigator on the UW’s SPS project, which is part of Management Sciences for Health (MSH) — an international nonprofit organization that helps developing nations strengthen their health systems.

Stergachis, a faculty member in the UW departments of epidemiology and global health and adjunct professor of pharmacy, is collaborating with colleagues from the UW and other institutions to implement various programs — from drug safety initiatives to medication-access programs — in multiple developing nations, including Ethiopia, Namibia, Rwanda and Vietnam.

Odegard and Downing joined him for the Ethiopia SPS project because of their expertise in implementing patient-focused pharmaceutical care models in community and hospital practices in the United States.

While in Ethiopia, they conducted five days of training for almost 40 pharmacy and health care representatives — including faculty members, students and deans from the four Ethiopian schools of pharmacy, government officials from Ethiopia’s equivalent of the Food and Drug Administration, and the president of the Ethiopian Pharmacy Association.

They also donated more than $1,100 worth of textbooks to the Ethiopian pharmacy students, thanks to a fundraiser that UW pharmacy students had organized back at home.

“Throughout the week, we could sense the Ethiopians’ eagerness to learn about how they could move forward,” said Stergachis. “I think the trainees started to feel this sense of obligation that they’re the people who will bring forward an improved level of pharmacy practice in their country.”

The pharmacy system in Ethiopia looks a lot like the U.S. system looked in the years following mass production of medicines — when pharmacists for a time became primarily dispensers of medications, rather than more integrated health care providers.

In Ethiopia, a number of government regulations prevent pharmacists from providing basic services such as blood pressure tests or vaccinations. Given the limited health care resources in this east African nation, pharmacists could ease the burden on the system if they were allowed to do more. If they could provide the patient-care services that U.S. pharmacists provide — such as vaccinations, screenings, education clinics, and medication-therapy management — they could improve the population’s access to care.

As a first step toward making this happen, the Ethiopian trainees and UW faculty members were invited to meet with administrators and physicians at the Jimma University Medical Center. While there, the group made a case to the leadership for increasing pharmacists’ responsibilities in hospitals.

The officials willingly listened to their suggestions. In a country that has only 2.6 doctors per 100,000 people and an average life expectancy of 55 years, viable suggestions for improving care were welcomed.

“At a minimum, we wanted to suggest that they have pharmacists out on the wards and clinics of the hospitals,” said Downing.

The pitch proved successful. Jimma University Medical Center has indicated that it cleared pharmacists to start providing pharmaceutical care in hospital wards as of December.

Downing, Odegard and Stergachis also had a handful of successful meetings with Ethiopian public health officials. So by the time they left Ethiopia, they felt hopeful that they had helped set in motion a movement toward positive change.

Since their return, the constant — and enthusiastic — flow of emails they’ve received from the Ethiopians they trained has confirmed that that’s exactly what’s happening.

Proposals for improving Ethiopia’s pharmacy system are continuing to move forward. Most recently, students and faculty members from the Jimma University School of Pharmacy helped update a Parliament proclamation about the role pharmacy students play in residencies.

The UW faculty members plan to continue to work with the Ethiopian pharmacists via teleconferencing, e-mail and conference calls during the next two years of the SPS grant. They hope to help them implement ever-more changes, thereby improving health outcomes for Ethiopians.

The UW faculty members also gained some new perspectives of their own from this trip. After touring a university hospital that lacked some basic resources like masks for infectious patients and vaccinations for preventable diseases, they were reminded of how resourceful people can be.

“They’re doing such a fabulous job with what they have,” said Odegard, “and they’re so excited to do more. Wouldn’t it be great if we could teleport that enthusiasm to the United States, where we often forget how resource-rich we are?”