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La Farmacia Esta Abierta
by Carrie Vogler, PharmD, BCPS, Clinical Associate Professor - SIUE School of Pharmacy
¡Hola! Can you imagine going to a country where the profession of pharmacy like we know it in the United States does not exist? I am currently writing to you from Antigua, Guatemala where it is 80 degrees and sunny in the beginning of March. This is my second time coming here for 3 weeks with three 4th year student pharmacists from Southern Illinois University Edwardsville (SIUE). We work in the clinics of Guatemala counseling on medications, providing immunizations, and screening patients for hypertension and diabetes. Guatemala is a country with very poor health literacy and people here live on average of about $2 per day.
What do you mean pharmacists do not exist in Guatemala? The pharmacy (or in Spanish, la farmacia) is owned by a person that does not require training and medical expertise. Nurses dispense medications in the Guatemalan government free clinics but the role is focused on dispensing and not counseling. A fixed amount of free medications is sent to the clinics each month. Once the medication runs out, it is the responsibility of the patient to go to a pharmacy and buy the medication. There are no appointments to see the doctors in the clinic; it is first come first serve so the line is long each day when we arrive at clinic. The patients are first taken to pre-consultation where they are weighed and have their blood pressure taken. Blood glucose test strips are in short supply, so only patients with known diabetes have their glucose checked in clinic once or twice weekly. No one has an A1c checked. Patients do not have blood glucose meters at home. There are no computers in the clinic or pharmacy, so everything is documented by hand. The patients are given a slip of white paper with a stamp on it to bring to the nurse in the clinic pharmacy. Many patients sign for the medication with a thumb print because they can’t read or write. The nurse manages all the medications on formulary in the clinic, which includes around 60 medications.
Something I found inspiring during my time here is how appreciative the patients are that we care for. Most of the patients have to walk several miles just to see the doctor and patients who live in more rural areas do not see a doctor. The kindness here is contagious. I have received more hugs after checking a blood pressure than I can count. I also am surprised that after waiting so long just to be seen (often hours) by the doctor, not once did I hear someone complain. Patients genuinely want to learn how to improve their health and this year we were able to spend time teaching patients about hypertension, diabetes, and medication adherence. This trip gives me a new perspective on life and I would encourage you to find your own way to give back.
Stepping out of your comfort zone can be a challenge but the bigger the challenge, the bigger the reward. This experience challenged me to improve my Spanish and learn the Spanish names for all of the drugs! ICHP has several opportunities where you can
give back. ICHP provides education to you so you can better care for others. I encourage you to spread kindness to those less fortunate by sharing your knowledge and time with your patients.