Written By: Mudit Verma, Third-Year Student Pharmacist
My time at the School of Pharmacy has influenced both my personal and professional growth in many ways, though perhaps most notably in my desire to become a better global citizen. Since enrolling in the Doctor of Pharmacy (PharmD) program, I have come to see that pharmacists are truly the most accessible health care professionals. But, to be successful in this profession, you must be able to cater to the needs of culturally diverse patient populations. I have been inspired and invigorated by the diversity present among my classmates, School, and university, and am confident that the many international experiences in which I have had an opportunity to participate – learning how to empathize with patients from different cultural and ethnic backgrounds as well as understanding how pharmacists impact the health care of patients in other countries – will enable me to become a culturally competent pharmacist.
Becoming A President’s Fellow
As a second-year student pharmacist, I had the privilege of serving as a President’s Fellow for the University of Maryland, Baltimore’s (UMB) Symposium on Cultural Competence. Our interprofessional team was tasked with producing a white paper that outlined the University’s stance on cultural competence. As the only student pharmacist in the cohort, I served as a student ambassador for pharmacy’s initiatives on cultural competence. We presented our findings to Jay A. Perman, MD, president of UMB, and his esteemed colleagues. The experience not only helped me begin to develop my culturally competent lens as a student pharmacist, but also prepared me for two major international experiences to come:
- Participating in a global health trip to Jamaica with UMB’s newly established student chapter of International Service Learning in May 2016
- Embarking on a month-long pharmacy internship at a new hospital in Singapore under a student exchange program
Providing Health Care in Jamaica
Before embarking on my trip to Jamaica, I knew that I would likely be the only student pharmacist attending the trip, as most of the other students making the journey would be from UMB’s School of Dentistry. Although I was excited for the opportunity to work with our University’s distinguished dental students under the guidance of Isabel Rambob, DDS, a clinical assistant professor at the School of Dentistry, I have to admit that I had some trepidation about serving as the lone resource for pharmacy during our trip.
Upon arriving in Jamaica, we performed home visits throughout the community that our clinic served. I had no previous experience visiting a patient’s home to provide care, and was excited to engage in a more thorough and authentic health screening process. We were later briefed by one of the physicians at the clinic about the workflow that he envisioned for the clinic, and we learned some new clinical skills, including how to perform a basic suturing as well as how to examine the nine sections of the abdominal cavity. The physician also covered how to take blood pressure readings manually using a cuff and stethoscope; however, because the School of Pharmacy goes above and beyond to prepare their students for the clinical setting, I already felt well prepared to take blood pressure readings. In fact, the manual blood pressure component of our training was my first opportunity to mentor my fellow teammates and help them understand what sounds and cues to listen for when taking blood pressures and respiratory rates.
Dr. Rambob later covered the chronic disease states commonly associated with dental complications, offering advice about how to best make clinical interventions and recommendations for patients. Because I was the only student pharmacist, I was tasked with managing all pharmacy operations taking place at the clinic. I was truly on my own for the duration of our trip, and quickly learned how to be a mentor in a clinical interprofessional capacity, as well as how to dispense medication and counsel patients from a different culture and who spoke a different language (Patois).
Taking Lessons Learned to Singapore
Less than a week after finishing my trip to Jamaica, I traveled to Singapore for a pharmacy internship at Khoo Teck Puat Hospital (KTPH) in Yishun, Singapore. Like the United States, Singapore has a rapidly aging population, and patients living with multiple chronic disease states are at the forefront of pharmacists’ interventions.
Singapore has four official languages, and the patient population reflects even greater linguistic diversity. Fortunately for me, English is regarded as one of the standard languages, and I was able to involve myself in much of the patient counseling. During the first portion of my internship, I was assigned to the outpatient pharmacy setting. One major difference that I observed between Singapore’s pharmacy practice and pharmacy practice in the United States is that community pharmacies in Singapore require customers to consult with a pharmacist before purchasing NSAIDs, cough medicines, anti-histamines, and other drugs that would otherwise be available over-the-counter in the United States. This additional tier in the community pharmacy setting enables patients to receive education on how to best take their medications.
I also had an opportunity to observe ambulatory care clinic visits, including cardiology, secondary prevention, geriatric, anticoagulation, and smoking cessation clinics. Singapore’s model of ambulatory care is very similar to that of the United States, and it was great to see pharmacists’ interventions extend beyond the counter in outpatient settings.
In the inpatient setting, I participated in interdisciplinary rounds in the general medicine and parenteral nutrition wards. I learned how satellite pharmacies operate to dispense medications for patients being transitioned out of the hospital, and was given the opportunity to observe pharmacy practice in atypical settings such as an ambulation studio for elderly patients, storage pharmacies, and drug information departments. To my surprise, I met a pharmacist who received his PharmD from Ohio State University, and we were able to connect our educational experiences to pharmacy practice in Singapore.
Moving Forward with My Pharmacy Education
Although my time at the School of Pharmacy is almost complete, my experiences abroad have led me to ask far more questions about global health and the role of the pharmacist than ever before. How do different cultures perceive and value their health, their pharmacists, and their health care policies? Pharmacist-patient relationships have multiple facets and my journey to develop cultural competence as a future pharmacist will surely extend beyond my years in school. True global health can only be achieved when multiple cultures come together to achieve cultural competence to address their diverse patient populations, and I hope to serve as a driving force towards cultural competence in global pharmacy practice.