Working as a pharmacist in the Central African Republic and the Democratic Republic of the Congo was a rewarding experience, despite considerable challenges, explains Barbara Pawulska

What with busy dispensaries and tricky patients to contend with, life as a pharmacist can present challenges in any walk of the profession.

But as Barbara Pawulska, pharmacist adviser at Medicins Sans Frontieres (MSF) faced even more when she worked two missions as a pharmacist in the Central African Republic (CAR) and the Democratic Republic of the Congo (DRC). She has been a pharmacist since the early 1980s and has worked with MSF since 2013.

What made you decide to join MSF?

It had been in the back of my mind for a little while. I guess it was knowing that there were many countries in the world where people don’t have access to healthcare and being able to play some small part in helping them access it. So I was a little bit motivated by my dislike of inequality and to make things better for people.

Do you need any extra training to join MSF as a pharmacist?

You don’t need extra training, and I am not an independent prescriber. But you need at least a couple of years of post graduation experience – preferably in varied settings.

Also you need at least some experience of developing countries, whether it’s just a holiday or volunteering, so you don’t arrive somewhere with squat toilets and no running water and throw your hands up in horror and have to be flown home again. Essentially, no other qualifications are necessary other than being a registered pharmacist.

What was your first mission?

It was to the CAR. I was there for nine months. Quite often, the pharmacy positions are flying and they’re not attached to one particular project or mission. In CAR, there were four separate projects, one fairly big hospital, one fairly small hospital and another of them was in community-based mobile health clinics. In July 2015, I went on another mission to the DRC and returned in late April 2016.

At the moment, the ability to speak French is a huge advantage. Most of our pharmacy placements are in French-speaking missions. So I certainly needed an update of my schoolgirl French before going to CAR. But after another 10 months in DRC, I’ve come out with a pretty good working knowledge
of French.

Most larger towns in DRC have universities and medical schools, so there are plenty of doctors and nurses and they’re really capable and very good. But there are no pharmacists, or at least not enough for us to use them routinely in our projects – the national staff we have in most pharmacies are usually nurses. But that’s a step up from the CAR, where we were lucky if the staff in the pharmacies had any knowledge of healthcare at all

So how was it for you as a pharmacist not to be working with other pharmacists?

That’s pretty much part of the job. You’re there essentially to supervise and to manage the local staff who are manning the pharmacies. That can come as a bit of a shock to people.

Did it take a while to adjust?

To some extent, yes. The biggest shock is always the availability of medicines. In countries such as DRC, we import all medicines – we go through Amsterdam so that we can assure the quality of them. We get deliveries three times a year, so a lot of what you’re having to do is manage the supplies of a medicine and make sure it’s prescribed appropriately because when it’s run out, there’s no picking up the phone and getting another delivery later that day. You might be waiting weeks or months for the next supply, so I think there’s a real role to play in managing and policing the prescribing.

What are some of your key responsibilities?

Staff training – certainly for the national staff. They are very keen on learning more and doing their job better. For me, there’s
a lot that pharmacists can add to the roles of the national staff in MSF simply to develop them from beyond a supply service, which is often how they’re seen and how they’re run, and to draw attention to the added value pharmacy can bring and make sure that that’s understood – first by the staff in the pharmacy and second by staff in the wider hospital.

What were some key challenges?

Certainly, one challenge was only receiving three medication deliveries a year. I arrived at one of the projects to find one of the antibiotics had completely run out and it’s one that’s used for infections in malnourished children, so running out is fairly critical.

I did some digging around and found the antibiotic was being prescribed by all sorts of different hospital departments that
didn’t have a good reason for routine use.

I discussed this with the national staff in the pharmacy to get an idea of what was going on and then took that to the medical team to see what we could do about it. A decision was made that it would be limited just to the nutrition ward, the intensive care unit and paediatrics. The pharmacy was responsible for enforcing that policy.

What were some highlights?

I think training of the national staff was a great highlight. If they can give appropriate information to patients, that’s absolutely key.

It’s also a common theme within pharmacy that we are the last contact the patient has with healthcare and it’s our responsibility to make sure the patient knows what to do with their medicines. It’s a big responsibility.

How has being a pharmacist with MSF changed the way you practise when you’re back in the UK?

I’m not sure whether it has. My beliefs in what pharmacy has to offer haven’t changed. What we offer as pharmacists varies according to the context, but the bottom line is the provision of assured quality medication to patients who know how to take it. That’s common everywhere.

I felt strongly about that working in the UK too, whether it was in community pharmacy or working with commissioning bodies.

Would you recommend MSF work to other pharmacists?

Yes, if they’re prepared for the possible privations that living on an MSF compound can bring – it’s not the most comfortable way of life – but it certainly opens your eyes to situations in other parts of the world.

You’re usually working six days a week and there’s certainly no nine to five. And if you’re needed on the seventh day of the week, you work it. It is hard work. But I’ve found it endlessly fascinating.