The University of Toledo

"After two years of participating in the mission, I am addicted. It is truly a unique experience... . I'm also taking Spanish classes now so that I can function without a translator next time!"

For more than two weeks last summer, approximately 25 volunteers from across the United States participated in a medical mission trip to Ayacucho, Peru, an isolated city in the Andean mountains of Peru. Sponsored by the Peruvian American Medical Society (PAMS), the mission, which takes place in the local hospital in Ayacucho, provides clinics in family practice, internal medicine, cardiology, infectious diseases, general surgery, plastic surgery, pediatrics and ophthalmology. Approximately 1,500 patients were seen in these clinics, and more than 100 surgeries were performed.

For the past two years I have served as the pharmacist for the mission, with the generosity of several pharmaceutical companies supplying the medications. Pharmacy services include filling prescriptions for patients seen in the clinics, counseling patients on medications, rounding with the inpatient medical teams, and providing medications to the inpatients and to the operating room. Antibiotics, pain medications and gastrointestinal medications are the most commonly needed items. Medications for chronic diseases such as hypertension or diabetes are also necessary, but appropriate follow-up measures must be arranged to meet specific patients’ needs.

"Expect the unexpected!" should definitely be the approach for anyone considering participation in a medical mission abroad. Attempts to communicate in not one but two foreign languages (Spanish and Quechua) proved to be quite a challenge and frequently comical. For instance, I learned to tell the patient to instill two gotas (drops) into the eye and not two gatos (cats). And, just when you think you have seen and heard absolutely everything, you might just look up and see something really unusual appear in your pharmacy; in my case, it was a llama.

The frustrations experienced during the mission involve mainly language barriers and the lack of adequate working equipment and medications. However, the reward of seeing the differences that can be made in the lives of people who have no other access to healthcare services is overwhelming.

Most often the largest successes of the day are things that we take for granted in our daily practice in the United States--for example, providing carbamazepine to a child with a seizure disorder or ketorolac to a post-operative patient who otherwise could not afford pain medication.

The opportunity to work with the Peruvian health care professionals provided great insights into the way that medicine is practiced in their country. Specifically, the approach to critically ill patients is very different. In general, death is accepted as a very natural event, and extensive measures to prolong life are neither desired nor provided in most situations. The Peruvian physicians view our two weeks there as a time to learn from us. In reality, though, I think we learn just as much or more from them. We bring them the latest techniques and medicines. In return, they show us how to accomplish a lot with very little, unique and innovative ways to solve problems and an appreciation for all that we have back at home.

Plans are currently underway for the 2003 mission. I will once again participate in the mission along with Amanda Zelek, 3rd year student in the College of Pharmacy and Michael Kistner, Spanish Lecturer, Department of Foreign Languages.

Dr. Close is a Critical Care/Infectious Diseases Research Fellow at the University of Toledo College of Pharmacy. Plans are currently under way for the 2003 mission. A dinner auction is being held on Saturday March 29th to raise additional funds for the 2003 mission. For information, please contact the Sandy Closer at (419)530-1961 or email SClose@UTNet.UToledo.Edu.

Department of Pharmacy Practice

Providing pharmacy services in the Family Medical Center of Michigan and the
Neighborhood Health Association of Toledo: A Demonstration Project

Dr. Monica Holiday-Goodman and colleagues have received a $250,000 grant from the Bureau of Primary Health Care (Office of Pharmacy Affairs) to implement and evaluate a demonstration project providing comprehensive pharmacy services for the Family Medical Center of Michigan and the Neighborhood Health Association of Toledo. The Family Medical Center of Michigan (FMC) consists of two community health centers located in Monroe County, Michigan on the Michigan-Ohio border. FMC is located in medically underserved areas, and is the only health care facility in the area that serves the uninsured and underinsured migrant population. Neighborhood Health Association of Toledo (NHA) was established over 30 years ago by grassroot organizations in Toledo’s African-American and Latino neighborhoods in response to residents needs for accessible, affordable, quality health care in primarily urban areas. NHA consists of ten healthcare centers located throughout Toledo. Today these centers form the foundation of NHA, the second largest community health care system in Ohio.

The Department of Pharmacy Practice provides comprehensive pharmacy services to these health centers, through the use of the Pfizer/Indian Health Service patient counseling program, the provision of disease state management programs in hypertension, diabetes, and pulmonary diseases, the provision of medication use education to physicians and patients, and through increased access to indigent drug programs. The Department runs the outpatient dispensary at the Cordelia Martin Health Center, a member of NHA. The Center also serves as a training facility for the college and the community pharmacy specialty residency program, as well as experiential training for doctor of pharmacy students.

Several Department faculty are involved in this project: