Career History:

• Last of the three year Bachelor of Pharmacy (Hons) (University of Bath) students

• Pre-registration year at Oxford Hospitals

• Three year residency,  including completion of MSc Clinical Pharmacy (University of Derby), at Derby Hospitals

• 10 months travelling, including three months working as Pharmacist in Charge at Calcutta Rescue, a non-governmental organisation in Kolkata, India

• Four years as directorate lead for critical care and theatres at Queen Elizabeth Hospital, Gateshead

• Joined Newcastle Hospitals in 2008 as senior lead clinical pharmacist for perioperative and critical care, later adding the second directorate of cardiothoracic services

Having established the pharmacy service to critical care at Newcastle Hospitals, and developed an excellent team providing the service, I was looking for a fresh challenge.  I’ve always travelled a lot and I was keen to work abroad for a time, potentially in a completely different country, to develop new skills and see the profession from a different angle.  After my first pharmacist post, I’d worked briefly in India, which had highlighted that you need time to understand the role of the pharmacist in a country and make effective changes. I applied for a one year sabbatical, for all of 2014, and was lucky enough to have supportive managers who encouraged it.  Having originally applied for, and been accepted onto the register for Médecins sans Frontières (Doctors Without Borders), there were few opportunities for pharmacists at that current time. A serendipitous conversation with an old colleague in Oxford put me in touch with someone in Malawi, who then mentioned a new school of pharmacy at the University of Namibia, in Southern Africa.  Having contacted the associate dean of the school, it transpired that the Center for Disease Control (CDC) had just awarded them a grant for a clinical instructor, with the intention that the post holder would establish clinical pharmacy teaching for the school. The school runs a four year BPharm degree, and at the time of my sabbatical, the first cohort of final year students was about to start.  Having successfully applied for the position, I had a fresh sheet with which to design the approach to clinical teaching, although the school was keen to have rotations in local state-run hospitals, including the tuberculosis (TB) hospital. I set up teaching blocks with students working in critical care, oncology, TB, medicine and psychiatry, as well as delivering tutorials and lectures to consolidate clinical knowledge and skills.  I also delivered sessions to the second year students around clinical pharmacy skills. Whilst I was there, the school was looking to expand its courses and I wrote a proposal for a postgraduate Masters in Clinical Pharmacy, which has subsequently started. Its first cohort are due to graduate this summer, and I still maintain a part-time contract with the school, delivering teaching in Namibia for a couple of weeks each year, as well as assessing students remotely and developing course content.

The school of pharmacy in Namibia was a brand new, state of the art facility, which I wasn’t expecting for a country with one of the highest GINI indexes in the world (disparity between the wealthiest and poorest residents).  The country has significant health challenges, particularly with TB and HIV, and these are compounded by it being a very sparsely populated country. There is a mix of private and public healthcare, and a dearth of pharmacists across the country, so it was important that Namibia create its own training programme to increase the local pharmacist population.

Clinical pharmacy is not routinely practised in the country, and so the students didn’t have role models to emulate, or a particular idea of what they should be doing when reviewing patients.  There was a need for me to engage with staff in the local hospitals, to allow the students onto the wards, and also to demonstrate to the students that there was a real need for them to be there, improving patient care.  Their presence was generally well-received, however, there was inevitable resistance to change at some points and a need to explain the role of the clinical pharmacist. At times, it felt like there was a lot more to be done, but not the resource to do it, but it takes time to develop services.  With the first cohort postgraduate course soon to finish their degree, clinical pharmacy should slowly expand within the country, and the students will, in time, become the teachers.

Lessons learnt from my year out:

• Don’t make assumptions: you may have perceptions about working in another country, including facilities available, but wait until you’ve experienced it first hand.

• Get the basics right: it’s important that students’ basic pharmacy skills are good and that they’re practising safely, before introducing new services, such as clinical pharmacy.  You need to prove that you’re improving patient care.

• Come out of your comfort zone: it’s easy to get stuck in a rut, but you may surprise yourself if you do something new/work somewhere completely different.

• Pharmacy has universal denominators: e.g. stores are run the same the world over; everyone has stock shortages!  You will have transferable skills.

• You can only do so much…

• …but something is often better than nothing: sow the seeds and things will slowly change

nicola.corkhill@nuth.nhs.uk