International Pharmacy Rotation: Experiencing Healthcare & Culture in Honduras By: Nancy Tran, PharmD Candidate Kristian Catahan, PharmD Candidate Dr. Carrie L. Griffiths Guachipilincito is a remote rural village in Southwestern Honduras in the state of Intibucá. This community is very poor, with most earning around $10 per day. The climate is tropical, with a rainy season in the fall. We had the privilege of doing an international Advanced Pharmacy Practice Experience (APPE) rotation in Guachi, Honduras. This opportunity is offered three times a year (February, June, and October) to Wingate University School of Pharmacy. These are the times of year the medical brigade travels to Guachi. Senior pharmacy students (max of 2 per brigade) and a faculty preceptor accompany a one-week medical brigade organized by Shoulder to Shoulder. Shoulder to Shoulder is a non-profit organization that collaborates with healthcare workers and community leaders to improve the quality of life of rural Hondurans. Their goal is to provide accessible healthcare to the people of Guachi by providing care for chronic disease states such as hypertension and diabetes. The medical brigades consist of at least one physician,
one pharmacist, and other medical professionals such as dentists, nurses, physical therapists, and learners at all levels. Anyone can volunteer to serve on a brigade, including pharmacy technicians and non-medical volunteers. Some in-country physicians and nurses will volunteer their time if able.
The clinic can see patients Monday through Thursday during the week-long medical brigade. This includes providing care to patients that come to the clinic, currently by appointment, and providing home visits to special needs children or elderly patients who cannot travel to the clinic. In preparation for our trip, we met online with our brigade team. When we saw the recommended packing list (e.g., toilet paper, a mosquito net, a flashlight, a reusable water bottle, a clothesline, bed sheets, etc.), we knew our living conditions for the week would be sparse. However, only when we arrived in Honduras could we appreciate the drastic differences in our Page 19
surroundings compared to the United States (U.S.). For example, roads were not paved and were filled with ruts. Additionally, adults and children frequently approached us to sell us various products to make money.
In America, access to healthcare is a right, but in Guachi, healthcare access is more of a privilege. Some patients must travel far to the clinic, some pay for taxis, and some walk for over an hour. Patients came to the clinic in their best clothing and were excited to see us even when they were acutely ill. The people of Guachi emphasized how grateful they were for each member working in the clinic. Everyone seemed incredibly grateful to be at the clinic, from Iris, Health Promoter, in the registration area, to William or Alan, interpreters provided by Shoulder to Shoulder, interpreting for the doctors, to the pharmacy team counseling every patient. It almost seemed like everyone came to celebrate. The patients celebrated having access to a physician and receiving free medications. Medications were provided to minimize symptoms, control chronic conditions, and help stock their home medicine cabinets. (Figure 1) The pharmacy’s formulary was limited to essential medications, many of which are included in the World Health Organization Model List of Essential Medications. (https:// list.essentialmeds.org/) All dispensed medications were free of charge to the patient. Each prescription was filled for a 120-day supply to last them until the next brigade. Figure 2 shows our team preparing and pre-packaging medications.