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Pharmacists matter in disaster relief

by Christian Splett
On emergency mission, physicians need support from pharmacists: a French doctor in Haiti after the recent earthquake

On emergency mission, physicians need support from pharmacists: a French doctor in Haiti after the recent earthquake

Drugs are essential in emergency situations. It is often forgotten that, while doctors prescribe drugs, it is pharmacists who manage, store and distribute them. Moreover, they tell people how to use pharmaceuticals. Crisis regions depend on a reliable supply of medicines. [ By Christian Splett ]

“Pharmacists urgently needed” read the headline of a recent job advertisement by Médecins sans Frontières Germany. Applicants were expected to have two years of professional experience, multicultural sensitivity and a good command of the English language. Moreover, they had to be prepared to work in crisis regions for six to nine months. According to this non-governmental organisation (NGO), the expertise of pharmacists is particularly important during or after wars as it serves to ensure access to essential medicines.

There has been a rethink in aid and disaster relief circles recently. The ad mentioned above is evidence of this trend. “There are too few pharmacists in aid agencies,” says Wolfgang Wagner, who used to be the chief pharmacist of Malteser Hilfsdienst, a Catholic charity in Germany. Unlike doctors, the role of pharmacists tends to be underestimated with the result of under-representation in relief missions. Or perhaps pharmacists tend to be underestimated because they are under-represented.

NGOs are well advised to pay more attention to pharmacists. Their skills are different from those of doctors. Pharmacists not only support physicians, they also contribute specific knowledge.

The right drugs

Many pharmacists become involved in development affairs as volunteers. They are active in medical and religious associations or professional unions. Pharmacists’ aid initiatives often make targeted appeals to colleagues and customers for cash donations. When private persons or medical practitioners donate drugs, they tend to not understand which medicines are actually needed. According to Germany’s Institute for Medical Mission (DIFÄM), it cost around $ 34 million to dispose of 17,000 tonnes of donated drugs which were useless in Bosnia-Herzegovina.

DIFÄM has published guidelines for drug donations. The guidelines are geared to the needs of developing countries and in tune with WHO recommendations. They state, for instance, that the packaging, labelling, quality and dosage of pharmaceuticals should, to the extent possible, match those of the drugs used in the recipient country. Following these guidelines, action medeor, a German pharma NGO, sent around 119,000 antibiotic pills from a German drug manufacturer to a hospital in Zimbabwe last year. The WHO’s Model List of Essential Medicines contains the 350 most important drugs needed to treat most illnesses.

In disaster relief, speed matters. Agencies therefore often rely on the globally accepted Emergency Health Kit. It weighs around one tonne and contains painkillers, antibiotics, infusion solutions and bandages. It covers the basic medical needs of 10,000 people for three months. The Kit consists of two units: a basic unit for aid workers with basic medical training and a supplementary unit for professional health workers. Depending on the region, anti-malaria medication is included.

Emergency pharmacists in action

Pharmaciens sans Frontières (PSF) is an international organisation based on the model of Médecins sans Frontières. For the German section, recruiting staff is the main priority. After natural disasters, these pharmacists travel to crisis regions and cooperate with doctors’ organisations such as Humedica and LandsAid. A sophisticated action plan allows PSF activists to respond fast in emergencies. At all times, there are two pharmacists on standby. They are prepared to leave Germany at short notice and spend two weeks in the crisis area.

PSF stresses the need to be prepared for such interventions. In cooperation with LandsAid, it runs outdoor training courses in order to convey the basic principles of humanitarian work to volunteers. The courses cover issues that are not standard knowledge of pharmacists in Western Europe, ranging from risks that arise from landmines or conflict management in extreme situations through to cooperation with international agencies.

In the disaster area, the most urgent challenge is typically to set up a reliable infrastructure to handle issues like food procurement and sanitation. At such times, a pharmacists’ tasks include taking pharmaceutical care of patients who underwent surgery, dispensing drugs to sick people, managing pharmaceutical stores and changing bandages and wound dressings. Moreover, pharmacists advise doctors on the use of drugs and sometimes assist during operations. Pharmaceuticals constantly have to be checked for moisture damage, and often a single pharmacist has to take care of several places. Another important issue is the correct disposal of drugs. “A good ratio would be two to three doctors per pharmacist,” says Ulrich Brunner, who heads the German section of PSF.

From January to May, the main focus of PSF Germany was emergency relief for earthquake victims in Haiti. In these months, a coordinator and two to three pharmacists were on duty on the island. The coordinator ensured that drugs reached the areas where they were needed. Meeting with other NGOs and institutions was also among his tasks, and so were visits to clinics and health centres. Exchanges were set up to balance out shortages and over-supplies. The coordinator reported from Haiti that there was a surplus of paracetamol tablets, but there were not enough other painkillers. Antibiotics in liquid form for children were also in short supply.

Emergency aid often becomes the basis of long-term commitment. For example, after the tsunami in 2004, PSF Germany started to set up a pharma dispensary at a Sri Lankan hospital. It was inaugurated at the beginning of this year. The sheer scale of Pakistan’s flood disaster in the summer, however, proved to be way beyond this NGO’s capacities.

Volunteer work won’t do

Some disasters do not require a pharmacist’s support to medical doctors. If, however, a national health-care system is to be developed or merely strengthened, pharma knowledge is of the essence, not only in referral hospitals or central medical stores, but also at the local level of small towns and villages. All too often, pharmacists are not accepted yet as competent advisers in health matters but only considered managers of drug warehouses. Better education in developing countries could contribute to changing matters.

For long-term missions, volunteer involvement is not enough. Local people need full-time partners. Therefore, the German section of PSF recently looked for a project coordinator to develop the pharmaceutical department of a health centre in Leogane, 30 kilometres west of Haiti’s capital Port-au-Prince. Part of the job is to train local health practitioners.

For similar purposes, action medeor is supporting a research laboratory in Dar-es-Salaam, Tanzania. This lab is working on a triple drug combination to treat HIV/AIDS, and some university students are being exposed to the practical side of pharmaceutical technology in the context. PSF Germany, moreover, is training health workers in the mountain regions of Baglung, Nepal, to handle and store drugs. In Mexico, this NGO has been training people in charge of health issues for years.

Experts agree that there is a shortage of well-trained pharmacists in many developing countries. Accordingly, demand for their skills is high. As a member of the Ecumenical Pharmaceutical Network (EPN), which works to improve the quality of pharmaceutical services, DIFÄM is planning to staff all hospitals with more than 50 beds in Malawi with pharma experts by 2014. Currently, only few hospitals in this country command basic pharma knowledge. DIFÄM’s plan is to fund three years’ training and accommodation for pharma experts. The annual cost per student is € 2,400. After training, these people are expected to work in Malawi.

This type of pharmaceutical capacity building should contribute to achieving the Millennium Development Goals (MDGs). The goals include reducing maternal and child mortality and combating AIDS and other infectious diseases. It is currently uncertain whether the numerical targets set in these areas will actually be achieved by 2015 as demanded by the MDG agenda. If humankind is to even come close, however, pharmacists will have to be allowed to play their role.