Volunteering in a developing country

Have you ever thought of volunteering abroad in a developing country and putting your pharmacist skills to use? Mary Jobling writes about her experiences of working in Tanzania and provides tips and advice on how you could do the same.

Do you feel like you are on a treadmill of studying, exams or qualifications? Do you have a yearning to see a bit of the wider world? Prefer the open road to the prospect of being stuck in a dispensary for the foreseeable future?

As I have experienced, a pharmacy qualification is a great passport to life and career-broadening experiences. Time out to travel is a rewarding experience, both in allowing perspective to reflect on your choices so far, and encounters outside your familiar context to draw on when you return.

There are many options worth exploring and this article focuses on volunteering in a developing country.

In 2006, I wrote for Tomorrow’s Pharmacist about helping to set up a rural dispensary at the Kiteto Christian Centre, Kibaya, Tanzania. Since writing, a nurse, Sister Sara Mbelwa, was recruited and has developed the project from a dispensary into a large health centre that operates outreach health projects into the surrounding area.

The base health centre treats outpatients with any presentation, but specialises in ophthalmology complaints. Mobile clinics operate through the area, taking supplies in a 4x4 and opening the clinic under a tree or in a church. Local villagers are able to access healthcare for which they would otherwise have had to walk distances of up to 20 miles.

The mobile sessions have focused on assessing infant health and, anecdotally, they have had an impact on reducing local child mortality in the past four years. This has been from simple interventions, such as encouraging parents to wash their children’s faces to prevent eye and other infections, boiling water before consumption, leaving a supply of deworming tablets to treat the village, and educating one key contact villager in recognising simple complaints and how to treat them.

Eye complaints, such as trachoma and cataracts, are an internationally recognised, multifactorial problem throughout Africa. The outreach clinics have highlighted patients who require surgical intervention and can be invited to the health centre for this. A visiting team of ophthalmic surgeons attends four times a year to operate.

Widening job description

I returned to the project in September 2008 and spent eight months with the remit of setting up a pharmacy in the newly built health centre. When I arrived, the pharmacy cupboards were not ready and this immediately stalled input. At the same time, possible misappropriation of funds from the school on site came to light so I found myself getting involved in the administration and financial management of a primary school.

My job description quickly widened to a general management role, mainly because I was the consistent long-term volunteer and partly because nobody local was available with an equivalent education level. My duties included liaising with the Tanzania Church Partnership Association in the UK (my umbrella charity), administrating projects and feeding back information about development and local needs. There was a steady stream of UK volunteers arriving for varying lengths of time who required collecting from the airport and support in the placements they were undertaking.

Some of the tasks that I would not have expected include collecting 200 chickens in the Landrover and driving them from the capital Dodoma back to the farm at the project base, acting as a dental nurse (taking notes for a visiting dentist) and observing cataract surgery.

Volunteering can require a flexible approach in responding to needs you see. I found it challenging balancing wanting to respond to a perceived need with the resources available and limitations of what I could personally achieve.

Developing the pharmacy

To give a general picture, the dispensing practices are archaic. There is no computer labelling, medicines are counted from large tubs into clear plastic wallets onto which directions are hand written. We did not have any local dedicated pharmacy staff available so dispensing was undertaken by a nursing auxilliary, Sam. A training intervention was to encourage Sam to write the name of the patients and the name of the medicines onto the plastic packet, as well as writing how many tablets and how many times a day the medicine was to be taken.

Literacy is poor so often counselling involves circling a picture of the sun or moon on the packet to indicate time of day to take the medicine.

Harrogate District Foundation Trust pharmacy department donated counting triangles and capsule counters, which improved hygiene in dispensing. Eye drops were manufactured extemporaneously from raw ingredients against a tattered, well used formulary. Empty bottles were boiled to sterilise them before use. Most medicines are sourced from India and surrounding countries and counterfeiting may well be an issue.

Unfortunately, there is no resource to analyse compounds to check integrity. Also, medicines are likely to be stored above 25C.

Early discussions with Sister Sarah about the development of the health centre and vision for the future led me to writing a five-year proposal for fundraising. This included proving the need for the centre, investigating local health demographics and strategic planning for future development and funding.

Looking at ophthalmology national guidance had led me to the Tanzanian Ministry of Health. I found the ophthalmology office and spoke to the national expert. The proposal has been sent to supporters such as Sightsavers International.

At the end of my time there, the pharmacy still was not set up to my satisfaction. I have used a donation from a friend to build the pharmacy cupboards, but a doctor from the government hospital was sent to inspect the clinic and decided the examination room should be located in the room we had designated for the pharmacy. We had no option but to change the rooms round and so I was left again without means of finishing the pharmacy.

This example sums up some of my wider experiences that, try as you might, there are external cultural factors that you cannot always influence but have to accept. So I left having not completely fulfilled my initial remit, but content that practice is appropriate for the resource available and that Sam is competent in what he is doing. 

Considering working abroad?

What kind of work do you want to do? Working as a pharmacist abroad can give you different professional experiences than you might not be exposed to in the UK.

Different health systems, work practices and resources can help influence approach to practice here. These are a valid contribution to professional development.

However, you are about to enter a career that potentially could span 40-plus years and you may want to seek alternative experiences while abroad: teaching, farm work, catering, etc.

Volunteering will mean you meet different types of people. This may also have a financial impact — labour or volunteering rather than professional work will not earn as much. Can you afford to support yourself while you volunteer or will you need to earn to support, for example, onward travel or student loans.
Where would you like to work? This seems an obvious question but your experience will vary from country to country.

Do you want to go it alone or have the support of an umbrella organisation? Solo travel means you have to conquer events yourself but training about cultural awareness, language, national infrastructure, etc, can make you more effective in post. Agencies that you can try are available in another article on volunteering abroad.

Things to consider

Registration and indemnity Both registration and indemnity will be easier to investigate and get before you go. For registration, expect to have to provide details of your pharmacy degree and education, validation of your identity (birth certificate, passport photo page) and a certificate of current professional standing (previously letter of good standing) from the Royal Pharmaceutical Society. Guidance on registration requirements for different countries are available through the Society’s website. 

Visa In most cases, it will be illegal to work without a visa. Therefore, your visa must be organised before you go. The Foreign and Commonwealth office website (www.fco.gov.uk) is a great starting point, it will direct you to the embassy website of your chosen country for details of immigration requirements. In addition to good general travel tips, it also has useful “know before you go” country profiles, which will inform you of any warnings or irritations you need to be aware of for your destination.

Personal protection Does your insurance cover repatriation? Have you had the correct vaccinations (eg, rabies if you are going to be more than 24 hours from medical attention)?

If you are going to be working for a long period in a developing country, is it politically stable and is it worth registering your details with the UK embassy in that country? Will you have mobile telephone reception where you are going? (I found better coverage in Tanzania than in Yorkshire!)

If you are in a rural area, do you have a telephone number immediately available for a flying doctor or your insurance company if there is an emergency? Do you have copies of your travel and insurance documents saved onto a memory stick or e-mail account in case they are stolen?

If this has whetted your appetite, further considerations on necessary personal qualities and skills, expectations of your trip, approach to a placement and what happens when you return are available.

References:

1. Jobling M. From cupboard to clinic — developing a dispensary in rural tanzania. Tomorrow’s Pharmacist 2006;58–60.

2. Snelling M. Enrich your career and outlook by volunteering abroad. Clinical Pharmacist 2009;1:367–9.

3. McCullagh F. Take away more than souvenirs when you work in a developing country. Clinical Pharmacist 2009;1:455–7.