High income countries have nearly eight pharmacists for every 10,000 people. In many low-income countries, there is not a single pharmacist for 10,000 people. Instead, doctors, nurses, or other clinical staff shoulder the duties of pharmacists, while continuing to manage other clinical care. This lack of trained pharmacists’ taxes health systems globally and prevents many from getting necessary care.

Carmela Berlin RPh, Christine Do, PharmD, BCPPS, and Thuyhong Do, PharmD are three MGH pharmacists working to reduce burdens and expand the role of pharmacists in global health. All three recognize the privilege associated with being in a stocked and well-staffed pharmacy in Massachusetts. By recognizing this privilege, they have identified ways to utilize their resources to advance pharmaceutical expertise globally.

Ms. Berlin is an Attending Pharmacist working at MGH’s Northshore Cancer Center. Eight years ago, when Typhoon Haiyan devasted the Philippines, she saw a need for her clinical expertise and joined the MGH Center for Global Health’s Global Disaster Response and Humanitarian Action program. She deployed with a team to the Philippines in 2013, and since then has deployed four more times with the disaster response team.

As a pharmacist working alongside international partners in post-disaster settings, Berlin has learned how important the knowledge and experience of pharmacists can be in a health crisis. On her first deployment the local logistics director, greeted her team with, “I heard you had a pharmacist.”

“[After landing] I barely could even eat my dinner,” she said. “I was working until four in the morning.”

She spent that night—and many nights on future deployments—cataloguing medical supplies and drug inventories. Berlin said this task is just one among many that pharmacists can perform on global health deployments. In addition to helping create sustainable cataloguing infrastructures, she has also offered help identifying clinical drug substitutions and managing supply chains.

For Berlin, responding to disasters requires more than just sending medications and medical supplies to places. Through her deployments, she realized the importance of collaborating with local responders to determine medication needs and helping to appropriately and effectively use medications.

But the global work of MGH pharmacy includes more than disaster response.

Dr. Christine Do, PharmD, BCPPS and Dr. Thuyhong Do, PharmD, are clinical pediatric pharmacists at MGH. They also serve within the Global Program for Palliative Care, working with colleague Eric Krakauer, MD, PhD. The MGH Division of Palliative Care provides specialized, multidisciplinary medical care for people with serious illnesses and focuses on improving quality of life for both patient and family.

The goal of the Global Program for Palliative Care is to offer training and technical assistance in pain relief and palliative care to colleagues in low-resourced settings. Since 2006, the program has been assisting the Vietnam Ministry of Health to integrate palliative care into their healthcare system.

Before Dr. C. Do and Dr. T. Do joined the program, the curriculum was designed to train physicians in Vietnam to learn and apply the principles of palliative care. However, Dr. Krakauer hoped to reach more than just physicians.

“Dr. Krakauer felt that palliative care is something that really needs to be trained in doctors and pharmacists,” Dr. T. Do said. “Both providers needed to feel more comfortable to treat patients suffering from pain or other symptoms.”

To expand palliative care training to pharmacists, the pair traveled to Vietnam and visited the University of Medicine & Pharmacy at Ho Chi Minh City, Vietnam. There, they built relationships to better understand the role pharmacists could play in palliative care. These relationships coalesced into a curriculum to better equip students and working pharmacists to practice palliative care.

To expand this curriculum to a larger scale, Dr. C. Do and Dr. T. Do worked closely with the University of Medicine & Pharmacy at Ho Chi Minh City to plan a virtual symposium. In October 2019—right before COVID-19 would limit international travel—the team watched their work come together. Their four-day, virtual symposium pulled together hundreds of local Vietnamese practitioners; they were ushering in a new wave of pharmacy-involved palliative care in the region. The program in Vietnam is just one of the many partnerships supported by the MGH Global Palliative Care Program.

Dr. Berlin, Dr. T. Do, and Dr. C. Do realize pharmacists are not the first type of healthcare worker many people think of when they think about global health. Yet the disparity in pharmacist access between high- and low- income countries illustrates the need for more engagement. Together, they look forward to meeting this need and expanding the capacity of pharmacists globally. A goal that fits the MGH Center for Global Health’s mission to support multidisciplinary engagement in global health across various areas of expertise.

“Pharmacists are the first person and the last person a patient sees,” Berlin said. “Pharmacists are the face of medicine.”

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