Kristine Wong, PharmD, Reflects on Her Advanced Pharmacy Practice Experience in South Africa

Kristine Wong, PharmD, recently finished one of her clinical rotations, and she says it was a life-changing experience.

She traveled to Cape Town, South Africa, as a Center for International Studies Ambassador Scholar to complete a six-week Advanced Pharmacy Practice Experience rotation. Each year a small number of students are selected to receive the Ambassador Scholarship. Ambassadors participate in MCPHS international programs, sponsored by the Center for International Studies, and offer a peer perspective on their experiences abroad.

“This experience challenged me in ways that I would have never encountered if I had not studied abroad,” said Kristine, who minors in public health. “Pharmacy school taught me all I need to know about the drugs, but this rotation showed me a different way to apply my knowledge that I would not have been exposed to otherwise.”

Kristine’s rotation involved shadowing a physician in an HIV clinic in a country that is experiencing the world’s largest HIV epidemic. She expanded her understanding of the healthcare industry beyond the United States and gained a new sense of confidence and independence that she says will empower her in her future career as a pharmacist.

Kristine shared her insight into the experience, and her advice for students considering a clinical rotation abroad.

Welcome back! How has your experience been since returning from South Africa?

I can’t believe it’s been seven weeks since I was last in South Africa! In addition to adjusting back to the East Coast time zone (a six-hour difference), I also had to learn the new pharmacy regulations that had been updated during the six weeks I was away. The field of pharmacy always surprises me with how quickly it moves and adapts. It’s true what they say – that one must be a lifelong learner to go into pharmacy!

So, what are your thoughts on your international rotation?

It was the best decision I’ve made in my five, going on six, years of pharmacy school! This international rotation has given me opportunities to grow and develop professionally as a future pharmacist.

Tell us more.

Because pharmacists in South Africa earn a bachelor’s degree and do not typically attend ward rounds, it was a challenge for me to take the initiative and face an environment in which doctors are not as welcoming to pharmacists as I was used to in the U.S.

How did you react to that?

I felt that I had to prove myself, and therefore it challenged me to be 100 percent certain in my recommendations and in my responses to any follow-up questions the doctors had. It motivated me to be an advocate for the patient and the field of pharmacy itself. I learned how to be more confident in myself, in my knowledge, and in my delivery of my interventions.

What happened when you moved forward with this confidence?

Although physicians were mostly not receptive to my suggestions, I know I made an impression on the medical team. I especially made an impact on the South African students in their last year of medical school because I would discuss with them the medication errors I noticed each day. By showing the next generation of physicians the important role pharmacy can have in the inpatient setting, I hope I can change the environment so that pharmacy is more accepted in ward rounds, leading to improved patient care.

What makes South Africa a unique place to complete your clinical rotation?

South Africa has the highest number of people living with HIV and the highest number of cases of MDR/XDR (multi- and extensive multi-drug resistant) tuberculosis. Before this rotation, I’d only seen one case of HIV and one case of tuberculosis during my time in pharmacy school. Therefore, this rotation strengthened my knowledge of TB and HIV because most of the patients I saw had either one or both diseases. Additionally, some of these patients also experienced disease complications that I had only ever learned about but never witnessed before this rotation, such as cryptococcal meningitis and progressive multifocal leukoencephalopathy.

What else did you experience during your international rotation?

I also had the opportunity to shadow a physician for a week in the HIV clinic at the hospital. Even though it’s an HIV clinic, patients often come for a multitude of complaints – from a cough to arthritis – because HIV is such a stigmatized disease that patients do not even want to see their primary care physician for these complaints. In addition to treating complications that come with having HIV, these physicians must also be prepared to treat anything, and it’s amazing to see how much they can do with limited resources.

Who guided you through this experience?

We had a highly accomplished preceptor to guide us and to learn from. Dr. Renier Coetzee is incredibly smart, and he challenged us with clinical questions regarding our patient cases that would make us think critically. He was also very responsive to our thoughts and ideas. For example, one of my classmates on this rotation with me had an interest in pediatrics, and Dr. Coetzee coordinated with the pediatric ward at the hospital to allow him to shadow in that ward for a week. He also was a wealth of knowledge regarding the tourist activities we wanted to do and made sure we made the most of our time in South Africa.

What is your advice for students thinking about studying or completing a clinical rotation abroad?

Just because this rotation was in another country doesn’t mean it was a vacation! You must be willing to learn a new set of laws, guidelines, and drug names, and a new way to do pharmacy in general was also given a lot of autonomy; therefore, students interested in this rotation specifically should be highly self-motivated to learn and work on their own to be successful.

What is your biggest takeaway from your experience?

The American healthcare system was all I knew, and I naively assumed that other countries would have similar infrastructure. However, I learned personally that healthcare is very different outside the U.S. and can vary majorly from country to country. The experience allowed me to gain perspective and to value what we have in America – such as electronic medical records – and see where we can improve. I also grew professionally to become more confident, assertive, and responsible. It was exciting to be treated not as students but as pharmacists, and to have the ability to make recommendations and decisions autonomously. I know this experience will make me a better pharmacist in the future!

The Center for International Studies at MCPHS is a network of individuals and departments that provides a spectrum of services to students drawn to MCPHS from countries around the world, and to students seeking educational and professional opportunities abroad. The center focuses on student success and global engagement, from enrollment through all aspects of the academic experience, and encourages collaboration among students, faculty, alumni, and institutions to pursue excellence in the global field of healthcare.