University of South Carolina 2019

Pharmacy, Peru Arequipa

Wagner, TylerA peer and I used Work the World to complete an Advanced Pharmacy Practice Experience (APPE) through the University of South Carolina, College of Pharmacy in November 2018. I traveled to Arequipa, Peru and had a very positive experience. Everything regarding my experience with Work the World exceeded expectations and was first-rate.  

Work the World has a very useful online planner called MyTrip and with a user-friendly interface, it helps coordinate the trip before you travel, providing you with guidance every step of the way. As soon as I arrived in Peru, I had a team member greet me and pick me up from the airport, assist in helping me get adjusted to the Work the World house, and provide a tour of the town, including instructions on how to get to and from the hospital and city center.

The Work the World house was definitely a home away from home while in Peru. The entire team were friendly, hospitable, and would go above and beyond to help ensure each student had a positive experience. Everyone contributed to me having a very welcoming stay at the house and in Arequipa. 

The house is a short 20-minute walk from the hospital and a 30-minute walk from the city center. It is located five minutes from a mall and is in a safe area of the city. Work the World provided us with two home-cooked meals a day, which was greatly appreciated and made our experience even better because it allowed us to focus on learning as much as possible about the hospital, the culture, and the people of Peru.

I learned so much from my peers staying at the Work the World house.

Wagner, TylerLiving with other health care students from around the world was one of the most enjoyable aspects of the trip. It provided me with the opportunity to discuss the differences in health care in various countries and learn more about the responsibilities physicians and pharmacists have in different parts of the world. This aspect of the trip was invaluable, as I learned so much from my peers staying at the Work the World house.

Regarding my time spent at the local hospital, I greatly appreciated the opportunity to engage with the medical professionals. The Work the World team worked with me to ensure that I had the opportunity to rotate throughout the hospital and spend time in different departments. 

During my time in the oncology department, I assisted with preparing chemotherapy for patients on both the inpatient and outpatient side, spent time within the compounding lab helping to prepare and deliver compounded medications to different wards within the hospital, assisted the central pharmacy with completing medication orders and delivering them to the wards, as well as shadowing outpatient physicians in the oncology and tuberculosis clinic. 

Wagner, TylerMy favorite experience was being able to observe surgeries during my final week in the operation theater. It was exciting to be able to follow a surgery and understand the pathophysiology behind the decisions that were being made. All of these rotations within my overall APPE provided me with a diverse experience, seeing how another country operates within the medical realm. I strongly encourage anyone who participates in a Work the World placement to have some knowledge of the country’s native language, as this will lead to an increased ability to not only understand patient-physician conversations but will allow you to have increased interactions in the medical community. 

One of the biggest take-aways from my time abroad was the cultural differences between health care in America and health care within a government hospital in Peru. In America, pharmacists are continuing to develop and push new initiatives, allowing for the billing of patient interactions and some prescribing capabilities, allowing pharmacists to be more than just the individual who is dispensing a medication to a patient. In my placement hospital in Peru, pharmacists served a more technical role, mostly filling medications and weighing drugs to be compounded at bedsides. While these are all important tasks, it is important to note that in the present day, a clinical pharmacist within the United States is vastly different than a clinical pharmacist within Peru. During my rotations within hospitals in America, I’ve noticed that pharmacists have increased opportunities to voice their opinions during patient rounds compared to my experiences in Peru. This is something an individual should know prior to deciding to pursue an international rotation. 

I am grateful for the ability to spend a month in the hospital in Arequipa, as I not only learned a great deal about the challenges other countries face when it comes to patient care when they are limited financially, but I gained a greater appreciation for the health care that we have within the United States.

The first thing that stood out was the reluctance of the family to seek medical care

Wagner, TylerA specific patient case that stood out to me during my month in Arequipa is that of a young adult female patient who had developed a mass on her neck and right shoulder.  The first thing that stood out was the reluctance of the family to seek medical care, this was a primary theme throughout many of my patient interactions. The second observation was that this patient and her family worked to conceal the mass, wearing multiple layers of clothing and a turtle neck, despite the temperatures reaching 80ºF during the day.

The mass had been growing from her neck for six years before arriving for a consultation within the outpatient oncology department. By the time this individual was seen by the physician, she ultimately only had two options. She could proceed with the surgery, in which the surgeon would have to remove both the mass and the patient’s arm due to the accuracy and precision of the instruments the hospital possessed. The other option was to travel to Lima to have the mass removed at a more prominent hospital.  While this may seem like an easy decision, for a family that has very limited resources, this was a very challenging decision. The family would have to spend money to take a bus to Lima, find lodging, pay hospital bills, and take time off work. In America, citizens are not often faced with a decision of this weight. But in a resource-limited setting decisions like this are not easy. They are not easy for the patient, for the family, or for the medical professionals providing care.

Wagner, TylerWhile this is only one example of a case I saw during placement, countless others fit the mould of patients who were seeking care just a little too late. Instead of patients receiving cancer screenings once they reached a certain age, they would be diagnosed with metastatic cancer.

My experience in Arequipa was one that I am very fortunate to have had. I whole-heartedly believe that Work the World helped to provide me with the best experience possible. 

The city was tucked in a valley between towering mountains and volcanoes, providing a spectacular view with every sunset. I learned many things about the country. I learned about their love for football, their love of alpacas, and the importance of showing compassion. I was a visitor within another country, and it was important for me to be a compassionate guest, being respectful of all customs that were different from my own. 

there was always someplace that you could explore during your time off. 

Wagner, TylerOn the weekends, my peers and I from the Work the World house had the opportunity to travel the country. Some hiked through Colca Canyon and up to El Misti, some visited Machu Pichu, Cusco, Lima, Lake Titicaca, and Puno, and some white-water rafted and visited the markets in Arequipa. Regardless of your personality and your preferences, there was always someplace that you could explore during your time off. 

For those who are considering a placement in Arequipa, Peru with Work the World, I would encourage you to have an open mind in order to fully observe and appreciate all of the cultural differences that exist between medicine there and medicine in your home country.

My second piece of advice would be to take advantage of the opportunities to bond with your peers in the Work the World house. People will be coming and going within the house the entire length of your stay. Take time to learn about those who you’ll be sharing your experiences with. You most certainly will not regret it.

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