University of Tennessee 2019

Pharmacy, Zambia Lusaka

Mischke, AnneIf you’re like me, you’re probably going to skeptically skim this testimonial half believing it and half wondering if I even went to Zambia or if this is just a paid positive review. I could be giving myself way too much credit here - my story might be really boring, and I am definitely flattering myself by thinking this might look polished enough to be “manufactured.” But I remember being in that position. There’s immense pressure to ensure that a program is reputable. I spent weeks looking at countless internships, speaking with representatives, and just generally poking around being a nuisance before I made a decision.

In the end, Work the World was the most professional, transparent, financially reasonable, and just generally friendly program available. Best of all, they still let me sign up even after how annoying I was!

People often expect a personal, poetic backstory explaining exactly what inspired me to spend a month in Africa. In reality, I made the trip to Lusaka, Zambia because I made a decision and followed through with it. One afternoon, I suddenly looked up from my books and decided I was going to Africa. That was it. When I got tired of waiting for the winds of fate to fill my sails, I simply picked up a paddle.

After landing in Lusaka, I proceeded through the airport and found a member of the Work the World team waiting for me outside the door wearing her blue shirt. She was just one of the many genuine and incredible team members I would have the pleasure of meeting.

Mischke, AnneWhen we arrived, I was absolutely stunned by the Lusaka house. The pictures I had seen looked amazing, but the house surpassed even my admittedly high expectations. My favorite spot quickly became the upstairs balcony, and within a day or two of settling in, I had established a routine of watching every sunrise and sunset there. This will sound ridiculous, but it’s true: every single sunset in Lusaka is absolutely stunning. I’ll remember those sunsets for as long as I live.

At the house, I met more members of the Work the World team. I’m doubtful that there is a human being alive that the Lusaka Program Manager could not make feel welcome. I got the feeling that they all genuinely cared about all of us.

Our cook in the Work the World house was always open to any reasonable request. Although his hilariously charming personality had already confirmed I would never forget him, one of his kind acts will certainly stay with me forever. I very much wanted to try a traditional Zambian dish called vinkubala that is made from fried caterpillars. I mentioned to him that the pharmacist who had wanted me to try this dish wasn’t able to bring any in.  A few days later, what should appear during our weekly cookout but the caterpillars! I was so touched.

Mischke, AnneI also had a great time befriending the Zambian pharmacy students.

The hospital where I was based had an overwhelmingly vibrant, intelligent, and friendly pharmacy team. On the first day, I met the pharmacy director and could not believe how much time he spent making me feel welcome. Even though he was clearly extremely busy, he made it crystal clear that he intended for me to have a pleasant, educational time while I made my way through his network of pharmacies. I also had a great time befriending the Zambian pharmacy students. They are an absolute joy and I had a ball moving around the hospital with them.

I greatly enjoyed this system, as it helped keep me on my toes because each day was distinctly unique from the last.

Each of the clinical disciplines operated slightly differently. As a pharmacy intern, I had an introductory period at the main pharmacy and then rotated through the various satellite areas. I greatly enjoyed this system, as it helped keep me on my toes because each day was distinctly unique from the last. A daily schedule was created for me, but as is the nature of Zambia, it often changed last minute for various reasons.

I had already become familiar with the concept of Zambian time (i.e., start times are more rough estimates and providers are never late but have arrived exactly when they intended to arrive) and wasn’t quite sure how that translated into pharmacy practice. Much to my delight, it really didn’t. Pharmacists are punctual even in Zambia.

Pharmacy is altogether a bit of a different beast in Zambia. My only point of reference, of course, is American pharmacy, but due to the unique environment, I would guess it’s a far cry from many other countries as well. There is much more autonomy and far less back-and-forth with prescribers. This is more out of necessity however, than any real difference in scope of practice compared to international counterparts. In America, one medication might have three or four different formulations and failing to dispense the exact compound prescribed can have extremely unwelcome legal results even if the patient tolerates it well. In Zambia, the patient was lucky if we found something even similar to what was prescribed, and there’s a tacit understanding on behalf of the physicians that, well, the pharmacy is doing the best it can with what it has.

Mischke, AnneAt the back of the pharmacy was a long table that ran about half the entire length of the room. There were boxes containing all kinds of medication – slightly out of date and slightly damaged. These were all the drugs donated from other countries for one reason or another – slightly out of date, slightly damaged.

Whether or not the pharmacy had specific medication in stock outside of the basic five or six we managed to keep in-house was almost completely up to chance. It was a very surreal experience the first time I was told to go check the table for something uncommon and found myself digging through endless piles of pillboxes desperately searching for the elusive medication. It’s almost impossible to adequately describe the feeling of brief hope that you’ve finally found that Celebrex, quickly replaced by disappointment that it’s just another box of Celexa and that maybe if you just check under that pile again you’ll find it, and honestly at this point you’d trade your right arm for a box if it meant that your anxious, hopeful patient won’t have to go home empty-handed.

Mischke, AnneThat’s not to say I didn’t have a great time observing the many pharmacists and pharmacy students at the hospital! One of my favorite experiences was when the pharmacist offered to buy me a traditional Zambian lunch called nshima. Nshima is a doughy ball made from cornmeal, usually paired with a protein and eaten with your hands. I was ecstatic to be acknowledged and included, and she so eager that I try traditional food. Word quickly spread that the American was about to try nshima, and as a crowd gathered around us it slowly dawned on me that I had no idea how to eat this! Not one to be beaten so easily, I used one hand to gather dough and one hand to gather protein. Laughter erupted all around. Nope. I bravely continued on, much to the endless amusement of the pharmacy staff. There are only a few things that warm my heart more than remembering how much joy I brought the pharmacy staff that day.

There aren’t enough hours in the day to go into detail about each satellite pharmacy I had the pleasure of experiencing. In addition to the main pharmacy, which operates in a similar way to a community setting, I participated in the clinical areas of women’s health, neonatal intensive care, OBGYN, adult oncology, pediatric oncology, infectious disease, surgery, acute care, and HIV/AIDS specialty care as well as attending meetings regarding pharmacy administration. The long-term children’s ward includes a classroom environment with teachers that offer lessons to the children. I highly suggest spending some quality time there. The HIV clinic also deserves as much time as you can manage to spend there too.

I had adventures so grand that they can’t very well be described in simple words. 

Mischke, AnneOutside the walls of the Work the World house and hospital, I had adventures so grand that they can’t very well be described in simple words. Luckily I took pictures!

My first weekend I went with some fabulous ladies to the Chaminuka Game Reserve outside of Lusaka. This game lodge offers bush walks, homemade cheese tastings, elephant observations, and many other things.

My second weekend I went with another group to Livingstone and Victoria Falls. We also took a trip through Zimbabwe, Botswana, and Namibia. We braved the hike up to Angel’s Pool above the Falls for even more stunning photographs. I still don’t believe it myself sometimes when I explain to people that it’s not forced perspective, and I really was that close to the edge of the waterfall!

Camping out in Chobe National Park, Botswana, was such a surreal experience. There I was, in real life, sleeping on the sacred ground I had grown up seeing in National Geographic, no longer needing to dream I might visit it one day. I spent the entire night listening to the lions roar, absolutely convinced that they’d come for us at any moment. Finally, we took a riverboat ride down the Zambezi River. The sunset over the water did not disappoint.

Mischke, AnneAlthough I greatly value the time I spent in the pharmacies, the thing for which I am most grateful for is without a doubt the Zambian people. Throughout my entire three-week trip, I never had a single negative interaction with a local. At every turn, I encountered open, honest people.

At the risk of sounding cheesy, my most poignant gift from Zambia was the understanding of how valuable and significantly meaningful cultural exchange can be. It can be silly sometimes, like how after our traditional African song and dance class we returned the favor by teaching the locals how to do the Macarena. It can be unspoken, like when I was there during story time on the ward, just hoping that the children would realize that even though I was from very far away and I look different, I still genuinely cared about them. It can take many forms. The most important thing is to remember how much pure, joyful human interaction you are capable of experiencing if you only leave yourself open to it.

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