I’m A.J. and I’m student pharmacist in my final year at the University of New England College of Pharmacy. I’m excited to share my experiences in Thailand on this international APPE and so grateful for the opportunity. Prior to journeying to Thailand, I was doing most of my APPE rotations in Bangor, Maine, a small city north of the Maine UNE campuses. It was snowing just before I left, so the scorching humidity of Thailand is definitely a change of pace!
I arrived on Saturday night and the group had our first day together, exploring some of the cultural highlights of Bangkok. Among these, we had dinner at the colorful restaurant Cabbages and Condoms. No misnomer, the eponymous items littered the decor of the place, with lamps and art made from and shaped like condoms. This curious theme was the invention of the non-profit Population and Community Development Association (PDA). Profits from the restaurant go to support the PDA, which funds many social entrepreneurial and public health endeavors. PDA seeks to promote family planning and HIV prevention through the irreverent and cheerful atmosphere of Cabbages and Condoms.
The prevalence of HIV in Thailand is among the highest in Southeast Asia, with 440,000 adults and children living with HIV in 2017 - 1.1% of the population. Comparatively, in the US prevalence rate is ~0.6%. Our first professional day was spent exploring the healthcare of these patients at the Bamrasnaradura Infectious Disease Institute (BIDI).
We received a warm welcome from the doctors, nurses and pharmacists of BIDI, where we discussed HIV/AIDS, TB and emerging infectious diseases like MERS-CoV and toured the specialized facilities for the treatment of patients with these disease states. It is amazing that on the other side of the world, in a very different healthcare system, some things in pharmacy and medicine are universal. Deciphering doctors’ poor penmanship, medication reconciliation and patient barriers to care like affordability, transportation and low health literacy, were themes held in common in all of our practice. The services provided by the pharmacists at BIDI for patients living with HIV are not dissimilar to those found within the United States, including counseling on proper administration and side effects, medication optimization and reconciliation.
As we have found as students, the latter can be challenging - as in our country, patients often have multiple healthcare providers, writing many prescriptions, or may opt to take complementary therapy, like herbal supplements. With all these medications there are often clinically relevant duplications or interactions. In Thailand, there is an additional challenge: many medications, including antibiotics, are available without prescription in community pharmacies. Pharmacists must counsel carefully on important contraindications, particularly with anti-retroviral therapy for HIV, so that patients do no choose to take medication that may cause harmful adverse drug reactions or reduce the efficacy of their ART, inviting drug resistance.
The pharmacists of BIDI have developed innovative strategies to work with their patients on adherence and medication reconciliation. Viral loads are only measured annually in HIV patients, so adherence is assessed through regular pill counts & additional counseling given to patients in error. Incentives for bringing in home medications, like a free egg, encourage accurate medical records, allowing pharmacists to optimize therapy and catch dangerous interactions.
As we continue into our first week in Thailand, I look forward to learning and sharing with all of you. Thanks for reading!
A.J.
