Student Spotlight: Mitchell Fairbrother Pharmacy Rotation in Cape Town, South Africa.

Mitchell Fairbrother, PharmD, recently returned to the United States from the adventure of a lifetime: a pharmacy rotation in Cape Town, South Africa.

During his international rotation, Fairbrother kept a blog about his experience, documenting not only the differences between pharmacy practice in the United States and South Africa, but also the stunning beauty of his surroundings.

We sat down with Fairbrother to learn more about his experiences in South Africa.

Can you tell us how you learned about the MCPHS connection with the University of the Western Cape? Why was the opportunity to have a pharmacy rotation in South Africa tempting for you?

I’ve known about MCPHS’s international rotation opportunities for a few years, just from word of mouth from upperclassmen. Early in my third year, I attended an information session presented by Dr. Prisco and knew right away that I wanted to apply. As a future pharmacist, I hope to help as many patients as possible achieve their healthcare goals; staying in one place won’t help me achieve that goal. Getting to see how another part of the world views and uses medications, as well as getting to share how we use medications here, was an amazing experience. I feel so privileged to have been given this opportunity to learn hands-on with healthcare professionals from other countries.

Did you have any particular expectations surrounding how the South African hospital and pharmacy systems might differ from the American system?

I did know that it was going to be very different experience than in the States; and I knew some aspects were going to be hard. During our time in South Africa we were precepted by Dr. Coetzee, a professor at the University of the Western Cape. Dr. Coetzee is one of the few PharmDs in South Africa, and quickly explained to us that pharmacy has a long way to go in his country. In South Africa, most students graduate after four years with a Bachelor of Pharmacy degree, and the “clinical pharmacist” is a very new concept.

The largest difference between our two countries’ pharmacy cultures is the number of career choices. After graduating in America, we have many job opportunities in retail, hospital, clinical, and industry settings to choose from. In South Africa, retail pharmacy is the primary postgraduate job, followed by hospital pharmacy. Hospital positions, however, have very little clinical application. While showcasing the value that pharmacists bring to a clinical team is still something we are working on here in the States, South Africa is much farther behind in their movement.

On your blog, you detailed the South African system of handwriting charts and patient notes. Did you feel that handwriting your notes made any difference in your practice?

Between terrible handwriting, and some notes being in Afrikaans (one of South Africa’s 11 national languages), it would sometimes be impossible to decipher why the patient was even in the hospital. It became very common for me to just talk with my patients and ask them for the information. If I had a recommendation, I would try to find the patient’s physician or leave a sticky note in the chart for the physician to review. Since I am so accustomed to electronic medical records and standardized record keeping, it was incredibly frustrating, to say the least. The largest drawback was how easy it was to misread something on the chart. Just as easily, a nurse could make a medication error.

You also mentioned the differing availability of drugs in South Africa. How did compensating for drug shortages or non-availabilities change your practice? Did you feel well-equipped to manage patients without some of your first line choices, or was it more of a struggle?

It was a struggle at first, but over time we were able to adapt and discover available resources. We had to think about things in extremely different ways than we were used to. It was frustrating at times, because we knew there were better treatment options available, but we had to overcome this barrier and go with what we had. This experience taught me variables, other than just lab values and symptoms, that I need to consider when treating a patient. You can have the best medicine in the world, but if the patient can't access it, it's useless. This perception definitely helped me even after returning to the United States, since drug prices and availability are factors we have to deal with on a regular basis. The whole experience has made me more adaptable.

Have your plans for your career shifted or changed as a result of your time in South Africa?

I firmly believe that this experience will make me a better healthcare provider. I have gained a perspective that I would not have gotten in a rotation in Boston. There were so many experiences during my time in Cape Town that brought me out of my comfort zone and forced me to think in ways I have never had to do before. I also felt that this rotation strengthened my leadership skills in ways I was not expecting. We had to be very comfortable with things not going as planned—because nothing ever did. Constant chaos had us on our toes and solving problems for the entire six weeks.

I experienced countless leadership, problem-solving, and decision-making challenges that I can use in future job interviews to stand out from the pack. I have gained a deep sense of empathy, and hope to provide as personal an experience as possible to each patient. This rotation only reaffirmed my desire to become an ambulatory care pharmacist and work directly with my patients. I also have a strong desire to become financially stable enough to donate to the healthcare providers of South Africa. They don’t need more healthcare providers, what they need is resources. I hope that one day I can help provide them with those resources.

Can you tell us a little about your favorite non-rotation activity or experience during your time in South Africa?

My favorite experience would be our day with elephants. We took a six-hour road trip from Cape Town to Plettenberg Bay. The drive was along the Garden Route, which is a gorgeous drive past mountains and cities along the coast. Everywhere you look looks like a postcard. We stayed the night in a backpacker’s lounge and started the next day nice and early. Upon arrival, we were introduced to our new friends Jabu, Thandie, Marola, Tabo, and Tomela. These five African elephants were found in the wild either injured or without parents, and then brought to this sanctuary for safety and recovery. We gave them their morning brushing, took them on walks, and fed them lots of pumpkin. During our day as elephant keepers we learned so much about these amazing animals. We got to see how incredibly intelligent and loving they are. What was most amazing to me was how the elephants whose trunks had been injured have adapted and learn to grab food in new inventive ways. The entire day was unforgettable, and something I’ll treasure for the rest of my life.