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St. Louis College of Pharmacy helps fight HIV/AIDS in South Africa

This article first appeared in the St. Louis Beacon, Sept. 13, 2013: When South Africa's Pharmacy Council announced an expanded pharmacy training program in 2010, the news was well received in a country with a chronic need for pharmacy skills. Now St. Louis College of Pharmacy is supporting the training efforts in South Africa with a year-long partnership with Nelson Mandela Metropolitan University (NMMU).

Approximately 5.38 million South Africans -- including nearly 20 percent of women of childbearing age -- are living with HIV, according to a 2011 report by the South African national statistical service. Pharmacists and pharmacy assistants are an important component of HIV treatment, which often includes the use of multiple drugs and consistent compliance with the drug regimen to prevent viral resistance.

Research suggests that about 2,500 pharmacy assistance personnel would need to be trained every year to meet the demand for HIV and AIDS drug distribution and medical care. Currently the country produces less than half that number.

Earlier this year the country's first class of pharmacy technical assistant students graduated from NMMU in the coastal city of Port Elizabeth.

By training additional pharmacy assistants capable of dispensing a limited number of drugs with limited pharmacist oversight, South Africa will be able to expand access to drug treatment and boost patient compliance.

The partnership with the College of Pharmacy is funded by $80,000 in grants from the Centers for Disease Control and Prevention and the United States President's Emergency Plan for AIDS Relief, matched with an equal amount from the college's own funds.

The partnership is one of many "twinning" programs supported by the American International Health Alliance, an organization established in 1992 to help “resource constrained” communities across the globe improve their access to health care. Twinning — partnering two institutions with shared characteristics and missions — has enabled the pharmacy college to provide NMMU with some of the resources it needs to develop the new program. 

"We knew when we started the program that we were going to need help," said Shirley-Anne Boschmans, head of the pharmacy department at NMMU and one of two NMMU faculty who visited the college and St. Louis area pharmacies recently. "We asked (the Alliance) if they could design something to support our program."

Dr. Ken Schafermeyer, director of international programs at St. Louis College of Pharmacy had done similar capacity-building work in neighboring Swaziland. He spearheaded the school's proposal for funding. Schafermeyer, along with two other faculty members, visited NMMU last May.

"It really is the perfect partnership," Schafermeyer said. "There is no language barrier, South Africa is a mid-developed country with high standards and good training."

Schafermeyer accompanied Boschmans and Teri-Lynne Fogarty, another NMMU faculty member, on a tour of Walgreens, at 4218 Lindell Blvd. Boschmans and Fogarty were shown the pharmacy operations with a particular emphasis on the division of labor between the pharmacists and the pharmacy technicians.

"We're trying to free up pharmacists to best use their time," Clark Kebodeaux, a pharmacist at Walgreens and an assistant professor at the College of Pharmacy, explained to the visitors. More of the primary drug dispensing responsibilities are given to technicians, allowing pharmacists to focus on what Kebodeaux described as "cognitive" services such as preventative screenings and patient follow-ups.

Increasing the capabilities of South African pharmacy assistants will serve a different purpose: expanding much-needed health-care delivery into rural areas. A national shortage of pharmacy personnel combined with the emigration from the rural areas to the cities of a large group of citizens with technical skills or knowledge, has left many health posts in rural areas vacant. The result is long lines that overwhelm existing clinics. Add in the hurdles of rural travel, and it's not surprising that patient compliance with recommended drug therapy is a challenge.

Boschmans believes the pharmacy technician program at NMMU will contribute to the pool of rural pharmacy assistance personnel. 

When asked what would prevent NMMU students from leaving their rural communities for employment in South Africa's larger cities or even abroad, Boschmans said, "Two things. First is that most of the (available) posts will be in those rural areas." 

"The second is the social compact bursaries." A bursary is a scholarship or grant given to a student. These bursaries provide funding to many of the students in the program and are tied to post-graduation work in specific districts. The people who live within a given district have a say in who receives the bursary linked to their district. This process, presumably, will favor students who are committed to returning to serve in their home districts.

St. Louis College of Pharmacy is supporting the efforts of NMMU with instruction materials, faculty development, curriculum development and practice analysis. They will assist in developing the capacity for long-distance learning between the institutions.

While funding for the twinning program will last for only one year, both sides have already expressed a desire to continue their relationship beyond the official partnering. There are three more scheduled visits between the partners before the end of the partnership year. NMMU hopes its pilot pharmacist technician program will be replicable at other institutions in South Africa, and eventually into neighboring southern African countries. 

In the meantime Schafermeyer is excited by the collaboration between the institutions and by the opportunities that local students will have through the partnership.

"Our students go there and it's a new world for them," said Schafermeyer. He took a group of students to South Africa over the summer. "What they learn is not what they are expecting to learn. They learn how to respect other cultures, how (South African pharmacists) are doing amazing things with limited resources. They become more globally aware."

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