In my own words

Heather Hresko, DPH-4

During my second year of pharmacy school, I completed a 5-week community health field experience in Ecuador through the Global Health Study Abroad Program. The excitement and challenges of full cultural immersion inspired my interest in an international pharmacy rotation in a country with an unfamiliar language, culture, and healthcare system.

Most recently as a fourth year student completing an Advanced Pharmacy Practice Experience (APPE) in northern Thailand, I gained a new perspective of pharmacy practice through direct provision of pharmaceutical care in the Neonatal Intensive Care Unit (NICU) of a 1,000 bed hospital. I was surprised to find many similarities between Thai and western clinical practice. The emphasis on evidence-based medicine, high standards of patient care, and comprehensive services available for drug therapy management challenged my expectations and biases of healthcare outside the United States.

I exchanged ideas about drug monitoring, medication preparation and distribution, patient advocacy, and student life with Thai pharmacy and medical students. The value of the pharmacist role was clear during our hospital-wide “Pharmacy Week,” as the pharmacy department prepared and facilitated interactive medication education games and activities throughout each unit of the facility. I began to think in new ways about interdisciplinary teamwork and how to improve continuity of care back home.

In the midst of a new system of status and respect, I became more aware of the impact of provider hierarchy on patient outcomes in different cultures. As I compared Thailand’s universal healthcare system with our healthcare system in the US, I reflected on the difficulties faced by both as a result of cultural norms and government infrastructure. For example, low funding and unavailability of first-line medications sometimes limited pharmacological treatment options in the NICU. However, Thai providers were ultimately more adaptable and better problem-solvers for having regularly overcome these barriers.

Outside of the hospital, I experienced the rich historical background of Thailand through travels to local attractions and cities around the country. I built long-lasting relationships with Thai students and pharmacists who were eager to teach me about their country as we shared meals, visited temples, and toured national parks. Interactions with street vendors and monks on my walk into work provided even better insight into Thai culture. Each day brought new challenges and growth as I worked through the language barrier and adapted to new settings. I will always remember the satisfaction of successfully ordering my morning coffee in Thai!

An international rotation allowed me to break away from the academic routine and expand my worldview in ways not possible through a domestic rotation. I gained confidence in handling the unexpected, and learned invaluable problem-solving skills applicable to any professional environment. As a result, I feel more prepared for a PGY1 residency and a successful career as a pharmacist.