25
March
For 20 years, the School of Pharmacy has supported international rotations that expand student pharmacists’ horizons — shaping careers, improving care, and making a global impact
By Logan Underwood
In the lush mountains of Thailand more than 8,000 miles from home, Katie (Scarpace) Hanke (PharmD ’13) arrives at the hospital she’ll be working in for the next eight weeks. And she braces for a challenge.
“I could not speak any of the language, and I couldn’t read it, either,” she remembers. Her preceptors spoke English, but most of the patients did not.
Always drawn to immersive global experiences, Hanke, then a PharmD student at the University of Wisconsin–Madison School of Pharmacy, chose to complete one of her fourth-year Advanced Pharmacy Practice Experience (APPE) rotations in Thailand to help broaden her horizons. And although the communication barrier was a challenging obstacle, she believes the experience has made her a better clinician.
Today, Hanke works at Gwidt Pharmacy, a small community pharmacy in Wittenberg, Wisconsin, where she often interacts with Spanish-speaking patients.
“I know what it feels like to be in that spot, so I try to help my patients be able to get what they need and make sure that they understand what’s going on,” Hanke says. “Even if I’m using a translation service, I can at least get them connected with a resource that can help them.”
Hanke is one of 223 student pharmacists who have participated in an international APPE rotation through the School of Pharmacy since 2006, when one student completed a rotation in Ecuador. The Ecuador rotation was developed in 2005 by Connie Kraus, emeritus professor of pharmacy practice, and Assistant Dean for Experiential Education Mara Kieser (BS ’81, MS ’84). Now 20 years later, the School has APPE partners in five countries: Belize, Oman, South Africa, Spain, and Thailand.
In the 2024–25 academic year, 15 PharmD students are making the journey, spending six weeks immersing themselves in the culture while working with patients, researchers, and providers in the area. Besides being able to apply what they’ve learned in the classroom, these experiences offer something else invaluable to student pharmacists.
“It broadens their scope of pharmacy practice around the world so they can see how other countries provide care and pharmacy services, and they can compare and contrast what seems to work best,” says Kieser. “It’s a great way to exchange knowledge about how practice is done around the world, and it really allows them to have a bigger perspective.”
Students making a difference
Ten out of the 15 students participating in an International APPE in the 2024–25 school year are traveling to South Africa. The school has close research ties to pharmacists in South Africa, which has helped it to become one of the most expansive international opportunities for the School’s students, now offering three separate APPE options: clinical, teaching, and public health.
Fourth-year PharmD students Nora Pecha and Alyssa Kuhn traveled to South Africa in 2024 to participate in the public health rotation. Both Pecha and Kuhn are also pursuing a certificate in global health, and this international experience gave them valuable insight into global health topics.
During their six weeks, Pecha and Kuhn worked on a project revolving around how to better educate providers in the public sector about the causes, treatment, and symptoms of Clostridioides difficile — an often severe infection that’s increasingly common in South African hospitals. Apart from this project, the students in the South Africa program worked in a variety of positions meant to serve the community.
“Some days, we went to help with delivering medications or making sure patients were up to date on vaccines by going door to door in different townships,” says Kuhn. “Another day, we would help with the women’s health clinic which provides long-acting birth control to interested women who may be at risk for intimate partner violence.”
Both Kuhn and Pecha were amazed by the direct and immediate impact they could make during their rotation. Alum Eric Huckins (PharmD ‘14) feels similarly about his international APPE experience.
In a clinical rotation to Belize, Huckins would switch daily between working at a clinic, a local hospital, a mobile clinic, and completing house visits. As one of the only pharmacy representatives on a team of physicians, he depended on the skills he learned at the School of Pharmacy to help his patients.
“They’re really leaning on you for those clinical skills,” says Huckins. “Now you’re put in this pharmacy that you have to improvise essentially with the treatments and resources in front of you.”
That’s part of the value Kieser sees in these international experiences.
“You have to be a little more self-reliant and resilient than if you’re here in the States,” she says. “They get the chance to improve their problem-solving, communication, and ability to think fast on their own.”
Laurel Legenza (PharmD ’13), the School’s director of global health, agrees. Operating without your typical safety nets widens the space for growth.
“Soft skills — like problem-solving, communication, and cultural humility — all get amplified when you’re abroad in a way that is really extraordinary and difficult to replicate in a system where at the end of the day you go back to the safety of your home,” Legenza says.
Career defining experiences
After graduating from the School of Pharmacy in 2014, Huckins worked in a variety of areas in the field of pharmacy before ending up at Lumicera Health Services, where he’s now the vice president of business development.
Although Huckins’ day-to-day work is worlds apart from what he did in Belize, he thinks of the experience as his most important APPE rotation, which taught him how to improvise.
“The biggest value that the experience had is that it puts you in a truly uncomfortable situation — unfamiliar surroundings far from home, with few resources and high demands,” Huckins says.
On top of cementing Hanke’s commitment to helping her patients overcome language barriers, her clinical experience in Thailand has also led to ongoing international work. She works with the Rotary Club, managing the pharmacy side of the group’s Guatemala Medical Resource Partnership, which runs a one-week clinic every January in the same Guatemalan community.
“My participation in that program is rooted in my love for travel and my international rotation that put into perspective that I wanted to give back to the world community, even if it’s not right in my backyard,” she says.
Pecha and Kuhn’s international experiences helped shape their career trajectories as well. Both graduating this year, they are beginning to think about how their rotations serve as an introduction into the world of pharmacy.
For her residency, Kuhn applied to larger, academic medical centers. She was inspired by her time in South Africa and wants to work with diverse populations in the future. Similarly, Pecha, interested in ambulatory care, is hoping to focus on preventative measures for chronic disease and disease advancement. Her experience in South Africa gave her exposure to working with new populations and new ways to manage chronic illness.
“Going into ambulatory care, you have to know a lot about the other facets of health, like socioeconomic status and how to be creative in helping patients overcome barriers to care,” Pecha says. “It was great being able to do an international rotation where a lot of these factors play a role in what kind of disease states they see on a day-to-day basis within their health system.”
An international future
Later this year, on August 9, the School of Pharmacy is hosting a fundraising gala, as well as a wine and food pairing and a tea party, to increase support for PharmD students to complete international APPEs. The event will also provide the chance to reflect on the impact that nearly 20 years of international experiences have had on the School’s alumni and their patients.
Legenza credits much of the current international APPE program’s success to earlier efforts from the School to build ties around the globe. For example, through the leadership of the late Curt Johnson, former professor at the School, the School of Pharmacy became a founding member of the US-Thai Consortium, which aims to provide opportunities for Thai pharmacists to come to US to enhance their pharmacy training. That consortium is now celebrating its 30th anniversary.
“What is so beautiful is that some of those pharmacists who came to Madison 10 or 20 years ago are now our preceptors or they’ve trained the preceptors that our students now work under in Thailand,” says Legenza.
At its peak, the School’s international APPE program offered rotations in seven countries, leading up to the COVID-19 pandemic. Re-establishing the sites lost during shut-downs is a top priority for Kieser.
“I hope that we can get back the number of sites we had pre-COVID, but we’re not there yet,” she says. “Our number one goal is building our program back up to where we had it before COVID shut everything down for three years, and we’re working very hard on that.”
“The students want to travel abroad want to explore, and I think that’s exciting.”
—Mara Kieser
Beyond that goal — and potentially securing an opportunity on each continent — Kieser just wants to see the program continuing to stoke curiosity in future pharmacists.
“The students want to travel abroad want to explore, and I think that’s exciting,” says Kieser. “I’m glad we’re able to provide these opportunities for them to go and explore and see and learn. It’s a cool thing.”
