Until recently, cancer patients at Tikur Anbessa Hospital in Addis Ababa, Ethiopia were unable to receive chemotherapy involving high doses of methotrexate — a treatment commonly used for a wide variety of cancers.
High-dose methotrexate treatment requires involvement from clinical pharmacists, who guard against severe toxicities. Clinical pharmacists at Tikur Anbessa had neither the protocol nor the training.
But when two PY4 students and a PGY2 resident from the UNC Eshelman School of Pharmacy visited the hospital in 2017, they noticed the limitation and worked with Tikur Anbessa to develop a training program so the hospital’s pharmacists could begin administering the treatment.
The pharmacy students were in Ethiopia as part of the Global Pharmacy Scholars (GPS) program at the School. The program is coordinated by Benyam Muluneh, Pharm.D., a clinical pharmacy practitioner at UNC Hospitals and an assistant professor of clinical education at the School, specializing in hematology and oncology.
Muluneh wanted the GPS program to incorporate a layered learning model, with both pharmacy residents and Pharm.D. students contributing to teach an oncology and hematology module to M.Pharm. students at Addis Ababa University (AAU) and work in a clinical setting.
In the clinic at Tikur Anbessa, the UNC students — PY4s Tieumy Gao and Anna Abrahamson and PGY2 Michael Chargualaf — were challenged to come up with a project that could be designed and implemented in a short period of time.
“They noticed this gap in the pharmacists’ role in chemotherapy and developed a review guide that is now part of the curriculum at the clinic and at AAU,” said Muluneh. “It’s incredible to see that kind of impact for our students in an international setting — going beyond simply shadowing to actually affect change in the clinic.”
The group is also working with Tikur Anbessa to design and construct a cancer registry, to better understand the epidemiology of cancers and assess ways to change chemotherapy and care to best serve patients. They are collaborating with medical and pharmacy faculty from UNC and Duke University undertaking similar projects in Malawi and Tanzania, as well as the Ethiopian Ministry of Health and the non-profit Aslan Project, in order to structure the registry and apply for grants.
Advancing pharmacy practice
In Ethiopia, pharmacy practice is product-focused, said Muluneh — based in business rather than in patient care.
Working with pharmacy students at Addis Ababa University and in the clinic allows UNC students to influence the future of the pharmacy practice as it moves to a more patient-centric approach.
“In 20 or 30 years, those AAU students are going to be leading the pharmacy profession, with the potential to revolutionize the field in Ethiopia,” said Muluneh.
The GPS Ethiopia site also gives students and residents the opportunity to experience the challenges of teaching and working in an under-resourced setting.
“The participants learned how to be advocates for the pharmacy profession — a skill they can take back home and use to advance pharmacy at home,” said Muluneh.
Muluneh will return to Addis Ababa in Ethiopia with the GPS program in March 2019.
To learn more about the program, visit the Global Pharmacy Scholars site.