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Personal View International Journal of
Pharmacy Practice International Journal of Pharmacy Practice 2015, 23, pp. 86–89
Ethics in global health outreach: three key considerations for pharmacists Matthew L. Romoa and Matthew DeCampb a
Epidemiology and Biostatistics Program, CUNY School of Public Health, New York, NY, and bJohns Hopkins Berman Institute of Bioethics and Division
of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
Keywords ethics; global health; medical outreach; medically underserved; volunteer Correspondence Dr Matthew L. Romo, Epidemiology and Biostatistics Program, CUNY School of Public Health, 2180 Third Avenue, New York, NY 10035, USA. E-mail: [email protected] Received September 30, 2013 Accepted March 2, 2014 doi: 10.1111/ijpp.12112
Abstract Objective The objective of this article is to explore three key ethical tenets that pharmacists should consider prior to participating in global health outreach. Key findings There are increasing opportunities for pharmacists to be involved in global health outreach; however, little attention has been given to the ethical issues that participation may raise for pharmacists. Pharmacists’ widely accepted and basic ethical obligations at home lay the foundation for effective management of these ethical challenges abroad. At home, pharmacists have an ethical obligation to provide the best possible quality of care to the patients for whom they serve. During global health outreach, this involves identifying and mitigating the potential for harm, as well as understanding and respecting cultural differences. Furthermore, pharmacists have an ethical obligation to not only meet individual patient needs, but also community and societal needs, when applicable. In global health outreach, this involves tailoring interventions to the needs of the population served. Conclusions Because of their unique skillset, pharmacists have the potential to make significant contributions to global health. Applying ethical principles, such as providing the best possible care, respecting cultural differences and meeting societal needs, provides the foundation for successful global health outreach by pharmacists.
Introduction Increasing opportunities exist for pharmacists to volunteer internationally in underserved communities. A common way for pharmacists to get involved is via‘short-term global health outreach,’ i.e. trips of various lengths, frequently abroad, in which pharmacists play a role in drug acquisition, dispensing, therapeutic interchange, and patient counselling, usually as part of a broader multidisciplinary team.[1] Although operational issues, as well as the educational benefits of global health outreach for pharmacy students, have been described,[2,3] comparatively little attention has been given to the unique ethical considerations participation in global health outreach raises for pharmacists. This is a critical oversight. Pharmacists have an important role to play in global health outreach because of their unique knowledge and expertise; however, pharmacists must also consider their ethical obligations when participating in outreach efforts. Regardless of practice setting, pharmacists are expected to comply with ethical standards, which exceed the minimum legal requirements governing pharmacy practice.[4] In this © 2014 Royal Pharmaceutical Society
paper, we describe three key ethical considerations for pharmacists engaging in global health outreach, focusing on the ways in which widely accepted professional norms and ethical obligations apply in this context.
Providing the best possible care One of the principal ethical obligations of pharmacists is to provide the best possible quality of care to the patients they serve.[4–6] At a minimum, this obligation can be summed up as Primum non nocere (‘first, do no harm’), with an emphasis on safety. However, pharmacists typically commit to more, such as helping patients and their clinicians choose therapies best tailored to a patient’s circumstances. For example, when a pharmacist helps select less expensive equivalent medicines, he or she helps in the delivery of patient-centred care consistent with patients’ values, such as cost considerations, and may also help reduce unnecessary costs within health systems. International Journal of Pharmacy Practice 2015, 23, pp. 86–89
Matthew L. Romo and Matthew DeCamp
Alternatively, therapeutic drug monitoring by a pharmacist might improve treatment outcomes by tailoring dosing to an individual patient’s clinical profile. Providing care to medically underserved communities abroad can pose challenges to this basic ethical obligation. In this unique context, pharmacists may find themselves without access to the ‘best possible’ treatment available in their home country, without many of the tools required for pharmacy practice, such as facilities for sterile compounding and computer technology to assist with drug information, and without understanding the precise role and obligations of pharmacists in a foreign health system (as prescribing and dispensing practices differ worldwide). Under such circumstances, the risk of harm is real. For example, it may seem altruistic to donate leftover medications to a community health worker or even a local pharmacist after an outreach effort. However, if that community health worker or local pharmacist is unfamiliar with the medication, must pay for its disposal (e.g. after expiration), is unable to dispense it because of local regulations, or simply cannot read the foreign language label, then an adverse event or consequence is likely to result.[7] Similarly, imagine a scenario where a particular antibiotic planned for use comes in a powder for injection. If there is no access to sterile water, then that antibiotic must either be used inappropriately (putting patients at risk for harm) or wasted. Either could negate the benefits of an outreach effort and undermine future collaboration. Both examples emphasise that careful planning beforehand is necessary to avoid potential harms. To meet this basic obligation, pharmacists should first understand the local laws, regulations and licensing rules governing pharmacy practice at their destination, preferably by communicating directly with pharmacists there. Second, they should help define the overarching goals of the outreach effort related to medication prescribing and dispensing. In doing so, pharmacists should recognise that benefits to the individuals in the community served override the personal interest of those travelling. This discussion may reveal that the goals of a particular outreach effort could be achieved by not going. Imagine a locale with a high incidence of cervical cancer and low rates of human papillomavirus (HPV) vaccination. If the goal of an outreach effort is to improve local access to HPV vaccination, but a local non-governmental organisation is already providing free HPV vaccinations, it might be more reasonable to donate money for purchasing more vaccines rather than duplicating efforts. Third, when outreach involves donated drugs, pharmacists should be familiar with best practice guidelines on drug donation.[7] Pharmacists typically work within multidisciplinary teams, and they should consider it their unique responsibility to uphold and reinforce these principles related to medication use among their medical and nursing colleagues. © 2014 Royal Pharmaceutical Society
87
Respecting cultural differences Another basic ethical obligation of pharmacists that directly impacts delivering the best possible care is respecting cultural differences.[4–6] Understanding and respecting cultural differences, whether they are related to age, gender, race, ethnicity, religious beliefs or other factors, is necessary for providing good pharmaceutical care.[8] When abroad, cultural differences occur more frequently and potentially have more impact than those pharmacists experience at home. While some may be relatively innocuous (e.g. etiquette issues related to greeting, such as handshakes), many other cultural differences can have a major impact on the outreach effort or even cause distress (e.g. radical gender differences). In some settings abroad, for example, the husband speaks on behalf of the wife, which would limit direct communication between the pharmacist and the patient. This could be an unanticipated challenge for pharmacists, when they are accustomed to speaking directly to patients. In some countries, local languages differ from the country’s official language; for example, in rural areas there may be a local language in which patients feel more comfortable discussing their health. Beliefs about health may also be altogether different, depending on the culture. For example, in the experience of one of the authors (MR), some South American cultures believe that a mother’s experiences and emotions can be transmitted though breast milk. If a mother is inadvertently frightened by an injection at the clinic, she may later consider any crying by her baby as a consequence of having received the injection and fail to return for follow-up visits. Failure to recognise cultural differences can have a range of adverse consequences, even if unintended. For example, patients may simply not accept services offered during the outreach effort or misperceive their intent. Either could result in lost benefits, wasted resources, potential psychological harms (e.g. related to distrust) or even interference with future collaborative efforts. To manage this ethical challenge requires specific attention to cultural awareness (sometimes termed ‘cultural competency’) prior to departing. At a minimum, this requires pharmacists be familiar with the local language and/or ensure access to adequate translation services. In addition, pharmacists should recognise the socio-cultural implications of history – even the historical relationship between their own country and the one where the outreach occurs – as these may contribute to the specific challenges that occur during the outreach effort. Many areas targeted by global health outreach are located in places that have complicated historical relationships with developed countries, including a past of colonialism that affects perceptions to this day. Pharmacists have an ethical obligation to prepare for anticipated cultural differences and to educate themselves about cultural compeInternational Journal of Pharmacy Practice 2015, 23, pp. 86–89
88
tency in advance of departing. Although not all cultural differences can be predicted in advance, educational resources about cultural competency tailored to pharmacists do exist, such as those from the American College of Clinical Pharmacy,[8] and should be utilised when planning an outreach effort.
Meeting societal needs Pharmacists have an ethical obligation to not only serve individual patients,[4] but also to meet community and societal needs.[5,6] This involves distributing available resources equitably, such as not dispensing medications differentially based on race. It also includes meeting broader social needs; during influenza vaccine shortages, for example, pharmacists play an important role in identifying and vaccinating those most at risk first. Compared with longer-term outreach efforts, this ethical obligation takes on increasing importance for short-term outreach. Failure to consider community and societal needs may result in drugs not being tailored to local disease patterns (e.g. antibiotic resistance), disrupted pharmaceutical supply chains due to the presence of short-term teams and unsustainable treatment practices (e.g. a month’s supply of an anti-hypertensive medication), for example. Another common challenge clinicians face during global health outreach is whether to screen for a disease for which the treatment is unavailable, unreliable or too expensive.[1] Would it be futile to screen for a disease if no standard therapy is accessible and doing so risks causing psychological harm to newly diagnosed patients? Or might screening create the motivation and advocacy response necessary for provision of treatment? Finally, in some circumstances the need for treatment is so vast that the inequity of who gets treated during short-term outreach (and who does not) can be both apparent and disturbing. If the pharmacist is part of a multidisciplinary team, he or she has an important responsibility to raise these issues and work with his or her team to find solutions. Managing these ethical challenges requires pharmacists to engage in depth with the local community – perhaps more deeply than they do at home. Community needs can only be identified by engaging with the community, including its members, leaders and health workers, well in advance to help define the needs that will be met by the outreach effort.[9] Needs should be shaped by a concern for both the sustainability of the intervention (‘Are locals available to continue managing drug dosing and dispensing?’) and for capacity building (‘If not, can we train them to do so?’).[9] Certain interventions, such as vaccination, are more likely to be sustainable and less likely to cause harm in the longer term and thus could be prima facie reasons to support such © 2014 Royal Pharmaceutical Society
Ethical global health outreach by pharmacists
approaches during global health outreach. Sustainability and capacity building are particularly important considerations for pharmacists in global health outreach, in part because they are often responsible for physical delivery of medications (i.e. acquiring medications, transporting them, maintaining adequate storage, assuring proper dispensing and disposal, etc.).[9] Indeed, the two may be related: capacity building is an opportunity to improve the sustainability of an outreach effort, depending on the circumstances. Meeting societal needs will also utilise pharmacists’ special skills and obligations pertaining to education. In some circumstances, meeting a societal need might be accomplished not through providing a drug, but by educating the community. For example, educating a community about diet and lifestyle modifications to prevent osteoporosis might be more appropriate than offering vitamin D supplements for 1 month or screening for the disease. Home management of paediatric diarrhoea by teaching the mothers of a community about the use of oral rehydration solution and zinc supplementation would be another relevant example. In other circumstances, pharmacists’ principal obligation might be to educate and empower the healthcare workers in the community responsible for dispensing medications in the absence of a pharmacist. This can help them promote good pharmaceutical practices based on important resources, as outlined in Where ThereAre No Pharmacists:A Guide to Managing Medicine for all Healthcare Workers.[9]
Conclusions In summary, pharmacists can make important contributions to global health through their special knowledge, skills and the ethical obligations that they possess. Involvement also presents an exceptional opportunity as an educational experience for students and practitioners alike. However, participation in global health outreach presents many ethical challenges, three of which have been described here. Pharmacists’ widely accepted and basic ethical obligations at home lay the foundation for effective management of these challenges abroad. Future research should focus on extending existing best practice guidelines[10] and ethical principles explicitly towards the challenges that pharmacists face during global health outreach.
Declarations Conflict of interest The authors declare that they have no conflicts of interest to disclose. International Journal of Pharmacy Practice 2015, 23, pp. 86–89
Matthew L. Romo and Matthew DeCamp
89
Funding
Authors’ contributions
This project received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
MR and MD contributed equally to the development and writing of this manuscript.
References 1. Johnson CA et al. Opportunities and responsibilities for pharmacists on short-term medical mission teams. J Am Pharm Assoc (2003) 2009; 49: 801– 807. 2. Brown DA, Ferrill MJ. Planning a pharmacy-led medical mission trip, part 1: focus on medication acquisition. Ann Pharmacother 2012; 46: 751– 759. 3. Werremeyer AB, Skoy ET. A medical mission to Guatemala as an advanced pharmacy practice experience. Am J Pharm Educ 2012; 76: 156. 4. International Pharmaceutical Federation. FIP Statement of Professional Standards. Codes of Ethics for Pharma-
© 2014 Royal Pharmaceutical Society
cists. 2004. http://www.fip.org/www/ uploads/database_file.php?id=209 &table_id= (accessed 11 January 2014). 5. American Pharmacists Association. Code of Ethics. 1994. http://www .pharmacist.com/code-ethics (accessed 29 September 2013). 6. General Pharmaceutical Council. Standards of conduct, ethics, and performance. 2010. http://www .pharmacyregulation.org/sites/default/ files/Standards%20of%20conduct ,%20ethics%20and%20performance .pdf (accessed 11 January 2014). 7. World Health Organization. Guidelines for medicine donations. 2010. http:// www.who.int/selection_medicines/ emergencies/guidelines_medicine
_donations/en/. (accessed 11 January 2014). 8. O’Connell MB et al. Cultural competence in health care and its implications for pharmacy. Part 1. Overview of key concepts in multicultural health care. Pharmacotherapy 2007; 27: 1062–1079. 9. Andersson A, Snell B. Where There Are No Pharmacists: A Guide to Managing Medicine for All Health Workers. Colombo, Sri Lanka: Health Action International Asia Pacific, 2010. 10. Crump JA, Sugarman J, Working Group on Ethics Guidelines for Global Health Training (WEIGHT). Ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg 2010; 83: 1178–1182.
International Journal of Pharmacy Practice 2015, 23, pp. 86–89
Personal View International Journal of
Pharmacy Practice International Journal of Pharmacy Practice 2015, 23, pp. 86–89
Ethics in global health outreach: three key considerations for pharmacists Matthew L. Romoa and Matthew DeCampb a
Epidemiology and Biostatistics Program, CUNY School of Public Health, New York, NY, and bJohns Hopkins Berman Institute of Bioethics and Division
of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
Keywords ethics; global health; medical outreach; medically underserved; volunteer Correspondence Dr Matthew L. Romo, Epidemiology and Biostatistics Program, CUNY School of Public Health, 2180 Third Avenue, New York, NY 10035, USA. E-mail: [email protected] Received September 30, 2013 Accepted March 2, 2014 doi: 10.1111/ijpp.12112
Abstract Objective The objective of this article is to explore three key ethical tenets that pharmacists should consider prior to participating in global health outreach. Key findings There are increasing opportunities for pharmacists to be involved in global health outreach; however, little attention has been given to the ethical issues that participation may raise for pharmacists. Pharmacists’ widely accepted and basic ethical obligations at home lay the foundation for effective management of these ethical challenges abroad. At home, pharmacists have an ethical obligation to provide the best possible quality of care to the patients for whom they serve. During global health outreach, this involves identifying and mitigating the potential for harm, as well as understanding and respecting cultural differences. Furthermore, pharmacists have an ethical obligation to not only meet individual patient needs, but also community and societal needs, when applicable. In global health outreach, this involves tailoring interventions to the needs of the population served. Conclusions Because of their unique skillset, pharmacists have the potential to make significant contributions to global health. Applying ethical principles, such as providing the best possible care, respecting cultural differences and meeting societal needs, provides the foundation for successful global health outreach by pharmacists.
Introduction Increasing opportunities exist for pharmacists to volunteer internationally in underserved communities. A common way for pharmacists to get involved is via‘short-term global health outreach,’ i.e. trips of various lengths, frequently abroad, in which pharmacists play a role in drug acquisition, dispensing, therapeutic interchange, and patient counselling, usually as part of a broader multidisciplinary team.[1] Although operational issues, as well as the educational benefits of global health outreach for pharmacy students, have been described,[2,3] comparatively little attention has been given to the unique ethical considerations participation in global health outreach raises for pharmacists. This is a critical oversight. Pharmacists have an important role to play in global health outreach because of their unique knowledge and expertise; however, pharmacists must also consider their ethical obligations when participating in outreach efforts. Regardless of practice setting, pharmacists are expected to comply with ethical standards, which exceed the minimum legal requirements governing pharmacy practice.[4] In this © 2014 Royal Pharmaceutical Society
paper, we describe three key ethical considerations for pharmacists engaging in global health outreach, focusing on the ways in which widely accepted professional norms and ethical obligations apply in this context.
Providing the best possible care One of the principal ethical obligations of pharmacists is to provide the best possible quality of care to the patients they serve.[4–6] At a minimum, this obligation can be summed up as Primum non nocere (‘first, do no harm’), with an emphasis on safety. However, pharmacists typically commit to more, such as helping patients and their clinicians choose therapies best tailored to a patient’s circumstances. For example, when a pharmacist helps select less expensive equivalent medicines, he or she helps in the delivery of patient-centred care consistent with patients’ values, such as cost considerations, and may also help reduce unnecessary costs within health systems. International Journal of Pharmacy Practice 2015, 23, pp. 86–89
Matthew L. Romo and Matthew DeCamp
Alternatively, therapeutic drug monitoring by a pharmacist might improve treatment outcomes by tailoring dosing to an individual patient’s clinical profile. Providing care to medically underserved communities abroad can pose challenges to this basic ethical obligation. In this unique context, pharmacists may find themselves without access to the ‘best possible’ treatment available in their home country, without many of the tools required for pharmacy practice, such as facilities for sterile compounding and computer technology to assist with drug information, and without understanding the precise role and obligations of pharmacists in a foreign health system (as prescribing and dispensing practices differ worldwide). Under such circumstances, the risk of harm is real. For example, it may seem altruistic to donate leftover medications to a community health worker or even a local pharmacist after an outreach effort. However, if that community health worker or local pharmacist is unfamiliar with the medication, must pay for its disposal (e.g. after expiration), is unable to dispense it because of local regulations, or simply cannot read the foreign language label, then an adverse event or consequence is likely to result.[7] Similarly, imagine a scenario where a particular antibiotic planned for use comes in a powder for injection. If there is no access to sterile water, then that antibiotic must either be used inappropriately (putting patients at risk for harm) or wasted. Either could negate the benefits of an outreach effort and undermine future collaboration. Both examples emphasise that careful planning beforehand is necessary to avoid potential harms. To meet this basic obligation, pharmacists should first understand the local laws, regulations and licensing rules governing pharmacy practice at their destination, preferably by communicating directly with pharmacists there. Second, they should help define the overarching goals of the outreach effort related to medication prescribing and dispensing. In doing so, pharmacists should recognise that benefits to the individuals in the community served override the personal interest of those travelling. This discussion may reveal that the goals of a particular outreach effort could be achieved by not going. Imagine a locale with a high incidence of cervical cancer and low rates of human papillomavirus (HPV) vaccination. If the goal of an outreach effort is to improve local access to HPV vaccination, but a local non-governmental organisation is already providing free HPV vaccinations, it might be more reasonable to donate money for purchasing more vaccines rather than duplicating efforts. Third, when outreach involves donated drugs, pharmacists should be familiar with best practice guidelines on drug donation.[7] Pharmacists typically work within multidisciplinary teams, and they should consider it their unique responsibility to uphold and reinforce these principles related to medication use among their medical and nursing colleagues. © 2014 Royal Pharmaceutical Society
87
Respecting cultural differences Another basic ethical obligation of pharmacists that directly impacts delivering the best possible care is respecting cultural differences.[4–6] Understanding and respecting cultural differences, whether they are related to age, gender, race, ethnicity, religious beliefs or other factors, is necessary for providing good pharmaceutical care.[8] When abroad, cultural differences occur more frequently and potentially have more impact than those pharmacists experience at home. While some may be relatively innocuous (e.g. etiquette issues related to greeting, such as handshakes), many other cultural differences can have a major impact on the outreach effort or even cause distress (e.g. radical gender differences). In some settings abroad, for example, the husband speaks on behalf of the wife, which would limit direct communication between the pharmacist and the patient. This could be an unanticipated challenge for pharmacists, when they are accustomed to speaking directly to patients. In some countries, local languages differ from the country’s official language; for example, in rural areas there may be a local language in which patients feel more comfortable discussing their health. Beliefs about health may also be altogether different, depending on the culture. For example, in the experience of one of the authors (MR), some South American cultures believe that a mother’s experiences and emotions can be transmitted though breast milk. If a mother is inadvertently frightened by an injection at the clinic, she may later consider any crying by her baby as a consequence of having received the injection and fail to return for follow-up visits. Failure to recognise cultural differences can have a range of adverse consequences, even if unintended. For example, patients may simply not accept services offered during the outreach effort or misperceive their intent. Either could result in lost benefits, wasted resources, potential psychological harms (e.g. related to distrust) or even interference with future collaborative efforts. To manage this ethical challenge requires specific attention to cultural awareness (sometimes termed ‘cultural competency’) prior to departing. At a minimum, this requires pharmacists be familiar with the local language and/or ensure access to adequate translation services. In addition, pharmacists should recognise the socio-cultural implications of history – even the historical relationship between their own country and the one where the outreach occurs – as these may contribute to the specific challenges that occur during the outreach effort. Many areas targeted by global health outreach are located in places that have complicated historical relationships with developed countries, including a past of colonialism that affects perceptions to this day. Pharmacists have an ethical obligation to prepare for anticipated cultural differences and to educate themselves about cultural compeInternational Journal of Pharmacy Practice 2015, 23, pp. 86–89
88
tency in advance of departing. Although not all cultural differences can be predicted in advance, educational resources about cultural competency tailored to pharmacists do exist, such as those from the American College of Clinical Pharmacy,[8] and should be utilised when planning an outreach effort.
Meeting societal needs Pharmacists have an ethical obligation to not only serve individual patients,[4] but also to meet community and societal needs.[5,6] This involves distributing available resources equitably, such as not dispensing medications differentially based on race. It also includes meeting broader social needs; during influenza vaccine shortages, for example, pharmacists play an important role in identifying and vaccinating those most at risk first. Compared with longer-term outreach efforts, this ethical obligation takes on increasing importance for short-term outreach. Failure to consider community and societal needs may result in drugs not being tailored to local disease patterns (e.g. antibiotic resistance), disrupted pharmaceutical supply chains due to the presence of short-term teams and unsustainable treatment practices (e.g. a month’s supply of an anti-hypertensive medication), for example. Another common challenge clinicians face during global health outreach is whether to screen for a disease for which the treatment is unavailable, unreliable or too expensive.[1] Would it be futile to screen for a disease if no standard therapy is accessible and doing so risks causing psychological harm to newly diagnosed patients? Or might screening create the motivation and advocacy response necessary for provision of treatment? Finally, in some circumstances the need for treatment is so vast that the inequity of who gets treated during short-term outreach (and who does not) can be both apparent and disturbing. If the pharmacist is part of a multidisciplinary team, he or she has an important responsibility to raise these issues and work with his or her team to find solutions. Managing these ethical challenges requires pharmacists to engage in depth with the local community – perhaps more deeply than they do at home. Community needs can only be identified by engaging with the community, including its members, leaders and health workers, well in advance to help define the needs that will be met by the outreach effort.[9] Needs should be shaped by a concern for both the sustainability of the intervention (‘Are locals available to continue managing drug dosing and dispensing?’) and for capacity building (‘If not, can we train them to do so?’).[9] Certain interventions, such as vaccination, are more likely to be sustainable and less likely to cause harm in the longer term and thus could be prima facie reasons to support such © 2014 Royal Pharmaceutical Society
Ethical global health outreach by pharmacists
approaches during global health outreach. Sustainability and capacity building are particularly important considerations for pharmacists in global health outreach, in part because they are often responsible for physical delivery of medications (i.e. acquiring medications, transporting them, maintaining adequate storage, assuring proper dispensing and disposal, etc.).[9] Indeed, the two may be related: capacity building is an opportunity to improve the sustainability of an outreach effort, depending on the circumstances. Meeting societal needs will also utilise pharmacists’ special skills and obligations pertaining to education. In some circumstances, meeting a societal need might be accomplished not through providing a drug, but by educating the community. For example, educating a community about diet and lifestyle modifications to prevent osteoporosis might be more appropriate than offering vitamin D supplements for 1 month or screening for the disease. Home management of paediatric diarrhoea by teaching the mothers of a community about the use of oral rehydration solution and zinc supplementation would be another relevant example. In other circumstances, pharmacists’ principal obligation might be to educate and empower the healthcare workers in the community responsible for dispensing medications in the absence of a pharmacist. This can help them promote good pharmaceutical practices based on important resources, as outlined in Where ThereAre No Pharmacists:A Guide to Managing Medicine for all Healthcare Workers.[9]
Conclusions In summary, pharmacists can make important contributions to global health through their special knowledge, skills and the ethical obligations that they possess. Involvement also presents an exceptional opportunity as an educational experience for students and practitioners alike. However, participation in global health outreach presents many ethical challenges, three of which have been described here. Pharmacists’ widely accepted and basic ethical obligations at home lay the foundation for effective management of these challenges abroad. Future research should focus on extending existing best practice guidelines[10] and ethical principles explicitly towards the challenges that pharmacists face during global health outreach.
Declarations Conflict of interest The authors declare that they have no conflicts of interest to disclose. International Journal of Pharmacy Practice 2015, 23, pp. 86–89
Matthew L. Romo and Matthew DeCamp
89
Funding
Authors’ contributions
This project received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
MR and MD contributed equally to the development and writing of this manuscript.
References 1. Johnson CA et al. Opportunities and responsibilities for pharmacists on short-term medical mission teams. J Am Pharm Assoc (2003) 2009; 49: 801– 807. 2. Brown DA, Ferrill MJ. Planning a pharmacy-led medical mission trip, part 1: focus on medication acquisition. Ann Pharmacother 2012; 46: 751– 759. 3. Werremeyer AB, Skoy ET. A medical mission to Guatemala as an advanced pharmacy practice experience. Am J Pharm Educ 2012; 76: 156. 4. International Pharmaceutical Federation. FIP Statement of Professional Standards. Codes of Ethics for Pharma-
© 2014 Royal Pharmaceutical Society
cists. 2004. http://www.fip.org/www/ uploads/database_file.php?id=209 &table_id= (accessed 11 January 2014). 5. American Pharmacists Association. Code of Ethics. 1994. http://www .pharmacist.com/code-ethics (accessed 29 September 2013). 6. General Pharmaceutical Council. Standards of conduct, ethics, and performance. 2010. http://www .pharmacyregulation.org/sites/default/ files/Standards%20of%20conduct ,%20ethics%20and%20performance .pdf (accessed 11 January 2014). 7. World Health Organization. Guidelines for medicine donations. 2010. http:// www.who.int/selection_medicines/ emergencies/guidelines_medicine
_donations/en/. (accessed 11 January 2014). 8. O’Connell MB et al. Cultural competence in health care and its implications for pharmacy. Part 1. Overview of key concepts in multicultural health care. Pharmacotherapy 2007; 27: 1062–1079. 9. Andersson A, Snell B. Where There Are No Pharmacists: A Guide to Managing Medicine for All Health Workers. Colombo, Sri Lanka: Health Action International Asia Pacific, 2010. 10. Crump JA, Sugarman J, Working Group on Ethics Guidelines for Global Health Training (WEIGHT). Ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg 2010; 83: 1178–1182.
International Journal of Pharmacy Practice 2015, 23, pp. 86–89
