Pharmacy with Timmy: Getting Back to Basics

Pharmacy with Timmy: Getting Back to Basics
July 11, 2013 Callie Daniels-Howell

By: Monica Golik Mahoney, PharmD, BCPS

Monica Golik Mahoney is a pharmacist specializing in infectious diseases working at Beth Israel Deaconess Medical Center in Boston, MA (the official hospital of the Boston Red Sox). She has volunteered with Timmy in Guatemala in 2009 and most recently in May 2013 in the Dominican Republic. This blog shares her reasons for volunteering her time abroad, and why she believes it is such a rewarding experience.

Some of the Timmy Team

Traveling to Monte Cristi with the Washington University/University of Minnesota team was my second trip with Timmy Global Health. When people see pictures and hear stories of the trips, I usually get raised eyebrows in response. They question why I’d be willing to bathe in DEET, be covered in sweat/dirt/grime, speak in a different language, and maybe—if we’re lucky—get a lukewarm shower at night. And all during a week I took off as “vacation”.

But to me, this is vacation. It’s a change of scenery and thinking. To be successful on these trips, in addition to knowing your vocation, you have to be flexible, creative and a team player. And since like attracts like, the other volunteers are of a similar mindset.

To me, this is fun.

And I get to help people.

And I get to travel to remote corners of the world that my husband would never dream of following me to.

There was a recent letter in the New York Times from a physician describing the feeling of being overwhelmed. He describes feeling pressured to keep up with the latest information, newest guidelines, different dosage forms, emerging side effects, and Dr. Oz’s ludicrous recommendations…

My experience in Monte Cristi was the exact opposite. It was back to basics in an obvious way. We had TimmyCare, but that wasn’t close to the computers we’re accustomed to in the state. My hospital in Boston received several “Leader in Technology and Wireless” awards…so Monte Cristi was a slight adjustment. We had no laboratory tests to review. No cultures to interpret. No diagnostic tests to aid our suspicions.

Our Pharmacy in the DR

However—what we did have—was a room full of experienced clinicians from many aspects of medicine. The pharmacy only had two references that we allotted precious cargo space to: LexiComp’s Drug Information Handbook (aka the Bible) and a Spanish-English medical dictionary. (Coincidentally, “diabetes” is still “diabetes” in Spanish). My pharmacy colleagues relied on our training and experiences and turned to each other for support and reassurance. A good portion of our care was treating infectious diseases, music to my ears, but maybe not so for the pediatric ophthalmologist, cardiologist, or OB/GYN (who were some of our fantastic providers). Since the pharmacy was often in the same room, providers stopped by to ask questions, to double-check doses, or get our opinion. Likewise, when we had prescription issues, we simply walked over and had a conversation. Also, we only had ~45 medications we could dispense.

Some particularly memorable interactions include:

-Manually checking for drug interactions (via reference books and good old medicinal chemistry).

-Panicking from the inability to “Google” ingredients for an obscure foreign anti-hypertensive (Fine. We cheated and had a TimmyCare guy use his global cellphone to look it up. For the record, we’d never seen 1 pill containing these 3 meds!)

-Consulting on a toddler for a skin infection. (Back home, we would treat topically. In Monte Cristi, we only had tablets. In adult strengths).

-Developing such a good relationship with the providers, that by end of day one, several were writing “dosing per pharmacy.”

-Playing the game of “Back home, I use ____, what can you give me here?”

Serving in Monte Cristi was a reminder of why I went into pharmacy. It removed all the distractions from home. On the trip, we were required to think critically and creatively, and focus on the patient in front of us. And, to top it all off, we had to do it all in Spanish (or Creole)! I will forever be in debt to our very capable Peace Corps Volunteers for translating.

And as counterintuitive as it sounds, there’s a freedom with a limited formulary.

And not having to deal with insurance was AMAZING.

And speaking of creative … When was the last time you saw a pharmacy operating out of a Magic School Bus? I think we made Ms. Frizzle proud!

On the Pharm Bus







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