1. Experiences involving an international advanced pharmacy practice experience (APPE) rotation
in Ecuador: review of prescribing practices and preparation for future trips.
Madison Block, Iulia Vartolomei, Jacque Garza, Amanda Hack, Joshua Burwell, Doctor of Pharmacy Candidates 2016
Shannon Panther, PharmD, BCACP Washington State University College of Pharmacy
Cebadas
Comprised of over thirty small communities just south of Riobamba. Families rely on
an agriculture economy and continue to remain extremely poor, thus lacking access
to basic needs and resources. The closest hospital is two and a half hours away
Retrospective : The population served was largely made up of indigenous Quechua
culture, fluent in both Quechua and Spanish. Patients were predominantly children
and elderly individuals that work in the fields under constant UV light being the
closet to the sun of all the world. Sunglasses are expensive and non-existent.
Leading Diagnosis: Pterygium
• Total of 196 people were seen, 13 of those were diagnosed with Pterygium (6.6%)
• These patients were given medication and sunglasses to help with the burning,
itching, tearing and dry eye symptoms. Surgery was not provided.
• 50 eyewash prescriptions were dispensed. Sunglasses dispensed not reported.
• Other commonly dispensed medications: mebendazole, vitamins and ibuprofen
• Patients were educated on proper eye care and encouraged to protect from sun.
Prospective: More eye washes, more sunglasses on future trips. Start education on
eye health at a younger age, catching it before it develops. Educate about
protection from UV.
Alao
In the Andes two hours from Riobamba. The road to the village is a rough, single lane
road alongside thousand-foot cliffs with washouts, and narrow bridges. The elevation
is 12,000 feet with lush vegatation and extraordinary views. The weather is cold and
rainy, which provides ideal farming conditions.
Retrospective: The villagers were primarily middle-aged individuals of poor
economic status. Farming is the only option for making a living. Their lifestyle is
physically taxing because the villagers must travel long distances by foot and often
work in fields along steep hillsides.
Leading Diagnosis: Pain and/or Arthritis
• Total of 118 people were seen, 34 of those had Pain/arthritis (28.9%)
• These patients were given medications to help with pain and inflammation
• 20 acetaminophen and 31 ibuprofen prescriptions were dispensed
• Other commonly dispensed medications included: mebendazole, and vitamins
• Patients were shown stretches and how to properly lift heavy objects
Prospective: Could provide more emphasis on exercise and appropriate osteo
health. Provide education on osteoporosis and hand out more Calcium with Vit. D
Panchancho
In the Andes at an elevation of ~14,000 feet. The land is barren. The air is cold, dry,
and dusty from the wind and ash from Ecuador’s many active volcanoes. It’s difficult
to grow crops without the assistance of a greenhouse, and water is a scarce
commodity. Travel is difficult, access to healthcare is obsolete.
Retrospective: Evenly distributed across all age ranges. Although practitioners did
not consistently document pregnancy, prenatal vitamins were dispensed more
frequently here than any other village, regardless of population size, indicating that
there was a higher pregnant and breastfeeding population in this region.
Leading Diagnosis: Pregnancy
• Total of 118 people were seen, 14 of those pregnant or breastfeeding (11.9%)
• They were given Prenatal vitamins to assist in healthy growth of mom and baby.
• 56 -100 ct. bottles of prenatals were dispensed, sunglasses and bandannas given.
• Other commonly dispensed medications: mebendazole, and eye washes
• Taught patients to use bandannas and sunglasses to protect their eyes and
airways while outside. Educated on health during pregnancy and prevention.
• Prospective: Make education a larger portion of the day. Hand out more
condoms and teach on a model how to use. Bring more pre-natal vitamins.
Bring an ultrasound machine to check on baby.
Calpi
Located south of Riobamba, it was the most developed from an infrastructure and
agricultural point of view. People have better access to healthcare and food as they
were closer to the city. The main occupation was farming as the climate was ideal.
Retrospective: We served 14.5% of the population. Primarily the elderly and
children. Calpi had a more advanced economics infrastructure when compared to
the other regions, poverty was still prevalent. Residents endured hunger which they
tried to cover up by drinking coffee. Children were given coffee for breakfast, just to
keep them full until supper, when real food was being served.
Leading Diagnosis: H. Pylori/GERD
• Total of 318 people were seen, 44 of those had H. Pylori/GERD (13.8%)
• Pharmacy set up a treatment protocol including ranitidine, amoxicillin and
metronidazole. Educated to properly cook foods and get adequate hydration.
• Other commonly dispensed medications: mebendazole, vitamins and eye wash
Prospective: To better serve the Calpi in the future, medical missions could provide
education about the importance of nutrition especially in growing children along
with identifying barriers to accessing better and cheaper food.
Top Diagnosis/ Concerns
by Percentage
1. Well Checks (26%)
2. Pain (22%)
3. Arthritis (12%)
4. Pterygium (7.3%)
5. H. Pylori (5.3%) GERD (6.1%)
Conclusion
• Limitations include:
• Recording uniformity, and availability of translators
• Varying degrees of knowledge base and experience
• Having a tight formulary
• All villages lack access to basic healthcare and resources.
• Disease states occurred at a similar rate in every village.
• There was a larger amount of H. Pylori than expected.
• Bring more inventory: (bandanas, sunglasses, and medications)
• A larger emphasis on education and a designated translator for that
purpose.0 20 40 60 80 100 120
Calpi
Cebadas
Panchancho
Alao
Glasses need based off percentage
compared across villages
Glasses No glasses Unknown
0
5
10
15
20
25
30
35
Well Check Pain Arthritis Pterygium H. Pylori GERD
Top Diagnoses by percentage
Calpi
Cebadas
Panchancho
Alao
amoxicillin,
45
metronidazole
26
fluconazole, 3
ceftriaxone
inj., 2
ciprofloxacin,
6
azithromycin,
13
cephalexin, 5
sulfamethoxa
zole and
trimethoprim
DS, 7
omeprazole,
1
ranitidine, 48
Dispensed Antibiotics