July 18th Kingdom of Tonga

It's Saturday night and with help from a frosty cold, supposedly formaldehyde laden, but none the less delicious Tongan beer, I've finally caught my breath. The Tongan clinic is a hit. Each day we get busier and busier. We are bringing patients in by the busload…literally! In five days we've seen roughly twenty five percent of the islands population. Today was a half day and we still managed to fill 180 scripts. Friday we churned out 411. I'm not going to sugarcoat it…we're pretty awesome ;)

But don't get the impression that we are just a prescription factory…mindlessly turning out script after script. Much to the contrary, this has been the most clinically oriented pharmacy of the entire Pacific Partnership mission. Every day I'm talking to the physicians; discussing dosing or drug selection. For example, we have seen a lot of tinea type skin infections in Tonga. Because we lack the medications indicated as first line treatment, each physician took a different approach initially. However, after some discussion we were able to agree on a treatment and standardize our approach to the problem.

Perhaps the biggest contributor to the clinical orientation of our pharmacy is the location itself. We are setup in the hallway in front of the hospital's pharmacy. The local pharmacist, Salome, has been terrific. She is very knowledgeable and has been helping us with translation and counseling. She has also allowed us access to her pharmacy and her medicines. This has dramatically increased our ability to provide care. The drugs that the Navy purchased for PP09 are all for treating acute illness. We have virtually nothing for chronic conditions. The pharmacy at Nui'ui on the other hand is stocked with a respectable selection of medications for a variety of conditions. Our physicians are now able to prescribe medicines for diabetes, heart failure, hypertension, and a variety of other conditions that we could do nothing for in Samoa. Furthermore, we will remain at this site for two weeks. This allows us to conduct follow up care; something that was impossible in Samoa. We can bring patients back to check the efficacy of their therapy, for routine wound care, or to complete a complex procedure. From the patient's perspective this lends credibility to our operation and makes us easier to trust. If they have questions or are unhappy with the care we've provided, they know right where to find us.

Working so closely with the physicians here has been one of my biggest challenges, but at the same time it is what I've enjoyed the most. One physician in particular, Dr. Ho, has been particularly challenging and fun to work with. Dr. Ho is a partner nation physician from Singapore. His style of medicine is noticeably different than that of the US. As soon as I started receiving his scripts, I knew I would find him interesting. One of the first things he wrote for was Ponstan tds 2/52. Now I could figure out that 2/52 meant two weeks and I reasoned that tds was equivalent to TID, but what the heck is Ponstan?

Now if any of my professors are yelling at their computer screens saying that I should know this drug, let me first say that I checked…I searched every PowerPoint and every note that I ever took in pharmacy school and the word Ponstan, or even its generic name, does not appear anywhere. But I digress…

Apparently it is an NSAID of sorts that works well for menstrual pains and is commonly used in Singapore. Who knew? Well it wasn't long before I was a familiar face to Dr. Ho. We were persistent thorns in each other's sides. He would use an abbreviation that I didn't know or would opt for an uncommon treatment approach and I would be right there in his office asking questions. I learned quickly that you need to be prepared if you are going to challenge Dr. Ho on a therapy choice. He's good, he knows his stuff, and he is always prepared to defend is position. A few times I came into his office, Sanford Guide in hand, thinking I had a superior approach to therapy; only to find out that he'd already considered my idea and dismissed it. He always seemed to have at least three good reasons to back up his position. Even when I'm wrong, I have found that I enjoy these encounters because I have never left his office without learning something.

Tomorrow is, by Tongan law, a day of rest and we all can use it. Monday morning we start back up again and, as tired as I am right now, I find myself anxious to see what the next week brings.