Week One ✔

As our first week working in the pharmacy at the Louis Pasteur Polyclinic has come to an end, we wanted to talk about some of our initial experiences. We have had the opportunity to work with two amazing pharmacists and people, Tu and Thương. They have been so incredibly helpful in teaching us about pharmacy in Vietnam, but also eager to learn and ask us questions about how pharmacy works in America. Every day we spend time learning different medical terminology in Vietnamese that help us with translating the prescriptions brought to the pharmacy. Michael and I also spend time discussing different medications that are used frequently in America that differ greatly than those used in Vietnam. It is amazing to have the opportunity to exchange our knowledge and appreciate the differences between both medical necessities and culture.

1. Common drugs & disease states seen at the clinic:

Some of the first things we found interesting were the types of medications that were considered ‘fast movers’ at the clinic:
Antihistamines:
Fexofenadine (Allegra)
Chlorpheniramine (Chlor-Trimeton)
Loratadine (Claritin)
Cetirizine (Zyrtec)
Rupatadine – not approved in the US
Cimetidine (Tagamet, also not used for stomach acid in Vietnam, but more commonly for urticaria)
Corticosteroids:
Methylprednisolone (Medrol)
Prednisolone (Deltacort)
Betamethasone/dexchlorpheniramine (Betadexin, not approved in the US, used as combination corticosteroid and antihistamine for itch/inflammation/urticaria)
Bronchodilators:
Salbutamol (AKA albuterol in the USA) – interestingly in our pharmacy it is available in tablet form, not as an inhaler
Antiparasitics:
Ivermectin
Spiramycin – not approved in the US (still considered an experimental drug in the United States, but can sometimes be obtained by special permission from the FDA for toxoplasmosis in the first trimester of pregnancy)
Supplements:
Milk thistle (Silymarin) – commonly used in the treatment of liver disease; e.g. hepatitis

Some of these fast movers make sense after spending a couple days at the clinic and in the pharmacy. Many patients in Vietnam are seen and treated for a number of parasitic infections, most commonly toxocariasis and toxoplasmosis. These diseases are usually spread by eating poorly cooked food that is infected with the parasite.

2. Clinical references

Since there is no integrated automated verification system at the pharmacy, the pharmacists working at the clinic rely on their knowledge and ancillary references to answer clinical questions regarding medications. When we asked them, the first place they tend to go to (and for good reason) is the drug package insert. If they are unable to find the information there, they use either Drugs.com or Medscape (both of which comply with the HONcode, Health on the Net, standard for trustworthy health information), but these clinical references are much different, harder to search for information, and can be less robust than the ones we use to analyze drug information at URI.
The pharmacists were eager to learn about some of the clinical databases we use at URI – and we showed them both LexiComp and Clinical Pharmacology, two databases they have not used or heard of.
They were also impressed with the number of medical applications available on smartphones. We demonstrated how to run quick interaction checks using the free medical app ‘Epocrates’ and both pharmacists quickly downloaded the app and were excited to use it in the future.

3. Drug pricing

Where to start?? This may have been one of the biggest shocks we had within our first couple days of working. Of course, we knew medications in the US are some of the priciest in the world, and there are a number of factors that go in to that, far more than the time we have to discuss or the time you have to read about (the cost for drug development/research, differing government healthcare systems, cost-effectiveness, patent systems, etc. etc. etc.)

As to be expected, the pricing of medications in Vietnam is generally less than in America; however, for some medications, the difference is astonishing. On our first day, we filled a a 4 week supply of Harvoni (sofosbuvir/ledipasvir), a newer drug used to treat hepatitis C with nearly all cases cleared after 12 weeks of treatment. With Harvoni being a major clinical breakthrough in the treatment of hepatitis C, drug pricing clearly is a complex pharmacoeconomic assessment.
At our clinic, the gentleman picking up us medication paid 7.000.000 VND (approx. $350 USD)  for his 4 week supply, and for someone living in Vietnam, this is incredibly expensive and many individuals cannot afford to pay this. However, this same prescription in America would cost ~$31,500 USD (without prescription insurance), nearly a 100x increase.

This was a phenomenal first week for us working at the pharmacy on-site at the Louis Pasteur Polyclinic. We will be spending one additional week working in the pharmacy until transferring into the injection room, helping doctors and nurses prepare and administer a number of vaccines for patients within the region!