When I arrived in Anchorage, AK, with three student pharmacists to begin an exciting and adventurous 5-week ambulatory care rotation at the Alaska Native Medical Center in July, I could not imagine the impact this experience would have on me. The rotation began with a cultural orientation that helped me gain an appreciation for the rural health care needs and the culture. I learned about cultural and communication barriers that I may experience throughout the rotation and the best way to handle them. I spent half of the rotation in the outpatient pharmacy at the medical center and the other half rotating through the clinics at the primary care facilities of the South Central Foundation.
I began in the anticoagulation clinic, which influenced my decision on a journal club article. I presented an article on self-monitoring of warfarin that was applicable to the rural patient population in Alaska. Many patients have to travel for hours to attend the clinic, which negatively impacts their quality of life. The article discussed using a machine to allow patients to monitor their international normalized ratios from the their home.
An anticoagulation clinic pharmacist attended the journal club and expressed interest in beginning a self-monitoring program to augment their established clinic. We discussed many ideas for how this system could be implemented and how it could help patients feel empowered in their health care. It was a rewarding experience to see the skill set obtained through my Medical Literature Evaluation course from pharmacy school become applicable in real life. I was inspired by making an impact in the anticoagulation clinic and became determined to continue making a difference throughout my remaining rotations.
One of the most unique features of this rotation was learning about a new health care system. Semi-private or private counseling rooms were available for patients when they came in to pick up medications. The Indian Health Service follows a “show and tell” approach, where each patient is counseled about new medications and is given the option to be counseled about refills. I became more comfortable speaking with patients and counseling about various medications. Patients were appreciative of all the services they received and truly valued the interaction with the pharmacist.
The creative and innovative ways that have been developed to meet the rural needs of patients was intriguing to learn about. An example of these innovative changes was the Rural Anchorage Service Unit pharmacy. I spent a day working alongside the pharmacists who check orders that are sent from the villages in surrounding parts of the state to Anchorage. Once the order is approved, the medication is dispensed from a Pick Point machine in the village. The Pick Point machine is similar to a vending machine, except it is loaded with medications instead of beverages and snacks. This allows one pharmacist to serve native Alaskans living in surrounding areas of the state.
Learning about the USPHS
Throughout this rotation I experienced pharmacy’s best kept secret: working for the U.S. Public Health Service (USPHS). I learned about the pharmacist’s role in the Indian Health Services, one of the many opportunities working for the USPHS. Learning about a new area of pharmacy practice as well as experiencing it first-hand was rewarding and opened my eyes to other possible job opportunities upon graduation.
The rotation experience was hard work but I spent my weekends exploring Alaska. I saw humpback whales and glaciers on a day cruise near Seward. I relaxed on the hillside in Talkeetna with a view of Mount McKinley and snapped pictures of grizzly bears, moose, and caribou in Denali National Park. The experience was life changing and I know one day I will make it back to Alaska.