Approximately 1 in 5 individuals in South Africa have HIV. The country is one of the largest epicenters of the HIV epidemic in the world with 7.7 million people living with the disease. That’s nearly the population of New York City. In the summer of 2019, WSU student pharmacists visited Cape Town, South Africa, to work with patients, doctors and pharmacists at health care institutions, allowing them to see the frontlines of HIV treatment and prevention, including application of precision medicine.
“I knew the health system would be very different from that in the United States however the extent of that difference was a bit of a surprise,” said student pharmacist Chad Schmitt. “Seeing people who have so little and don’t have things I take for granted, like electricity and clean water, makes me appreciate everything I have.”
He and fellow College of Pharmacy and Pharmaceutical Sciences student pharmacists Rozita Zandkargar and Chantel Robinson spent two weeks learning about HIV treatment firsthand in Cape Town. The experience was part of a new 6-week international Advanced Pharmacy Practice Experience (APPE) spearheaded by Dr. Rustin Crutchley, clinical associate professor in the Department of Pharmacotherapy at the WSU Yakima extension.
“I wanted students to have an opportunity to learn about a new culture and gain a global health perspective that could make them more well-rounded in their view of care of individuals living with HIV,” said Crutchley, who specializes in antiretroviral treatment and precision medicine in HIV patient populations.
At the Helderberg Community Health Clinic, students shadowed HIV physicians throughout their day, watching as they interacted with patients. The clinic sees about 300 to 400 patients per day with a total patient population of 3,500. On a day dedicated to children living with HIV, they saw 10 patients in just two hours.
The student pharmacists spent most of their time with Dr. Renier Coetzee’s masters in clinical pharmacy students from the University of Western Cape (UWC) School of Pharmacy. Coetzee is one of the leading pharmacists in developing the Clinical Pharmacy program in South Africa. Working with their South African peers, WSU students developed a better understanding on how pharmacy functions in the country including its role in different institutional settings. Off-campus, the WSU group also observed UWC students at the Tygerberg Hospital—the second largest hospital in South Africa with 1,400 beds. The experience exposed student pharmacists to managing patient cases such as TB meningitis and Kaposi’s sarcoma that are rarely observed in the US.
“One of the primary goals of this rotation is to plant seeds in students that change their lives so that they can in turn change patients’ lives,”
On one of the days, students traveled to Khayelitsha, one of the poorest areas in Cape Town, with a population of nearly 400,000 people and the largest HIV clinical site in the city. The clinic serves 11,000 patients living with HIV, with as many as 70-80% of whom also live with tuberculosis (TB). The primary health care facility, which provides HIV, AIDS and TB-related treatment, care and support services, gave WSU student pharmacists a unique chance to watch physicians in action as they worked with patients. The clinic was the first site in South Africa where patients received antiretroviral medications, a common HIV treatment worldwide, to help prevent the progression of the virus.
“Seeing such a deficit in care and the need of such a large population tugged at my heart. While there I kept thinking, ‘how can I get back here to help and what can I do to help these patients,’ ” said Robinson. “It has always been a goal of mine to serve the underprivileged and underserved, and this experience has reignited this passion… it is an experience that I will never forget and has helped shape my future.”
While in Khayelitsha, the WSU team also observed the HIV vaccine clinical trial unit. Student pharmacists learned about the latest, novel HIV vaccine clinical trials that are currently ongoing at this site.
“One of the primary goals of this rotation is to plant seeds in students that change their lives so that they can in turn change patients’ lives,” said Crutchley.