I've recently become more involved with an "Emergency Medical Team" (a World Health Organisation (WHO) initiative) and am struck by the central - but underrepresented - role of pharmacists and medical supply chain experts.
What's the EMT initiative?
Essentially the WHO aims to validate any team that proposes to deliver international medical care during a Sudden Onset Disaster e.g. an earthquake.
It's worth pausing for a moment here to reflect on the importance of this or, to put it another way, to consider what could happen without this kind of global governance. Imagine the unintentional harm that could happen - has happened - by teams of unregistered, ungoverned, unaccountable healthcare professionals, who arrive at a disaster zone without suitable supplies, language, infrastructure, coordination ... and then start conducting invasive surgery, before going home a few days later. Harrowing.
So the WHO EMT initiative aims to end this poor practice and to capacity build those wishing to become registered members.
What does an Emergency Medical Team do?
There are several types, all of which are self-contained and designed to be responsive to the needs of the population.
A "Type 1" is like a primary care facility, providing emergency care for outpatients.
A "Type 2" is like a hospital, providing acute and surgical care for major trauma cases.
A "Type 3" is like a large, specialist hospital, able to deal with complex surgical and medical cases, as well as providing intensive care.
A "Specialist Cell" is able to bolt on to a Type 2 or 3, to deliver a tertiary service like spinal care or dialysis.
No matter the EMT type it's a self-sufficient unit, able to be rapidly deployed and provide healthcare within hours or days of a disaster.
What role can Pharmacy & Medical Supply Chain play in an EMT?
In summary, it's vast.
It's probably only a slight exaggeration to think of an EMT as an enormous medical logistics operation with a cluster of highly committed clinicians at the "frontline". The success of the deployment - the ability for those clinicians to save lives - is contingent on having a high-functioning and agile Medical Supply Chain.
I recently thought through the considerations for building this high-functioning, agile Pharmacy & Medical Supply Chain for an EMT. Here's the "mind map" overview of what I came up with:
I say "overview", as each of the categories can be exploded into greater detail, like this example:
You'll probably be relieved to hear that I'm not going to summarise each of these sections here! (Although if there's enough interest I'd be happy to do so and toshare my thoughts on each - just leave a comment.)
What I find amazing is the sheer scale and breadth of activities that demand specialist pharmacy knowledge... and therefore the pivotal role that pharmacy and medical logistics professionals can have in the Emergency Medical Team - for the World Health Organisation, as well as for health providers enrolled in the project.
...but where is the humanitarian pharmacy workforce?
In my experience, there's a substantial skill gap in the Humanitarian Pharmacy Workforce - and yet the significance of this is wildly underappreciated by the Global Health community.
How many humanitarian pharmacists do you work with? I'm willing to bet that you could count them on one hand! How about Humanitarian Pharmacy Technicians or Assistants...? Rarer still. Humanitarian Medical Logisticians are more common, but then this is a self-certified title (and many who claim it are pharmacists).
It seems that Humanitarian Pharmacy is facing something of an identity crisis. We struggle to properly define the roles and therefore the competencies needed to excel at them. As a result, we're confused about the skills and qualifications that a pharmacy professional should possess. This makes recruitment bewildering for employers, career progression a mystery for employees, and advocacy a much greater challenge for people like me!
"Emergency" pharmacy staff.
It's not only EMTs that stand to benefit from a larger, stronger, more empowered Humanitarian Pharmacy workforce - it's a central component to Global Public Health and to achieving Universal Health Coverage. Arguably however, disaster response is an easier context to define and therefore the roles involved with it are more clear cut. Perhaps then, this is a good place to start when tackling this Humanitarian Pharmacy identity crisis?!
Over the coming months I'll be documenting the roles, responsibilities and competencies of various EMT pharmacy staff, before developing a training programme for them. Hopefully this work will also provide a foundation for future advocacy on the role of pharmacy and medical supply chain experts in EMTs.
I'd be delighted to hear from others working in this space - to collaborate, share perspectives and, I'm sure, to hear what I've missed in the Mind Map above!
Kate Enright is a humanitarian pharmacist (whatever that means) and the founder of GlobalPharmacyExchange.org - a place for Global Pharm-ers to connect, collaborate and create change.