Hospital Pharmacy Practice in Namibia

Hello, and Welcome to my Blog! 

My name is Mason Benjamin, and I am a doctor of pharmacy student at the University of Michigan College of Pharmacy. I began the program imagining my career as an in-patient clinical pharmacist in a hospital, but practical exposure early in my first year led me to discover a new passion for improving medication access systems. Realizing that this path would necessitate my branching out into areas that were still largely unfamiliar to me, I began taking classes at the Stephen M. Ross School of Business to complement my pharmacy education with a private sector framework. Courses in healthcare innovation, finance, commercialization of biomedicine, and entrepreneurship exposed me to case studies from around the world and I loved every minute of it. I realized then that an international career would bring me the ability to improve far more patients' lives, as well as greater personal fulfillment. I feel incredibly fortunate to have found an opportunity to begin this career transformation at the William Davidson Institute, where I am currently a 2018 Global Impact Fellow! In this blog, I will be discussing my 2018 summer internship in Namibia. In each post I will aim to describe what I'm doing in my project, share some of my favorite parts of Namibian culture, and talk about some of the more memorable experiences.

The Project, the Team, & the Location

My project is focused on pharmacy workforce development and hospital pharmacy practice. In this multi-organizational project, I will be collaborating with the William Davidson Institute (WDI), The International Pharmaceutical Federation-Hospital Pharmacy Section (FIP-HPS), and the University of Namibia (UNAM). Over the course of my project, I have been traveling all across Namibia to visit hospital pharmacies in different regions. Accompanying me on these site visits are two intern pharmacists, Moses and Olivia ('Liv), who recently graduated from UNAM's pharmacy program. I have been inspired by their drive and passion about their profession. I'm lucky to be traveling with them, talking about the future of pharmacy, and learning from them about Namibia. I'm beyond thankful for their help navigating the roads, introducing me to the culture, and for translating as needed during site visits. They're two of the best friends and colleagues I could have asked to meet!

Here I am with my project team in Namibia at the 4th Annual MURIA Conference, hosted by UNAM's School of Pharmacy. From left to right: Moses Thikukutu, Olivia Fikameni, Mason Benjamin, and Dan Kibuule. Moses and Oliva are the UNAM interns accompanying me on site visits around the country, and Dan is my project mentor here in Namibia. 

During my second week in Windhoek, I had the chance to attend the 4th annual Medication Utilization Review In Africa (MURIA) Conference with Moses, 'Liv, and one of my project mentors, Dan, pictured above. I'm thankful my time in Namibia lined up so well with this conference, because I had the chance to learn an incredible amount about pharmacy practice in Namibia (and indeed across Africa) before my site visits had even begun. I was aware of how different the healthcare system in the United States might be from anywhere else in the world, but always felt that researching other systems online had its limits. I much prefer to learn right from the source and in person, so I was grateful for the opportunity to ask questions to practicing pharmacists from over a dozen different African countries about how things worked in their setting. This, combined with three and a half days of presentations, workshops, and practice-sharing forums, was a fantastic way to develop understanding of some of my project's topics of interest. I also had the chance to present a poster on technologies used to improve medication use at this conference, which I felt was quite the honor! I will certainly look for opportunities to attend more conferences like this one in the future that present a platform to learn from other professionals and share stories, best practices, and discuss recent research.

UNAM's Health Sciences Campus, where I go to work when I am not

traveling, and where MURIA was hosted. I'm always in awe of how 

beautiful the architecture here is, and wish we had facilities as nice 

as these back home.

Here I am in front of my poster at MURIA, titled 

"Methods for Improving the Medication Use 

Process," for which I also gave a short podium

presentation. I felt honored to receive a time slot

at an international conference!

The Importance of Customs, as a Visitor

Olivia, Moses, and I at our first northern site visit in Rundu with

the chief pharmacist outside the hospital.

Reflecting on the preparatory work I did before traveling to Namibia, I'm the most thankful for the time I spent learning about Namibian history and present-day culture. This was probably more necessary even than my understanding of pharmacy practice or business was. There were customs I needed to understand to be well-received at these sites to avoid offending the people there, including the etiquette surrounding introductions, the proper way to shake hands, and especially the Namibian perception of schedules and time. For instance, the people I have met here have very relaxed, warm, and friendly attitudes, so long as you don't try and rush things. Pleasantries and affiliations are extremely important, and not to be taken for granted. Developing this understanding was especially important given my role as someone who was representing multiple affiliations including WDI, FIP-HPS, and UNAM for this project, as well as the University of Michigan in a broader sense. It was also very helpful on these site visits to be accompanied by Namibians, especially two who were affiliated with UNAM. Thankfully, we received a warm welcome everywhere we went.

Traveling Around Namibia

My first view of Namibia, upon waking from some much-needed

sleep in-flight. I always love the first glimpse of a new place, 

and this time it was especially exciting since I knew I'd be going

around to each of the places I was seeing from the plane.

Because traveling all around the country was a large part of my project, I thought in this first post that I should share a bit about the different areas in Namibia and my journey here so far. 

At the start of this trip, I had never before been so excited to board a plane. After a red-eye bus ride, 3 connecting flights, and 48 hours of continuous travel, I had also never been so excited to land! It wasn't as tiresome as it sounds though. I had the chance to get a Chicago Dog in the O'Hare airport after my flight to Chicago from Detroit, and also several hours to walk around Amsterdam during my layover there. That was a nice chance to stretch my legs and wake up a bit. I also got to visit the tulip museum, cheese museum, and walked around the network of canals. While the journey was long, I was glad that I arrived safely and that everything went according to plan with my connections.

Mountains south of Windhoek on the way to Mariental. I'm

originally from the foothills of the Rocky Mountains in Colorado,

and used to seeing a carpet of evergreen trees on those hills. It

was fascinating seeing a familiar sight with a new twist! 

Thankfully, my travels in Namibia wouldn't end when I arrived in Windhoek, due to the nature of my project. Namibia is home to several fascinating geographical regions, which I have been fortunate enough to see over the course of this summer. While it is named after the Namib desert and receives the least annual rainfall of any Sub-Saharan African country, Namibia is also home to beaches, jungle, and some of the most sought-out Safari parks in the world filled with unique grasslands, savannah, and an incredible diversity of flora and fauna. Namibia actually has a small population of 2.5 million for such a big country, and many areas are not inhabited. This resulted in some very long drives, and we were advised to fill our tank every time we saw a petrol station. They also don't stop filling when the pump shuts off. Instead, they'll shake your car a bit to settle the petrol, and over-fill it all the way to the brim since they know you may need more than a full tank to make it to the next town.

   

The coast in Swakopmund, where the desert meets the ocean, and the sand dunes

between Swakopmund and Walvis Bay. It was incredible on the drive between the

two being able to look one direction out the car out to the ocean, and then turn my
head the other way to see a vast desert and towering dunes.

One of Namibia's special claims to fame is being "the land where the desert meets the ocean." The vast landscape of desert sand sinks into the Atlantic Ocean along the west coast of Namibia, and this is quite the sight to behold! I would love to return some day when I had the time to enjoy the area and explore a bit, but our travel schedule only had us there one evening.

The long hours in the car gave me a good opportunity to study the variations in this landscape in detail, and spending time in over 20 cities for my site visits gave me an up-close look at some very diverse sections of Namibia. 

Basically all of Namibia is covered in palm

trees, as they grow well in hot, low-

moisture conditions. Many areas looked 

almost tropical because of all these trees!

This shot was taken leaving Oshakati.

In Rundu, looking out over the river

that forms Namibia's natural border

with Angola to the north. We had to

pull over for some stubborn goats, so I

had the chance to take a couple photos.

While I have traveled internationally a few times before, each time I would visit only one or two major cities. This project has given me a unique chance to truly get to know an entire country, and I can confidently say that I've never seen anything quite like Namibia. You also never knew when you were going to see animals crossing the road. That was exciting in two ways; first, you had to make sure you avoided a crash (especially in the north where there are commonly cattle, donkeys, and goats hanging out on the pavement), but second, you might see something really cool. We were extremely lucky to see this elephant!

One of my favorite moments of the summer was seeing this "little" guy cross the road. On the side of the highway, I had quite a list of animal sightings, including: ostriches, baboons, oryx, termite mounds taller than houses, springbach, flamingos, sheep, cattle, goats, warthogs, giraffes, wild horses, hippos, and crocodiles. 

Tagua Nuts: A Piece of the Culture

Carved tagua nuts purchased from a

craft market in Windhoek, early after

my arrival to Namibia. Namibians will

usually carve "The Big Five" into these

nuts, including lions, leopards, rhinos,

elephants, and buffalo. It was also not

uncommon to see zebra and oryx.

As an artist, one of my favorite things about Namibia is the tradition of carving animals into tagua nuts, sometimes called "ivory nuts" based on how closely the nut's color and texture resemble ivory. These nuts come from palm trees in the northern part of the country, and you will find craftsmen selling them all over the place. Commonly they leave a blank rectangle, which they use to personalize the piece by carving a name or desired message. After buying a handful for family and friends back home, I became fascinated by how beautiful they were, and decided that during my stay I would learn how to carve them. 

This is a tagua nut, which had an outer, furry husk that had been removed. 

Carving away the bark-like covering that remains reveals a slick, alabaster-

colored nut. It was a bit tricky to get the hang of it, but after twenty minutes

or so it becomes second nature. These things are sturdy, and nearly as hard

as stone. Apparently elephants will eat them, but human teeth would break!

My offer to purchase fresh, un-carved nuts from a local artist named Alfons started quite the conversation. He was curious why I wanted to buy the unfinished ones, and it turned out that in 30 years he had never had any visitor express interest in learning how to carve the nuts themselves! We chatted for 45 minutes about carving techniques, the preparation steps beforehand, the source of the nuts, how he began his career, and also what materials I would need. Because I hadn't seen any animals yet, I decided to carve the landscape I snapped a picture of on the way from the airport. 

I thought that since these nuts come

from palm trees, and since I had seen

so many of them, it was only right that
I include one of the makalani palms.

As instructed by Alfons, I included an

elephant I had seen in this carving. It

was both in-line with tradition, and
authentic to a memory that I'd made.

When I returned the next week to buy more, he was happy that I'd given it a go, and generous enough to give me five more nuts, along with the leather, beads, and wire to finish them for free in exchange for the promise that I return to show him what I carve. He had no doubt I would see animals during my travels, and so tasked me with inscribing the ones I saw. Nut carving ended up being one of my favorite hobbies during the weekends, and has resulted in some souvenirs that will last a lifetime! I decided I would try to commemorate this internship by carving the outline of Namibia, the names of the organizations I worked with, a makalani palm tree (where the nuts come from), and of course the elephant I saw crossing the road.

It was tricky to get in one shot, but I also carved the silhouette of Namibia, the year, and the initials for WDI, UNAM, and FIP into this nut to commemorate the purpose of my visit for this internship.

Until Next Time!

Thanks for reading this far! Hopefully now you've gained an understanding of the nature of the work I'm doing this summer, and can picture what I'm referring to when I talk about the country. In the next post, I'll share an update on the activities I'm involved in and highlight additional parts of Namibian culture!

Namibia has remarkably beautiful sunsets, and I thought it was only appropriate to end this first post with a shot of one :)