International Pharmacy: A Traveller’s Perspective

Pharmacy practices around the world are wide and varied. On a six-month overseas journey, I had the chance to experience first-hand the services provided by a number of community pharmacies. Here is a background to international pharmacy practice and how this translated to my actual experiences.

International Pharmacy Organisation and Regulation

The International Pharmaceutical Federation (FIP) is the federation of worldwide pharmacist and pharmaceutical scientist associations which deals officially with the World Health Organisation. There are 127 member organisations across the globe, three of which are from Australia. Overseeing community pharmacy practice for FIP is the Community Pharmacy Section (CPS), with an executive committee made up of pharmacists from Finland, Sweden, Switzerland, France, Great Britain, Jordan, Israel, Australia, Canada, and the United States.

Although many of the associations represented by FIP have advanced pharmacy systems with specific regulatory, educational and economic structures, there are also associations from developing and third world countries. A couple of notable examples are China and Mexico. China, although represented by its major organisation in FIP, still lacks definitions for pharmacists and pharmacy technicians, and pharmacy practice is still a mixture of Western and traditional medicine. Mexico has only observer status within FIP and, although there are pharmacists, laws regarding the sale of prescription medicines are limited; therefore queries exist if the drug supply
is compromised. Work is ongoing in many developing countries to improve pharmacy standards according to ‘Good Pharmacy Practice’.

Personal Experience

The variation in regulation and professionalism was evident whilst travelling around the world. Here are a few examples of my experiences.

Malaysia

Quite similar to Australian pharmacies (compared with many other destinations), perhaps as it is also a Commonwealth country. A typical community pharmacy has the traditional layout as in Australia – front of shop with cosmetics, vitamins and general health products; and a back of shop dispensary with a pharmacist who is quite knowledgeable and can speak English (as well as probably Malay and Cantonese).

China

Depending on which pharmacy you venture into, they may be more like a pharmacy or more like a Chinese herbalist. Someone with pharmaceutical knowledge could order almost anything. Drug names on packets tend to be in English as well as Chinese so it’s not too difficult to select amoxycillin or cephalexin if required. A couple of interesting observations are that cold and flu medicines often include an antiviral (amantadine) and that it is possible to purchase erectile dysfunction medicines (Viagra and Cialis) in some hotel lobbies.

Given this type of availability of medicines, it’s no wonder there have been concerns over counterfeiting – one case involved glibenclamide tablets containing six times the normal dose, resulting in two deaths and nine hospitalisations.

Mongolia

The Mongolian Pharmaceutical Association is a full member of FIP, so perhaps it shouldn’t have surprised me that the pharmacy we visited seemed very similar to a typical Western pharmacy. It was in the capital, Ulaanbaatar, so it is possible that standards vary from the urban centre. The difficulty is the language barrier; not only is spoken English limited, but labels tend to be in Cyrillic (Mongolia converted to the Russian alphabet a long time ago). Once you’ve learnt the Cyrillic alphabet however, the spelling is phonetically the same as the English variants, although it is still difficult to get something as simple as Zovirax^® cream. The pharmacists we visited seemed well educated, with technicians seeking their advice, although unlike in Australia, the pharmacist doesn’t have to be in the building at any given time.

France

As one might expect of a FIP CPS Executive member, pharmacy practice in France is advanced and highly regulated. Paracetamol isn’t available in supermarkets in France, however we had no difficulty purchasing some from the small corner pharmacy we visited. The label had ‘paracetamol’, the alphabet is Latin and units metric and so there is a feeling of familiarity.

United Kingdom

Pharmacy in the UK is the origin, and so similar to the Australian system, although there is a dominance of branded pharmacy chains (such as Boots and Lloyds) and a move towards corporate ownership. What is interesting here is the marketing of healthy lunchtime ready-made foods.

At the Boots at Heathrow Airport I was able to buy lunch including pre-packed sushi, or a salad wrap, packaged with a snack such as carrot and celery sticks (and at a fraction of the price of nearby cafes).

United States

Practice in the US is markedly different to that experienced in Commonwealth and EU countries. The transposition of pharmacies into supermarkets (and indeed transformation into supermarkets) certainly changes the dynamics of the pharmacy experience. Whilst it’s interesting to visit CVS or Walgreens to look at all of the products available, (they sell everything from medical goods to fresh fruit andcereal), I found personal service lacking. I had a prescription filled at a Walmart pharmacy, where the pharmacy technician simply handed me the medicine with an information leaflet and no other information. I had no contact with the pharmacist who was hidden behind a wall and several glass windows. There are still true community pharmacies around, but they’re few and far between. The model of care appears to be one driven towards cost saving rather than expanding cognitive roles.

Central America

Different countries within Central America have very different systems. My first pharmacy related experience was in Mexico, when I went into a convenience store to purchase a snack and was offered any drug I wanted over-the-counter with no prescription required.

By comparison, Guatemala actually seems to have regulations and the pharmacies look like typical pharmacies, with pharmacists present.

Peru

Regulations concerning the supply of pharmaceuticals aren’t tight in Peru, although pharmacies appear to have a typical professional pharmacy setup. In Cusco we were able to purchase multiple analgesics (in preparation for our hike to Machu Picchu) including tramadol, diclofenac and Panadeine Forte^®. The system seems to be similar to the US in that every tablet is taken from a bulk container and repackaged for dispensing, with the main exception being that none of it requires a prescription.

Conclusion

Australia has one of the most progressive pharmacy professions in the world, with a growing emphasis on cognitive and primary care roles. Developing countries are still producing laws and regulations to ensure safe supply. Ultimately most countries are working towards safe practices; however there is an obvious disparity of wealth that has a long way to go before systems become consistent.