In America, the ratio of women-to-men in pharmacy is approximately 3:5. After being in the various pharmacies so far in Cluj, I believe (but am not sure because it is hard to find stats on the demographics of pharmacists) that ratio is similar in Romania. I spent one week in a central pharmacy in a gastroenterology and hepatology hospital, and all the staff and pharmacy director were women. In a clinical setting, it was empowering to see strong, brilliant women taking on an entire department. I felt a sense of community, which I tend to feel around women.
I worked in a central pharmacy at the University of Iowa Hospital and Clinics, so I was accustomed to the process that the nurses (technicians) showed me. The major difference I found was the copious amounts of ampules. We use a lot of vials in the United States, so to see various size ampules being used instead of vials was interesting. I am not sure why ampules are not popular in the States. If someone knows the answer, the please send me a message!
Our guide, Ionela, demonstrated how to fill an order for a unit, which composed of a list of needed medications and supplies (ampules, vials, tablets, and med supplies). We had to gather all the items on the list, then send it to a separate room to get double checked. Controlled substances are only handled by a pharmacists; at Iowa, techs will stage all the controlled substances and the pharmacists would sign off on them. The pharmacy also had a compounding room and large stock rooms.
Ionela said the one problem they have is that most of the orders that come down are incomplete or they do not have the drug, so they have to send it back. Dr. Stefanescu (we completed patient cases with him and his residents on the last day) said one of the medications that is hard to acquire is albumin, a crucial drug for liver-diseased patients. They would request 12 boxes and sometimes receive less than half. Drug shortages are not surprising in the pharmacy field, but the fact that these issues happen globally is alarming. Pharmacists struggle to find medications, and doctors have to change treatment protocols, which may or may not be beneficial for the patient.
Surprisingly, the hospital lacks clinical pharmacists on the units. The nurses and pharmacy director do not have much say in the prescribing practices of the doctor, so it makes me wonder who is double-checking the treatment or medication choices. The only institution that has clinical pharmacists is a private rehabilitation hospital called Polaris. Most people in healthcare know the benefits of clinical pharmacy in the healthcare team. Being among pharmacy students here in Cluj, they know and preach the same beliefs. However, to have so many pharmacy schools and students and not have positions on the healthcare team makes movement in a clinical setting difficult. The passion and determination among pharmacists and students here in Romania brings hope to the field. They all want opportunities, change, and a future that does not always involve community pharmacy (abundant in the country).
Once again, I cannot stress how gracious and welcoming people are in Romania. The honesty, openness, and giving of their time was unbelievable.
My last site for the rotation will be at an infectious disease hospital. So sad this experience is coming to an end. Until next time!