by Sara Peebles
volunteer writer for Angels in Medicine
Copyright © 2024 Sara Peebles
“Pharmacy is the most complex part of a mobile clinic. When pharmacists receive a prescription from the doctors, they need to locate, prepare, and label the medication, and then counsel the patients on how to take it properly. It is a very time-consuming process and must be executed with accuracy and safety in mind.”
— Dr. Jennifer Wilson, “Grant Us Tomorrow“
One day, a colleague asked Dr. Linda Dresser to help source medicines. Her colleague was heading out on a medical mission, which intrigued her. In fact, it sparked an interest for her to “get back to the grassroots of what drove me to be a pharmacist… doing one-on-one patient care and helping the person in front of you.”
She felt very lucky that someone came to her. “Can you tell me more about where you’re going, and do you guys ever need a pharmacist?”
Early Training
For Dresser, a career in pharmacy has been a lifelong calling. She began her career by attending pharmacy school at the University of Toronto, earning a bachelor’s of science degree, and completing a hospital practice residency in Hamilton, Ontario.
Dresser then worked as a pharmacist for almost seven years at a hospital in Bermuda. This experience early in her career was very influential in the clinician that she became. She noted, “It was Bermuda that gave me some initial insight into understanding that we are more alike than we are different, even though we are trained in different countries and schools and have different backgrounds and cultures… everyone, no matter where they live, deserves excellent health care.”
To continue her education, she earned a doctor of pharmacy (Pharm.D.) degree at Wayne State University in Detroit, and since 2003 she has been an Assistant Professor at the University of Toronto Faculty of Pharmacy.
Shortly after her discussion with her colleague about medical missions, Dresser joined an international health team, and her calling was expanded to new settings and challenges. After completing a few missions to South America, Dresser developed a network of colleagues and friends, and got connected with a team going to Ghana. She had such a positive experience there that it led her to make multiple — ten! — return trips.
From Mobile Facility to New Hospital
The health teams in Ghana that Dresser joined were part of the Ghana Rural Integrated Development (GRID) organization. They would typically be staffed by 12 or so doctors plus several surgeons, 5 or 6 pharmacists and pharmacy technicians, up to 20 nurses, and a handful of dentists and optometrists. Some of the most common acute and chronic issues treated at the team’s mobile facility in northern Ghana were malaria, snake bites, car accident injuries, hypertension, asthma, chronic pain and glaucoma caused by hypertension. Dresser began as a member of the pharmacy group, but after four years she stepped into a leadership role with the team.
The NGO in Ghana (a partnership between Northern Empowerment Association [NEA] and GRID) had the goal to build a hospital that could provide excellent care year-round. Therefore, in parallel to the ongoing short-term, once a year medical missions, the plans for this hospital were initiated. Dresser’s role with this partnership included working with the pharmacist in Ghana on a variety of aspects related to hospital and pharmacy development such as logistics, supply chain, operations, policies and procedures, and staffing of both the in-hospital and outpatient pharmacy space at the facility.
“In 2019 they broke ground on the hospital, and that’s the last year we went as a mobile group.” The hospital had its grand opening in 2022, and in 2023, the group traveled twice to the new hospital.
Several members of the original mobile group, like Dresser, were now leadership partners of the hospital. As partners, they provide training programs, and assist hospital leaders with planning operational and clinical processes and services as requested. “We’ve transitioned from this group that went and did everything, to a group that goes, and we provide coaching and mentoring, and are colleagues to the group that have now opened this hospital. It’s an amazing story that this community and surrounding area could go from no health care facility of this kind of stature, to building a brand-new hospital and getting it opened and running and thriving.”
Pharmacists without Borders Canada (Pharmaciens sans Frontiérs, PSF) has partnered with Dresser in her work with the hospital since its opening. PSF has provided resources and the sharing of knowledge from pharmacists who have worked in hospitals around the world.
Challenges and Breakthroughs
In the earlier years of Dresser’s work in Ghana, her biggest challenges were related to the logistics of supplying a mobile pharmacy. Her pharmacy team would determine which drugs to take, a target quantity to last for the duration of the trip, and how to source the medications, keeping in mind what was feasible to transport.
“One of the challenges for the team is that you can only treat the person who is in front of you right now,” Dresser said. “You only have so many hours in the day, and there is going to be somebody that you’re going to have to turn away.” Sometimes, patients will need medication or equipment that you could not bring. “You know, ‘I would normally do this,’ and you can’t.”
Figuring out how and where to procure the medicines (in-country or out), as well as how much and which drugs to transport, was always the subject of much careful planning and forethought. She noted the assistance of Health Partners International of Canada in the supply of medicines. “We would have, for the whole team, 30 hockey duffel bags of just pharmacy drugs.”
Even packing the drugs was challenging. “You always separate, don’t put all of everything in one bag. So, we would have to think about what are we going to pack where to make sure that if we lost some bags, we would always have what we needed.”
One of the most exciting and rewarding moments of Dresser’s experiences in Ghana was the year that injectable antimalarial drugs became available on the market to supply the mobile pharmacy. Prior to this, the drugs could only be administered orally or as suppositories. The immediate improved efficacy and stability that these drugs provided was a moment she remembers as a gamechanger for what the team was able to do in the field. Previously, they would have had to give the patient a suppository and send them urgently to the closest hospital, a two- or three-hour drive away.
“The challenge was that the drugs did not have reliable or consistent absorption… so when we got intravenous or intramuscular antimalarials… we had that turning point where we could do something in our little clinic and then give them dextrose or other drugs they needed, and they were able to walk out of clinic that same day.”
Building for the Future Alongside Inspiring Leaders
Dresser contributed her skills and experience in logistics, policies and procedures, and building a formulary to assist GRID/NEA in planning for the hospital. The NGO was very deliberate in planning and implementing best practices, including electronic medical records (EMRs).
“The hospital is thinking about their carbon footprint and wanting to be paperless but also wanting to be sustainable and thinking towards their own capacity and building capacity… They want to function at a higher level, they aspire to be much more like a North American or Western institution…It is a remarkable system for a hospital in a low-income country to walk in and see this [EMR system].”
GRID/NEA is committed to improving social determinants of health, including education. The high cost of education in Ghana means that literacy rates and school completion rates are lower in the poorer regions than other parts of the country. The NGO has provided many scholarships to equal numbers of male and female students. The scholarships send students to high schools as well as to post-secondary education and training. For example, one of the scholarship recipients will come to work at the hospital as a physician once training is completed.
When asked who she considers an inspiration or a hero, Dresser named two people. First is her colleague Dr. Jennifer Wilson, who was the medical director of the Ghana Health Team when they went as the mobile team and now leads the new smaller group of Ghana Health Partners. She is a board member of GRID as well. (Wilson has written a book about her medical work in Ghana called Grant Us Tomorrow).
“There are a few people that you meet in your lifetime who are leaders that you’ll follow anywhere,” Dresser said. “Between [Dr. Wilson] and the leader of the NGO, Dr. David Mensah, they are both that kind of leader. You want to follow them; you want to make them proud because they walk the walk. Whatever they ask you to do, they would do themselves.”
Dresser is inspired by their achievements. “They can see what it is that they’re trying to achieve and find a path to get there. Lots of people have great ideas, but they can’t figure out the path. These are two that I’ve really learned a lot from because of their ability to not only create the picture but find a way.”
When summarizing what drew her to join the Ghana Health Team and then keep returning, Dresser said she initially went into medicine to help people. When the opportunity presented itself, she decided to walk through that door and stretch herself to pursue her professional calling in a different setting. She noted that it might not be for everyone, but she found that it was a fit for her skillset and personality. Dresser loved the work, and she discovered that she thrived in an environment where no day was the same and “every day was an adventure.”