by Elizabeth McMahon Bsc (Pharm.)
When disaster strikes, the needs on the ground can be great. The Canadian Red Cross mission is to improve the lives of vulnerable people by mobilizing the power of humanity in Canada and around the world – I am proud to say I am one of the many aid workers contributing to this important work. Currently, I’m on the ground in Mozambique where I am working as both the pharmacist and the medical logistician. My job is essentially to keep the hospital stocked with necessary medical supplies, so I order and receive as well as distribute these supplies and make sure we don’t run out of stock needed to support our patients.
As a result of Tropical Cyclone Idai, hundreds of thousands of people in Mozambique are in need of medical care as basic health services have been severely disrupted. Many local health facilities have suffered extensive damage and are disconnected from power, relying on Red Cross generators to continue functioning. With stagnant flood water covering an area of 3000 square kilometres, there has been an outbreak of waterborne diseases, including cholera.
The most challenging part of my job is when we first arrive on the ground. Medical logistics includes a lot of trucks showing up and getting offloaded with forklifts. We set up our large tent and then fill it as fast as we can; initially just to get everything out of the heat, sun, dust and dirt. We create a system of shelves and pallets so that we can respond quickly when we have many patients to deal with. We are ready and able to service the medical team, whether paramedics, nurses or surgeons, who come to our warehouse for whatever they may need.
The most noticeable difference about pharmacy in Canada and in the field with the Canadian Red Cross is the tents. My warehouse consists of a large, rectangular tent, whereas the triage and the entire cholera treatment centre is set up in nearby massive inflatable tents. Bright orange fencing which separates the cholera treatment centre from the rest of the hospital ground. It’s important for infection control that people know where those boundaries are.
The pharmacist plays an important role within an emergency response unit field hospital. The work is fast paced, requires quick thinking and a depth of knowledge about medications as well as medical supplies. The pharmacist can also provide alternative solutions when particular drug choices may not be available or are in short supply in the host country. I have approximately 3,000 different items in stock from injectable and oral medication to blood pressure cuffs and IV catheters.
In a post-cyclone, post-flooding environment we can often see an increase of water-borne illnesses, like cholera and malaria. The most in-demand supply item right now is Ringer’s lactate IV solution, since the critical thing cholera patients need is fluid; they are losing so much so quickly. For patients who can drink, they are given oral rehydration solutions at their bedside round the clock. More severely dehydrated patients may go through many bags of IV fluids. We also use antibiotics to shorten the course of severe diarrhea and anti-malarial medications when a patient tests positive for malaria. In Canada, we sometimes see anti-malarial medications being taken prophylactically by people who are travelling, whereas here they are used to treating people who are sick with malaria more often.
When it’s caught early enough, and with enough fluid and medical supervision, people with cholera can recover quickly. We had one patient who arrived in the cholera treatment centre on a stretcher, they were nearly unconscious. The nurses started an IV right away and within an hour, the patient was able to talk to the staff and she even knew a few words in English. Knowing that we are able to provide support to someone when they needed it the most is an incredible feeling, and every day we are working together to help people recover.
Moments like these, when I get to see the impact we have, is what makes me leave my job, home, and family for a month at a time. The work is hot and tiring and sometimes it can be frustrating, but every time I hear a story of recovery, I remember the struggles are worth it. The type of work we are doing right now in Mozambique is very important to the recovery of those impacted. It is very rewarding to have a chance to share your skill set with others, in order to meet the needs of the local population in a time of disaster.
About Elizabeth McMahon:
A graduate of Dalhousie University of Nova Scotia, Ms. McMahon has had a career in many fields of pharmacy. She has worked in both hospital and community pharmacies and was a pharmacist in the Canadian Forces for 27 years. She has worked across Canada in clinic and hospital settings, field hospital tours in Croatia, Dubai, Germany and Afghanistan.