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An American PharmD candidate describes his trip to Istanbul, Turkey, where he was fascinated by the similarities and differences of pharmacy practice conducted among people of different culture, beliefs, and expectations.
My experience began amid a surging, immensely crowded population of 12 million people, 98% of whom are Muslim. The community practice I was going to was located right off Istiklal Avenue in Taksim Square, in the Beyoglu district - perhaps the most diverse and progressive sector of a city steeped in rich tradition.
Routes to professional practice
Conversations with Turkish pharmacy students gave me the impression that industry offered attractive benefits, including the opportunity to balance reimbursement (i.e., work) with quality of life, a major concern of new pharmacists. This issue drives career decisions and ultimately the way the profession evolves. I also observed that the training students receive is designed almost exclusively along the lines of industrial practice. In Turkey we won't find the clinically focused care model we're used to; the incentives for practitioners are simply not there.
Almost all medications in Turkey can be obtained without prescription. Those medications requiring a prescription are paid for almost entirely through government insurance. In Turkey, medications are mostly the same as those available in the United States, but they are kept behind the counter and organized in glass cabinets according to disease state. All tablets and capsules come in unit-of-use boxes of varying amounts. In addition, almost half the cabinet space is devoted to vitamin and herbal supplements. Patients are received in the center of the pharmacy at a waist-level counter that runs along the entire pharmacy. Many interactions are very direct. Chairs in which waiting patients may sit are arranged around the walls, facing into the center of the room. Overall, in a Turkish pharmacy one sees an emphasis on the intimate nature of a patient encounter.
When you understand the structure of a Turkish pharmacy, even if it's from the point of view of community pharmacy only, you can understand the quality of care provided in such a pharmacy as well as what patients expect from their pharmacists.
My pharmacist made the point that patients are looking for remedies to illness, not monitoring of outcomes. In this regard community pharmacists in Turkey feel somewhat frustrated, since they have the pharmaceutical knowledge and see enough patients to know which medication is associated with the most favorable outcomes. However, in the view of most patients, the doctor is the only individual responsible for bettering their health. The pharmacist is simply a means to an end.
I think the most valuable lesson I learned during my visit to Turkey was just how much pharmacy is evolving. Both my pharmacist and the students I worked with were extremely generous with their time and knowledge.
I feel that the experience of living in such a culturally diverse region has added tremendously to my outlook on my career and taught me the importance of tolerance in a pharmacy practice conducted among people of different cultures, beliefs, and expectations.
Mike LaRosa is a third-year pharmacy student at Jefferson School of Pharmacy, Thomas Jefferson University, in Philadelphia. To read more about his experience, visit http://istanbulpharmacy.blogspot.com/. He can be reached at firstname.lastname@example.org