Clinical Features

Experiences of a Hospital Pharmacist Abroad

Written by Barry O’Sullivan, Manager, Outpatient Pharmacy, Imperial College London Diabetes Centre – Adjunct Clinical Lecturer, School of Pharmacy, University College Cork, Ireland

Covid lockdowns gave us all time to think, to reflect and indeed plan for the brighter days ahead.

“What is next for me? Was the question that arose time and time again for me. The only possible solution to the question: change.

Pre and during Covid I undertook some studies to upskill. An MBA from University of Limerick and qualifying as a Chartered Management Accountant were the culmination of the endeavour.

For a number of years I had wanted to work in the Middle East, a totally different landscape but one with easy access to home. The idea of working there intrigued me. Western healthcare is held in high esteem, English the working language and healthcare is JCI accreditation which I had familiarity with. COVID lockdown gave me time to reflect on where I was and what was next. I decided to make the move happen.

I had applied for a few Pharmacist roles in the region, but the interest was one directional. There is a large supply of Pharmacists in the region already, not much need to import one more. For some healthcare workers, the route to the Middle East is navigated with the assistance of agencies, some of the large hospitals actively host recruitment drives for some professions such as nurses. Less so for Pharmacists.

How my role came about was untraditional. For years I read the career paths of business people in Business section of the Sunday papers, a curiosity I apply to Linkedin also. On this platform I noted an Irish name in a prominent role in a large healthcare organisation based in the middle east. I sent a direct message to Teresa Quinn, Senior Director of Clinical Operations, Mubadala Health, along the lines of “your career trajectory is very impressive, what path did you take?”

A conversation ensued and after some initial discussion, my CV was requested. Over the course of a few weeks there was a few rounds of video calls culminating with an offer letter arriving into my inbox.

I was offered a position of Pharmacy Manager with Imperial College London Diabetes Centre, a comprehensive, state-of-theart outpatient facility specialising in diabetes treatment, research, training and public health awareness. The Centre opened in Abu Dhabi in 2006 as the first healthcare facility established by the state owned Mubadala Investment Company in partnership with Imperial College London.

Then started the administrative element to move to Abu Dhabi. It began in earnest in October, culminating with my Pharmacist licence for Abu Dhabi being issued late December.

My new employers assisted with all the various elements, such as the pre departure paperwork with Department of Health licence, verification of all previous role and qualifications and on arrival helping me get settled with the all important Emirates ID card, phone etc. On arrival new colleagues aided my settling in, especially Shukri Abu Ata.

Working as Pharmacy manager leading three clinics, two in Abu Dhabi and one in Al Ain poses a new challenge. It requires all elements of my clinical, financial and managerial skills.

Leading a team of over 70 across the three sites is a demanding job. Our team processes over 110,000 packs of medications every month

Our Home Delivery service ships over 4000 deliveries every month.

The day to day clinical processes are very similar to Ireland and the UK.

Imperial College London Diabetes Centre provides a comprehensive range of treatments at its branches in Abu Dhabi and Al Ain across the full spectrum of diabetes and related complications under one roof. A one stop shop if you will.

The specialised focus, backed by customised software, allows patients to undergo all the necessary tests, obtain results, and receive tailored consultationbased diagnosis and prognosis during the same appointment.

During medical consultation the prescription is issued on the clinical software then the Pharmacy team will commence with the insurance approval, dispensing and clinical check.

If a patient wants to get the medication elsewhere, they are given a hard copy external prescription and get same dispensed in another Pharmacy in the Emirate.

Healthcare in the UAE is a mix of private and public sectors, but expats will be using the private system. Different to Ireland in terms of the payer, the UAE national patient’s medications are typically covered by insurance. There can be a small co-pay but not much cost.

UAE nationals are covered under the Thiqa program. Citizens get a Thiqa card, which gives them full access to a large number of both private and public healthcare providers within the Daman network. To apply for this, you must be a UAE national (living in Abu Dhabi) and aged between 18 and 75.

For expats, employers and sponsors are responsible for providing health insurance for employees and their families. This includes coverage for one spouse and three children under 18.

When it comes to dependents, the employer is only required to pay 50% of the coverage, with the rest paid by either the sponsor or the employee. For additional dependents, the obligation falls to the employee to pay for their health insurance.

The day to day clinical work is pretty much identical to home. Evidence based care in line with best international practice is the standard. Governance structures are in line with internal best practice and we liaise with the Department of Health frequently.

Any prescription collected face to face has a Pharmacist consultation, usually lasting around 7 minutes.

Indication, mechanism of action, side effects and so on are all detailed. For home delivery patients, this is done on the Phone if a new item or any changes.

Any clinical interventions on a prescription are discussed with the prescriber and noted on the patient file.

We use the MERP scale for near misses and medication errors, with a robust reporting structure and outcomes review for any required changes.

As a learning tool, medication errors and “interaction of the month” are shared with the clinical teams, an idea I copied from the excellent Medication Safety Minute run by St. James’ Hospital in Dublin.

Pharmacy supports the other clinical teams in the usual way with clinical input, supply and other considerations. We work closely with non clinical teams of procurement and given the insurance element, the Revenue Cycle Management team also. They act as the point of contact with the insurance companies.

Healthcare is an international village no matter where you are and the United Arab Emirates is no different. Indeed, some my colleagues have siblings working in healthcare in Ireland. Others have studied with Irish institutions such as the Royal College of Surgeons, both in Dublin and on their campuses in the Gulf region.

In the international village that is healthcare, the main currency is respect. The culture here is one of politeness and respect, especially amongst colleagues. We see, in Ireland and other countries, when healthcare staff aren’t paid respect

be it in terms of conditions or pay, they leave. The numbers of healthcare staff leaving the sector or the country highlights this.

Self doubt and uncertainty were inevitable for me with such a career move but focusing on what I did know, what I could do and what I could help improve allayed, for the most part, those negative feelings.

Having worked in a private hospital in Cork was a huge help as the JCI accreditation is applicable over here too.

Slowly but steadily I am getting used to the change in both personal and professional life.

Packing up and leaving Cork was not without an emotional cost. I am the youngest of seven, uncle of 14 and have a close relationship with my mother, Mary T. Leaving home at 4am on a January morning wasn’t an occasion full of smiles I’ll be honest.

From a work point of view, it feels like a huge opportunity to develop myself and in time, progress. In the short few months here, I have been involved wide array of projects using clinical and financial skills utilising both my Pharmacist and Chartered Management Accountant skillsets.

The learning curve is vertical at times, but often we know more than we realise and being recruited by such a prestigious organisation instils a sense of self belief that you can perform.

For me, at this moment in time, the United Arab Emirates is the best place for me to be. The standard of living and options of things to do is amazing. It’s safe, clean and friendly. In making the reasoned decision to move, there has been of course the element of doubt, is this the right thing to do? So far, for me it has been. For anyone else, there is only one way to find out.

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