July 2013 – Tan Kai Hsin, a Bachelor of Pharmacy graduate from the International Medical University (IMU), went for an exchange programme in the University at Buffalo, United States of America (USA). Kai Hsin shares with us her experiences there. “I never imagined that I would have the opportunity to gain United States pharmacy practice experience in Buffalo, New York. I liked the idea of travelling and shadowing a pharmacist in another country at the same time. With this in mind, I took the plunge and applied for a student exchange programme organised by the International Pharmaceutical Student Federation (IPSF). Knowing that USA is one of the countries that have adopted advanced clinical pharmacy practice, I believe that being an exchange student in the USA can broaden my horizons as well as my learning experience as a pharmacist. At first, I was a little afraid because this was my first time travelling alone out of Malaysia. But all the anxiety were unnecessary as my local exchange officer, Hye Ji Kim took good care of me. She arranged different visit and work sites for me so that I can be familiar with the pharmacy practice in the United States. This one-month programme included a University at Buffalo campus tour, hospital attachment, community pharmacy attachment as well as social activities. Although the duration of this trip was relatively short, the impact and exposure it brought me was definitely enormous. My first placement experience began at Mobile Pharmacy Solution which is a little different from a conventional pharmacy, because it offers a combination of free in-home delivery and clinical pharmacy service. Apart from that, they provide courtesy refill services which allow pharmacists to refill the patient’s prescription automatically when they are due. What amazed me most is they offer in-home consultation at no charge to the patients who require additional counselling. This is something not emphasised on enough in Malaysia. Besides that, Mobile Pharmacy Solution has high volume of extemporaneous dispensing compared to conventional pharmacy and I was given the opportunity to help out in producing the extemporaneous products. This allowed me to put some of my laboratory experience into practice. 
As part of my exchange programme, I was introduced to a typical USA community pharmacy, Walgreen Pharmacy, one of the largest chain pharmacies in USA. In the USA, the vaccination rules vary across state lines, in New York State, licensed pharmacists are allowed to administer influenza vaccination, meningitis, pneumococcal and shingles vaccine in-store for individuals who are 18 years and older. In addition, drive-through service is relatively common in United States community pharmacies. On top of that, the most interesting part is the advanced technology implemented in Walgreen Pharmacy. Their computer system contains full patient records and inventory control which can facilitate dispensing service. IntercomPlus is a system used in Walgreen to connect all the pharmacy chain stores via satellite and enables seamless store-to-store prescription filling. Besides that, they apply barcode scanning system for packaging and labelling of medication which can significantly reduce medication dispensing errors. The advance technology in USA may serve as a guide for development in Malaysia’s community pharmacy to increase the efficiency as well as accuracy of dispensing. Erie County Medical Centre (ECMC) is one of the teaching hospitals in Buffalo and where I had my HIV clinic, ambulatory care management and Terrace View rotation. In the HIV clinic rotation, I was given an opportunity to shadow a specialist pharmacist in counselling HIV patients, something which I have definitely not seen in Malaysia. In ambulatory care rotation, the pharmacists will review medication charts of an individual and discuss with the resident if any changes have to be made. Pursuant to that, they will perform regular follow-up counselling with patients who have chronic disease such as diabetes and high blood pressure. Terrace View is a nursing home in ECMC which provides long term care facility to patients who need short-term rehabilitation or behavioral geriatric intervention. In this rotation, I had the chance to review patient’s medication profile as well as discuss some of the cases with a preceptor. Throughout my time in Buffalo, my local exchange officer (Hye Ji Kim) and her friends had planned plenty of activities for me to experience the real American life. There’s an old saying, while in Rome do as Romans do. With this in mind, while in Buffalo it is compulsory to try its world renowned namesake, the Buffalo wings. This succulent tasty creation certainly does live up to its hype and it is truly an awesome dish for the weary traveler. I have experienced everything from Niagara fall to the city festival (Taste at Buffalo), Shakespeare play in Delaware Park and attending house party. I was so astonished by the magnificent view of Niagara fall that I even visited it thrice! One of my most memorable experiences was celebrating American Independence Day on 4 July where I watched the fireworks at night in Niagara Fall Park. 
This exchange programme was fruitful and unforgettable and certainly a life-changing experience.”
