2015 Mathew Peck Traveling Scholar Report

By Alistair Pickmere

Having the privilege of being the 2015 Matthew Peck Scholarship recipient enabled me to travel to the Fijian capital Suva, to conduct two studies on the usage of antibiotics, the first looking at the prescription, usage, compliance and the medical profession and public perception of antibiotic usage within the Divisional Health Centres within Suva, the second looking at the use of the “last option” and highly restricted antibiotic Colistin, within the main Hospital of Suva, The Colonial War Memorial Hospital (CWM).

As luck would have it, the beginning of my five week experience coincided with the start of Antibiotic Awareness Week in Fiji which headed by the Fiji Pharmaceutical and Biomedical Services Centre (FPBSC), involved various displays, promotions and the launch of the National Antimicrobial Awareness Plan, which I was lucky enough to attend at Ministry of Health Headquarters with my supervisors Beverley Snell and Nargina Macalinao.

The initial week of my time in Fiji was spent primarily focused on the review of the prescription of antibiotics within the Divisional Health Centres. This involved travelling with Nargina to regional health centres, where we would run through one questionnaire with patients (which involved asking their understanding of the need, use and requirements of antibiotics) and another with the Doctors which queried what restrictions, guidelines, ‘patient pressures’ and patterns motivated the prescription of antibiotics; followed by the collection of scripts from the previous week from the Centre Pharmacy for further review.

After talking to the patients in line with the questionnaire there was an opportunity to offer counselling, as the majority of patients were not familiar with what antibiotics were. Many held the belief they were a pain relief medication, and they were happy to understand more about their use and what antimicrobial resistance could be. Overall the majority of the patients were incredibly receptive and interested in finding out further information.

The majority of diagnoses were either URTI or Dermal Infections primarily the result of scabies associated scratching.  Amoxycillin and Flucloxacillin were overwhelmingly prescribed, as these are two of the very few antimicrobials not regarded as restricted in Fiji.

In talking to the Doctors it became clear that they are faced with the enormous task of seeing about 80-100 patients per eight hour shift, limited antimicrobial options in availability and affordability, patients incessant insistence on non-indicated prescriptions and limited patient knowledge.  There is great difficulty in always adhering to the guidelines in the prescription of antimicrobial agents.

At the end of this first week, I began my time at the CWM Hospital, where I set about collecting all the necessary records, backgrounds, microbiology reports and histories of the The staff of FPBSC at the start of Antibiotic Awareness Week, taken at FPBSCpatients in that had been prescribed in the previous 18 months of Colistin being available. Further interviews and discussions involved intensive care, pediatric and infectious disease consultants. They provided far greater insight, detail, and answers to my questions about the microbial burden endured within the Fijian Hospital Setting.  During this time I was fortunate enough to have Rashika Gounder take me under her wing. She was an absolute blessing in facilitating anything and everything that was required to complete the needed data collection and also offered incredible guidance during this time.

Key findings that were prominent from the beginning were that the need for Colistin arose primarily from nosocomial infections.  Given that its need arose as the bacteria of infection were resistant to all other antibiotics, combating their pathogenicity would be to reduce transmission through proper infection prevention and control measures, which were found to be completely sub-optimal within CWM.

Through further availability of microbiology reports, with thanks from the Microbiology Lab and Infectious Control Team, continual assistance from the staff of CWM from within the Pharmacy Department, Pediatrics, Intensive Care and Infectious Disease, a detailed review and analysis of Colistin and its usage has been implemented, with results identifying how this last option can be conserved, and its clinical life and efficiency extended.

As enjoyable, educating and unique as these experiences were the absolute highlight was being on the receiving end for five weeks continually of Fijian Hospitality and Friendliness – the staff of CWM and FPBSC were incredibly welcoming and did everything possible to make my time in Suva as enjoyable and rewarding as possible, as well as ensuring and facilitating whatever was required to enable the successful completion of our work to the fullest extent.

I was told that the involvement of Mat Peck Scholarship placement students in FPBSC projects is a seen as win-win situation. The student has the opportunity to be involved in a project that provides challenges and enjoyable learning opportunities while the FPBSC gets a project done that needs to be done and that will lead to implementation of recommendations to address identified targets.

Finally, I hope that my commitment and involvement both during my time in Fiji and efforts following my return have done justice to the memories, beliefs and standards of Mathew Peck, and my extensive gratitude to the Peck family for facilitating such an incredible opportunity each and every year for students of the Pharmacy Program at Monash University to undertake a Pharmaceutical Project in and to the benefit of communities within the Asia-Pacific region.