Pharmacy Check-in: Sandy Hewitt
Sandy Hewitt, RPh (she/her)
Pharmacy Clinical Coordinator, Mercy Ships
Windsor, ON
Sandy Hewitt is a pharmacy clinical coordinator with Mercy Ships, a faith-based international organization that delivers free surgical care to patients in some of the world's most underserved countries. With over 30 years of pharmacy experience across Alberta and British Columbia, Sandy joined Mercy Ships after her children had left home, inspired by the opportunity to combine clinical skills with humanitarian service.
Sandy's role involves managing pharmacy operations across both of Mercy Ships' floating hospitals, including training, staffing and overseeing clinical procedures. Working alongside volunteers from more than 70 countries, Sandy plays a key part in supporting safe surgical care, medication access and multidisciplinary collaboration in regions where pharmacy infrastructure is limited or absent. She describes her experience as deeply rewarding, collaborative and a constant reminder of how we must be grateful for in Canada’s health system.
Q&A with Sandy
We caught up with Sandy to talk about her journey into global health, the realities of providing pharmacy care on a hospital ship, and what she’s learned from working with patients and volunteers from around the world.
Can you tell us about your background and how you found your way to Mercy Ships?
I have been a pharmacist for over 38 years, raising a family and working in Alberta and BC until our kids had both left home for university. My husband and I had no plans to serve internationally but we saw a feature on 60 Minutes about Mercy Ships and were inspired to apply. We served on board the Africa Mercy hospital ship from 2015 until 2020, with me as Senior Pharmacist and my husband as a Biomedical Technologist. My husband used to travel for work, so it was a big change to be living and working so close together, with his workshop right next door to the pharmacy!
What does your current role with Mercy Ships involve?
I oversee the pharmacy departments of 2 hospital ships. We have a team of 4 pharmacist on one vessel and 3 on the other. I support the team, answering questions, helping in clinical decision-making and providing historical context for a constantly changing staff complement.
I am the staffing resource manager for pharmacy. This role involves approving applications to serve as pharmacists or pharmacy technicians, staffing short-term and long-term pharmacy positions, developing training courses and materials for pharmacy technologies, as well as live video training and in-person training of staff. I generally travel to each ship once every year.
I am involved with the planning and procedures for importing controlled and non-controlled medications, drafting import requests to the Departments of Pharmacy in the Ministries of Health in the nations where we serve. I work with another colleague to plan the medications required for a 10-month field service. Our logistics are such that ordering medications requires months, not days, like we are used to in Canada.
I am also the document manager for Mercy Ships pharmacies, creating and maintaining policies, procedures, instructions and guidelines for the organization, and I review all other hospital documents involving pharmacy. I set the agenda, then collect and share the data at our quarterly Pharmacy and Therapeutics Committee meetings.
How does this experience compare to pharmacy practice in Canada?
Our patients present with advanced, untreated conditions that at first can seem shocking. The size of hernias and tumours are unheard-of in a Canadian context. The curvature of legs on some children seems impossible to repair. The number of years that some women live with obstetric fistula, leaking urine or feces is heartbreaking. Because our Canadian health-care system addresses these issues early, we don’t usually see the effect of the lack of available surgical care or the inability to pay for surgical services in our country.
Some of our surgical specialties are ongoing throughout a field service and others happen only in a specific calendar block. This means that our wards are constantly changing with the type of surgical patients that pharmacists see during surgeon’s rounds.
Mercy Ships are surgical hospitals, so we do not provide medical treatment for chronic diseases. Therefore, our formulary is limited to medications required in a surgical context, as well as general medications needed for crew health.
Because of our lengthy logistics and shipping and our short-term prescribers, we monitor medication use frequently to prevent shortages. Inevitably, we need to be more adaptable and resourceful, looking for alternatives and arranging for expedited shipping. The hospital (with volunteers from more than 70 countries) relies heavily on the pharmacy to advise on formulary medications, available alternatives, ship-based prescribing guidelines and dosing.
What do you want people to know about pharmacists working in global health?
The pharmacist role in global health is essential. It is not possible to provide any hospital services without good pharmaceutical care. Pharmacy has traditionally been a behind-the-scenes role, but pharmacists are a well-respected clinical resource in our multi-disciplinary hospital team, engaging directly with our patients.
Working as a pharmacist in an international setting and in an unconventional environment with many short-term volunteers means you need to be flexible and innovative, a problem-solver, a team player and be able to learn new workflows and technologies. Inventory planning and management is a particular challenge, requiring import permits and complex shipping and logistics. This means we can’t get a medication we need on the next day, like at home.
Many pharmacists in Canada wonder about volunteering to serve on a mission but don’t know where to begin. There are opportunities waiting for pharmacists and technicians, no matter what age or career stage. Many choose to do so when they retire, but short-term service is possible with a planned leave-of-absence or vacation. The experience you gain by working side by side with pharmacists and other health professionals from many other countries is invaluable. People come to give their time and expertise and come away with far more in expanding their world view and engaging with other cultures and people in need.
What makes you proud to be a pharmacist?
I think that all pharmacists want to make a difference in the places where they practise. I feel privileged to work with an organization that provides free and timely surgery to those who cannot afford and have no access to surgery in their home country. Pharmacists are essential to the patient’s journey, from pre-surgery vitamins and iron to increase patients’ nutritional status, to the post-op medications required for healing and continued health. Seeing the difference in the life of a patient first-hand has been so rewarding. Celebrating with the blind cataract patient receiving their sight, or with the obstetric fistula patient who is finally dry and able to join her community again after years of being ostracized is life changing. Watching the children with bowed, wind-swept or knock-kneed legs receive their surgeries, heal and learn to walk again is heart-warming. And to know that medications and pharmacy services played a part makes me proud.