PharmD Highlight: Nina Ameli, Class of 2020

This summer, Nina Ameli, PharmD Class of 2020, completed a clinical rotation at an independent community pharmacy that specializes in homeopathic medicines, Pharmacie Centrale, located in the heart of Vieux Nice (Old Nice), France.

Why did you choose to pursue this opportunity?

I wanted to live in the south of France for six weeks - who wouldn’t? Actually, a huge part of why I wanted to pursue setting up a new site in France is thanks to my experience with the exchange program Tempe Sister Cities. In 2011, I was paired with a host family that lived in a city called Èze near Nice. I fell in love with the city, culture, and family. I had my heart set on arranging a site when I found out international rotations were possible at UA. It was a bit of a challenge since there is not a pharmacy school in Nice and their equivalent to rotations are much longer than six weeks. But with the help of my French family and several emails later, my dream became a reality.

How is pharmacy different in France? The same?

Prescription billing and processing is much simpler. Prescriptions are scanned in upon intake, stamped, and given back to the patient, so no need to store them onsite. In France, everyone has immediate social security benefits accessed through a Carte Vitale. The Carte Vitale is a physical identification card with a chip used to pay for all healthcare services. Many people also have secondary insurance or (a mutuelle) that can have more pharmacy coverage. Generic medications are at no cost to the patient. Even if something is not covered the price is much less than the states. Maybe 10-20 euros instead of 100-200 dollars in the US. Medications are all in pre-doses boxes so no counting pills either. Some similarities are how people consult community pharmacists for just about anything such as a rash, cough, allergies, bug bites, etc.

Pharmacists are very much a trusted and utilized resource by the community.

What surprised me is how close pharmacies are in proximity. In the states, we have maybe different chains across the street but here you can have two different independent pharmacies with only one store in between them. Competition is hard for them and keeping customers coming back is essential to build a clientele. Another thing that surprised me is that pharmacists in France do not administer vaccines at this time. Patients come in with a prescription to take back to their physician. The legislation is changing that next year and pharmacists will start administering vaccines.

What has been a highlight of your time in France and/or during your rotation?

Since our pharmacy tracks a lot of tourists, I get the opportunity to meet people from all over the world. I’ve enjoyed connecting over similarities and differences and seeing how small the world really is. It made my day meeting a girl from Texas who just applied to the UA College of Medicine. Many tourists are enlightened to hear an American accent and find comfort in finding someone who speaks English. There was even a patient who came back two or three times just to speak with me. I have helped many patients from the states find equivalent products or active ingredients by blending my new knowledge of the French brands and U.S. products. I have enjoyed practicing and refining my French I had lost over the years. Enjoying a Nespresso with the staff every day after lunch was a custom I will miss as well.

What did a typical day look like for you?

My day for a community pharmacy in France is unique since they specialize in homeopathic medicine. I usually spend my morning in the lab making dilutions and homeopathic tablets for stock or on-demand for prescriptions. I measure out granules or globules (different size sugar pellets) which are the base to absorb the oil, then add the strength of the dilutions of the compound and let it dry. After it is dry, I created and print the labels on the computer and input the lot info for verification and release.

In France, homeopathic medications written by a doctor are reimbursed by the social security insurance but next year reimbursement will go down to 30% reimbursement and the year after stop. I think learning about the different compounds and natural oils is super interesting. Some common ones are Arnica Montana, Natrum Sulfuricum and Nux Vomica.

After lunch, I help in the main pharmacy with tourists, process and release prescriptions, and go through the order to put back stock. The days go by really fast.

Why should someone consider pursuing an international rotation?

Putting yourself out there to take on an international rotation is so much more than just vacation. By stepping out of my comfort zone to practice in a completely different country and language has made me grow immensely. It also gives you skills you can carry into any aspect of pharmacy and giving you real-life experiences to talk about in interviews. I highly recommend pharmacy students to pursue one and take the leap if you want to set up your own. Do not hold yourself back for fear of the unknown. You will only regret the things you didn’t try.