The decision to leave Sierra Leone was a hard one no doubt, but aside from pharmacy, moving to the United States was greatly influenced by the Daily Show-Jon Stewart. He was a social justice warrior that was not afraid to speak up about issues and by God he was good at it. He helped unravel a side of the US that one does not get to see living outside the US.
Logistically speaking, getting foreign education credentials and pharmacy licenses timely evaluated represents one of the major challenges of any foreign graduate pharmacist (FGP). License evaluation usually involves getting pharmacy school transcript, pharmacy license and registration from your home country to the evaluating body (usually ECE) in the US. This process ideally takes about a year for a FGP to gets an approval to take the FPGEE. Once the evaluation is completed by ECE, authorization to test is sent by NABP to take the FPGEE exams.
The greatest obstacle for FGP licensing in my opinion is passing the TOEFL exams. The TOEFL exams comprises of four sections: listening, reading, writing, and speaking and failing any of these sections require the candidate to retake all 4 sections again Individuals take the examination in a room full of at least 30 candidates all speaking at the same time. There have been cases of FGP still trying to pass the TOEFL five years after completing the FPGEE. For me, I spent over 6 months preparing to pass the exams and was ready to give up by my third attempt before I was successful.
Next up, is practicals. Obtaining an internship position after certification is of uttermost importance for most foreign grad pharmacists, as they must complete 1500 hours of internship before getting an approval to take the NAPLEX. The usual route for most is starting out as a technician with one of the giant chain retailers and hope they get hired on as an intern post certification. This has traditionally been challenging. One can cite multiple reasons for the non-hiring from training concerns, payment challenges, to simply hiring entities not understanding the process. The difficulty is there nonetheless.
To get around this, most foreign graduate pharmacists volunteer their time at independent pharmacies, which usually allows them to keep their non-pharmacy job. Unfortunately, this training is not ideal since the hours are sparse, leaving most graduate students in need to look for additional opportunities in multiple locations. Personally, I had to complete my internship in three locations just to be able to receive adequate knowledge on pharmacy practice.
In my experience, getting oriented with the pharmacy practice in the United States is a very intensive yet exhilarating experience. I decided to start as a pharmacy technician in a retail/specialty pharmacy (behavioral health.) Working in behavioral health introduced me to the US health benefits and insurance process. This was a totally foreign concept and it helped me realized how healthcare (especially mental health) management disproportionately affects people from disadvantaged communities compared to people from affluent backgrounds. Armed with that information I began thinking of ways to help leverage the community we serve with the best care possible. Unfortunately, as a technician my suggestions only went so far.
From behavioral health, I moved on to compounding. The process of creating medications from the inception to the final product had always fascinated me. I was a compounding technician for about a year, preparing steroid injections and eye drops. This position was educational in that I had never worked in industry pharmacy, and creating standard operating procedures, working in clean rooms, abiding to sterile techniques, and implementing sterile procedures to ultimately produce a sterile product was a game-changer. In that role, I was promoted to lead compounder and trainer and was able to draw from my extensive experience and background to mold new trainees into excellent compounding technicians.
Shortly after, I finally completed my licensure evaluation, which allowed me to start my internship period. With long-term care being one of the growing areas of pharmacy that were most unfamiliar to me, I decided to start my internship with County Line Professional Long-Term Care Pharmacy. Internship lasted about a year with me getting to appreciate the benefits of providing excellent pharmaceutical care to the elderly, before starting my work as an official pharmacist in the US.