Right Place, Right Time

Saturday, October 10, 2020

Five years ago, I was in my third year of pharmacy school in Singapore studying alone for my year end exams, or rather spending my time scrolling through Facebook and pretending to study.

Then, a news article about a natural disaster in a neighboring country caught my eye. I started to wonder about how useless the knowledge in front of me was. How could I make a difference when I barely knew how to do anything practical as a student?

That was when I felt a tugging in my heart to sign up as a volunteer in a community clinic for low wage migrant workers. I stopped scrolling.

One of my best friends had asked me recently about volunteering there, saying that as a pharmacy student I might be of help.

I had brushed it off then, as I was on a research scholarship that mandated I pursue a PhD straight after I graduated from college.

Upon feeling that tugging though, I signed up as a volunteer, and went consistently for 4 years before I moved to San Francisco for graduate school.

In a weird way, being a student volunteer inspired me to later pursue full pharmacist licensing (which took another year after graduation) because I realized I liked clinical work a lot.

I had no idea if being a licensed pharmacist was going to be useful for research, but I went ahead anyway.

This threw me into a struggle about whether or not I would have been happier being a clinical pharmacist, or being a researcher.

Fast forward to 2020.

The week of Good Friday was undoubtedly a defining moment for many Singaporean healthcare professionals as we imposed our own version of shelter-in-place and opened up community isolation facilities around the island to house COVID positive patients.

The majority of these cases were coming from the migrant worker dormitories due to crowded housing conditions.

These were the people I had been serving for the past 4 years. I remember that moment very clearly, sitting in my room in San Francisco.

For a moment, I wondered if teleportation is possible. I took a deep breath and started to weigh my options. Was it actually possible for me to go back?

I had availability since I could afford to work remotely (my thesis work is 50% computational), and ability, since I had been upkeeping my pharmacist license as active anyway.

I discussed my case with multiple people here, until a lab friend reminded me that I choose to join healthcare to serve others anyway.

A few emails and phone calls later, I signed up as a volunteer and purchased a ticket back immediately.

Back in Singapore, I was deployed to a hospital pharmacy. I began revising all my guidelines, desperately trying to recall all my drug doses and counselling points, things that I had not seen for at least 2 years.

I became fully operational within a day (not that I had much of a choice with the shortage of manpower) and my confidence as a pharmacist returned over the next few days.

However, we were presented with a huge problem: ensuring that our patients with chronic conditions had enough medications while being isolated at different facilities all around the island, some of which did not have medical teams on site.

Chronic medication management was still very important, due to the increased risk of mortality of COVID associated with chronic conditions, as well as the need to prevent complications that arise from these conditions themselves.

Ever-changing guidelines our workflows and low medication supplies issue due to the disruption of drug supply worldwide, meant figuring out which patients we needed to supply medications to was a puzzle involving multiple databases of various electronic medicalcare records.

Thankfully, prior to this, I had been doing quite a bit of computational analyses on microbiome data and host gene expression. That involved pooling multiple different databases using R package “tidyverse” to answer my research question.

I replaced bacteria and RNA sequencing reads with admissions and dispensing records instead. That allowed the team to generate our daily work lists within a span of 30s, freeing us to do actual pharmacy work, rather than spending time agonizing over 4-5 different Excel databases that update daily with 18 sheets and 26 columns each.

The rest of the team, not having much coding experience, was initially a little apprehensive.

However, once they learned how straightforward the process was, they quickly adopted my codes.

Having to program for an end user other than myself was quite an experience; I had to ensure that the code was user-friendly and could run reproducibly.

There were also the questions to answer from supervisors about the reliability of the codes, which thankfully were easily addressed.

After pharmacy school, I wanted to stay on as a pharmacist for a few more years before entering grad school, but was unable to due to my scholarship restrictions.

However, if I hadn’t been forced to start grad school earlier than I would have liked, I wouldn’t have known how to code, and thus would not have been able to contribute to the COVID response in Singapore as I did.

I was really just in the right place at the right time.