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GALMI, West Africa - Vivian Nguyen was expecting "culture shock" when she went to a remote hospital in Niger as part of a college outreach program: Most people were poor, had no running water, electricity or bathrooms, and they lived in mud huts. She knew that going in.

But by the time she was helping to deal with fatal burn cases, struggle against an AIDS epidemic, and hold a diseased leg steady while a surgeon sawed it off, the Portland, Ore., resident said she also was experiencing a little "medical shock." At Galmi Hospital, being overwhelmed with desperate patients was a daily event.

"The hospital was what you would have found in the United States 100 years ago, except they have penicillin," said Nguyen, a student in the College of Pharmacy at Oregon State University. "Surgeons operate with headlamps in case the electricity goes out. People there die every day of things that you could never imagine seeing today in the U.S., like cholera, malaria, typhoid and tetanus."

The experience was part of what OSU and increasing numbers of pharmacy programs all over the country are trying to help more students understand - the immediate and sometimes desperate needs of underserved populations, and the role that pharmacists on the front lines can play to help address that.

In Oregon, that might include working in a rural outreach program, learning to provide vaccinations, or helping break through language or cultural barriers. In other parts of the world, the experience can be more extreme.

"One man was paralyzed from the neck down when a brick wall fell on him, and there was nothing we could do," Nguyen said. "Sometimes there were no surgeons, and children with advanced typhoid disease had to be sent home to die because there was no one within 300 miles able to perform an intestinal operation."

Other volunteer medical experts, besides Nguyen, also experienced "medical shock." She would make rounds with doctors and offer drug prescription and dosing recommendations, not necessarily based on what the doctor wanted or was optimal for the patient, but based on what was available and might be able to help.

She went to local villages, teaching malnourished people how to treat lice, scabies and worms. She vaccinated babies to prevent polio. She worked at the HIV clinic.

"It is often easy to focus solely on the healthcare issues here at home and forget how millions of people live around the world," Nguyen said. "I hope more people will donate to organizations working in these areas, or go themselves to help make a difference."