ence did not provide any definite answers, it is important to realise that change is inevitable. We must either move with the change or make the change happen, for without change, the profession will not progress, or worse, suffer a demise. As George Bernard Shaw quoted 'progress is impossible without change; and those who cannot change their minds cannot change anything'.IT changes should provide opportunities for us. So, while we may not understand or need to understand all aspects of the changes fully, we must understand the implications and how to best utilise new and evolving resources and opportunities. As I sit here typing on my PC with limited IT, but with expanding potential, I thank SHPA and the DBL Development Fund for the opportunity to contemplate and plan, with an international perspective, what will be the next 20 years in the profession of pharmacy.

Background Australia's closest neighbours in the Western Pacific face many procurement, distribution and regulatory challenges providing patients with quality pharmaceuticals on limited budgets. This study tested the hypothesis that some antibiotics being used within the healthcare systems of Papua New Guinea, Vanuatu and the Solomon Islands were substandard, and through this pilot project explored challenges and constraints around collaborative regional pharmaceutical quality testing opportunities. Methods A list of 11 commonly used and ‘essential’ acute care intravenous and oral antibiotic products was compiled. A purposive sample of 20 units of each listed medicine was collected at the earliest possible point of the supply chain within the three participating nations. These samples were transported to Australia for analysis. Results All oral and intravenous product samples complied with uniformity of mass standards, except for oral amoxicillin from Country 3. Most antibiotics showed uniformity of content except for cloxacillin. Conclusion Most samples met quality standards, except for cloxacillin, which failed dramatically and this may indicate increased susceptibility to degradation in tropical settings. Although the results are reassuring compared with recent studies of pharmaceutical quality in this region, products of substandard quality were identified. The issues encountered in the timely testing of samples demonstrate the need for innovative solutions to promote pharmaceutical quality assurance, particularly in resource‐limited settings. Strategic regional cooperation could greatly increase testing capability for Small Island Nations, benefiting the most vulnerable populations and strengthening antibiotic stewardship across the region.

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Remote villages and health facilities in Vanuatu are visited to help train pharmacy officers, update remote area nurses on pharmaceutical issues and provide community education about appropriate use of medicines and general health issues. Limited communications and irregular visits by medical staff makes a visit by the principal pharmacist and a trainee an occasion for the community. Updates for nurses include latest treatments for common conditions such as malaria, pneumonia, and non‐communicable diseases which are increasing in these communities. Training includes blood glucose machines, repair of medical equipment and cold chain management. Touring allows the trainee pharmacy officers to observe first‐hand the needs of the remote communities. They learn how to assist clinic nurses with their stock ordering and store management. Direct involvement in the medical care of some patients has reinforced their knowledge of drug treatments.

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