A Fond Farewell to Uganda

Friday, May 1, 2015

Today is Uganda’s Labor Day so campus and government offices are closed. It was nice for our last

This is the staff of the EdgeHouse, the visiting scholar house on Makerere University campus where we stayed this week. Pictured are Diana, Eva, KarenBeth and Eric. They are wonderful and make staying here a real treat.

This is the staff of the EdgeHouse, the visiting scholar house on Makerere University campus where we stayed this week. Pictured are Diana, Eva, KarenBeth and Eric. They are wonderful and make staying here a real treat.

day since we were able to have plenty

Kristen and I at Mediterraneao, a delicious Italian restaurant on our last night.

Kristen and I at Mediterraneao, a delicious Italian restaurant on our last night.

of time to pack and get ready to go. This morning we slept in a bit later than usual and met a friend for breakfast at one of my favorite cafes- Endiro Cafe at Kisemente. After a yummy bacon and cheese omelette and a double Cappacino, Kristen and I did some last minute shopping- such fun!! Back at EdgeHouse I thought I would have lots of time to reorganize and pack but instead I spent quite awhile in conversation with a new guest and his colleague from Makerere University.  Finally the packing got done and we had a delicious dinner at one if my favorite restaurants, Mediterraneaneo. We are now at the airport and ready to fly home. When one of the guys who helped with my luggage asked how we liked Uganda and if we were coming back I replied that I loved Uganda and one of the things that made leaving easier was knowing when I’m coming back. So, for me the next trip is September or late August. I’ll return to help teach the pharmaceutical care skills course I helped develop and teach last fall.

The other great news I have is that during this visit I advertised, accepted applications and interviewed pharmacist candidates to come to the USA in June to work me for 2 months to advance their pharmacy skills. I ran this course for the first 2 pharmacists back in November 2013. The goal is to equip pharmacists who will be role models and champions of clinical pharmacy practice in Uganda where pharmacists work directly with patients and other healthcare providers to improve patient health outcomes. The next 2 pharmacists to participate in this training are Gonsha Rehema and Cathy Namulindwa. I’ll be telling you more about this in the near future.

This was another extremely successful trip and experience for me and the students. I had a wonderful crew and I think they are coming back to the USA with new cultural competency skills and an enhanced appreciation for the U.S. healthcare system as they have truly experienced many challenges impeding better health in Uganda. They will be an asset to the profession of pharmacy as they join our ranks in a few weeks. Hanna and Stacy, already pharmacists, will continue to advocate for their patients with new understanding as well.  So bye for now.

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Back in Kampala- It’s OSCE Time!

Wednesday, April 29, 2015

This is one of the 4th year students going through my OSCE station, which was about a patient with sinusitis that came to get a prescription filled. Hillary, a pharmacy intern was portraying the patient and I must say his acting skills were terrific!  He brought a handkerchief with him and kept dabbing his nose. When he spoke he used a nasal-congested voice and he looked like he was in pain from his bad headache. This obviously seemed real to the student by the empathetic and concerned looks on their faces as they proceeded through the station.

This is one of the 4th year students going through my OSCE station, which was about a patient with sinusitis that came to get a prescription filled. Hillary, a pharmacy intern was portraying the patient and I must say his acting skills were terrific! He brought a handkerchief with him and kept dabbing his nose. When he spoke he used a nasal-congested voice and he looked like he was in pain from his bad headache. This obviously seemed real to the student by the empathetic and concerned looks on their faces as they proceeded through the station.

Kristen and I are back in Kampala and we had to say goodbye to Hanna, Lizzie, and Amanda earlier this week. They have all arrived safely back in the USA but Kristen and I have the pleasure of savoring a little more time in Uganda. Now we are working with the faculty at the Pharmacy School at Makerere University to administer an Objective Standardized Clinical Examination (OSCE) to the 3rd and 4th year students to assess their pharmaceutical care skills and knowledge retention from the course I helped teach last fall. The students aren’t that happy to be doing this when the course was last semester and they haven’t had any clinical content or experiences at the hospital this term. But, that is exactly the point. We need to find out if the students are able to retain what was learned last fall and apply it now because if not, then perhaps something needs to be changed. Maybe clinical content needs to be added in both terms.

This was another station where Nicholas, the "soon to be pharmacist after intern year" was portraying a patient with a wound infection from  Boda-boda accident, the most common of causes of accidental death and injuries in Uganda. (Motorcycle accident)

This was another station where Nicholas, the “soon to be pharmacist after intern year” was portraying a patient with a wound infection from Boda-boda accident, the most common of causes of accidental death and injuries in Uganda. (Motorcycle accident)

Or maybe we need a different approach to teaching or better reinforcement to the students that these skills will be used lifelong as a pharmacist and are not just to be crammed for a course and then forgotten. This is especially important for the 4th year students as they are soon to be done with all classes and will go out on internship where they will need these skills. I don’t want them going to the hospitals and saying “I don’t know how to do that; we were taught that a year ago.”  Hopefully that will not happen and today I was generally pleased with the 4th year results for my OSCE station.  Putting on this OSCE Assessment is quite a feat, as Kristen noted today. Her help was invaluable.  It takes the dedication of many to pull an OSCE off.  We had to engage current pharmacy interns and soon-to-be pharmacists to help out by role-playing the standardized patients. Everyone had to come by 8am to be trained and all, including faculty, had to dedicate their entire day to this event.  And, it has to happen again all over tomorrow for the 3rd year class.  But I was really impressed- not a single person was grumpy about this and many of the intern helpers mentioned they were glad for the opportunity.  In addition to the event-day, planning is also very time consuming, which is why I haven’t posted for 2 days.  But, this type of assessment is really good for the students. It is an individual event and may be the only time, before real-life practice, for them to get a chance to see if they really have the skills needed.  And for faculty, we get to see if what we are teaching is actually “sticking”. And if not, it give us the motivation and direction to make improvements.

Dinner with new friends from the Infectious Disease Institute in Kampala: Eva, KarenBeth, Shadia, Kristen, and Julian

Dinner with new friends from the Infectious Disease Institute in Kampala: Eva, KarenBeth, Shadia, Kristen, and Julian

Yesterday Kristen had the opportunity to spend 5 hours with the pharmacy staff of the Infectious Disease Institute (IDI) in Kampala, on the campus of Mulago Hospital.  Ever since I started coming to Uganda I have wondered about their activities. The only experience I’ve had so far is using their bathrooms- last fall I needed a facility and one of the interns said that she would take me to a bathroom. She said it was far, a long walk, but “believe me, it will be worth it”. Wow, she was right! Anyway, this trip I was able to get in touch with one of the IDI Pharmacists, she had emailed me to inquire about the Pharmaceutical Care Program I was advertising for (more on that later) and we started an email conversation that led to the opportunity for Kristen yesterday.  I would have been there as well, but my energy was needed to prepare for the OSCE.  When Kristen was done for the day at IDI, she was just glowing and couldn’t stop talking about all she had seen and learned. The IDI focuses on care for patients with HIV and AIDS. It is funded, at least in part, by the U.S. government. They do a lot of research to make sure patients are getting better with the current therapies and to make sure there aren’t drug interactions with antimalarials, which they actually have found a problem with some.  Patients get all their HIV meds and visits for free. The pharmacists at IDI are really involved with both the research and monitoring patient safety with the drug therapy, called Pharmacovigilance.  Since I couldn’t meet Eva and her crew earlier, we arranged to go to dinner at a lovely place called The Bistro.  We had such a good time!  Eva brought Julian, another pharmacist, and Shaida, a physician they work with.  We had many laughs- Julian is so funny. Since we told him about the OSCE’s we were doing, he regaled us with his OSCE stories from his education at Makerere. Boy, after a number of year, he still remembers all of his mistakes. I’m sure he did well on many of the stations, but I guess what sticks in your mind are the times you messed up.  It was a great evening and hopefully Wilkes students will be interested in working with the IDI pharmacists in the future.

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Murchison Falls National Park Safari Day 2

April 25, 2015

DSCN8880We thought our Safari experience couldn’t get any better than seeing 2 lions plus a cub on our first outing, but we were wrong. DSCN9027The day started out with a lovely boat cruise up the Victoria Nile where we saw lots of croccodiles, hippos, birds, and other animals watering down by the river.

Many animals came to the riverside for water- I just love to capture photos showing multiple animals species- here we have elephants, cape buffalo, jackson hardebeest

Many animals came to the riverside for water- I just love to capture photos showing multiple animals species- here we have elephants, cape buffalo, jackson hardebeest

Then after a nice refreshing dip in the pool and another yummy lunch, we embarked on our final game drive. This time, not only did we see 2 lionesses with their cubs, but we also saw 2, yes, you read that correctly, 2 leopards!!

I couldn't have posed this picture better if I tried.

I couldn’t have posed this picture better if I tried.

A warthog family- notice the nursing baby in the background- although we think of "Pumba" as the name of the warthog in Disney's Lion King movie, the locals call the warthog- Pumba. I think it is the Swahili name for the animal.

A warthog family- notice the nursing baby in the background- although we think of “Pumba” as the name of the warthog in Disney’s Lion King movie, the locals call the warthog- Pumba. I think it is the Swahili name for the animal.

Leopards are shy creatures and stay up on high branches in Acacia Trees all day and they are usually not near the vehicle paths. Our wonderful tour guide, though, seemed to have the eye for the leopards because he spotted 2 of them for us. The first was quite far and only 2 of us had cameras that could pick them up. But,we all had a great view through the guides binoculars.

This Mama had 2 cubs and boy were they playful.

This Mama had 2 cubs and boy were they playful.

As we watched the 2 cubs ran under a bush for awhile and then all of a sudden, they sprung out and just hopped on top of the Mama- it was so cute!

As we watched the 2 cubs ran under a bush for awhile and then all of a sudden, they sprung out and just hopped on top of the Mama- it was so cute!

The 2nd leopard, though, was much closer and even my point and shoot automatic camera with only a modest zoom lens picked it up. Check out the photo!  All in all, the weekend was fabulous and although we saw lots of animals, we left Murchison eager to go back another time.

This leopard shot is from my camera-and you can definitely make out the leopard in the distance on the tree branch

This leopard shot is from my camera-and you can definitely make out the leopard in the distance on the tree branch

Now we’ve safely reached Kampala and had to say goodbye to one of our party- Hanna’s flight leaves shortly to head back to the USA.  Tomorrow night we will say goodbye to Lizzie and Amanda, then Kristen and I will be left to carry out some work for the Makerere Pharmacy School.  More on that later this week. For now, enjoy some more animal photos.

This amazing picture is from Hanna's camera- there is no doubt we saw this leopard.  He just watched us intently as we gazed at him for about 20 min.

This amazing picture is from Hanna’s camera- there is no doubt we saw this leopard. He just watched us intently as we gazed at him for about 20 min.

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Murchison Falls National Park Safari Day 1

April 24, 2015

The Wilkes crew at the top of Murchison Falls

The Wilkes crew at the top of Murchison Falls

DSCN8759

“What a nice meal of warthog, now I’m so tired…”

Murchison Falls National Park, Uganda truly is a gem. It is smaller than the large game parks in Kenya, Tanzania, and South Africa, but it has most of the same animals and is very non-commercialized.  I haven’t been to the large parks, but this is my 5th time to Murchison and I never ceased to be amazed.  The 4 woman seem to have brought good luck for animal sightings this year.

Nap-time after the exercise of the kill (warthog in the background) and a delicious meal.

Nap-time after the exercise of the kill (warthog in the background) and a delicious meal.

On the first day we saw the best lions I’ve ever seen- a large male resting next to his kill and a Mama lioness with her single cub playing around while we watched from about 10ft in the vehicle.  We also saw many of the other animals- I’ll let the pictures do the talking- enjoy!

Elephants just crossed the road right in front of us!

Elephants just crossed the road right in front of us!

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Uganda Kob, a type of Antelope

Uganda Kob, a type of Antelope

We sat in the vehicle only 10 ft  away from this Mama and her cub for probably 30-45min.  She was loving and playful with the cub and didn't seem to mind that we were watching

We sat in the vehicle only 10 ft away from this Mama and her cub for probably 30-45min. She was loving and playful with the cub and didn’t seem to mind that we were watching

A Patus Monkey

A beautiful sunset over the Savannah to end a beautiful day!

A beautiful sunset over the Savannah to end a beautiful day!

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An Afternoon with the TASO Drama Team

Friday, April 24, 2015: We are currently on safari at Murchison Falls National Park in Uganda but you will have to wait until tomorrow to hear about our first days escapades. 😊

Wednesday afternoon we had the unique opportunity to go to a rural village and observe the TASO Drama Team provide both an afternoon of entertainment as well as HIV testing and counseling (HCT).

image imageThe entertainment started with drumming, singing and dancing. It was extremely energetic and joyful. The crowd grew as the music went on. There were many, many children along with adults numbering greater

TASO drama team in their opening dance

TASO drama team in their opening dance

than 100! Although the HCT started right away at some tables set apart from the show, it didn’t become swarmed with people until the Drama Team took an intermission. The Team also acted out a short skit to encourage use of condoms for safe sex. This was all conducted in the local language so we couldn’t understand all of it but the acting conveyed the gist of the points made. The villagers obviously found it hilarious by their robust laughter. Later, the Team Leader elaborated a little more so we could fully understand. Culturally, infidelity is common and accepted as a part of adult life with both men and women, but is much more common with men. The aim of the skit was to use condoms to protect against HIV transmission with all sexual partners to stay healthy. The TASO team seemed really happy that we took the time to see this side of their work, but truly, the pleasure and honor was all ours. Check out the pictures to get an idea of what went on. (Having internet issues- will add more photos and 2 videos later)

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A Fond Farewell to Masindi-Kitara Medical Center

Friday, April 23, 2015

The students worked hard but there was definitely time for some play with the kids at the clinic.

The students worked hard but there was definitely time for some play with the kids at the clinic.

Today was our last day at Masindi-Kitara Medical Center (MKMC) and tomorrow we are embarking on our Safari to Murchison Falls National Park.  It has been a wonderful two weeks at the clinic working with the competent clinicians and other medical staff. They have warmly welcomed us into their lives and shared their experiences with us. We have all gained a better understanding of the healthcare challenges facing Ugandans.  We have learned not only about the diseases but also about the barriers to treatment.

This is Dr. Godson, an amazing physician. His insight about the illnesses his patients have is amazing.

This is Dr. Godson, an amazing physician. His insight about the illnesses his patients have is amazing.

For example, today I learned that many Ugandans don’t really understand the disease, Cancer, and we were asked to consider doing some educational programs about this next year. It is really hard for them to understand that cancer of the breast is different from cancer of the lung and why some cancers can be treated and others don’t respond well to therapy.  Also, cancer doesn’t always cause pain so women who have breast lumps often don’t seek care until the cancer has spread greatly because initially it doesn’t affect their ability to continue on with their normal life.  As I mentioned in a previous post, we have learned that many patients don’t understand the concept of chronic diseases that need medications every day for the rest of their lives to prevent complications and illnesses.  In this resource-poor environment, many people just live day to day and crisis to crisis and have no  capacity to plan for the future.

This is Patrick, the onsite Project Manager of the Masindi-Kitara Medical Center

This is Patrick, the onsite Project Manager of the Masindi-Kitara Medical Center

But, we also have learned how much families care for each other. When someone is sick, the entire family may come to stay at the hospital. And when bills need to be paid, the family at large will chip in to cover the bill.  As I have kept all I’ve learned with me over the years as I practice in the USA, I hope the students and resident with me will also ponder their experiences and let them shape the way they care for patients as well as the way they think about the U.S. Healthcare System. We are so fortunate to have the opportunities afforded us in terms of healthcare services. Even patients without any insurance or those with poor insurance are able to access care. No one will be turned away and the variety of testing available to determine the problem is amazing.  But as we have seen here, tests are not always necessary to provide good patient care.

Hagai is the MKMC Manager.  Although his expertise is business management, he has great ideas about how to improve healthcare services at MKMC

Hagai is the MKMC Manager. Although his expertise is business management, he has great ideas about how to improve healthcare services at MKMC

A good clinician can listen to their patient’s story and use their astute clinical assessment skills to determine the problem and devise a solution.  It is great that in the USA we have more lab tests and radiology test to diagnose diseases, but I think these are often overused. We could all learn a lot from the clinicians at MKMC and in Uganda, in general.

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Learning More About TASO and Safe Male Circumcision To Prevent HIV Transmission

Wednesday, April 22, 2015:  A Blog Post by Hanna Raber and Lizzie Cook

These are the Boda-Boda's (motorcycles) that the TASO healthcare workers use to go to the field to set up clinics. The supplies and equipment to do HIV testing and CD4 counts along with the drugs follows behind in a 4-wheel drive vehicle with more healthcare workers.

These are the Boda-Boda’s (motorcycles) that the TASO healthcare workers use to go to the field to set up clinics. The supplies and equipment to do HIV testing and CD4 counts along with the drugs follows behind in a 4-wheel drive vehicle with more healthcare workers.

We spent Monday morning at TASO, The Aids Support Organization, once again today. The original plan was for us to spend time in the clinic, checking weights and administering surveys on their general health status. However once we arrived we were told that because of the Easter Holiday the schedule was really light today- only 16 patients were scheduled as opposed to some clinic days when over 150 patients would be scheduled. So instead we were given a really in depth tour of the facilities. We were really impressed by the holistic approach that TASO takes to HIV management. There were patient counseling rooms, education rooms, family planning space, an area dedicated to youth, and a well-organized pharmacy (a rare site to see). We were also shown an area of the property where a little garden was growing. They called this the “demonstration garden” and taught clients how to plant seeds and care for crops at their own homes. TASO also provides certain patients with “starter-kits” for certain careers including farming, hair dressing, and auto-mechanic.

This is an example of the cute huts that are used as patient consultation rooms at the TASO facility in Masindi, Uganda.

This is an example of the cute huts that are used as patient consultation rooms at the TASO facility in Masindi, Uganda.

After we finished touring the TASO facility we were able to walk down the road to the government sponsored HIV clinic. It was significantly smaller than TASO but did include a counseling room, pharmacy, lab, and physician rooms. The TASO facility does see more patients per day than the government clinic- on their two clinic days they see about 50-70 patients.

One of the most interesting parts of the day was our next stop- we were taken to the SMC (Safe Male Circumcision) tents out in a field across the street. We were told that males from age 10 and up were taken to these tents to undergo circumcision. This has been a huge initiative to help reduce the spread of HIV. One significant caveat of providing such a service is that many men believe they are immune from contracting HIV if SMC is performed. This prompts many men not to use condoms and many women to believe that men who are circumcised are “clean.” Therefore, it is very important that a comprehensive approach is taken to educate both men and women on safe sex practices.

This is one of the Safe Male Circumcision (SMC) tents

This is one of the Safe Male Circumcision (SMC) tents

When we arrived to the circumcision tents, there were roughly 30 boys waiting (they were brought in from a school with permission slips signed by their parents or older siblings) to be circumcised. Prior to the procedure, each boy would be taken under an awning for a counseling session about the scope of the procedure and how to use barrier contraceptives, such as male and female condoms.

None of the boys who were waiting seemed nervous and there were no sounds of screaming coming from the tent. We were later told that this was a right of passage and that the boys were expected to be calm, cool and collected during the process in order to be deemed “men.” We were told that the boys were not given any topical numbing agents before the procedure and they were only given Tylenol after for pain management.

Another SMC tents

Another SMC tents

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