Our Visiting Ugandan Pharmacist Gives a Presentation for Wilkes University Students and Faculty

January 10, 2016:   

 Back on December 1, 2015, Pamela Blessed, the visiting Ugandan Pharmacist who is working on her PhD project in the Pharmaceutical Sciences deparment, had the opportunity to teach Wilkes Students and Faculty about her beloved country.  She talked about Uganda’s history, its  government and cultural traditions. Below are some pictures from the event. 

Pamela with Jonathan Summers, Associate Director of Diversity Affairs

  

Crystal Cool, Assistant Director of International Student Services, Pamela, and Erica Acosta, Associate Director, Diversity Affairs

  

Pamela talks with Georgia Costalas, Executive Director Diversity Affairs

 

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    Pamela Blessed, Pharmacist from Uganda

     
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Uganda in the American News for Improving Access to Pain Medicine for Seriously Ill Ugandans 

January 3, 2016:  Everyday I receive Google Alerts for news in Uganda so that I can keep up with the “happenings” there and this morning I was pleasantly surprised with a story reported by NPR (America’s National Public Radio) that I want to share with you. It was on the improvement of pain management and palliative care in Uganda by Dr. Anne Merriman’s Hospice Africa Uganda (HAU) and their morphine production facility.  http://www.npr.org/sections/goatsandsoda/2015/10/16/449243933/how-uganda-came-to-earn-high-marks-for-quality-of-death

If you want to learn more about how the morphine is produced or how these services are rendered, please check out my old blog posts from March 2014 on HAU and Dr. Moira Leng’s Palliative Care program at Mulago National Referral Hospital. (Long time readers of mine may recall these.)

(http://pharmacyclassintoafrica.com/2014/03/06/hospice-and-palliative-care-in-uganda/, http://pharmacyclassintoafrica.com/2014/03/07/a-day-in-the-field-with-hospice-africa-uganda/, http://pharmacyclassintoafrica.com/2014/03/09/hospice-africa-uganda-supplies-morphine-for-the-entire-country/)

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Uganda Blog Stats: 2015 in review

Dear Faithful Blog Readers: Thank you so much for coming along on this journey with me as I have chronicled my Uganda Projects- travels there with my Wilkes Pharmacy Students, my travels to teach the Ugandan Pharmacy Students, and my work with Ugandan Pharmacists in the USA in 2015 and since the beginning back in 2011.  Below are some interesting stats that WordPress put together that I thought you might like to see. I’m especially impressed with about 10,000 views this year!!

I also have more to share with you about happenings in 2015 so I’m going to be posting a few blog entries over the next few weeks to finish up 2015. My next trip to Uganda is in April 2016 and I’ll be posting about that before you know it.

To catch you up, Pamela Blessed, the Ugandan Pharmacist who is also a faculty member at Makerere University is still in the USA completing her Pharmaceutical Sciences PhD project on the development and testing of a pharmaceutical-grade exipient from Banana (i.e. she is creating a new starch that can be used to make drug tablets).  The pictures below are of the Pharmacy Practice Christmas Party which Pamela attended with me. It was a breakfast held in a large mansion Inn called the Stegmaier Mansion and it is beautifully decorated with many antiques and was especially impressive with the Holiday Decor. Our department has a tradition of having a really funny gift exchange. Instead of purchasing a gift for a specific person, we all just bring a gift and put them in one big pile. Then we pick numbers from a bag and then choose one gift from the pile in the order of our numbers with #1 going first.  The best number is the last number because when it comes your turn to choose, you can steal a present from someone else rather than picking from the pile if you want. If your present is stolen, then you get to go get another one. No one opens the gifts until the end so people end up stealing gifts from one another without even knowing what is in it.  There are lots of laughs with this gifting game. I’ll let the pictures tell the story.

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Jen, in the red sweater, is trying to hide her gift. This one turned out to be the most coveted gift and must have been stolen back and forth about 10 times. I’m not sure who finally got it but I believe there might have been chocolate candy in the triangle gift on top.

 

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Some people have gifts already but we are all waiting until everyone has one to open them

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Pamela and KarenBeth with our gifts, prior to opening them. I got comfy blanket and pillow with owls on it from Erica Hoot (ha-ha- hoot-owls, get it.) By the way, she is coming to Uganda with me in April. Pamela got a gift certificate to a Japenese Restaurant.

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Dana’s gift was in a huge box- someone else chose it first and then she “stole” it from someone. When she finally got to open it, it was a “squatty potty”. We all had a good laugh! check out this link if you want to learn what it is and be sure to watch the Unicorn Icecream video: http://www.squattypotty.com

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Dana loves her squatty potty but I’m not sure who she’s pointing at- maybe the person she “stole” it from.

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Kim is getting in the spirit by putting the poisetta bow on her head

 

The WordPress.com stats helper monkeys prepared a 2015 annual report for this blog.

Here’s an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 10,000 times in 2015. If it were a concert at Sydney Opera House, it would take about 4 sold-out performances for that many people to see it.

Click here to see the complete report.

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Spreading the News about Advancing Pharmacy Practice in Uganda

18 October 2015:  I’ve been back in the USA for just 2 weeks now but my Ugandan friends, pharmacists and pharmacy students are never far from my thoughts.  This past trip was incredibly successful and rewarding for me and I hope, also for the students and pharmacists I worked with. From their comments and emails, I think this was a mutually beneficial experience!  Although I won’t be back to Uganda until April 2016 when I arrive with my Wilkes Pharmacy students, until then I will be busy working on spreading the news about the progress of teaching students and pharmacy interns the skills to provide pharmaceutical care that can help improve safe medication use and the health of patients.  I also am very proud of the positive changes that are occuring within the practice of pharmacy in terms of the implementation of clinical pharmacy services and direct patient care.

Professor Richard Odoi presents our Poster on the Development of a Pharmaceutical Care Skills Course... at the FIP meeting in Germany Oct 2015.

Professor Richard Odoi presents our Poster on the Development of a Pharmaceutical Care Skills Course… at the FIP meeting in Germany Oct 2015.

During the last part of my stay and work in Uganda, Professor Richard Odoi, whom I’ve collaborated with on my “Uganda Projects” for the past 4 years, went to the International Pharmaceutical Federation (FIP) meeting in Dusseldorf, Germany.  We had a poster accepted which he was able to present for us on this work called “Development and Evaluation of a Pharmaceutical Care Skills Course for Ugandan Pharmacy Students to Bridge Didactic Learning and Clinical Application with Assistance of a Fulbright Specialist”.

This is the poster Professor Odoi presented at the FIP Meeting in Germany-Oct 2015

This is the poster Professor Odoi presented at the FIP Meeting in Germany-Oct 2015

He was excited to tell me how well received it was and about the great interest from other participants.

A view of the "Poster Hall" at the FIP meeting.

A view of the “Poster Hall” at the FIP meeting.

I am currently at the American College of Clinical Pharmacy Meeting in San Francisco (ACCP) which has a Global focus this year and has many international participants. On Sunday there were presentations on the advancement of clinical pharmacy practice in Singapore, China, Philippines, Saudi Arabia, and Europe and I was highly impressed with their progress!  Uganda still has very far to go but I think little by little, they are making strides in the right direction. Sometimes it can be hard to see improvments when there are still so many issues to address and so many patients that need help but I have to keep reminding myself of two things. First, one of my favorite sayings is “Two steps forward and One step back is still forward progress” and second, I try to remember the story about the starfish. It goes something like this:  One day 2 people were walking on the beach and hundreds of starfishes had washed up on the shore and were going to die from being out of the water.  One of the people kept picking them up and tossing them back into the ocean but the other person questioned her effort. “why are you throwing the starfish back into the ocean? There are so many, you can’t possibly make a difference.”  The woman replies “Well, I made a difference for this one, and this one, and this one….”  So, although we can’t fix all of the problems at once, all we can do is the best we can at this point in time and helping address the medication issues for one person at a time is making a difference for that one, and that one and that one…

I think the most important roles I play when I am in Uganda is to inspire and mentor Pharmacy Students, Interns, Pharmacists, and Faculty in the ways they can positively impact patient care. The people I work with are extremely bright, but they live in a resource-poor environment where the drugs that are supposed to be available often aren’t and it is really hard to address drug therapy problems when the necessary drugs aren’t there. And it can be very frustrating to work within a system that doesn’t reward a good work ethic and when you are the only person who seems to care about the patients and is willing to stay late to do whatever is necessary. In fact, it is easy to get caught up in the ways of most people who work for the government system and who are under-appreciated. It is not only that their salary is extremely low, but also they are seldom given positive reinforcement for the good things they are able to accomplish. I’m hoping that by sharing the work I’ve been doing in Uganda, I can interest other American Pharmacists and Pharmacy Faculty into joining my project. The more people that can be involved and who can work together on the same project will help to make a bigger difference, faster.

Presenting the Poster on the Fulbright Specialist Program.

Presenting the Poster on the Fulbright Specialist Program.

One of the posters I presented at this meeting was about the Fulbright Specialist Program and how this short-term funded exchange was able to support my work on developing a Pharmaceutical Care Skills Lab for Makerere University to help students learn how to educate patients, how to evaluate medication regimens to identify and solve drug therapy problems and how to communicate their findings and recommendations to other healthcare providers.

Presenting the Poster on the Pharmaceutical Care Training Program for Ugandans in the USA

Presenting the Poster on the Pharmaceutical Care Training Program for Ugandans in the USA

The other poster was on the program I developed to bring Ugandan pharmacists to the USA to train with me at my hospital to teach them these same skills so they could bring them back to Uganda to teach others.

Another opportunity I was able to participate in at this ACCP meeting was an informal pre-meeting of Pharmacy Faculty and Pharmacists who have been involved with Global Health Experiences.  It was convened by Dr. Tina Brock from University of California-San Francisco on behalf of a small group of people who had envisioned developing a small discussion group. The group was called “Apoteko”, which means “Pharmacist” in Esperanto.  (For those who aren’t familiar with Esperanto, as I was not, it turns out that this is a made-up language meant to help people communicate thoroughout the world with a politically-neutral language. Apparently, there are about 2 million people who are able to converse with it.) It was great to be able to talk about our projects in a small group setting. Tina also brought in a physician who has spent much of his time working in global health both in the USA with the Navaho Nation and in Haiti after the earthquake and more recently in Liberia during the Ebola epidemic. His talk was truly inspiring! There were a lot of young people at this meeting both young faculty, pharmacy residents and some 2nd year pharmacy students from UCSF that are really interested and passionate about global health.  Their energy is catching and makes me realize that if we reach out to the young and up and coming pharmacists, they will be there to help continue our projects. In my age group, not that many are interested in global health but it is amazing how many young people today are service-oriented and specifically are interested in working to help improve patient care in the developing world.  Below are a series of photos from the event.

Tina Brock moderates a discussion by Sri, a Global Health Physician at UCSF. Stephanie Lukas, a Pharmacists who recently came back to the USA after spending 2 years in Rwanda is asking a question.

Tina Brock moderates a discussion by Sri, a Global Health Physician at UCSF. Stephanie Lukas, a Pharmacists who recently came back to the USA after spending 2 years in Rwanda is asking a question.

This list contained interesting information the participants shared about the Global Health experiences they have participated in.

This list contained interesting information the participants shared about the Global Health experiences they have participated in.

Some of the discussion we developed- we didn't answer these at the event but hopefully this will be the basis for the beginning of a great conversation.

Some of the discussion we developed- we didn’t answer these at the event but hopefully this will be the basis for the beginning of a great conversation.

This is the Apoteko group, in front of the Global Health Center on the Mission Bay campus of UCSF

This is the Apoteko group, in front of the Global Health Center on the Mission Bay campus of UCSF

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Last Session with the Ugandan Pharmacy Interns in Kampala

4 October 2015:  

Teaching the Pharmacy Interns on the campus of Mulago Hospital

Teaching the Pharmacy Interns on the campus of Mulago Hospital

On Thursday I had my last teaching session with the Ugandan Pharmacy Interns working in the hospitals in Kampala.  I spoke to them about making drug dosage adjustments when patients have impaired kidneys. I started to teach this 2 weeks ago but ran out of time and since I was going really fast, I think they didn’t all quite get it. This time I was able to go slow and take lots of questions.

This is half of the pharmacy interns in attendance

This is half of the pharmacy interns in attendance

The Interns had taken a pre-test oat the prior session so I reviewed that in detail.  The will also complete a post test to make sure they have comprehended the material and are able to start putting it to use in the hospital to help real patients.  There was a great turnout for this Thursday.

The rest of the pharmacy interns

The rest of the pharmacy interns

Gonsha, one of the Ugandan Pharmacists who came to the USA to work with me this summer runs the weekly intern training program.  She precepts them as they work up and present patient cases so all can learn as well as schedules special speakers with unique area of expertise.

(Left to right) Susan, Carol, and Julie reunite- former teacher with her students

(Left to right) Susan, Carol, and Julie reunite- former teacher with her students

Friday evening, Susan Raber, pharmacist from the USA, Carol, the Mengo Hospital Pharmacist, and Julie, another pharmacist gathered for a nice dinner.  Susan, works for Pfizer Drug Company and back in 2008 she spent 6 months in Kampala helping to teach in the pharmacy program as well as precept students and interns at Mulago hospital.  One of her areas of expertise is Pharmacokinetics and Pharmacodynamics and she taught this course as well as helped in others.  What is really neat is that Carol and Julie were her students back then.  Now they are accomplished Pharmacists and are doing wonderful work to improve patient care.

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Last Day Teaching at Makerere University School of Pharmacy

2 October 2015:

3rd Year Pharmacy Students with me and Susan Raber on the steps of the Pharmacy School

3rd Year Pharmacy Students with me and Susan Raber on the steps of the Pharmacy School

Today was both happy and sad for me. Once again my time in Uganda teaching the pharmacy students at Makerere University and working with them and the Pharmacy Interns at Mulago and other hospitals has come to an end.  I’ve been here for 4 weeks but the time has gone quickly since I seem to pack every minute full of activities. Besides teaching the Pharmaceutical Care Skills Lab all day every Tuesday, working at the hospital with students all day on Wed and Thursday morning, working with Interns on Thursday afternoons, and teaching all day on Friday, I’ve also spent 1 day at Nsambya Hospital and 2 days at Mengo Hospital with Pharmacy Interns.  I’ve presented a career day talk on Pharmacy Careers in Academia for the Pharmacy School, educated Internship Supervisors of Kamapala about Pharmaceutical Care and delivered a talk on Strengthening Pharmaceutical Care in Uganda to the membership of the Pharmaceutical Society of Uganda at their Annual General Meeting. I’ve also had the chance to meet some new people this trip and forge new collaborations with the Medical Microbiologists at Makerere University Medical School and the Pharmacists of the Infectious Diseases Institute.

The 4th Year Pharmacy class with George, one of the faculty, and me.

The 4th Year Pharmacy class with George, one of the faculty, and me.

The other 1/2 of the 4th Year Pharmacy class

The other 1/2 of the 4th Year Pharmacy class

After class today, I was surprised by the Makerere Pharmacy students when they held a small event to thank me for my work with them.  They had asked if I could meet with them but I was expecting an informal conversation. We did get a chance to talk about why some of them decided to go to pharmacy school and I told them more about pharmacy careers in the USA, but in addition to that, they all had kind words of “thanks”.  Some of them told me that they thought they wouldn’t like going to the hospital but now they see how a pharmacist can truly help patients and have developed an interest in pursing clinical pharmacy as a career. Two of them told me that I have motivated them to “be the change they want to see in Pharmacy Practice in Uganda”.  I think these students motivate me as much as I motivate them!

A gathering of students to say goodbye and "thanks" to me.

A gathering of students to say goodbye and “thanks” to me.

I look forward to seeing them when I come back to Uganda in April when I bring Wilkes Pharmacy Students and hopefully on many more trips to help teach at Makerere University.  These students are so capable and bright and I just know they will make a big difference in the care of patients in Uganda if they continue to desire this and work towards it!

Faith, one of the two female 3rd year students, made me a beaded necklace/earring chain. What a special gift!

Faith, one of the two female 3rd year students, made me a beaded necklace/earring chain. What a special gift!

Simon, the MUPSA President and the leader of the 4th Year class welcomes Susan Raber back to Uganda to teach. I love the notepad they gave her. I use them all the time while here- they are the perfect "pocket" size- not too big but not too small

Simon, the MUPSA President and the leader of the 4th Year class welcomes Susan Raber back to Uganda to teach. I love the notepad they gave her. I use them all the time while here- they are the perfect “pocket” size- not too big but not too small

Finally, they presented me with a beautiful framed certificate and a really nice MUPSA (Makerere University Pharmacy Student Association) polo shirt!  Thanks guys! It’s been a pleasure to teach you!!!

Simon presents the certificate to me.

Simon presents the certificate to me.

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A Few Very Busy Days in Kampala

1 October 2015:

3rd Year Students role-play how to educate a patient in class

3rd Year Students role-play how to educate a patient in class

Wow, I can hardly believe another month has passed as today we enter October.  I think I’ve just gotten used to writing 2015 but soon it will be 2016.  This also means my visit here is coming to an end.  The past few days have been really busy for me and the students.  On Tuesday, I taught the Pharmaceutical Care Skills Lab (PCSL) course again for the 3rd year students but Cathy taught the 4th years and did a fantastic job. I think she is ready to go on without me.

3rd Year Students role-play how to educate a patient in class

3rd Year Students role-play how to educate a patient in class

We had to hold the class in a large lecture hall this time due to another meeting in our usual room, hence the difference in the pictures.

3rd Year Students role-play how to educate a patient in class

3rd Year Students role-play how to educate a patient in class

On Wednesday, Cathy and I precepted the 4th year students during ward rounds at Mulago Hospital and then later in the day, we welcomed another American Pharmacist to Kampala.

Susan Raber and Freddy Kitutu, one of the Makerere University Faculty Members

Susan Raber and Freddy Kitutu, one of the Makerere University Faculty Members

Susan Raber has been working in Uganda on and off since 2008.  She started her original work here teaching Pharmacokinetics at Makerere Pharmacy School as a Pfizer Global Health Scholar when she spent about 6 months here. Since then she has made numerous trips back to Kampala as a volunteer Pharmacist and Pharmacy Faculty member with Healthcare Volunteers Overseas (HVO).  She was here last year as well and helped to teach the PCSL and precept pharmacy students and pharmacy Interns at Mulago Hospital.  Susan and I have known each other by email and by phone calls for a couple of years now but this is the first time we’ve been able to meet in person. She currently works in the Clinical Pharmacology Division for Pfizer and she is an expert in Pharmacokinetics/ Pharmacodynamics and Infectious Diseases.  Today she and I precepted the 3rd year pharmacy students at Mulago and it was really nice to hear her thoughts about antimicrobial use and find out they are in line with mine.  If you want to learn more about that, check out my Blog from a couple of days ago.

4th Year students consult with each other while they review a patient's medical record at Mulago Hospital

4th Year students consult with each other while they review a patient’s medical record at Mulago Hospital

Finally, this afternoon I spent several hours at the Pharmaceutical Society of Uganda (PSU) in a meeting to design a pilot project to implement Pharmaceutical Care in a few hospitals.  It was a really interesting meeting but as we talked through all the steps, we realized the project is larger than we first imagined.  Since my talk for the Intern Supervisors here a couple of weeks ago and my talk and Cathy’s at the PSU Annual General Meeting last week, the momentum to implement Pharmaceutical Care in hospitals has grown, which prompted the meeting today.  Although, there are some significant challenges to overcome.

4th Year students at the bedside of a patient at Mulago Hospital as they interview the patient to learn about the medications the patient was on at home.

4th Year students at the bedside of a patient at Mulago Hospital as they interview the patient to learn about the medications the patient was on at home.

The literature is filled with reports of how pharmacists can positively impact patient care and the economic use of drugs, but we need to plan a study that will show this is also possible in Uganda.  To demonstrate this we will need access to data that may not be reliably collected. For example, when pharmacists are involved in direct patient care as a member of the healthcare team, safe medication use is improved. One way to measure this would be to see if the reports of adverse effects from drugs that have either been used inappropriately or given in the wrong dosage because the patient had impaired kidney function decreases after the onset of the Pharmaceutical Care project. In the USA, these reports are routinely documented and it is actually required by our accreditation bodies that we report this data.

4th Year students at the bedside of a patient at Mulago Hospital as they interview the patient to learn about the medications the patient was on at home.

4th Year students at the bedside of a patient at Mulago Hospital as they interview the patient to learn about the medications the patient was on at home.

In Uganda, no one requires such reporting and even if they did, there probably wouldn’t be a way to enforce this. This is a regular problem with many issues they face. There may be great policies put in place about the way drugs are dispensed or prescribed but there is no infrastructure able to enforce such regulations. An example is the dispensing of Antibiotics without prescriptions by the pharmacies as I mentioned in my last blog. The Pharmacy Act provides a list of drugs that must not be dispensed by pharmacies without a prescription, but there is no way to enforce this policy hence antibiotics are routinely sold without prescription and no evidence of a bacterial illness in a patient.  Another issue that Pharmacists can really help with is finding out exactly what medications the patient was on prior to admission to the hospital to make sure the appropriate drugs are continued and the ones no longer needed are stopped.  This is called “medication reconciliation” and is one of the key practices I’m teaching the students.  While rounding with them this week, they were able to determine that the HIV medications the patient was on at home were different than those written for in the hospital. The physician team had somehow made a wrong assumption about his therapy and if we had not intervened, the patient would have received the wrong HIV medications.  Though there are many challenges to the systematic implementation of Pharmaceutical Care, I think that the group that met today will do their best to address the barriers and will come up with a solid plan to both measure baseline data regarding the safe and rationale use of medications and then a pilot study design that will show the benefits of pharmacists being more involved with patient care.

4th Year students consult with each other while they review their notes from a patient interview at Mulago Hospital

4th Year students consult with each other while they review their notes from a patient interview at Mulago Hospital

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