3 Weeks In the USA

Gonsha, Zach, Greg, and Cathy

Gonsha, Zach, Greg, and Cathy

It has now been 3 weeks since Cathy and Gonsha arrived in the USA to participate in the Advanced Pharmaceutical Care Experiencial Training Course (APCET) and they definitely have been learning a lot and strengthening their pharmacy skills. But they have also had many other  non-healthcare related new experiences.  During their first 2 weeks here at Wilkes-Barre General Hospital (WBGH) with me, they worked alongside my two Wilkes APPE (advanced pharmacy practice experience) students, Greg and Zack, who did a great job of showing them the ropes and helping them get acclimated to the American Healthcare system and the patient care process at WBGH.

Cathy presents information about Pharmacy Education in Uganda to American pharmacy students at Wilkes (note the chocolate cupcakes-we were celebrating her birthday)

Cathy presents information about Pharmacy Education in Uganda to American pharmacy students at Wilkes (note the chocolate cupcakes-we were celebrating her birthday)

During Cathy and Gonsha’s 2nd week, they participated in the Topic Presentions by the APPE students, which is one way the students share what they have learned with others. Cathy and Gonsha prepared a talk on pharmacy practice and education in Uganda but due to time constraints, only Cathy was able to give her talk. But Gonsha will get to give her talk to the next group of students who start their clinical rotations with me next week. Below I’ll include a series of photos to give you an idea of the experiences they have had.

Gonsha and Cathy outside Walmart

Gonsha and Cathy outside Walmart

Gonsha, I’m particular, is always so excited to see American Pharmacies.  At first I thought she was just amazed at how large some of them are, but what interests her most is our signage and marketing strategies.  These aspects of the pharmacy business are much different from pharmacies in Uganda.  Gonsha owns 2 pharmacies in Uganda and I suspect she may be making notes for how she can improve her presence among the zillions of pharmacies in Uganda.

Gonsha in front of Walgreens where she received a Tdap (tetanus, diphtheria, and accellular pertussis) vaccine from a Pharmacist

Gonsha in front of Walgreens where she received a Tdap (tetanus, diphtheria, and accellular pertussis) vaccine from a Pharmacist

A pharmacy is one of the most popular and lucrative businesses in Uganda so you find them all over the place. They are mostly owned and run by business people, rather than pharmacists.  Each pharmacy owner must have a pharmacist supervisor on record but the pharmacist doesn’t have to be present and currently there would not be near the number of pharmacists required in Uganda if this were the law.  For a population of just under 40 million people, Uganda has less than 800 practicing pharmacists.  This compares to about 300,000 pharmacists in the USA for our population of about 320 million.

Gonsha and Cathy at Joel Koos exhibit for the Wyoming Valley Art League

Gonsha and Cathy at Joel Koos exhibit for the Wyoming Valley Art League

Gonsha and Cathy clowning around in the decorated hallway at St Luke Lutheran Church Vacation Bible School- the theme was Mount Everest so it was decorted like a snowy wonderland

Gonsha and Cathy clowning around in the decorated hallway at St Luke Lutheran Church Vacation Bible School- the theme was Mount Everest so it was decorted like a snowy wonderland

I took Cathy and Gonsha to Yoga at Studio B in Danville, PA. We are pictured with Becky Duignan, the owner and head instructor

I took Cathy and Gonsha to Yoga at Studio B in Danville, PA. We are pictured with Becky Duignan, the owner and head instructor

Gonsha

Gonsha

tuwanakilisha

Gonsha

Gonsha

Cathy

Cathy

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Welcome to Wilkes University & A CPR Exam

 

Cathy and Gonsha prepare to take the CPR practical exam

Cathy and Gonsha prepare to take the CPR practical exam

It’s hard to believe we are already into the 2nd week of the Pharmaceutical Care Training program for Gonsha and Cathy.  Last week involved orientation to Wilkes University and the American Healthcare System as well has completion of a few assignments to help them get prepared for working at my hospital practice site, Wilkes-Barre General Hospital.  They have also been meeting lots of new people.  Obtaining CPR certification is one of the things they had to accomplish on their first day at Wilkes, in order to complete the credentialing process to allow them to work at the hospital, as for all of our pharmacy students.   CPR stands for cardiopulmonary rescusitation which is the procedure of chest compressions and rescue breathing that can save lives.  Cathy and Gonsha completed the online knowledge component before they came to the USA but once here, they needed to take a practical examination where they had to demonstrate the technique of CPR, how to help a person who is choking, and application of the AED, automatic defribrillator device, that is sometimes needed to save a person who collapse in cardiac arrest (where their heart has stopped beating.)  This exam Wilkes University Nursing Department’s simulation suite.  This is a series of rooms that have been set up to look like hospital rooms and clinics and even includes “dummies” that the nursing and pharmacy students use to practice direct patient care skills.  Some of the dummies are hooked to computers and they can be made to answer questions that the health professions students ask.  Also, their blood pressure can be measured and other vitals obtained like heart rate and respiratory rate. This is all controlled by a computer that the Nursing Faculty cause to do what they want.  Anyway, upon entering the Sim Suite, I could tell that Cathy and Gonsha were nervous and didn’t know what to expect. Although they both knew about CPR and had been exposed to the didactic components before, they had never gotten a chance to practice on a dummy to learn the skills of CPR.  I’m proud to announce, though, that they both passed with flying colors and left the center with smiles on their faces.

 

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First Impressions of the USA

Two happy Ugandans have safely arrived and passed U.S. Customs at Washington-Dulles Airport in Virginia.

Two happy Ugandans have safely arrived and passed U.S. Customs at Washington-Dulles Airport in Virginia.

Gonsha and Cathy arrived safe and sound in the USA yesterday. When we met up in the waiting area, they were all smiles!  When I travel to Uganda, we arrive late at night and although I’m so happy to be there, I feel like I must look like I’ve traveled for 24 hours. But, Cathy and Gonsha seemed as fresh as the moment they stepped on the plane. On our long drive home, my husband and I drove them through Washington D.C. to get a their first look at our Nation’s Capital.  From the car they saw the Washington Monument, the Capitol Building, many Smithsonian museum buildings, and the Jefferson Memorial.  We also drove them through the Gettysburg Battlefield memorials.

We stopped at a scenic overlook of the Potomac River on our way home from Washington DC but the trees had grown up so much that the river wasn't visible at this point. (KarenBeth, Gonsha, Cathy)

We stopped at a scenic overlook of the Potomac River on our way home from Washington DC but the trees had grown up so much that the river wasn’t visible at this point. (KarenBeth, Gonsha, Cathy)

Their first American meal was at a Friendly’s Restaurant.  Gonsha couldn’t believe how large the glass was that they served her Fanta soda in.  I’m sure this won’t be the last thing that seems really “large” in the USA.  I’m going to let the series of pictures tell the story of their first 2 days here. Some their first impressions:  Gonsha “I’m learning so much already!” “Everything is different” She was amazed at all of the different license plates on cars- in Uganda there are only numbers on the plates and no pictures. “The cars are so BIG”. She remarked on how well kept the homes and yards are. “It’s interesting how you can serve yourself at the Petrol stations- In Uganda there is always an attendant.”

At a Gas Station, Gonsha was impressed by the large American Red Cross bus fueling up opposite my car. She asked the driver if she could take a picture and it made me smile because that is what I do all the time in Uganda. She also found the automatic, self-pay fueling machines fascinating.

At a Gas Station, Gonsha was impressed by the large American Red Cross bus fueling up opposite my car. She asked the driver if she could take a picture and it made me smile because that is what I do all the time in Uganda. She also found the automatic, self-pay fueling machines fascinating.

Cathy “I’ve noticed that Americans don’t like the word “fat” but in Uganda “fat” is just a normal word we use to describe someone- the same way we talk about someone being tall or short” “Customs was so nice and more calm than expected (referring to going through U.S. Customs at the airport)” “It’s a lot greener, with trees and grass, than I expected. Most visitors come to Uganda and remark on how green it is so we thought it would not be that way here”

Clowning around on the balcony of their new apartment on the campus of Wilkes University. The view of downtown is beautiful and they were surprised how nice and large the space is. It is not furnished, except for beds, desks, and dressers, so I borrowed a kitchen table and couch as well as cooking supplies and eating implements from people from my church.

Clowning around on the balcony of their new apartment on the campus of Wilkes University. The view of downtown is beautiful and they were surprised how nice and large the space is. It is not furnished, except for beds, desks, and dressers, so I borrowed a kitchen table and couch as well as cooking supplies and eating implements from people from my church.

She was amazed at how large the Department of Agriculture was when we drove by it in Washington D.C.  “After seeing many farms (on the way home) and putting into perspective how big America is, I can see why that department would be huge. Just never thought America was big on farming.  Hollywood should do something about that….”

Lunch at Thai-Thai- we had a delicious meal after moving the furniture into their apartment at this Thai Restaurant in walking distance from Wilkes and where they will stay. (Gonsha, KarenBeth, Jeff (husband), Cathy)

Lunch at Thai-Thai- we had a delicious meal after moving the furniture into their apartment at this Thai Restaurant in walking distance from Wilkes and where they will stay. (Gonsha, KarenBeth, Jeff (husband), Cathy)

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Arrival Day in the USA

Today the culmination of planning and preparation comes to fruition as I eagarly await the arrival of Cathy and Gonsha, the two pharmacists from Uganda who will be training with me for the next 8 weeks. I can imagine what they must be feeling as they endure the last couple of hours of flight on their almost 24 hour trip here.  Neither one of them has been to the States before the same way I had never been to Africa back in 2011 on my first trip. I was so excited to see, hear, taste, touch, and feel the life and get to know the people of a totally new world and culture to me.  Yet, at the same time I was quite nervous- would I live up to their expectations, would my work be helpful and of adequate quality, would I be able to stay healthy and eat only safe well-cooked food, drink clean water, and avoid malaria, would I encounter language difficulties, would I get homesick, would my student have any problems adjusting….? Cathy and Gonsha’s worries may not be exactly the same as mine but I know they have some.  I’m pretty sure, though, that their positive emotions are coming out on top right now. One big difference between my first trip to Uganda and theirs to America, is that I had never met my hosts before. Today, as Gonsha and Cathy arrive, we will be reuniting as friends. I have worked with Gonsha at Mulago Hospital to help train the Pharmacy Interns for a couple of years now and over the last year, I have spent a significant amount of time with Cathy, a faculty member at Makerere University, to develop and teach the Pharmaceutical Care Skills Lab course.  So now, let me go greet my friends…stayed tuned over the next two months and follow along with me as you can experience the USA through the eyes and ears of two newcomers.

Now I’d like to introduce Catherine (Cathy) Namulindwa.

Cathy

Cathy

I strive to be a positive change-maker. I am passionate about changing the face of health care delivery in Uganda, especially through improving pharmaceutical care delivery. I have a leaning towards infectious disease pharmacy, as infectious diseases are Uganda’s greatest burden of disease. I am also passionate about empowering young adults in various spheres of life, in and outside the classroom. These two passions come well together in my job, teaching pharmacy students at Makerere University. Understanding the current limitations of both the curriculum and learning environment of her students, I labour to see that my students can translate classroom concepts beyond the abstract, into real life practice. Training at Wilkes will equip me to equip them better.

Outside work, I like to spend my time reading, doing some yoga, traveling and meeting new people, and singing in the church choir. My pass-time to do list includes acquiring a sewing machine and making my own clothes from lovely African prints, an interest carried over from my catwalk days.

I am so thankful that Dr Bohan and I crossed paths, and for this opportunity she and the Wilkes community have availed me to train at Wilkes. I am eager to improve my pharmaceutical care skills, I know it will make me a much better teacher, and a more well rounded health care provider. I am also looking forward to learning more about American culture from sources other than Hollywood, and making some new friends. I can’t wait!

Cathy

Cathy

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Exciting News: 2 Ugandan Pharmacists are on the way to Pennsylvania

Although this blog has been silent since the beginning of May, behind the scenes much has been going on.  Two Ugandan Pharmacists have been preparing to travel to the USA to work with me to complete an Advanced Pharmaceutical Care Experiential Training Program and I have been getting ready to receive them.  Cathy Namulindwa and Gonsha Rehema both are experienced pharmacists and have teaching responsibilities, to the Pharmacy Students at Makerere University and the Pharmacy Interns at Mulago Hospital, respectively.  During their time with me at my practice site, Wilkes-Barre General Hospital, they will learn new skills to help assess the medication regimens of patients and how to make recommendations to our physician team if any drug therapy issues are encountered.  They will gain experience evaluating the medical literature and using electronic drug databases to help them with clinical decision-making.  They will also get a chance to improve their patient and healthcare provider communication skills.  All they learn will be taken back to Uganda and used to help improve patient care as they teach other pharmacists to do the same..  Stay tuned to this blog to hear all about their adventures.

Now I’d like to introduce Gonsha Rehema.

Gonsha and KarenBeth at the Intern Presentation at Mulago Hospital

Gonsha and KarenBeth at the Intern Presentation at Mulago Hospital

I am a licensed Ugandan pharmacist with a Bachelor of Pharmacy degree and a Bachelor of Science with Education. This makes me a pharmacist and teacher at the same time. Currently, I am the secretary to the Intern Pharmacist training committee in the Pharmaceutical Society of Uganda (PSU). I develop the training curriculum to cover relevant topics to be taught across different disciplines. The training method I use is practical experiential learning with a few interns who in turn discuss the knowledge and skill with the other general interns. I go to the ward with two to five Interns to discuss the patient case. We find out if the patient is taking appropriate medicine for the disease, correct dosing, find out whether the prescribed drug is being administered and then look for other drug related problems like drug interactions and allergies. We research and put together a presentation with the interns and this is presented to the other general interns that did not go to ward. They also comment and give in their ideas. We then identify the gaps in pharmaceutical care and suggest possible solutions. The final recommendations and solutions are discussed with the doctor taking care of the patient. In most cases the doctor takes our advice and even changes patient’s treatment and as a result the patient becomes better and is discharged.

I also work in a Community Pharmacy, Extra Care Pharmacy, as the Managing Director. Some of the activities I engage in include training of staff, patient counseling and follow up, stock management, drug dispensing, prescription review, expiry date monitoring, Blood pressure management and monitoring, Pharmaceutical care, Referral of patients to both Hospitals and Doctors. We see more than 200 patients per day.

In my leisure time I go to the gym, visit friends, watch plays and movies and travel once in a while.

Gonsha and KarenBeth at another Intern Presentation at Mulago Hospital

Gonsha and KarenBeth at another Intern Presentation at Mulago Hospital

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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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