My first FIP World Congress conference was fabulous! It was full of valuable networking experiences both with new pharmacist friends from around the world as well as with colleagues from different parts of the USA. Below is a photo of new friends from a pharmacy school in Madrid. (Much more about that in a separate blog post- they hosted me for a visit there this week.)
My research poster presentation entitled Ugandan Third Versus Fourth Year Pharmacy Student Knowledge of Pharmaceutical Care was well-received and I enjoyed talking about this work with many people. This is from a new project that Dr. Erin Pauling, one of my pharmacy practice colleagues at Binghamton University, and I are working on with colleagues from Makerere University School of Pharmacy. Eight years ago I helped them develop a pharmaceutical care skills lab to augment their clinical pharmacy curriculum and they’ve been teaching it ever since. However they still have challenges teaching it due to lack of capacity with very few clinical pharmacy faculty so we are creating new video trainings to enhance it. (The first of those were developed during my last trip to Uganda not quite 2 months ago.) The poster discusses the results of the baseline knowledge assessment and student perception of pharmaceutical care skills. There is a QR code below the poster photo where you can read it in its entirety.
One evening, the Academic Pharmacy Section of FIP (AcPS) hosted a dinner for their members at a really nice restaurant in Seville. This was an extra special occasion because the AcPS is celebrating 50 years of being an official section of FIP. In addition, a colleague from University of Kentucky, Dr. Melody Ryan, and I were honored for our work at guest editors for a special edition of the Pharmacy Education Journal (PEJ), the journal of the AcPS. We have both been working on a committee within this section for the past 3 years focused on Promoting Scholarship in Pharmaceutical Education and this has resulted in a special issue of PEJ to highlight the work of the AcPS committees over the past few years as well as celebrate 50 years of AcPS. We also accepted other papers related to the mission and vision of the AcPS.
Greeting from sunny Sevilla, Spain! I’m here to attend the International Pharmaceutical Federation (FIP) meeting. This is my first FIP meeting and I’m so excited to attend with hundreds of other pharmacists across the globe. There are pharmaceutical scientists, pharmacists that work in both the community and hospital settings, and academic pharmacy educators. Today I went to the opening ceremony which was quite amazing. There were lots of speeches and welcomes from both the FIP staff and elected leaders but also from our hosts in Spain- the Mayor of Seville and the Minister of Health of Spain. We were entertained by Flamenco Dancers and a well-known Spanish vocalist with his band. The musicians were so entertaining and lively that I was dancing in my seat. I’m looking forward to the sessions tomorrow and the rest of the week.
The time has come for my return to the USA. When I came here I had specific plans but I knew that lots of things could potentially disrupt them. I was on a short time-line but was hoping I could complete the work of creating the Pharmaceutical Care Training Videos. My hopes were far surpassed. The training videos are complete and I’ve seen drafts of some. They are excellent and I believe they will make an even bigger impact to the student’s learning that I had even imagined. They even made an impression on the film crew director, David. He, Winnie, and I had a very candid talk today about how what we are trying to teach the pharmacy students is not in line with the current cultural hierarchy. When he watched the hospital video where the pharmacist had found a way to improve the patient’s drug therapy and interacted with the physician to explain what he recommended, David felt this was not what would happen in real life. To him it seemed like the pharmacist was telling the physician what to do but the physician is supposed to know everything, right? Winnie and I explained that the state-of-the-art in medical education is to treat the patient using a team approach. All of the healthcare workers have their expertise and when all work together the patient outcomes will improve. I explained how this is called Interprofessional Education (IPE) and at Binghamton, we have medical, nursing, pharmacy, and social work students interact in the classroom to learn what each other is trained to do and how we can contribute to the care of the patient. When they go on their experiential learning rotations, they interact together on real patients. For example, as a pharmacist I might want to know how the patient is doing over night, such as how well the pain medication was working and I will ask the nurse. The physician may want to know how many days of antibiotics the patient has been on from me, the pharmacist, so she knows if it can be stopped. Or I might identify an abnormal lab result which I can convey to the physician because it might have been caused by one of the drugs the patient is on. I work with the social worker to determine if the patient can afford the medication when they go home and if this is a problem, together we seek a solution. David will finish up producing the videos and get them to me next week via Google Drive. I’m eager to see them and use them in my classroom in the USA to teach my students about the Ugandan culture, as well have Winnie use them in her Pharmaceutical Care Skills Lab here.
This trip I have also met new friends and reunited with old friends. Although >2.5 years elapsed, since I was here last, it didn’t feel like that as I greeted my colleagues and friends. Everyone remembers me and we were able to pick up the conversation that we started back in January 2020. There have been changes to the roads and to the Mulago guest house, but almost everything else is the same. COVID took many Ugandans, one of them a physician I had worked with at Mulago National Referral Hospital, but the resilient Ugandans have bounced back.
I leave here with lots of new ideas for research and collaboration and a renewed vigor to continue the work we’ve started together. Improving health care in Uganda is an extremely slow process. We take several steps forward but then there will be a step back, however progress is moving forward. Winnie, Kalidi, Professor Odoi, Sam Opio and are doing great work here to further pharmaceutical care but what we need now is young Ugandan pharmacists and pharmacy students to get involved with our work and carry it on with us. This is going to require a deep dedication and passion to the work and most of the time there will be no compensation. The work truly brings its own rewards and down the road, the efforts you use to help improve the lives of others will always pay off. Winnie and I spoke today about how many of our pharmacy students don’t seem to have that internal drive and motivation to make the world a better place by working above and beyond what is paid for or required by coursework. Of course there are many compassionate students out there but to affect change, takes more than that. Every US pharmacy student that is accepted openly on ward rounds by the medical doctors is walking on the backs of those pharmacists who laid the paths for clinical pharmacy a very long time ago. Uganda is in the very beginning of clinical pharmacy. They need pharmacists to step up and go find physicians who want to work with us. No, they are not going to pay you. Yes, the work is hard and you will not always be appreciated, but there is someone who will- the patients. If you want a better life for your countrymen and your children, step forward. Seek out Winnie and Kalidi and tell them you want to join the effort. They will explain what they had to do and teach you the necessary skills. You are taught in years 1 and 2 in university alongside the medical, nursing and allied health students so go find a peer in one of those professions and tag along with them in the hospital. Learn about their challenges and find small ways you can help. Interact with their patients to do a medication history and if you find any issues, communicate them in a polite way and always a provide a possible solution. Talk to their patients and explain how to take the drugs and explain that a chronic illness like hypertension needs to be treated every day, even if you don’t feel sick. I think that often the nursing and medical staff don’t think pharmacist care about patients the way they do because we don’t go to the floors often. Show them you are different. My passion clearly shines through this lengthy message but if you have read this far, you get my message.
Today at breakfast I met a new friend, Benjamin Mukumbya. Ben is an amazing young man who is Ugandan but studying for his Masters in Global Health at Duke University in the US. He is here doing research regarding neurosurgery care in Uganda and aspires to become a neurosurgeon himself. I love to meet and talk to new people and Ben was the 2nd person to arrive at breakfast today after me so we sat together. Of course I asked how he came to study in the US and I was totally unprepared for his answer: Chess. Yes, that is right, he came to to US to study Chess. Now if you are a Ugandan or anyone who has done work here, this statement probably brought to mind the acclaimed movie hit that was filmed in Uganda back in 2016: The Queen of Katwe. So of course, I had to see if he was related to this movie. And he actually was. He is the young boy in the movie who was the librarian for the chess team—he kept the records. He graciously told me his amazing story. His chess mentor, Robert Katende, was using a sports ministry to reach kids through football (soccer) but noticed many didn’t aspire to play. So he decided to see if they wanted to learn chess. One of the girls he trained, Phiona, became a chess prodigy and even went to Russia to play in the Chess Olympiad. The original story takes place in 2009 so Ben was much older by 2016 but he said it was an amazing experience to be on the set while filming. As he was the person on the chess team that kept all of the records, the movie producers came to him for those records so Ben can vouch for the accuracy of the movie, regarding the chess tournaments. There was some additional stuff added like the dancing and the flood scene wasn’t as accurate as their floods usually were (their floods were worse), but overall the movie was quite accurate. I told him that I had a new found appreciation for those in the movie or journalism business from my work this trip filming the videos. The small cuts we see on the news or even full length movies take so much more effort and skill to create than I had imagined. Fast forward after the movie was made, Ben was offered the chance to go to Seattle with Phiona for more chess training at no cost to them. This was through the sponsorship of a company that trains children to play chess. Through this experience, Northwestern University in Washington State offered Robert a scholarship to do his Masters in Community Development and Phiona was also given a scholarship for university. Then, as Ben was in the right place at the right time, the President of that university also offered a scholarship to Ben. He went on to get his Bachelors in Biology and Pre-med. Wow! I was so pleased to have met Ben at breakfast today. We will keep in touch as I do with so many of the people I meet here. I know he will be very successful in his career.
11 August 2022 (updates 12 August to correct Sam’s district)
I had an exciting meeting today with Sam Opio, an elected Member of Parliament (MP) representing the Kole District of Uganda, which is in the North. His office is in the building across the street from the Parliament Building in downtown Kampala. Sam is a pharmacist and I’ve known him since 2012, when we met on my 2nd trip to Uganda. He served as the Secretary of the Pharmaceutical Society of Uganda (PSU) for many years and in that role was extremely industrious and passionate about advocating for the implementation of pharmaceutical care and clinical pharmacy in Uganda, to help improve patient outcomes. PSU carries out the regulatory function for pharmacy in Uganda (writes the registration and intern examinations) as well as is the professional organization for pharmacists in the country. It is like our USA NABP (National Association of Boards of Pharmacy) as well as the APhA (American Pharmacists Association) combined. He only left PSU a year or so ago to pursue his elected position to Parliament. Sam knows that to really effect change in Uganda regarding the policies and improvement of pharmacy practice and medicine’s use, you need a seat at the table. I enjoyed hearing all about the work he has accomplished so far as an MP for healthcare as well as his agenda for the future. He is only 1 of 2 pharmacists who are MP’s. He has a passion for improving health care but he also works hard to ensure a better life for his constituents in the Kole District. That area was know for its cattle ranching before the war. One of the things that has adversely affected the economic situation in this area, is the loss of 90% of their cattle during the war. I’m not sure which war he is referring to, but this has caused economic hardship. In his first year, he has been able to secure government compensation for some of this loss.
One of the issues before Parliament now is an act to allow organ transplantation. Currently, there is no option for organ transplants such as the life saving procedures of kidney and heart transplants that are common in the USA. If someone has kidney failure, they must try to live on dialysis or go to another country at a great cost for a kidney transplant. This is not an option for most people. Some external funding agencies are trying to help Uganda develop the capacity to do in-country organ transplants but they first need a law to allow it. If this becomes a reality, it will also have to come with the capacity to provide the immunosuppressant drugs that are crucial to keep the patients from rejecting the transplanted organs and those drugs often are dosed specifically for patients based on their blood level of the drugs. This is also a lab test that is not readily available in Uganda. So, there is much to change if transplants are to become an option for Ugandans.
We spent a good amount of time discussing the issue of Antimicrobial Resistance, which is a critical problem facing Ugandans. Antibiotics are dispensed over the counter without the need for a prescriptions and this is contributing to the fact that many of the infections are caused by microorganisms that are now resistant to most of the drugs that Ugandans have access to. People are dying on a daily basis because the antibiotics in the hospital no longer work. This is one of Winnie’s passion areas, to improve antibiotic use and decrease resistance. However, Uganda needs to recognize the importance of utilizing their pharmacists during patient care to help make sure the antibiotics prescribed are both necessary and the best for the patient’s infection. Most of the people in the position to recognize this role for pharmacists unfortunately see pharmacists only as dispensers of meds at the pharmacy or working to improve the supply chain of drugs. These are certainly important functions but there are pharmacists who want to work as a member of the healthcare team, at the patient beside, advocating for the rationale use of drugs and improving patient care. There are many pharmacists trained in clinical pharmacy in Uganda from either out of the country or at Mbarara University of Science and Technology’s Masters of Clinical Pharmacy program but no one is hiring them for this role. Winnie worked for 4 years as a VOLUNTEER at the Neurosurgery Unit at Mulago National Referral Hospital alongside the neurosurgeons who truly valued her assistance in helping to improve patient care but still they have not created this job position.
In the afternoon, I was able to formally hand over the Video Conferencing Equipment to the Department Head of Pharmacy, Mr. Robert Otto. Kalidi, Winnie, and I were able to get it up and working. I’m so excited about how this will advance our current research as well as enable other collaborations such as Binghamton Students learning with Makerere Pharmacy students.
Today we filmed the Hospital Pharmaceutical Care training videos at the new Makerere University Dentistry Hospital. This place was state-of-the-art and just opened in May 2022. The dental chairs are fancier than the ones my dentist uses at home. They kindly allowed us to use one of their procedure suites which contained a hospital bed.
Nickson and Paul lived up to their acting caliber on the first day of filming and we added another actor, Clovis Mawanda, 4th year pharmacy student. Clovis portrayed the patient who had a bandaged head secondary to head trauma. He technically had the easiest job which was just to lay in the bed, but I imagine laying still for several hours, was also tiring or at the least, very boring. In addition, he had powerful lights shining down on him the whole time. The learning goal for the videos today was to teach the pharmacy students how to communicate with a physician or other health care provider using the SBAR technique. This is a way to communicate the appropriate information in an organized way (Situation then Background then Assessment then Plan). In these scenarios, the pharmacist identified one or more drug therapy problems and wanted to offer the physician a recommendation about how to improve patient care for the patient.
Once again I thought these straightforward scenarios would not take long to film but not so. It was a bit shorter than yesterday, but the film crew needed multiple takes from multiple directions to create the best outcome. By the way, I had a sneak peek of one of the completed scenarios from yesterday, albeit a draft, and it was great! I’m excited for Makerere to use this in training. In fact, I might even use these videos to teach my students about pharmacy practice in Uganda and to give them a flavor for the culture.
This evening I enjoyed a delicious meal at the closest mall to Mulago Guest House, Acacia Mall. The restaurant is called Caffesserie and I me a brand new friend there. From time to time people reach out to me from reading my blog and a few years ago, a woman named Grace did that and told me she and her sister were living in the US but had been born in Uganda and her sister, Idah, is a pharmacist in Pennsylvania. Well we never got together until now when by a huge coincidence, Idah, Grace, and their families were back in Uganda visiting their Mom and family all over Uganda. Today I met Idah for dinner and we had a great talk both about pharmacy practice in the USA, the good and bad of retail pharmacy, as well as the practice of pharmacy in Uganda. It was a lovely evening and I’m so glad to have a new friend!
Today we filmed the Community Pharmacy pharmaceutical care videos at Extra Care Pharmacy in Gayaza, one of my friend, Gonsha’s, pharmacies. I can’t believe how well everything went. It was much more involved and it took much longer than I anticipated. There was a crew of 3 led by David Mulindwa. There was fancy lighting, lapel mics for the actors, and at least 2 cameras. It was all fascinating to watch but Kalidi, Winnie, and I had the easy part- watching the process. Thank you so much to our wonderful actors, Pharmacist Nickson Drabe and Pharmacist Paul Kakande. They had to repeat the scenario very many times so the camera men could get all of the angles, not because they were making a lot of mistakes. David explained you have to film the scenes from several angles to get the actors faces and make sure the lighting is just right. He will then take all of the segments of video and put together the best ones for the final film. I’m sure Nickson and Paul are now happy to be pharmacists and not actors as acting is hard work. Paul was portraying a very sick patient and by the end of the session, I’m sure he felt as tired and worn out as they patient he was playing. And Nickson had lots of lines to memorize and had to keep repeating over and over for each take but he stuck with in and I’m sure we will have a good outcome with the videos. Tomorrow we film the Hospital Pharmaceutical Care Videos.
On the way back to the Mulago Guest House, Kalidi invited us by his home for “tea”. “Tea” turned out to be a full meal which was super delicious. We had fresh squeezed passion fruit juice, rice, avocado, Irish potatoes, a mixture of peas and some other vegetables, fish fingers (fried fish in the shape of sticks or fingers), and a delicious beef sauce for the rice. We ended the meal with the sweetest, most pink watermelon I’ve ever seen and yummy Uganda bananas.
This evening I had the pleasure of meeting up with an old student from Makerere University Pharmacy School, Sam Twahirwa. He is now a PhD student at the University of Oklahoma in the USA. It is kind of funny that we both had to come to Uganda to see each other again, even though you we are closer in distance in the USA. But, as he has realized, the US is quite large. It would take me 2.5 to 3 days to drive to Oklahoma from New York. He is here for a short visit and then will return to go back to his studies.
I think I am showing my age with the title of this blog post. Who remembers that song? (produced by the band called the Bangles back in the 80’s) However, the title is fitting for today’s post. It was a fantastic day but a lot of “moving up and down” as my Ugandan drive, Haji, would say. Winnie and I started the day by attending a meeting at the Makerere University College of Health Sciences that was convened by the US Embassy and a visiting professor, Dr. Wing Kai from Bridgewater State University in Massachusetts, to have an open dialogue about how to attract more US Scholars and students from American Universities to your college. It was great to be able to participate in this forum. I got lots of ideas for my future trips with Binghamton students to Uganda. In addition, several Ugandan medical students spoke of valuable virtual experiences they have had with students from other countries and certainly that is even more doable. They spoke about how not many Ugandan students are able to go to the US for exchanges due to the cost but how equally valuable it is for them to learn from us in the US as for us to learn from the Ugandans. Makerere University hosted 60 American students last year but American universities only hosted 4 Ugandan- not a quite an equal exchange. Traveling abroad is a huge expense, even for US students, but Ugandans could learn so much and bring back those skills to help their own country. Helping to improve health care in Uganda is actually a way to improve the health of the world’s people. One only has to remember the Ebola epidemic of 2014-2015 in Western Africa to remember how close we were to having Ebola cross the world. That is a pandemic you DO NOT want to have. Ebola is a disease with >50% mortality rate. COVID has been bad enough but it is not as lethal as something like Ebola. Ugandan are actually quite good with their public health and identifying and controlling outbreaks. But, they can always learn more and improve.
After that meeting we went to the pharmacy school where I met up with Kalidi and we drove downtown to make some exciting purchases. To enable our collaborative research, I helped them purchase a video conferencing system and TV for their new skills lab area. This will enable me and Dr. Erin Pauling (my Binghamton partner in this research) to participate in their pharmaceutical care skills lab training from the USA. It will also greatly improve our ability to have meetings. I teach an elective this fall, Complementary and Alternative Medicine, which is a course that also covers cultural aspects to health care and traditional medicine. Each year I have Ugandan students, faculty or pharmacists come into my class by zoom to teach the Binghamton students about how traditional medicines and herbs are used in health and healing in their culture. I can’t wait to have them join us from the new skills lab room with the video conferencing equipment!
After returning to campus with the AV equipment, the team met with the pharmacists and students who will be the actors in the pharmaceutical care training videos. We went over the hospital scenarios and review the community ones again. Tomorrow is the big day- we will go to film the videos at Extra Care Pharmacy in Gayaza, a village on the outskirts of Kampala. This is one of 2 pharmacies owned and run by my Ugandan friend, Gonsha Rehema. Gonsha is one of the pharmacist who came to study with me in the US back in 2015. She is an amazing business woman and pharmacist. I can’t wait to see her! I’m also really eager to see how these videos turn out.
I spent a lovely afternoon with an old friend, Vicky Nyombi, and her family at her house in one of the villages outside the heart of Kampala. I’ve known Vicky since 2012 and she was one of the first pharmacists to participate in the Pharmaceutical Care 8-Week Experiential Training with me in the US back in 2013. She is currently working at Mulago National Referral Hospital. Like many people in Uganda, the house she and her husband, Nelson, built sits behind a large stone fence and to enter the enclave you go through a big metal gate. Once you get behind the gate, it is like you are in the countryside. The sounds of the city are left behind and you can relax.
Natasha, Vicky’s mother, and I enjoyed a nice conversation on the lawn in their comfy chairs. Natasha is Russian and is a Pediatric physician specializing in neonatology- the smallest babies. She has lived and worked in Uganda for many years. I also was able to meet Vicky’s youngest sister this visit, Katharine. She is a house attorney for a public company offering micro finance loans to groups of people at lower interest rates than they would get through a normal bank. Vicky served a feast of both roasted pork and chicken, salad, French garlic bread, tomatoes and avocado, and Irish potatoes. A funny thing about how they refer to potatoes here. The white round potato that we just call “white potato or just potato” in the states, they refer to as Irish potatoes and even more commonly, they just simply call them “Irish”. For example, if you wanted to order a side with your meal and they were offering a choice of items, they would say, “Do you want chips (fries), rice, matoke, cassava, or Irish”. The only other potato I’ve heard of hear is sweet potato. But, their sweet potatoes are not really very sweet and they are not orange.
6 August 2022 (apparently this wasn’t posted when I wrote it- just figured that out)
Meeting up with an old friend, Benjamin, was a great way to start my Saturday. Benjamin Mwesige is a pharmacist with an expertise in cancer treatment. When I met him years ago, probably back in 2014 or maybe even before that, he was the head pharmacist at the Ugandan Cancer Institute (UCI) and the most hard working pharmacist I had ever met in Uganda. He had a true passion for improving the health outcomes of his cancer patients. He would stay late, come in early, and advocate to the government for an increased budget to buy high quality chemotherapy drugs. He had to contact politicians and meet with lots of people but he made a difference and eventually he won his case and UCI was able to purchase better quality drugs. Flash forward to 2018 when Benjamin decided to start a PhD program in South Korea. I am always amazed at the lengths Ugandans go to further their education and Benjamin became interested in the biology of cancer cells. He was frustrated at the lack of effective treatment for the cancers his patients had and wanted to learn more about the behavior of the cancer cells. He knew that this is the first step to the development of more effective therapies. So he found a program in South Korea and with support from the UCI and then later grant support from the South Korean university, Benjamin set off on a 4 year journey to achieve his PhD Cancer Biology. He had to leave his wife and 3 girls for 4 years! He had planned to come back to Uganda every once in awhile but COVID intervened and he only made it back 1 time in 2019 and then got stuck in South Korea for the rest of his program. However, he is back after receiving his PhD in January 2022. He is now the Head of Research for the UCI! And he also has shared his training with 2 other pharmacists whom he brought to his South Korean university where they both received Master’s degrees and are now back at the UCI heading up the pharmacy services. Benjamin’s research was in modeling a specific intrahepatic tumor in mice (IMND), which he did successfully, and then was able to study the subtypes, mutations, and response to chemotherapy. He has also published his work which gained the interest of the University of Cambridge in the UK. Benjamin will be off to work with them as a Research Associate for 2 years where he will continue his work in their lab. The plan is then for the university to help him establish a similar lab in Uganda.
Today I met the pharmacists who will be acting in the videos, Nickson and Paul. I met Nickson a few years ago when I was here. I’m so glad to have their help. We went over the 3 community pharmacy scenarios we will film and they helped me to make sure they were realistic. They assured me I was on the right track. Over the weekend I need to finish up the 3 hospital scenarios so we can review them on Monday.
Shortly after I got back from the university today my trusted driver, Haji, brought me some little yellow bananas. He had remembered they are my favorite. They are tiny but pack great flavor. The are sweet but not too sweet as they have a little tang to them. I’m looking forward to the weekend. I may do a little shopping tomorrow and I’m seeing my old friend, Vicky, and her family on Sunday. Vicky is a pharmacist at Mulago National Referral Hospital and she spent some time with me in the USA for pharmaceutical care training back in 2013.
As we pulled up to the pharmacy school this morning we were greeted by the biggest ugliest bird you will ever see- a Maribou Stork. They eat garbage and are all over the Makerere campus. They are quite a sight to see.