Fond Farewell to Uganda

14 January 2020

The time has come for me to say “see you later” to Uganda and all of my old and new friends. I knew the 2 week trip would fly by and I’ve been so busy that I am returning home a bit exhausted. But, that is OK. The work was productive and has moved all of my projects along. I can accomplish so much more when here for a couple of weeks than months of email and WhatsApp phone calls from the USA. Those are fine with current partners whom I’ve worked with for years and know my motives and motivation, but to bring someone else on board, an in-person meeting is really necessary. How can they know much about me, this white lady, who has such grand ideas about improving pharmacy education and practice in Uganda when they hear from me by email? When in person, they can listen to my story and I can listen to their story. They realize I am sincere and have been working with Ugandans for years and I wish to have only mutually beneficial projects.

The leaving this time is very pleasant because I know I am coming back soon, for the Regional World Health Summit at the end of April. At this conference, I will be presenting along with others on the role of the pharmacist in improving patient outcomes in NCD’s (non-communicable diseases such as Diabetes, High Blood Pressure).

Sometimes the traffic jam, or just usually called “the jam” by Ugandans, is often bad when traveling from Kampala to Entebbe Airport. I have gotten in the habit of leaving Kampala early in the day when the jam is less and then I get to spend the day at the Entebbe Airport Guest House for the afternoon and evening. They have day rooms available to be able to take a nap or clean up and they have a delicious dinner served out on their beautiful lawn if the weather is fine. They will also take me to the airport at just the right time and from here it is just a 10min. The Uganda National Road Authority has now built a fast highway linking Kampala to Entebbe so the travel back and forth is much better, at least for the time on the highway. Right now they do not charge a toll, but the toll booths are built and the locals say the toll is coming. They don’t let boda-boda’s (motorcycle taxis) on this road and pedestrians aren’t allowed to walk beside it. And, even the matatus’s, the van taxis, don’t go on it because there wouldn’t be people to pick up and drop off. You can still run into jam on the way to the highway, but it is much less than before the highway was built. I definitely think this is progress!

My friend and Kampala driver, Haji, brought me to the 1000 Cups coffee house this morning on the way to the Airport Guest House. I’d been so busy, I didn’t have time before now to go out and purchase coffee beans to bring back. I love Ugandan coffee, as does the rest of my family and it has become a staple in my house. I can’t link to their website at the moment because they told me it is undergoing renovation but if you are in Kampala, and love coffee, you should try it out. You can reach them by phone: +256 772 505 619 (0772505619).

As I was getting back to the car with the coffee, guess who I ran into? An old Makerere University pharmacy student of mine, Sam, saw me and came over. I think I had called him Andrew but as I looked through my old blogs, I realized his name is Sam. During March 2014, when I was here for the Fulbright work, I had taken Sam, Linda, and Edel to Masindi to help me organize a blood pressure screening clinic. They were 3 of the most motivated students I was teaching at that time. Sam is now working primarily in community pharmacy but is still interested in the provision of pharmaceutical care to his patients/clients. Currently my projects on PC are within the hospitals in Uganda, but branching out to community pharmacy is very, very important, as they see many more people than the hospital pharmacists. They could positively impact the health of patients from NCDs if they provide pharmaceutical care. A challenge is that patients/clients don’t know how the pharmacist can help them and often are too busy to stay and learn about the medicines or the importance of adherence. Hopefully, once PC is implemented in the hospital, where patients are acutely and severely ill, we can start a project to train community pharmacists and a campaign to advertise to regular people about how a conversation with a pharmacist could help improve their health.

It is about time to leave for the airport, so farewell Uganda for now!

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A Visit to the Mulago Neurosurgery Ward

13 January 2020

These 2 weeks have gone quite fast. I’ve come to my last full day of work in Kampala and I packed it full of excellent meetings. This morning Winnie and I had the opportunity to present the research we worked on last summer to the Neurosurgery Department at Mulago National Referral Hospital. The title of the project was:  Phenytoin Dosing Practices in the Absence of the Availability of Therapeutic Drug Monitoring. It was a retrospective medical chart audit to characterize the current prescribing practices for this anti-seizure drug being use to prevent seizures in patients with traumatic brain injury. The work was well received and we were able to learn a little more background about how the drug doses were chosen which will be helpful when writing up the paper.

IMG_2184We then went to meet with the Dean of the School of Health Sciences, Dr. Freddy Kitutu. He has been in this position only a few months and we had a great discussion about the upcoming pharmaceutical care research project and the status of our current collaborative efforts relating to research, training/education, and community service. I’m not sure when I first met Dr. Kitutu, but it was either 2012 or 2013 on my first or 2nd Global Health-Uganda APPE (advanced pharmacy practice experience) trip with students from Wilkes University. He had finished with his Master of Clinical Pharmacy training and was one of the clinical faculty and now, just recently he achieved his PhD!

Then, while on the medical campus of Makerere University, we went to see Dr. Charles Ibingira, the Principal of the College of Health Sciences who I met back in 2014. He is the husband of my friend, Lydia, with whom I had Sunday brunch with last week. Dr. Ibingira is also the President of the International World Health Summit, and he is the host of the Regional World Health Summit in April, here in Kampala. I was also able to meet with Dr. Charles Batte, who is head of the organizing committee. They had just put up a beautiful banner announcing the conference so we were able to get a photo in front of it.

Then we trekked over to the main Makerere University Campus to the Pharmacy School to meet with the Head of the Department, Pakoyo Kamba and to also meet with Professor Odoi for the last time this trip. I was also able to briefly talk with Pamela Blessed who is a pharmaceutics faculty. She also spent 6 months in the US working with an old colleague of mine, Prof Art Kibbe, working on her PhD project of isolating a pharmaceutical excipient from banana. We forgot to take a photo today but I’ll add one from her time in the USA.img_6101

I ended the day having dinner with Vicky, who one one of the pharmacists who came to the USA for the short-term Pharmaceutical Care Training Program back in 2013. It was great to catch up with all she is doing. Currently she is the Pediatrics Pharmacist at Mulago Hospital. We also talked about our new puppies. This was a little unusual because most Ugandan’s do not have any use for animals as “pets”. They use dogs as  guard dogs and cats to eat the rats and other rodents. But Vicky has had both cats and dogs as pets and recently acquired a new puppy who is so cute!IMG_2201

I can’t believe my time here has come to an end. I will head back to the states tomorrow.

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A Day of Successful Writing

12 January 2020

My primary focus for today was to stay at the Mulago Guest House and WRITE. My collaborators and I are working on a manuscript regarding our projects Building Capacity for Pharmaceutical Care Education, Practice and Research in Uganda that is due in a couple of days. I just needed to do some last minute editing like make sure the references are formatted correctly and tidying up the tables and figures, but it took me all day long. There are 9 of us writing this paper and we’ve been working on it for months. It is gratifying to have it done!

On left:Dr Godson and son, Ethan, KarenBeth; On right Winnie, Dana, Racheal

Winnie in the Simulation Center at Binghamton University

The USP 797 Certified Sterile Compounding Room

Our unique DNA Sculpture in the Atrium of the Pharmacy School

Binghamton University Mock Community Pharmacy

Since I don’t have anything else new to report, I wanted to take this time to tell you about Winnie’s trip to the USA back in September. Dr. Dana Manning and Wilkes University School of Pharmacy sponsored her short, 2-week trip, to learn more about Pharmaceutical Care in the USA but I was grateful to have her spend time with me in Binghamton over a long weekend. On Friday she participated in a lecture about the different roles of pharmacists in a colleague’s first-year pharmacy school class (P1). Last year Winnie participated in that class by video conference on a day when Dr. Riley and Dr. Spencer had asked several pharmacists from all over the world to speak to the P1 class so it was great fortune that Winnie just happened to be in the states and could participate in person. On Monday, Winnie met with my Complementary and Alternative Medicine class and taught them about how herbal medicines (called traditional medicine) play a major role in the healthcare of many people in Uganda, even though they also use western medicine.

Here are some photos from her trip. Dr. Godson and his  wife, Racheal, are Ugandan and he is here doing an Internal Medicine residency with UHS healthcare system in Binghamton. I had first met Godson when he was the physician at Masindi Kitara Medical Center in Masindi, Uganda. I always enjoyed working with him and when he expressed interest in coming to the USA to pursue medical residency training, I gave him all the support I could. It is a miracle that he was placed with my local hospital and so when Winnie was here, we all got together for dinner.

KarenBeth’s husband, Jeff and Winnie

I also took Winnie on one of my favorite site-seeing trips—to the New York States wineries in the Finger Lakes. We all had great fun and Winnie got to experience the unique practice of bridal showers via tour bus through the wineries. These women were really happy to pose for a photo. I think they were as excited to interact with a Ugandan as Winnie was to see what kind of crazy fun American Bridal Showers can be.

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Visiting Friends

11 January 2020

This afternoon I had the pleasure of going out of Kampala to Entebbe to visit with Winnie and her family at her parent’s home. It is located right on the road to the airport but once you enter through a very tall gate, it feels like you are far away from the city. It was so lovely sitting on their porch. The flowers and greenery are beautiful!

We had a delicious meal of matoke, which is the mashed green banana, rice, macaroni noodles, Tilapia fish right from Lake Victoria, fried chicken, and red beans.  It was all delicious and even now I am still full! One thing about the local Ugandan food customs is first, they give you lots and lots of food, and second, it really sticks with you. I had a really great time talking with Winnie’s father, Edward, who is a retired physician. While we sipped wine, we spoke about all kinds of things. He was interested in what a usual meal would be in the USA as compared to the Uganda local foods. He asked if we purchased all of our food at the grocery store, which for me and my husband, is true for most foods. I mentioned we do like to go to the farmer’s market on Saturdays for vegetables and sometimes for free-range, organic chicken. He then said, “like the chickens we have running around here?” Yes- exactly. In the US, we pay a premium for organic, free-range chicken but in Uganda this is less expensive. He said they have a garden which he really enjoys and it provides a large amount of their daily food. Our garden provides us mostly herbs, but we did have success with our cherry tomatoes and peppers this year. He said that the little tomatoes grow wild here. We also spoke about the President Trump and all that is going on in the states. I’m always amazed at how the Ugandans follow our politics—much more than a lot of Americans. He knew all about the Impeachment proceedings and had watched it all on TV. He wanted to know what I thought would happen next and if Trump would win another term. Edward also wanted to know about how the flora and fauna in the USA differed from that in Uganda. I was able to show him pictures from my son’s wedding in Grand Teton National Park in Wyoming in 2018 so he could see how different the mountains are. We spoke about how climate change is affecting Uganda and the rest of the world. Currently, it should be dry season and very hot with only a little rain. Although it didn’t rain today, there has been a rain shower on many of the days since I’ve been here and the temperature is quite pleasant. I will have a rude awakening when I get back to the cold of New York, I’m sure.

It was a wonderful day and I sincerely thank Winnie’s parents, Edward and Rose for their hospitality. When my son Christian was here back in March, they met him and were so happy he is now a physician and in his Neurosurgery Residency. They want all of my family to come visit!

Left to right: Rose, Christian (now Dr. Bohan, MD), Dr. Edward Ssebatya, Winnie

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A Visit to Lubaga Hospital & Learning About TeleMedicine in Uganda

9 January 2020

The morning began with an excellent visit the the Executive Director of Lubaga, Dr. Andrew Ssekitooleko, the Principle Pharmacist, Dr. Michael Mubiru, and the pharmacist interested in pharmaceutical care, William Kalule. I love that they started and ended the meeting in prayer, which is quite common in Uganda even in a secular setting like the Makerere Pharmacy School. Also, they have a formal way of introducing everyone which show so much respect and sets the atmosphere for a collegial meeting. Winnie and I were there to explain the PC research to the ED and the principle pharmacist to see if they were interested in participating. We had a fantastic conversation about the role of the pharmacist and Dr. Andrew remarked how this could improve the quality of patient care and improve safety. Their hospital focuses on patient care, training and research and the PC project fits every area. We all left the meeting feeling uplifted and excited about the future!

We immediately headed to our next meeting. Early in my stay here in Uganda, I received a message through LinkedIn from the grants mHealth Project Manager, Dr. Louis Kamulegeya, of The Medical Concierge Group, a telemedicine organization in Uganda. Yes, healthcare workers and IT experts have partnered to develop a Telehealth organization. They started in 2012 and it is amazing to see their operation now. Dr. Louis had reached out to me because he had seen my blog post on LinkedIn, read about my pharmaceutical care work and thought we might have research interests in common. Winnie and I didn’t really know what to expect as we headed to this meeting but we were both interested to learn more about their company. You can click on the link above for more information but in brief, they provide healthcare via phone consultations with physicians. When needed, they send a laboratory technician to your home or place of business to obtain the specimen for lab testing. When the results are back, they contact the patient with those results and if a prescription is needed, the physician writes it and then it is delivered to the patient. They also have a state of the art Telehealth clinic where patients who need to be seen and examined are sent to have their vitals taken (blood pressure, heart rate, etc.). A nurse can place a stethoscope so the Telehealth physician, who is not present can hear the heart beat and the lungs and see the patient via computer or TV monitors. All of the patient’s information is kept in a detailed patient database, an electronic medical record, and can be referred to in the future should the patient need another consult. This type of service is only in its infancy in the US so I was completely amazed at what they are doing in Uganda. They also have an eStore, RocketHealth, a pharmacy, where clients can purchase over the counter meds and have them delivered. They can fill prescriptions written by outside physicians, too, but they CAN NOT get antibiotics and antimalarials without an appropriate prescription! I was so happy to hear this. In Uganda, and in many LMIC (low and middle income countries), antibiotics and other meds that would usually be available only by prescription in the US are casually sold without a prescription. This has contributed to the severe Antimicrobial Resistance problem that now exists in Uganda and all over the world. I was really impressed with the healthcare practitioners we spoke with today, including Louis, but also his partners, Dr. Davis Musinguze, Managing Director, and a Telehealth pharmacist, Dr. Paul Mirondo. Winnie and I were both so excited about all of the possible ways we could collaborate. Winnie was focusing on this organization as an opportunity for her pharmacy students to learn about this healthcare model and was asking if they would be willing to have pharmacy students or pharmacy interns be place there for experiential learning. I was excited to learn that they collect all of the patient data and it is housed in an eMR just waiting to be extracted and analyzed to look for ways to improve healthcare. To date, I’ve not worked with any hospitals in Uganda who have a comprehensive electronic database with patient information that could be used to determine what is needed to improve patient health care outcomes and to show how the pharmacist can be a part of the solutions to improving outcomes from NCDs (non-communicable diseases). In the US we call these chronic illnesses like high blood pressure and diabetes. In most of the rest of the world, illness is split into 2 categories: NCD’s and communicable diseases, which are infections like HIV, pneumonia, Typhoid, Malaria, etc. I’m not sure what collaborations will develop in the future but I’m sure there are ways we can partner. And regardless, I am so grateful to have learned about this organization!

After a delicious dinner at a Mexican place in Kampala, I went back to the guest house and Winnie went to a garage to check on her brakes in her car. Everything was fine until yesterday when her car started making scary sounds. She found out it was her brakes and hopefully they will be able to fix them soon. You really need good brakes in Uganda. There are many hills and steep grades. Even the parking ramps seem very steep at times.

A little later I had a visit from a Makerere University pharmacy alumni who was one of my students when I taught here in the past. It was so great to catch up with him! I remember his enthusiasm for pharmacy when I first met him in the canteen at Makerere Pharmacy School. I explained I was there to teach pharmaceutical care skills and he told me about his passion to develop drugs and go into the industry. I tried to turn him towards clinical care and he graciously said he’d consider it, knowing full well that drug chemistry was what got him going each day. He is currently doing well and working in one of the pharmaceutical industries in Kampala, Cipla.

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A Visit to the Uganda Ministry of Health and Other Meetings

8 January 2020

Today I went where I haven’t been before, the Ministry of Health (MOH). This is the government body that writes and regulates healthcare policy. They advocate for public health and mobilize resources needed to support healthcare providers and innovations/initiatives to improve health. It is the MOH who ultimately needs to be convinced how important the pharmaceutical care role of the pharmacist is to improving safe medication use and patient health in Uganda. It is not that they don’t know this – the pharmacists and other healthcare providers know that pharmacists are critical members of the healthcare team but they need evidence to be able to convince the rest of parliament to make policy changes and then support these with appropriations. Winnie and I were invited to speak with Dr Fred Sebisubi, the Pharmacy Commissioner at the MOH to discuss the pharmaceutical care implementation project. I had briefly met him yesterday at the One Health meeting but today we were able to succinctly outline my work over the past 10 years with PSU and Makerere University towards building capacity for pharmaceutical care (PC) implementation in Uganda. All of that prior groundwork has led to the currently project proposal and PC implementation research. It was a fantastic meeting and sharing of ideas and goals. The MOH has already begun work towards this as well and it is time to bring everything together.

I also spoke with Dr. Sebisubi about his role in the upcoming Regional World Health Summit (WHS) presentation. Behind the scenes while at home in New York last September, Winnie and I hatched a plan to propose a platform session for this conference to be held in Kampala in late April. Did you catch that? Winnie was a guest in my home for a long weekend in September!! She was actually hosted for 2 weeks in the US by Dr. Dana Manning and the Wilkes University School of Pharmacy, my prior university, and I was able to have Winnie stay with me for a few days in Binghamton, NY. She participated in a lecture in one of my colleagues’ courses on a Friday and gave a short presentation about the use of traditional medicines, herbal products, in Uganda to my Complementary and Alternative Medicine course. It turns out that Winnie is on the organizing committee for the WHS in Kampala and as we were sitting at my dining room table working on the PC protocol, she received an email calling for proposals for the conference. We recognized this would be a great opportunity to share our work. The idea behind the World Health Summit is to bring stakeholders from all sectors, civil service, public sector, academia, private sector, and government and policy makers, together to figure out how to solve healthcare challenges. Every proposed session has to include at least a few of these. Winnie and I had asked Dr. Sebisubi to contribute and we are thrilled he agreed back then. So today, we were able to present our ideas for the session, which was accepted, and discuss his role.

Before leaving the MOH, Winnie and I met with a friend of hers, Jimmy, a Biostatistician for MOH. He had lots of helpful ideas regarding the PC research and I’m so glad we were able to catch him in the office on the spur of the moment.

In the afternoon, we went to Nakesero Hospital, another private hospital in Kampala, to speak with the Principle Pharmacist, Esther Gasana. I wanted to speak with her to see if she and Nakesero are interested in participating in the PC study. Winnie had told me she is really interested in PC and our conversation confirmed this. I thoroughly enjoyed talking with her and found that she already does quite a lot regarding direct patient interactions and pharmaceutical care. The only factor holding her back is being able to find dedicated time for PC activities when she has full-time administrative duties. She has identified many ways to improve patient care and reports this out at the monthly staff meetings. She also has a very supportive Executive Director who is also encouraging the pharmacists to go on ward rounds. I’m so glad to have her on board for the study!

This evening, we met with the Secretary of PSU, Sam Opio. It was a great reunion as it has been 1.5 years since my last visit to Uganda. Although Sam’s professional pharmacy focus is the pharmaceutical industry, it is his vision for implementation of pharmaceutical care and seeing that it needed to be implemented in Uganda to improve safe medication use way back at our meeting in 2012 that has spurred me on and kept my work on track. He is one busy man but always makes time to see me when I’m in Uganda and tirelessly advocates for pharmaceutical care. It has taken many years, but the time is right to proceed with the PC research and PSU is, of course, in support! Sam will also be a part of the platform session at the WHS. It is shaping up to be an excellent session- Winnie and I are so excited!!!

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Successful Meetings

7 January 2020

Today was a GREAT day! This morning I had the pleasure of meeting with William, a pharmacist at Lubaga Hospital in Kampala. This is a private not for profit Catholic hospital and I’m hope to engage the support of the hospital executive director and pharmacy administration to allow 2 of their pharmacists to participate in the pharmaceutical care implementation project and collect and share their clinical intervention data. William was very interested in this research and has had many positive interactions with the other healthcare providers in the past. In fact, the physicians have asked for the pharmacy interns to start attending ward rounds to assist in drug therapy management and have frequently sought William’s advice about drug therapy. If Lubaga Hospital joins this project, they will be able to have systematically collected data over 6 months which will inform pharmacy practice and policy to improve patient care and health outcomes at their institution. The type of intervention data to be collected to show what pharmacists are able to contribute to the healthcare team include actions such as educating the patient about adherence, reviewing a medication profile for drug interactions, and utilizing lab data to assess kidney and liver function and recommend dosage changes of drugs as necessary to prevent adverse events. In addition, we want to assess the perceptions of patients and healthcare providers about the interactions with the pharmacists. Winnie and I will go back to Lubaga on Thursday to meet with William and the Executive Director.

This afternoon was spent observing a task force meeting of the One Health program in Uganda which is working towards reducing antimicrobial resistance in the country by improving antibiotic use in both animals and humans and implementing better microbial surveillance and infection control practices. One Health is a worldwide accepted concept that human health is connected to the health of animals and the environment. We have to consider all angles to improve human health. An example that many have heard of is that the antibiotics added to animal feed can cause microorganisms in the animals to become resistant to normal antibiotics, meaning they aren’t killed, and then when humans get infections with these resistant organisms it becomes very difficult to treat them. Below is a graphic from the CDC website to illustrate.

The meeting ran from about 2 – 5:45 pm and I was thrilled to have the chance to attend. I also ran into several Ugandan pharmacists I have worked with in the past, which was an additional treat! I was aware that over the past few years, the Ugandan government has had a large focus on antimicrobial resistance and it was great to see the work that has been done. In addition, I have a big interest in Infectious Diseases as I work with a couple of local hospitals and a colleague at the pharmacy school back home on projects to improve antimicrobial stewardship, which is the term we use to talk about how we have to use the antibiotics judiciously and care for them so we don’t lose them. Antimicrobial resistance causes us to lose the ability to have effective antibiotics. One big area that EVERYONE can help be a better steward of our precious antibiotics is to not pressure your physician or other healthcare provider to prescribe antibiotics when you have a cold, or the “flu” as they say in Uganda. Here the symptoms we refer to as a “cold” in the US like runny or stuffy nose (congestion), scratchy/sore throat, and cough are called “flu” here in Uganda. In the US, “flu” is what we call Influenza which has symptoms like high fever, severe body aches and pains, and cough. Regardless, both the common cold and influenza are caused by viruses and antibiotics DO NOT WORK! In the US, pharmacists and other healthcare providers advocate for every woman, man, and child to get the influenza vaccine yearly to prevent this infection. Unfortunately, there is no vaccine to prevent the common cold. The best prevention is to use hand washing regularly. When you get a cold, the best medicine is rest and increasing your fluid intake. You can also take mild analgesics for sore throat or mild fevers like acetaminophen or paracetamol as it is called in Uganda or even ibuprofen or naproxen. For stuffy nose, a decongestant can help. Your local pharmacist can advise you about specific products. But, don’t go to your physician expecting and insisting on an antibiotic. First, it won’t work, second, it will cost money for no good use, third, just like putting antibiotics in chicken feed, antibiotics we take can cause resistant bacteria to grow in our body. Then when we really do get a bacterial infection, the antibiotic may not work. By saving antibiotics for the bacterial infections that really need them, all humans and animals can have better health.

I ended the day by having dinner with Gonsha, whom I’ve known for many years now. She is one of the Ugandan pharmacists who came to the US to study with me back in 2015. She owns 2 pharmacies and they are both doing really well. Gonsha calls her pharmacies, Extra Care Pharmacy, which is what she provides to her clients/patients. She truly cares about her them. I remember one time that a patient of hers needed money for surgery and she raised the money for him. I believe he had diabetes and had a really bad infection in his leg and needed to have it amputated to save his life. She is a leader among community pharmacists and organizes a Whatsapp chat for pharmacists all over Uganda to communicate, share ideas, and assist each other with questions. She also has a Whatsapp chat group for her clients/patients. It was wonderful to catch up with her over a really good Funghi Pizza at Cafesserie, which is in the Acacia Mall. Yes, you can get really delicious pizza in Uganda.

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