Stacy dispenses medications to a patient under the supervision of Pharmacy Intern, Vivian

Today was our last day at Mulago National Hospital as tomorrow morning we head for Masindi at 7am. We have all thoroughly enjoyed our time in Kampala and have made many new friends. It has been a joy to watch the relationships between the US students and the Mulago Pharmacy Interns and Makerere Pharmacy Students grow. They have definitely learned from each other. We have tried to model Pharmaceutical Care (advanced pharmacy practice where pharmacists assist prescribers and patients in managing drug therapy) as we rounded with the medical teams and worked with patients to make sure their drug dosages were correct and directions understood. An example is our interaction with the caregiver (daughter) of a patient at the hospital today. Her mother was just diagnosed with cancer and was constantly moaning while we were in the room. The daughter reported this had gone on all night. It appeared the patient was in serious pain but had no routine pain medication ordered. We went to talk to the medical team and they said that a palliative care consult had been ordered two days ago but when we went to seek out that team, they never received the request to get involved. We explained the situation and they said they’d “take it from there” so we went back to the original team to report our findings. We checked back an hour or so later and sure enough, the patient had been seen by palliative care and now had routine morphine orders and was resting much more comfortably. Lack of communication is not a problem unique to Uganda for sure; even with electronic medical records and our advanced technologies, communication regarding consults can get “lost”. This is just an example of a normal activity that a pharmacist can get involved in- helping to make sure that appropriate medication orders reach the patient.

Jeff and Stacy review a chart with Vivian and discuss the drug therapy regimen

Vivian dispenses medication and provides education to a caregiver for one of the patients; notice the beautiful outfit- I thought this woman might have “dressed up” to come to the hospital but I was told that this is her normal, everyday traditional garment.

Despite the lack of many drugs and lab tests that are readily available in the US, the Ugandan healthcare providers truly care about their patients and have learned to think “out of the box” and improvise as needed so their patients improve. More than ever I have personally realized that in the US we waste precious medical dollars on unnecessary tests. If we could just learn to listen more carefully to the health stories our patients tell us, we would be able to figure out what is wrong much of the time and streamline the tests we order to confirm diseases. For example, when a patient is clearly improving, is another CBC and BMP (blood count and chemistry tests) really necessary for monitoring and confirming, that “yes” this patient is indeed improving? We should be thinking twice before ordering tests and considering what we will do with the results we get. If the answer is “nothing different than we are doing now”, then is it really necessary? Definitely, care to patients in Uganda could be improved with a constant supply of drugs and testing reagents (no “out of stocks”) but I’m amazed at how well patients are managed under these difficult circumstances. Overall we have been very well received in Kampala; the medical team members seem to really appreciate our input and it appears that the pharmacy interns and students are truly motivated to learn new skills and provide pharmaceutical care. We leave Kampala with plans to see everyone once again on October 14, before we leave Uganda, as it is way too soon to say goodbye.

China-Uganda Friendship Hospital-Naguru with Pharmacist Vicky

Vicky and KarenBeth outside China-Uganda Friendship Hospital-Naguru (this hospital just opened in 2012)

Nikko, Stacy, and Jeff check out the new GeneXpert machinery at Naguru Hospital that can very quickly identify if the TB organism is in a sputum specimen, helping to make the diagnosis sooner to assure appropriate therapy more quickly.

A view of the Pediatric Pharmacy

Now, on to Masindi and many more adventures. Note: our travel tomorrow is long and we are getting up very early in Masindi on Sunday to conduct our first Blood Pressure screening, so it may not be possible to post tomorrow night- but no worries- I resume as soon as possible.