This in not an official U.S. Department of State (DOS) blog and the views and information presented are my own and do not represent the Fulbright Program or the DOS.
I spent Thursday with the Pharmacists and Pharmacy Interns at Mulago Hospital and participated in their weekly Continuing Professional Development (CPD) case conference. This is an event that is scheduled every Thursday from 12-1pm where the Interns and Pharmacists and occasionally Pharmacy School Faculty gather to discuss patient cases and learn from each other. This week, two Interns presented a patient who had been admitted for the treatment of Hypertensive Emergency and Exacerbation of Heart Failure. She was only 44 years old and her initial BP upon triage was 220/150! After the students presented, I helped to facilitate the discussion of the management of this patient and also introduced the new American Hypertension guidelines, JNC-8. In addition, I had done a little research prior and presented information about how the treatment of hypertension in the Sub-Saharan African population needs to be different than the way we treat North Americans or Europeans, the people who have participated in most of the research. Fortunately, this is reflected in the new JNC-8 guidelines. Lack of research on the population that is being treated is another barrier to providing appropriate drug therapy and medical care in Africa. The students in pharmacy and medical school here use the same textbooks and references we do in the USA- ones developed primarily using research study results on North Americans and Europeans. But, Africans don’t necessarily respond to the same drug therapy. Regardless, most of the initial drugs regimens are from those textbooks. Over the past couple of decades, there has been much research in Africa regarding the treatment of some of their most common diseases like HIV/AIDS and Tuberculosis and certainly the treatment of tropical illnesses. More recently, though, the incidence and prevalence of chronic illnesses like Hypertension, Heart Failure, Diabetes and Kidney Disease are on the rise but the research hasn’t caught up yet.
At the end of the Case Presentation and my talk, a drug wholesale company in Uganda, Wide Spectrum, treated the Interns to lunch. Prior to this, three pharmacists who work for the company as marketing representatives presented information on some over-the-counter (OTC) products they would like the pharmacists-to-be to keep in mind for patients with appropriate aliments. I found this extremely interesting and similar to the drug rep talks in the USA. The main difference was that Wide Spectrum brought a whole host of products to hand out and these included both OTC and prescription products, or at least what would be available only on prescription in the USA like antibiotics. The other thing I noted, once again, was the wholesalers took great pride on the fact that all of their products were manufactured in countries like Eygpt, Jordan, and the United Arab Emirates, as opposed to India. As I mentioned in a previous blog, in the USA we just take it entirely for granted that the drugs we dispense and take as patients are going to be safe and effective. No patient or even pharmacist would know or care what country manufactured the drug on our shelves. We have full confidence in the pharmacovigilence of FDA, knowing that the regulations are very tight and this watchdog is making sure the products for sale in the USA are what they say they are. Occasionally issues arise with impure products or sub-therapeutic drugs, but again, there is a very good process in place for notification of all pharmacies that purchased the product in question and drug-recall policies that assure patients don’t receive these drugs.