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 just finished my second full workweek in Uganda and I am very pleased with my experiences so far. I’ve been super busy teaching the new curriculum and working on the logistics of how the Pharmacy Rounds at Mulago Hospital will work. I’ve been precepting Pharmacy Interns at the hospital to help them learn more about how to best treat the diseases their patient’s have and I’ve been working with the Pharmacists at Mulago to figure out how they can interact with the Interns and Pharmacy Students to help facilitate learning. Today I spent the morning observing the 4th year Pharmacy Students’ presentations about the patients they saw at the hospital this week. Just in case you aren’t familiar with the concept of medical training and Case Presentations, this is a teaching method where the experiences of a few can provide education to a group because not everyone will have the chance to work with the same patients. All of the patient’s identity is removed from the slide set and it is not possible to recognize the specific patient by the students’ presentation.
I only had time to listen to 2 groups present this morning but I was really impressed with the effort put forth and the incorporation of the new skills they have learned in just my first 2 weeks of teaching. It is clear to me that these students really want to learn and they want to help improve patient care. Of course they missed certain points but overall, for the first presentation of the year, they were excellent. I was especially happy to hear how one group actively advocated on behalf of their patient. When they went to the ward to see the patient, she was obviously in pain and an intravenous pain medication had been ordered, but the nurses hadn’t been around to give it yet. They found the doctor and mentioned it to him but were told they would have to find a nurse and convince her to give the drug. This brings us to one of the “other” barriers and challenges I mentioned in a previous blog.
Given that Mulago is a hospital in a low to middle income community it is not a surprise that Nursing Care is greatly understaffed. Unfortunately this is a frustrating barrier to patient care with no easy or apparent solution. Patients often don’t receive IV medications on time and they can also be missed altogether because there aren’t enough Nurses to serve the thousands of patients they have filling the beds. It doesn’t help to get annoyed at the Nurses because they are generally doing the best they can. I suppose the obvious solution is to hire more Nurses but if it was that easy and the finances were there, it would be done. The compensation for Nurses is also poor, not unlike that for Pharmacists, although I’m sure is it much less than the Pharmacists. I think it is going to take a clear study of all of the factors that impact patient care for the Ministry of Health and Hospital Administration to realize all that needs to be addressed before improving the health outcomes of their patients and being able to assure sustainable high quality of care for all patients. It doesn’t matter if the hospital has the best doctors in Uganda, or if the Pharmacists are the most knowledgeable and skilled with the proper use of medications, or if Researchers from all over the world come here to offer advice to Physicians or provide some patients the most up to date treatment, IF the drugs aren’t available and/or if there are not enough Nurses to administer the medications. Patient care won’t be optimal until this is addressed.
Although this may sound dismal, the situation certainly isn’t. Patients at Mulago Hospital certainly do have access to better and more advanced care than is available in the rural villages, but there could definitely be improvements that could make a huge difference in healthcare outcomes for Ugandans. One of the learning points I’m trying to make with the Pharmacy Students, Interns, and Pharmacists, is that our active input into the appropriate use of drugs can help alleviate the situation a bit by making sure that the IV drugs that are available are saved for those patients who truly need them. Oral medications that are administered by the patient’s caregivers can be used when the patient is not seriously ill and when they have no vomiting and can take and absorb oral medications. In this way, frequent dosing with oral meds isn’t as much of a concern regarding missing doses, when a Nurse’s time isn’t required. For example, if IV medications are ordered for 20 patients on the Ward, but only 10 really need IV meds, if those patients could have their drugs switch to oral drugs, the Nurses may have adequate time to administer all of the doses for the remaining 10 patients.
I started out with the story of the Pharmacy Student’s interaction with a Nurse on behalf of the patient and it has a happy ending. The students were successful in facilitating the administration of the IV painkiller by the Nurse and their patient was feeling much better very soon. So, one patient at a time, the Pharmacy Students are making a difference!