The Road to Eldoret, Kenya: Off on Another Journey

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.

It has been a couple of really busy days but now, as I’m on the road to Kenya (more about that in my post for tomorrow), I will try to write a short or not-so-short update, in 2 Parts due to the length.

Part 1
My 3rd Pharmaceutical Care Skills Labs all day on Monday went really well. As much as I am here to teach, mentor, and provide a role model for pharmacists that are actively involved in improving patient care, I am constantly motivated and energized by the students I’m working with. These Makerere University Pharmacy students are clearly hungry for the clinical skills I am teaching them. I have their rapt attention, even during the lecture sections. The best part, though, is to see them role-play the scenarios. They really get into it and are able to help me to better understand the common barriers and responses of Ugandan patients. This leads to the questions I ultimately want them to answer and situations I want them to be able to manage involving helping real patients to better understand their medications which leads to better overall health. Although some Pharmaceutical care content could be taught in a large lecture classroom, the beauty of small groups working together to enact scenes from real life helps them to learn how to manage real patients. People don’t always listen to your advice and often patients think they know what they need. But, as a healthcare professional, just giving the patient what they asked for is not always in their best interest. This week’s lab was using patient care skills in the outpatient treatment of malaria. I chose this disease state because I knew every student would have life experience with this disease- just about everyone growing up in Uganda would have had a personal experience with this nasty disease, and may have had many episodes. Now they are in a professional program to learn to be a Pharmacist, so although they have some knowledge from the past, it is time to put this into perspective, use evidenced-based medicine, and learn about the importance of trying to make a definitive diagnosis of malaria using rapid drug testing in the outpatient setting, rather than just treating someone who has the symptoms. Treating for malaria when it is another infection can delay the right treatment and patients can deteriorate and then need more costly care in the hospital or with expensive antibiotics. I was trying to make the point that it is now time for them to learn not to just follow the common practices they are familiar with such as dispensing antimalarials on patient request when the diagnosis hasn’t been confirmed. Another problem with doing this is the emergence of resistant malarial parasites which is already occurring. If they don’t start to “be the change” now, there may be a time when malaria becomes even more difficult to treat, especially for poor patients when the cheapest drug no longer works.

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Monday evening I had a lovely dinner at a restaurant that is new to me, Emin Pasha, with one of my good friends in Uganda, Benjamin, whom I’ve known since summer of 2011. He is the head pharmacist of the Uganda Cancer Institute and is one of the most proactive and energetic pharmacists I’ve ever met, including those from the US, in terms of working towards the improvement of patient care. When he noticed that the oncology drugs from the National Drug Stores didn’t seem to be effective, he investigated and successfully advocated for the ability to purchase from suppliers that had superior products. This is not an easy process in Uganda. It took dogged persistence and letter after letter and meeting after meeting before he was successful in significantly increasing the drug budget over the past several years to better serve his patients. Benjamin also develops a personal relationship with his patients whenever possible. He meets with patients to explain the chemotherapy and ease their worries. I’ve know him to go to great lengths to track down a patient to find out why they didn’t come back to get their next dose of chemo because he knew the patient had a curable cancer, if proper treatment is received. It is so sad to see people succumbing cancers that are easily treated in the developed world, like cervical cancer, because of lack of access to good detection and prevention and early treatment strategies here is Uganda. He will even learn to perform tasks that aren’t usual for pharmacists, like dressing changes, when he realizes the nurses are too busy to do it and no matter what antibiotics he gives them, the infection won’t be cured if the wound isn’t clean. I could go on and on about the ways that Benjamin is a great role model for pharmacists in training- he is proof that change is possible, even in this difficult environment. As you can tell, it’s always a joy for me to talk with Benjamin- he also motivates and inspires me to continue my involvement in this endeavor to advance pharmacy practice in Uganda.

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About kbohan

Professor and Founding Chair, Department of Pharmacy Practice Binghamton University School of Pharmacy and Pharmaceutical Sciences Binghamton, NY USA
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