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 yesterday working on planning the next steps in the process to Advance Pharmacy Practice in Uganda. The Professor and I have had numerous talks during this trip and in prior ones, but now the time has come to put it down on paper and start seeking approvals from the appropriate stakeholders. I’m so happy to say that the first conversations have started off well. The biggest part of the plan that needs both approval and funding is the need to develop the skills of practicing Ugandan Pharmacists who can then begin to work in the healthcare setting to develop a clinical practice site. A Clinical Practice Site is a facility or even just a ward of a hospital where a Pharmacist’s job description provides for working directly with the patients, physicians, and other healthcare providers for the purpose of improving patient care outcomes. These duties do not include administrative work such as managing staff or the drug supply chain management, and often don’t include basic dispensing. The latter can be done by trained support staff and the former is best accomplished by Pharmacy Administrators who have been trained in Management. Preferably this practice site will be Mulago National Referral and Teaching Hospital for a number of reasons. First, it is the largest teaching hospital in the country. It is also the primary training facility for all healthcare providers; it is in Kampala, and perhaps most of all, I believe small and easy changes that Pharmacists can implement will make a huge difference in the care of patients and will also reduce drug expenditures. The things I’m referring to include activities like talking with and reviewing the patient’s medical charts to be sure their drugs are given in doses that are appropriate to treat infections or other conditions without putting the patient at risk for toxic effects. Pharmacists can evaluate patients and determine their risk of developing other problems in the hospital like blood clots (DVTs), stress ulcers, and new infections and can recommend therapy to help avoid these. Acquired additional problems while in the hospital are one of the main reasons patients can have prolonged length of stay, which puts a drain on the healthcare system and is also not pleasant for them. Pharmacists can help manage the blood sugar of diabetic patients so that high blood sugar doesn’t impair healing or a quick recovery. One of the most important things that I have a special interest in is the appropriate use of antibiotics, called Antimicrobial Stewardship. If Pharmacists were allowed the time to help Physicians both make decisions about initial antibiotic therapy and also changing therapy based on the culture results and the patient’s response, not only do patients heal faster and go home but the hospital can also save money and drugs for the patients that need it. It is quite common for Mulago to run out of certain antibiotics or other drugs and have gaps of days to weeks, at times, before the drugs are restocked. If drugs were used more appropriately in the first place the supply shortages would be diminished.
I want to be clear that I am not saying the Physicians or other healthcare providers are making wrong decisions or don’t have the abilities to do these things but that as we’ve clearly learned in the USA, the best healthcare is provided when there is a team approach with many healthcare providers looking out for the patients in the special ways we are trained. Doctors have traditionally been the lead manager of the patient’s illnesses and this is still basically true, but as any CEO or Executive Director relies on the expertise of his well-chosen staff around him to help advise him on important decisions, so can the adjunct healthcare professionals such as Pharmacists, Nurses, Therapists, Social Workers, etc. play a very important supportive role. In the USA, we have many cases where Pharmacists even take a larger responsibility for the management of certain healthcare problems for patients who require regular medications for chronic diseases such as Diabetes, Hypertension, Heart Disease, etc. Again, our role is in no way to supersede the Physician or diagnose such conditions. We act in a supportive role to provide more time for the Physicians who have to see large numbers of patients a day in their practices or at the hospital. Instead of the Physician having to take time educating the patient about medications or helping to figure out how the patient can manage to pay for drugs the government isn’t able to provide, the Pharmacist can do this. And when patients simply can’t afford drugs, the Pharmacist can help identify alternatives for the Physician. All healthcare providers have different areas of expertise and only when this is leveraged using a team approach (commonly called Inter-Professional Practice), will patient health outcomes be improved.
So to start working towards developing the skills of already practicing Pharmacists, you may remember, if you’ve been following my story for awhile, I along with a partner faculty member at D’Youville School of Pharmacy in NY, hosted 2 Ugandan Pharmacists in the USA for 8 weeks in the fall of 2013. They participated in an advanced Pharmaceutical Care Experiential Program where they worked with us at our hospitals to learn the role of a Clinical Pharmacist and the skills to do this back here in Uganda. Both Pharmacists, Vicky and Patrick, found the program quite worthwhile and highly recommended it be repeated in the future. (See blog entries from March 2014 for more information.) Because the FSP Grant brought me to Uganda for 3 trips this year, the program hasn’t been repeated yet. Last night, though, Professor Odoi and I had a very successful meeting with Sam Opio, the Secretary of the Pharmaceutical Society of Uganda (PSU). This meeting officially launched the planning stages, pending final approval from my Administration at Wilkes University and the Council of the PSU. The plan is to again bring 2 Ugandan Pharmacists who have some knowledge and skills in Pharmaceutical Care AND a passion for working with Patients and other Healthcare professionals to the USA for 8 weeks to work with me at my hospital practice site in Wilkes-Barre, Pennsylvania. This would take place in June and July 2015. In addition, we are hoping to find an opportunity for them to put the new skills to work right away upon return to Uganda in a dedicated Clinical or Ward Pharmacist positions. This is still preliminary but I’m hopeful for approval by all parties so we can start to seek candidates soon. Keep your fingers crossed for us. 🙂