Pediatric Ward Rounds at Mulago National Referral Hospital

Eating dinner at New Court View Hotel, Masindi, Uganda- it was a delicious meal

Eating dinner at New Court View Hotel, Masindi, Uganda- it was a delicious meal

Today was a travel day.  We packed up this morning and took off for Masindi around 3pm. We arrived safe and sound at 7pm. Most of us caught up with our sleep on the drive.  We will now be staying in cute little huts. Each hut is its own room.  We will be eating most of our meals outside in cabannas, which is pretty cool.  Everyone agreed our first night’s dinner was delicious.

A Blog Post by Hanna Raber, PGY1 Resident

I was fortunate enough to spend some time in the pediatric wards with one of the pharmacy interns, Ivan. After 4 years of pharmacy school the Ugandan pharmacy students graduate and then spend 1 year as a pharmacy intern working in a hospital. After intern year (which is similar to our rotation year except with a modest income) the interns look for jobs either managing community pharmacies or working in a hospital. I was really looking forward to being in the pediatric ward with Ivan as I knew that we would have the opportunity to participate in ward rounds. I was very excited to compare rounds here in Uganda with what I have experienced back in the United States.

Ivan is sitting on the right in the second row with the white coat. There is a Sanford's guide on the table near him.  He participated by answering questions from Lizzie's talk.

Ivan is sitting on the right in the second row with the white coat. There is a Sanford’s guide on the table near him. He participated by answering questions from Lizzie’s talk.

First to compare: rounds consisted of physicians (local and visiting), medical interns, medical students, and us pharmacy interns. The structure of rounds was essentially the entire group would go from crib to crib and discuss the patient as a team. Typically a medical student would present the patient to the group and it seemed that a medical intern (or resident as they are called in the States) would also be assigned to each patient and would fill in the gaps if needed. Then there would be some minor “grilling” of the medical student presenting conducted by the physicians. To contrast: there are about 20 patients all situated in the same small ward (as opposed to in the U.S where many patients have their own room or share with only one other patient). There is also a caretaker for each patient (a family member usually who is responsible for feeding, cleaning, and administering medications to the patients) and sometimes multiple other family members all crowded around the patient beds which are only a few feet away from the next patient beds. So to pack around a single patient to do wards was challenging with nearly 15 people on rounds. This means there would be quite a bit of background noise (you can imagine with 19 other pediatric patients and family members in the same room).That combined with the fact that Ugandans tend to be more soft spoken it was rather difficult to hear. However what I was able to hear was very interesting. One case there was a small baby with suspected downs syndrome. This could not be confirmed by genetic testing as we would do in the U.S and instead the medical students had to rely on signs from this 3 month old baby in order to make a diagnosis.
The most impressive part of rounds was being able to witness Ivan, the Ugandan pharmacy intern, participate as part of the medical team. He was asked multiple questions during rounds about availability and preferred regimens and he also spoke out multiple times with clarifications. He did an excellent job demonstrating to those participating in rounds why having pharmacists present is valuable to patient care. This was especially important because having pharmacists participate in clinical activities such as patient rounds is a relatively rare occurrence in Uganda (although a shift is happening thanks to the work of Dr. Bohan and other faculty at Makerere University) and not all physicians are used to utilizing a pharmacist in this way. Ivan had a thorough knowledge of what medications were available and was able to offer alternatives when the team selected an antibiotic that was unavailable or out of stock. This was very valuable to the team because they were instantly able to modify the treatment plan rather than order a medication that was unavailable and risk a delay in administration or even a missed dose. Overall it was a really great experience to spend time in the pediatric ward and to witness what a difference pharmacists are making here in Uganda.

About kbohan

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