A Blog Post by Kristen Konosky
I spent the majority of my time between two pediatric wards, but I was also able to spend a day each in endocrine and solid tumor at UCI. At all the sites, I was able to round with a varying team of physicians, nurses, medical students, and intern pharmacists. The teams I worked with were all am
azing and welcoming and happy to teach me and ask questions of me whenever possible. I chose to spend most of my time in pediatrics because it is not an area that I have dealt with at home and the challenges here are many, though they are similar and different than those at home. It was great to get some experience in pediatric dosing, but it was difficult to see such small children with sickle cell disease, malaria, HIV, pneumonia, and often a combination of those diseases.
At the Ugandan Cancer Institute, I was able to see several types of devastating tumors. It was really heartbreaking to see the overflow of patients that resulted in lying on mats on the floor. The unit was so small that patients were forced to lift the edges of their mats up so the team could get by with the cart. I was also surprised to learn that the most common cancer in women here is cervical. In the USA, the HPV vaccine is readily available and can help prevent cervical cancer but often patients refuse it because of stigma about a common sexually transmitted infection or propaganda against vaccinations. I was able to learn a lot from the team at UCI and took away a very valuable learning experience.
My day in the endocrine ward was truly eye opening. As someone who works in community pharmacy and just coming off an ambulatory care rotation, I felt confident about my knowledge of diabetes management and the available options. I, of course, anticipated that healthcare would be very different here in Uganda, but I was hopeful that my experiences would translate well. I walked into the ward and began rounding with the team, only to find that most patients were hospitalized to manage diabetic foot infections. Many of the patients had been on the floor for more than a month with infections taking over their entire toe and foot area, some down to bone. I found out from the team that these patients had been receiving antibiotics for weeks and still were not seeing improvement.
One of the many challenges faced is that drugs are not reliably available and often Doctors write for antibiotics the pharmacy doesn’t have. Rather than try to get a medicine changed, patients with little to no money would be told to go buy them from an outside pharmacy. During rounds, the doctors would look at charts and assume the caregivers were able to get the medicine and that patients have received doses as prescribed, but rarely would they speak to the caregivers or nurses and ask if doses had actually been given. This issue may be a contributing factor in the number of patients not improving.
When I asked about patients’ insulin regimens, I was told that many patients followed the same rarely adjusted dosing of a 70/30 mix given twice a day. Patients did not have money to afford glucose monitors or supplies to check their sugar regularly or at all, and would wait until their infections were too far gone to present to the hospital. This was really difficult for me to see because at home in the USA many patients receive free monitors, are told to check their glucose and check their feet regularly. They can get specially fitted diabetic shoes and free classes to support a healthy diabetic lifestyle. American patients are often given all the tools to manage their care, but make excuses to not test because they don’t like pricking their finger or just have to have those fast food meals. Most Ugandan patients aren’t even afforded a chance to help themselves.
Mulago provided great opportunity to see the differences between healthcare here and at home and really made me appreciate what we have in the USA. I was able to see intern pharmacists successfully joining the team and saw many opportunities for a clinical pharmacist to reduce medication errors and improve patient care. These past two weeks really helped to encourage the work that Dr. Bohan and my fellow students are doing here and I can only look forward to the next three weeks!