This is a picture of the entire group, before Stacy had to head back to Pennsylvania last Saturday, at a lovely quiet restaurant on top of one of the hills in Kampala called Cassia Lodge. The view is spectacular and I always like to bring the students there early so we can watch the sunset over Lake Victoria

Before I move on to the post of the day I wanted to let you know all is going well in Masindi. We just spent our second day working with the physicians and medical staff of the Masindi-Kitara Medical Center and have already learned about a lot of new illnesses.  We have prepared a presentation for the staff which we will give a 8am tomorrow to provide education on some pharmacy-related topics they had questions about.  We were also able to have a brief visit with the medical director of the Masindi Branch of The Aids Support Organization (TASO) today to set up opportunities for the students to accompany the nurses on some community visits later this week and next.  Although Masindi is much more quiet and rural than Kampala, all of us are really enjoying the change of pace. There will be much more about our experiences in Masindi to come later.

Labor and Delivery:  A Blog Post by Lizzie Cook

(Since I’ve already posted the pictures of Lizzie giving her talk at Mulago Hospital, I’ve decided to post a variety of animal pictures, since she is a serious animal lover- even snakes.)

This praying mantus was perched on the ledge of Mulago Guest House near Lizzie’s room. He stayed still quite awhile and just looked right at us while we took his photo.

I spent the majority of my time on the Labor and Delivery floor of Mulago Hospital in a ward that specialized in handling postpartum complications, primarily infections post cesarean section delivery and management of HIV/AIDS in the mothers and their newborn babies. On my first day I attended ward rounds with a medical student from Makerere University and a physician who specialized on Obstetrics and Gynecology. I was very surprised how willing the physician was to have me along with his team and he made sure to quiz me about all of the medications we encountered, so it was a great learning experience. The physician I worked with was exceedingly knowledgeable, but I was startled by the lack of hygiene he observed between patients, palpating and inspecting a c-section incision of one woman, then proceeding to do the same on another woman without washing his hands or using hand sanitizer. While I was scared to speak out of turn at the time, after that experience I made sure to bring hand sanitizer and gloves with me on and offer them to all in contact with patients.

This small little guy is rather harmless to humans unless you try to squash him or brush him off your arm. It is called a Nairobi Eye and looks like an ant or fly but is in the beetle family. Today we were saved from getting a serious rash or burn from the toxin it releases when crushed. Dr. Godson spotted it on the ledge and pointed it out to us but stopped me as I went to “get it”.

I also worked alongside the pharmacy interns on the floor, Enoch and Lillian, to dispense medications to patients. There I learned about the numerous barriers pharmacists at Mulago Hospital face in facilitating patient care. Procurement of drugs is a huge issue, and many doctors will write scripts for out of stock medications, forcing the patients to either go without or send a family member to a local pharmacy to buy it. Additionally, documentation in patient charts is sporadic, the notes that physicians write are often not in chronological order, and there is no readily available medication administration record, among other things.

I had the privilege to address these issues in a formal presentation about sepsis at Pharmacy Rounds last Thursday with interns and pharmacists from Mulago Hospital. Lillian, Enoch and I selected a patient from our ward and presented her individual case as a team. After presenting the basic information, I lead an interactive discussion with the lecture hall about the pathophysiology, diagnosis and treatment of sepsis, focusing on interventions that pharmacy interns at Mulago can make to enhance patient care. Many students were eager to participate and all of them had innovative thoughts on how to remedy issues such as lost microbiological cultures, lack of vital sign documentation and irregular administration of medications, and how to develop alternative antibiotic regimens when drugs are out of stock.

This is the largest snail (or slug) I ever saw. It was on the front porch of the Mulago Guest House one morning just slowly creeping along. It was probably about 3 inches in length.