22 September 2015:

The 4th Year students work together on a patient case in class- The Pharmaceutical Care Skills Lab

Time and the value of timeliness is one of the biggest cultural differences I’ve encountered since working in Africa. Most everyone has heard the term “Africa Time” or something similar. I’ll speak only to my observations in Uganda since all of Africa is not the same. Many Americans, though, lump the countries together and some aren’t even aware of the major differences among the African countries both in culture and location. Some don’t even realize that Egypt and Libya are in Africa- no they aren’t in the group of Sub-Saharan countries that we tend to refer to as “Africa” but they are on the continent- Africa. Ok, forgive my digression. Let me get back to TIME. I had come to Uganda a couple of times before I was referred to a book called “Foreign to Familiar” by Sarah A. Lanier. It is a small, inexpensive paperback book that I’ve found invaluable to both myself and understanding the cultural differences between Uganda and the Eastern Part of the USA where I’m from as well as for preparing my Wilkes Pharmacy students for their experiences here. The author explains how “warm” cultures, like Uganda’s, value people and relationships much more that timeliness and getting tasks accomplished where as “cold” cultures like the Northern Europeans and the areas of the USA which are similar, like Pennsylvania where I come from, value getting tasks done. An interesting example she gives in the book that I can easily relate to is the way one enters a store and asks for the location of an item. Someone from a “cold” culture will walk into the store, find the shopkeeper and simply ask “where can I find the XYZ”. In a “warm” culture, this would be considered downright rude. Instead, you are expected to enter the store and GREET the storekeeper before just jumping right in and asking for something. Although I am aware of this and have tried hard to act appropriately while in Uganda, a few trips ago I was entering the Orange (mobile and internet store) and I must have been frazzled from running around doing errands because I entered the store, went up to the shopkeeper and said straight out “I need to purchase some airtime.” Immediately I realized my mistake- the woman almost visibly stepped back, composed her shock at my forwardness, probably realized I must be one of those impertinent foreigners (she wouldn’t have probably known whether I was European or American because although I think I sound quite different in my accent than a Brit or Dutch person, Ugandans aren’t always able to discern the differences in our accents). Anyway, the shopkeeper said to me, “Good afternoon to you and how are you doing today?” It was immediately clear to me that I made a hugh faux pax. And this was in front of my students- not a good example. I immediately made right, apologized, greeted her, and eventually we got on with the sale. My point is that relationships are really important and always come first in Uganda. This is often why someone might be late to work or to a meeting. Someone in their family may have needed something that caused the delay. Still, I wonder if the lack of appreciation for showing up on time has gotten out of hand. Could it be that this is one of the reasons they find it hard to advance in certain ways? I certainly don’t think the American focus on tasks or timeliness to the detriment of family, and our workaholism is something I want Uganda to embrace, but sometimes it is a little frustrating- OK, a lot frustrating- when people/students don’t show up on time. I had once asked a Ugandan Pharmacist, after I realized that no one ever shows up on time for meetings, if school classes start on time. I mean, how can the teaching be adequate if the full class time isn’t able to be utilized. I was sincerely told, that “yes”, classes do start on time and when something like this is important, the students will show up. But, I have not found that to be the case. Last year and this year I am helping out to teach the Pharmaceutical Care course that I’ve written about previously but the students are not showing up on time, as they didn’t last year. It is supposed to start at 9 and run to 12 but yesterday, once again it was 9:59 and only about 11 of the 4th Year students showed up on time out of a class of 33. What am I supposed to think and do? If I go ahead and start and let the students trickle in, I end of re-explaining things or the students are just out of luck. I’m not sure they realize that I feel like their lack of showing up means they don’t value what I’m here to teach. It turns out that when I confronted the members of the class that had arrived on time, they told me that the rest of the class is not likely to show up because they have an exam scheduled for the next day. OK, well this sounds like a typical student thing to do, but I sure wish I would have known the reason earlier because I would have been able to start on time with those who did show. Once the class got underway, it went really well and the students present were fully engaged and I think they got a lot out of the class. My time at Nsambya and Mengo Hospitals was so fulfilling on Monday as I worked with Pharmacists and Pharmacy Interns who really wanted me to be there. And, yes, they were all there on time. The Intern who picked me up to go to Nsambya Hospital was in fact a few minutes early and I wasn’t quite ready. I have become so used to tardiness that I, myself delayed. Luckily, I was just about ready and we only left my place a few minutes late. And then the group I met at Mengo Hospital in the afternoon was also there on time and waiting for me to arrive. So, it is clear to me that sometimes the “Africa Time” excuse is just that, an excuse. When it is important, people can be on time. Today this very issue of Pharmacy Students and Pharmacy Interns came up again in two different conversations. Both the Pharmacy Administrator at Mulago Hospital as well as the Faculty of the Makerere Pharmacy School admit that the students and interns lack of punctuality needs to be addressed. Part of the problem seems to be the lack of holding the students or interns accountable for tardiness and absences. In the past, everyone has just looked the other way, possibly because they, themselves, can be late from time to time (or more than that). But, I think all are beginning to realize that for progress towards the implementation of Pharmaceutical Care to take place and for the rest of the healthcare workers to understand the role of the pharmacist and value what we do, punctuality, responsibility, and reliability are going to have to become priorities.