April 6, 2016

 

 On Tuesday, our 2nd day in Uganda, the team was priveledged to work at the Infectious Diseases Institute (IDI).  IDI was developed as an NGO (non-governmental organizion) within the College of Health Sciences at Makerere University in 2002 with a mission to strengthen the health systems in Africa. (http://idi-makerere.com/) Most of the initial work was to improve access to testing and treatment for HIV infected patients in Uganda.  Currently, as this has greatly improved since the inception of IDI in Uganda, their clinical work focuses more on the management of complicated patients with HIV. They still maintain a huge teaching and outreach program to train healthcare workers across Uganda and in other African countries. They also maintain a strong research focus and study drug therapy, drug interactions, the effect of other infections like malaria on HIV treatment and outcomes- basically anything related to HIV-so that patient care and quality of life can be maximized. 

The day began as we were welcomed to attend the regular weekly “Switch Meeting”. This is a multidisciplinary meeting of Pharmacists, Physicians, Nurses, and Counselors who meet to discuss the care and possible change of HIV medications for specific patients who are not improving and/or failing current treatment.  The room was filled and approximately 30-40 practitioners were present. After the Physicians and Counselors presented the patients, there was an open discussion. It was interesting to learn how social issues with the patient and his/her family could affect the patient’s response to drug therapy.  For example, a patient who usually is very adherent to their medications has a spouse that dies or becomes divorced which causes the patient to become depressed. This in turn can lead to forgetting to take his medications and I think most people know that HIV is not curable and to control the HIV virus so it doesn’t cause major problems for the patient, taking the medications on time and regularly is critical.  Even missing a single dose puts a patient at risk for the virus to become resistant to therapy.  So, if a patient starts missing doses of medication, their clinical condition deteriorates.  It take the team of healthcare practitioners working together to identify that this is an issue so that the patient can be helped. It was also eye-opening to realize that Uganda basically only has 1st and 2nd line drug options for their patients. So if a patient fails first-line therapy and then fails second-line therapy, there is not much more that can be done.  Some newer drugs that are readily available in the west can be purchased for a fee at local pharmacies, but they are so expensive that most patients couldn’t afford them.  In the USA, we have far surpassed the available options for patients in Uganda, yet, the regimens that are available here have made a huge reduction in the death rates due to HIV as well as have reduced the transmission rates from pregnant mother to child.  One of the components of the holistic care the patients receive that is essential to success of treatment is the counseling and support systems that are in place for Ugandan patients with HIV.  

 In the afternoon, the students worked on a project.  In September 2015, I met with IDI pharmacists, Eva and Julian, and a physician, Dr. Lamorde, to discuss a potential collaboration that would be mutually beneficial relationship for IDI and the Wilkes Pharmacy Students. So, for this trip, we decided that the students and I would help conduct a small chart review to look for drug therapy problems, specifically drug dosing issues in a sub-population of high-risk HIV patients. The IDI chose to have us look at the data for their patients with kidney problems (renal disease). The IDI is much more advanced that the national government healthcare system in terms of record-keeping and we were not only able to review patient paper charts, but we were also able to gather data from the computerized medical record.  The goal is to help IDI identify high risk patients that would benefit from a pharmacist’s review of their medical record so that optimal and safe medication use can be assured.  The students and I also hope to leave them with a renal dose adjustment policy or guideline so that they can begin this work on their own.  Since we are only in Kampala for 2 weeks and also have committed to work at other hospitals, we have our work cut out for us.  All in all, it was an excellent day!

PS:  One of the announcements made at the end of the Switch Meeting was made by Dr. Noela, as pictured above.  She reminded everyone that Thursday is World Health Day and this year’s focus is on Diabetes.  She encouraged all practitioners to educate their patients about the prevention of Diabetes. She also had a saying, that I think could be applied to many scenarios and I want to share it with you. “Sing the songs we’ve been singing, but sing them louder.”  I will remember this for the future as change in any context is hard and we, as healthcare practitioners, need to be persistent in all our endeavors to improve patient care.