April 21, 2016

Today I sent the students with my driver, Sam, to go out with the TASO group (The AIDS Support Organization) on a community visit to deliver HIV medications and check up on the patients. I will let them tell you about that at another time. But today I got the chance to invite a Makerere University 3rd Year pharmacy student to come visit me at the Masindi Kitara Clinic (MKMC) and go on ward rounds. I met John last fall when I came to Kampala to teach the Pharmaceutical Care Skills Course. I knew right away he was a very bright student and he expressed an interest in Pharmaceutical Care (PC). The students and I ran into him again at Makerere University last week when they gave their presentations for the pharmacy students and he said that he had a job at Masindi Hospital and would actually be in Masindi while we were here. We agreed to  meet up- he thought he could show us Masindi Hospital and I could show him the MKMC. I asked permission at MKMC and with that granted, invited him to round with me and the Clinical Officer, Vincent, today on ward rounds.  MKMC is such a wonderful environment for great patient care and I want to share this model with any Ugandan healthcare worker I can find, so that they can see how their healthcare system can be improved and realize change is possible and great patient care can be a reality. MKMC is a system where all healthcare providers (HCP) work together to make sure their patients get the treatment needed so they improve. All healthcare providers are valued. Unfortunately, in the government system, especially at Mulago National Referral Hospital, there is a true hierarchy of “who is most important” in patient healthcare and physicians are at the top. Now, there are definitely some HCP who value pharmacists and want them to be on ward rounds and provide advice and suggestions about patient care, but it is not universally accepted.

John not only was able to rounds with us on the wards, but it turns out that he knows the local language, Runyoro, and could help with translation and was able to do the medication histories as we rounded. I was impressed with his willingness to speak up and he made several important comments.  I really hope that he and MKMC might develop a mutually beneficial relationship of some sort in the future, since he is going to be working right here in Masindi after graduation.

Lauren, Makenzie, Casey, Assunta, the nurse, and Dr. Bohan

In the afternoon, John invited us to Masindi Hospital. He showed us around the outpatient facility and asked a nurse, actually an ophthalmic specialist, to walk with us to show us the rest of the hospital. The structures were somewhat similar to Mulago Hospital, although the drug supply situation is much more dismal- and I thought it couldn’t get worse. Although the staff try to order for the drugs they need, they are constantly being shorted, hence supplies aren’t there when the patients need them. With my optimistic attitude I try to think that this must be a process problem and one that could be fixed if the government was aware, but I’m often told that they “just don’t care”.  But, one thing that was evident at Masindi Hospital that sometimes seems lacking at Mulago, is that the nurses and other staff really seem to care about the patients. Despite the limited drug supply, they try to do the best they can. I was assured that the nurses show up on all shifts and administer the drugs ordered on time.  John attested to their committment and passion. They even have a really nice poster on the wall in one of the nurses stations that reminds them of their duty to care for the patients. Another interesting facility design is that the women’s ward actually has double rooms instead of a ward just filled with beds. There is a concrete barrier between each 2 beds so that the patients have privacy.  Perhaps this was because a doctor had given the money and designed it in honor of his late mother or wife.  All in all it was another GREAT day!

Lauren, Casey, John, Makenzi and Dr. Bohan