10 October 2016

A Blog Post by Mike

Mike and Emily talk about how to behave professionally on Medical Rounds with other healthcare professionals in the Lecture Theater at Makerere University School of Pharmacy

Through my time in Uganda, one of the things that took some adjustment is the pace of life relative to that back in the United States. In Uganda, the tendency is for things to happen when they happen. Examples of this include students trickling into class after the official start time or people showing up an hour or two after work started when it is raining in the morning. I noted an entertaining encounter yesterday which helps to illustrate the situation.

A local who was driving stopped to talk to some boda boda (motorcycle taxi) drivers that were waiting for customers. A muzungu (foreigner) drove up behind him and impatiently laid on his horn. Normally people will beep to get someone moving but that’s usually a quick little beep to let someone know they are there- this was the angry New York City, full-hand smashed against the horn, blaring honk. The local driver slowly pulled out as he finished his conversation and the muzungu proceeded to angrily tailgate the local through the parking lot. Following this interaction I overheard one of the boda boda drivers make the comment, “This is Africa- there is no hurry.” This statement made me laugh as I have observed it to be true during my time here in Uganda. The boda boda driver saw me laughing and commented on how I understand how it is.

Today we had the opportunity to present to the third and fourth year Makerere University pharmacy students. Nick and Jennie presented on Medical Apps for smart phones that the students can use while practicing on rounds and in clinical settings. Emily and I presented on communicating with providers and how to organize a recommendation to a physician. These presentations went well and the students brought up some very good points during our discussions.

Nick talks about Medical Apps for smart phones

Following the presentations we were able to work with the fourth year students on their case presentations. We reviewed use of the mnemonic I ESCAPED CPR (for assessing the appropriateness of drug therapy) and how to incorporate the Apps and the information which they provide to make the assessment of the drug therapy. This process included using the Apps to calculate patient specific information and then reviewing the drugs to determine if dosing adjustments were necessary.

Emily talks about Medical Apps for smart phones

In the afternoon Dr. Foote presented on aminoglycoside and phenytoin dosing and monitoring. The pharmacy school had asked him to present on some aspects of the pharmacokinetics of these of drugs. The students were very interested in the process of monitoring these drugs and adjusting the medications based on the results.

Dr. Foote discusses the pharmacokinetic dosing of Aminoglycosides, an antibiotic

{Note from Dr. Bohan: although the students are very interested and they will likely be examined on this material and the calculations, the ability to do therapeutic drug monitoring is not very common in Uganda. Government healthcare doesn’t pay for drug levels and I don’t even think they have the equipment to do them. Patients could get drug levels done at private labs, but this is not affordable for most people. So it is important to help the Ugandan students to understand the limitations of therapeutic drug monitoring in their low resource environment and think of different ways to monitor drug use such as by observing patient symptoms for adverse effects and monitor for drug toxicity with lab tests that are available like Serum Creatinine for kidney function. I always want the students to learn Best Practices so they can advocate for newer drugs and laboratory tests but until those are available, their recommendations to the Physicians need to be based on what is possible in this setting.}

This evening we were intending to go and see the new Disney movie “Queen of Katwe”. This movie is about a young girl in the slums of Kampala who learns to play chess. Through her abilities she becomes a top player. The movie was both based and filmed in Kampala. Unfortunately, Monday is the cheapest night for movie tickets and the showing we wanted to see was sold out. Hopefully we’ll be able to make it there another evening this week. Instead we went for some gelato before returning to our guest house for an early evening.