11 October 2016

Divide and conquer in the morning. Dr. Foote goes back to Mulago and the students head to a local pharmacy! – a post by Dr. Foote
In the morning, I walked over to Mulago hospital to meet with Gonsha, a pharmacist who supervises the pharmacy interns, and Joshua, one of the new interns. In Uganda, after graduation, pharmacists must complete a one-year internship in a hospital (similar to our optional residencies). Gonsha is pushing the interns to get into the wards and help the doctors and nurses rather than staying in the pharmacy dispensing meds. Since my area of practice is nephrology, Gonsha wanted one of the interns to present a patient case related to that during the normal Thursday pharmacy intern case presentations. So today, we met to help the new intern identify a good patient. We found a good case in the urology wards. I say “good” because the interns can learn from the case but sadly the patient is probably not receiving the care he needs due to limited access to medicines, proper monitoring and dialysis treatment. For example, this patient had a serum potassium level of 8.2 mEq/L. This is VERY high and would be an urgent call to the physician at home with immediate action to correct this level. The first line treatment includes insulin and glucose. These medications are available here BUT they do not have a way to easily monitor blood glucose levels – something that is absolutely necessary when using insulin in this setting.

Gonsha and Joshua outside one of the wards at Mulago Hospital. Some of the wards can be seen in the background

Fun Fact Nurses here are all called “Sister”. The first one or two times I heard it I thought maybe they were nuns but after a few times hearing this I started thinking that there can’t be THAT many nuns here. Then I thought it was a very general phrase to show general friendship or collegiality. In reality, the phrase “Sister” for nurses goes back to colonial and missionary times when many of the nurses, were in fact, religious sisters and the term just “stuck”. “Sisters” in Uganda still wear nursing caps.

While I was at the hospital, Winnie took the students to a pharmacy in the Acadia Mall. The Acacia Mall is a very modern mall in Kampala. As mentioned in an earlier post there are LOTS of pharmacies all over Uganda and a pharmacy does not need to be supervised by a registered pharmacist at all times (like it is in the U.S.). The students enjoyed hanging out with Winnie and learning more about community pharmacy in Uganda.

Jennie, Mike, Winnie, Emily and Nick at Ecopharm Pharmacy

In the afternoon we visited IDI, The Infectious Disease Institute, for a tour. IDI is part of the college of Health Sciences at Makerere University. IDI was created nearly 15 years ago at the height of the HIV/AIDS crisis in Uganda. The vision of IDI  is “A healthy Africa free from the burden of infectious diseases”. IDI provides direct patient care, education, research and capacity building services. While there has been much progress in the treatment of HIV/AIDS in Uganda there is much more that needs to be done. Too few people are tested for HIV in the county. The majority of transmission is through heterosexual contact by young adults. So a big emphasis needs to be put on prevention. Many more people are living longer in Africa with HIV because of greater access to medication. That is the good news. However, there needs to be more strides in decreasing the transition of the virus.

Next up for the blog tomorrow: A review of the movie “The Queen of Katwe”!