Tuesday, 12 June 2018

This morning my day started very early.  Winnie had a meeting with the Executive Director of the Mulago Hospital scheduled for 7am to discuss the severe antimicrobial resistance problem they are having right now and to present some solutions that the Infectious Diseases Institute (IDI) can help with. I was waiting for her promptly at 6:45am but it turns out she got pulled over this morning by the traffic police on a routine check of having the correct and in-date driver’s permit. She had hers but the stop took a long time and when you don’t beat the morning traffic, you get stuck in what’s called a really bad “jam” (traffic jam). It can then take you an hour to go a couple of miles. These routine traffic stops are just one of the regular obstacles people deal with around here.  It is meant to help make the roads safer but ends up delaying everyone.  Anyway, things worked out, as they tend to do, and when we reached the appointment, the Executive Director was just arriving—he probably got stuck in the “jam”, too. He listened to Winnie and my ideas carefully and agreed with the Infection Control procedures we suggested and said to write them up so he could approve them.

A waterless hand soap station donated by the Duke Neurosurgery Team for a research project.  The sign explains in the local language of the central district, Luganda, the importance of hand washing and infection control.

This will allow IDI to come in and do a full work-up to find the source of contamination, if possible, and stop the spread. This will involve taking cultures from the healthcare practitioners and also swabbing and culturing equipment and beds, etc, on the wards.  They will also perform disinfection procedures.  One basic issue is that the bed linens are not washed and sterilized by the hospital. The patient’s family members have to wash them and re-make the beds. And they certainly aren’t sterilized. Also, something as simple as waterless soap stations or sinks with running water for hand washing in between patients that we take for granted in the USA is something that is not standard in Uganda.  Old facilities just weren’t created with sinks near the patients and even though there are some waterless soap stations on the walls, they were donated from a Duke University project and many of them are now empty. The hospital doesn’t have the funds to make this sustainable.

Professor Richard Odoi and KarenBeth

We then headed over, through the traffic, to Makerere University Pharmacy School where I was reunited with Professor Richard Odoi. It was so good to see him!  He has been collaborating with me from the beginning and my first research project assessing the water, health and sanitation endeavors of The Water Trust in Masindi, Uganda back in 2011.  We actually started our conversations via email back in early 2010, maybe even 2009.  Anyway, this trip I have brought a memorandum of understanding to formalize our relationship, Binghamton University and Makerere University. He will be taking it to the Dean of the College of Health Sciences for signing.  We also discussed possible next steps in the Pharmaceutical Care Research and hope to develop another project for next summer.

This is how many of the medical records are filed. No electronic records here!

Finally, we made it back to Mulago Hospital where we spent the rest of the day going through the paper medical records of the neurosurgery patients we need for the Phenytoin Study.  We found many challenges. First, the charts are not organized well but somehow the medical record staff know what they are doing.  They brought out this huge duffle-type bag (white bag in the photo) and it was labeled “neurosurgery”.  But, the charts were just stuffed in there in no particular order. It took about 5 of us to sort through them to find the patients that qualified for our study. They needed to be adults 18 years of age or older, they needed to have had neurosurgery, and they needed to be ordered Phenytoin.

The large white bag had neurosurgery charts piled in there in no particular order. The pharmacy student standing next to me is Sara, one of Dr. Melanie Nicol’s APPE students who is being precepted by Winnie.

Then we found out that the charts of the patients who had died were kept in a separate location and to pull those, we needed to hunt for an inpatient record number. Unlike in the USA where everyone gets 1 medical record number that stays with them their whole life, these patients get a new number every time they are admitted and old records are not pulled routinely to see what happened to the patient on the previous visit. We had to go to the neurosurgery ward to look through the ledger books to find more patients.  We met with the head nurse, called the “Matron”, and other nurses who dropped everything to help us find the correct ledgers and explained the codes.  We were then told that there may be more charts in the outpatient clinic, so tomorrow morning, the first order of business it to go there to look for more records.  The picture above gives you an idea of what the records room looks like. There are some files on shelves but they are just stuffed in there.  It’s a little bit crazy.  But I have to compliment the medical records staff. They know where to find what they need. It is kind of like my Dad’s old workshop. When you walked in there it looked like a bomb blew up but just ask him where something was, and he knew just where to go get it.