Wednesday, 13 June 2018
I slept really well last night and enjoyed getting up a little later and the delicious breakfast at the guest house. I always love the fried potatoes and onions they make in Uganda. They call these “Irish Potatoes” as opposed to the other common potato which is called a “Sweet Potato”. Actually, if someone wants the Irish potatoes which are normal white potatoes, they may say “I’ll have some Irish.” If a Ugandan came to the USA and asked for sweet potatoes they would be in for a big surprise. In Uganda, sweet potatoes aren’t orange and they aren’t very sweet. They look basically like a peeled russet potato and they are gray when cooked. In the USA, sweet potatoes are orange on the inside and are more sweet than the Ugandan version.
Today we planned on spending most of the day recording data from the patient charts but we made a stop by the Neurosurgery ward first, and the head consultant, head Neurosurgeon, insisted we help out on rounds. He was doing teaching rounds this morning, called Major Ward Rounds, and he and the other surgeons have come to rely on Winnie’s expertise in terms of making sure the patients are receiving the drugs that are ordered and making recommendations about antibiotics and other therapies. A Global Health student for Western Canada also joined us for rounds. She is here for her Global Health Program but is interested in pursuing a pharmacy degree so Winnie is going to let her observe. Rounds were quite interesting and I saw very quickly why they rely on Winnie. Many of the patients had drug issues. One major issue is that the Neurosurgery ward has very few drugs. Most of the patients had to send family to purchase their medications at the local pharmacies. And when they can’t afford them, they go without. Winnie always looks at the actual drug products and asks how the patient is taking it. In one instance, the pharmacy labeled the medication envelope (they don’t put the tables in vials as we do in the States) with “phenytoin 250mg – 1X1” but clearly the capsules in the envelope were labeled phenytoin 100mg. The 1X1 means the patient is to take 1 capsule once a day. But, the doctor’s order in the chart read “phenytoin” 300mg OD. This means the doctor wanted the patient to have 300mg which would be 3 capsules of 100mg and these should be taken once daily. How did the pharmacy get it so wrong? Well, probably because most drugs are dispensed by non-Pharmacists. Although a Pharmacist must be the supervisor of the store, they do no need to be present to dispense drugs. Much of the time, non-medically trained people are hired and trained on the job to dispense the drugs. For a country (USA) where you can’t even open a pharmacy if the Pharmacist is not present, this is just a bit scary. It is fortunate the patient didn’t have seizures because he was only taking 1/3 of the required dose. Winnie spoke to the patient’s family member and changed the directions on the envelope and explained the correct dosage. In another situation, Winnie was asked to recommend and dose an antibiotic for an infant, and in another we recommended discontinuation of an antibiotic when infection was no longer present.
We finally made it to the records room and spent a couple of hours collecting data. In the afternoon, we went to the Pharmaceutical Society of Uganda (PSU) offices for an Education Committee Meeting. I was invited to attend to discuss the USA PharmD Program. This committee has been tasked with making a recommendation about whether Uganda should develop a PharmD program and they’ve been talking to Pharmacists trained in these types of programs all over the world. They had a Pharmacist trained in Algeria these who spoke about his program and some others. It was so interesting that despite the common name, these programs all different. I also explained to them about how our Continuing Education programs to maintain our licensure works. They have a requirement that all Pharmacists complete programs yearly but there are not specific numbers of credits or hours right now. Most of the time, they do this as part of the annual general pharmacy meeting of the PSU.
This evening a friend stopped by the guest house to visit. I met Arthur, my regular tour guide of EconestTim Tours and Travel Uganda, back in either 2011 or 2012. He was eating lunch at The New Court View Hotel in Masindi. I sat near him and we started to talk. He told me about his tour company and how he got started. I liked him right away but didn’t have need for a tour guide at that time. I kept his card and reached out to him the next year. Who would have ever guessed that 6 years later we’d would still be working together and developed a friendship. He has taken me and my students on numerous safaris and trips to Jinja. He has great knowledge of all things cultural in Uganda as well as flora and fauna. I highly recommend his tour company. Plus his vehicles are great!!