Thursday, 14 June 2018
When I woke up this morning and pulled back the curtain, it was bright and sunny outside. By the time I had gotten ready to go down for breakfast, it was pouring down rain. It was actually really loud. Needless to say, I needed to wait this one out, since I happened to be lucky enough to still be in my room when the rain shower hit. My colleague, Winnie, was walking across the hospital complex when the skies broke loose and had to quickly find a building to duck into. This is a pretty common phenomena here and I knew it would soon pass. Sure enough, 10min later, the skies were clearing and the rain had stopped and I headed out to breakfast. But, I forgot how slippery the red dirt roads can be in the rain. The red dirt seems impossibly hard and packed down when it is dry but just pour on some water and it turns into a gooey and slippery mess. When I’m back home, I’m constantly on the look-out for just the right pair of shoes to wear in this type of weather so I don’t slip down the hill. But, alas, short of wearing spiked shoes, I don’t think there is much out there that won’t succumb to the slippery roads. I just had to walk gingerly and take my time. Even if walking on pavement, you have to be careful because the slight layer of red dust turns into to a slick mess. You can equate it to “black ice” for those who live in snowy areas. For those who don’t, that is when the black macadam roads get covered with such a thin sheet of frozen water—ice—that you can still see the black road through it. It is easy to slip on because it doesn’t appear icy. Anyway, I made it to breakfast and then hiked through this red gunk to the hospital. By the time I got there, my shoes were caked with red goo. I haven’t looked yet, but I bet my legs were probably spattered with red mud all day. The order of business for the day was chart review and data collection. We’d already gone through a few before, but today that is all we did—chart after chart—we collected the information required for the study. I forgot how tedious it is to look through paper charts. And in Uganda, probably in much of the developing world, the charts are not well-organized and are often missing pages and information that we need. But, we just do our best to make sense of it. At first I tried to sort through the chart to find the beginning and then work my way though the pages in order but that was way too time consuming. Then I realized I just needed to start with whatever was the first page in the chart and note down the info. I’ll recreate the correct order after the fact.
Finally we needed to call it quits for the day. We walked back to the Guest House and had a cup of coffee. Then Winnie headed her way, and I started back to my room to get some work done. But on the way, I noticed two newcomers to the Mulago Guest House sitting at a table on the lawn. I had run into them as they arrived last night. I ended up sitting and talking with the gentleman and his daughter for probably 1.5 hours. It was a delightful conversation in a beautiful setting. After the rain this morning, it turned out to be a gorgeous day. Finally I got ready to meet up with a friend at a nice cafe at local mall. Linda was one of the first students I taught at Makerere University School of Pharmacy back in Fall 2014. She was a 4th year student then and was quite interested, and still is, in clinical pharmacy. We’ve kept in touch over these years as I have kept in touch with a number of the Ugandan pharmacy students. Their enthusiasm and desire to learn and gain skills to help improve their healthcare system is one of the major motivators that keeps me going in this work. She’s doing quite well now but not able to pursue a strictly clinical position at the moment. She has a couple of jobs, as does almost every Ugandan, and one of them is working for a drug company. She helps develop marketing materials for them—she showed me some pocket cards she developed to help pharmacists remember how to counsel / educate patients about their drug therapy and she included the 3 Prime Questions! I was thrilled—this is clear evidence she has kept up with what I taught her and is teaching others today! (for non-pharmacists, the 3 Prime Questions is just a method of helping us remember what we need to ask the patient and what we need to inform the patient about their new medications.) It was so nice to catch up but eventually I went into “teaching mode” and taught her about evidence-based medicine and calculating the Number Needed to Treat (NNT) to determine how clinically relevant statistically significant findings are in clinical drug trials. For those who are not in the healthcare field, don’t even worry about understanding that. Linda- so sorry if that is not what you were expecting when we met tonight, but know that I really enjoyed talking with you. Just hang in there…your next step towards becoming a clinical pharmacist will show up when you least expect it. I’m really proud of your accomplishments and enjoyed our conversation. Plus, my pizza was totally delicious!!