7 January 2020

Today was a GREAT day! This morning I had the pleasure of meeting with William, a pharmacist at Lubaga Hospital in Kampala. This is a private not for profit Catholic hospital and I’m hope to engage the support of the hospital executive director and pharmacy administration to allow 2 of their pharmacists to participate in the pharmaceutical care implementation project and collect and share their clinical intervention data. William was very interested in this research and has had many positive interactions with the other healthcare providers in the past. In fact, the physicians have asked for the pharmacy interns to start attending ward rounds to assist in drug therapy management and have frequently sought William’s advice about drug therapy. If Lubaga Hospital joins this project, they will be able to have systematically collected data over 6 months which will inform pharmacy practice and policy to improve patient care and health outcomes at their institution. The type of intervention data to be collected to show what pharmacists are able to contribute to the healthcare team include actions such as educating the patient about adherence, reviewing a medication profile for drug interactions, and utilizing lab data to assess kidney and liver function and recommend dosage changes of drugs as necessary to prevent adverse events. In addition, we want to assess the perceptions of patients and healthcare providers about the interactions with the pharmacists. Winnie and I will go back to Lubaga on Thursday to meet with William and the Executive Director.

This afternoon was spent observing a task force meeting of the One Health program in Uganda which is working towards reducing antimicrobial resistance in the country by improving antibiotic use in both animals and humans and implementing better microbial surveillance and infection control practices. One Health is a worldwide accepted concept that human health is connected to the health of animals and the environment. We have to consider all angles to improve human health. An example that many have heard of is that the antibiotics added to animal feed can cause microorganisms in the animals to become resistant to normal antibiotics, meaning they aren’t killed, and then when humans get infections with these resistant organisms it becomes very difficult to treat them. Below is a graphic from the CDC website to illustrate.

The meeting ran from about 2 – 5:45 pm and I was thrilled to have the chance to attend. I also ran into several Ugandan pharmacists I have worked with in the past, which was an additional treat! I was aware that over the past few years, the Ugandan government has had a large focus on antimicrobial resistance and it was great to see the work that has been done. In addition, I have a big interest in Infectious Diseases as I work with a couple of local hospitals and a colleague at the pharmacy school back home on projects to improve antimicrobial stewardship, which is the term we use to talk about how we have to use the antibiotics judiciously and care for them so we don’t lose them. Antimicrobial resistance causes us to lose the ability to have effective antibiotics. One big area that EVERYONE can help be a better steward of our precious antibiotics is to not pressure your physician or other healthcare provider to prescribe antibiotics when you have a cold, or the “flu” as they say in Uganda. Here the symptoms we refer to as a “cold” in the US like runny or stuffy nose (congestion), scratchy/sore throat, and cough are called “flu” here in Uganda. In the US, “flu” is what we call Influenza which has symptoms like high fever, severe body aches and pains, and cough. Regardless, both the common cold and influenza are caused by viruses and antibiotics DO NOT WORK! In the US, pharmacists and other healthcare providers advocate for every woman, man, and child to get the influenza vaccine yearly to prevent this infection. Unfortunately, there is no vaccine to prevent the common cold. The best prevention is to use hand washing regularly. When you get a cold, the best medicine is rest and increasing your fluid intake. You can also take mild analgesics for sore throat or mild fevers like acetaminophen or paracetamol as it is called in Uganda or even ibuprofen or naproxen. For stuffy nose, a decongestant can help. Your local pharmacist can advise you about specific products. But, don’t go to your physician expecting and insisting on an antibiotic. First, it won’t work, second, it will cost money for no good use, third, just like putting antibiotics in chicken feed, antibiotics we take can cause resistant bacteria to grow in our body. Then when we really do get a bacterial infection, the antibiotic may not work. By saving antibiotics for the bacterial infections that really need them, all humans and animals can have better health.

I ended the day by having dinner with Gonsha, whom I’ve known for many years now. She is one of the Ugandan pharmacists who came to the US to study with me back in 2015. She owns 2 pharmacies and they are both doing really well. Gonsha calls her pharmacies, Extra Care Pharmacy, which is what she provides to her clients/patients. She truly cares about her them. I remember one time that a patient of hers needed money for surgery and she raised the money for him. I believe he had diabetes and had a really bad infection in his leg and needed to have it amputated to save his life. She is a leader among community pharmacists and organizes a Whatsapp chat for pharmacists all over Uganda to communicate, share ideas, and assist each other with questions. She also has a Whatsapp chat group for her clients/patients. It was wonderful to catch up with her over a really good Funghi Pizza at Cafesserie, which is in the Acacia Mall. Yes, you can get really delicious pizza in Uganda.