9 January 2020

The morning began with an excellent visit the the Executive Director of Lubaga, Dr. Andrew Ssekitooleko, the Principle Pharmacist, Dr. Michael Mubiru, and the pharmacist interested in pharmaceutical care, William Kalule. I love that they started and ended the meeting in prayer, which is quite common in Uganda even in a secular setting like the Makerere Pharmacy School. Also, they have a formal way of introducing everyone which show so much respect and sets the atmosphere for a collegial meeting. Winnie and I were there to explain the PC research to the ED and the principle pharmacist to see if they were interested in participating. We had a fantastic conversation about the role of the pharmacist and Dr. Andrew remarked how this could improve the quality of patient care and improve safety. Their hospital focuses on patient care, training and research and the PC project fits every area. We all left the meeting feeling uplifted and excited about the future!

We immediately headed to our next meeting. Early in my stay here in Uganda, I received a message through LinkedIn from the grants mHealth Project Manager, Dr. Louis Kamulegeya, of The Medical Concierge Group, a telemedicine organization in Uganda. Yes, healthcare workers and IT experts have partnered to develop a Telehealth organization. They started in 2012 and it is amazing to see their operation now. Dr. Louis had reached out to me because he had seen my blog post on LinkedIn, read about my pharmaceutical care work and thought we might have research interests in common. Winnie and I didn’t really know what to expect as we headed to this meeting but we were both interested to learn more about their company. You can click on the link above for more information but in brief, they provide healthcare via phone consultations with physicians. When needed, they send a laboratory technician to your home or place of business to obtain the specimen for lab testing. When the results are back, they contact the patient with those results and if a prescription is needed, the physician writes it and then it is delivered to the patient. They also have a state of the art Telehealth clinic where patients who need to be seen and examined are sent to have their vitals taken (blood pressure, heart rate, etc.). A nurse can place a stethoscope so the Telehealth physician, who is not present can hear the heart beat and the lungs and see the patient via computer or TV monitors. All of the patient’s information is kept in a detailed patient database, an electronic medical record, and can be referred to in the future should the patient need another consult. This type of service is only in its infancy in the US so I was completely amazed at what they are doing in Uganda. They also have an eStore, RocketHealth, a pharmacy, where clients can purchase over the counter meds and have them delivered. They can fill prescriptions written by outside physicians, too, but they CAN NOT get antibiotics and antimalarials without an appropriate prescription! I was so happy to hear this. In Uganda, and in many LMIC (low and middle income countries), antibiotics and other meds that would usually be available only by prescription in the US are casually sold without a prescription. This has contributed to the severe Antimicrobial Resistance problem that now exists in Uganda and all over the world. I was really impressed with the healthcare practitioners we spoke with today, including Louis, but also his partners, Dr. Davis Musinguze, Managing Director, and a Telehealth pharmacist, Dr. Paul Mirondo. Winnie and I were both so excited about all of the possible ways we could collaborate. Winnie was focusing on this organization as an opportunity for her pharmacy students to learn about this healthcare model and was asking if they would be willing to have pharmacy students or pharmacy interns be place there for experiential learning. I was excited to learn that they collect all of the patient data and it is housed in an eMR just waiting to be extracted and analyzed to look for ways to improve healthcare. To date, I’ve not worked with any hospitals in Uganda who have a comprehensive electronic database with patient information that could be used to determine what is needed to improve patient health care outcomes and to show how the pharmacist can be a part of the solutions to improving outcomes from NCDs (non-communicable diseases). In the US we call these chronic illnesses like high blood pressure and diabetes. In most of the rest of the world, illness is split into 2 categories: NCD’s and communicable diseases, which are infections like HIV, pneumonia, Typhoid, Malaria, etc. I’m not sure what collaborations will develop in the future but I’m sure there are ways we can partner. And regardless, I am so grateful to have learned about this organization!

After a delicious dinner at a Mexican place in Kampala, I went back to the guest house and Winnie went to a garage to check on her brakes in her car. Everything was fine until yesterday when her car started making scary sounds. She found out it was her brakes and hopefully they will be able to fix them soon. You really need good brakes in Uganda. There are many hills and steep grades. Even the parking ramps seem very steep at times.

A little later I had a visit from a Makerere University pharmacy alumni who was one of my students when I taught here in the past. It was so great to catch up with him! I remember his enthusiasm for pharmacy when I first met him in the canteen at Makerere Pharmacy School. I explained I was there to teach pharmaceutical care skills and he told me about his passion to develop drugs and go into the industry. I tried to turn him towards clinical care and he graciously said he’d consider it, knowing full well that drug chemistry was what got him going each day. He is currently doing well and working in one of the pharmaceutical industries in Kampala, Cipla.