2 August 2022
As I sit to write this evening at around 9pm East Africa Time (2pm U.S. Eastern Time), I’m quite pleased the weather is cool. There are very few places with air conditioners but fans are available and I have one in my room. But even with a fan, sometimes it can be hot enough at night to disrupt sleep. Not this time, so far anyway. The weather now is wonderful. It gets up to the mid to upper 70’s F during the day and into the mid to low 60’s at night. That’s a range of 16 – 21 C. At the moment, my weather app said 68F/20C but there is a breeze and it is cool enough to put on a sweatshirt. This morning Winnie picked me up from the guest house and we went to the Makerere University School of Pharmacy to start our work. I ran into lots of old colleagues and friends and surprised almost all of them as I hadn’t told many people that I was returning. Some other Ugandan friends have also reached out to me after seeing my blog posts on twitter or LinkedIn. Contrary to the soft-spoken Ugandans, when I talk in even just a conversational tone, my voice carries and that actually brought one of my friends, Pamela, to come to the office to see if it was really me. Pamela is one of the Ugandan pharmacy faculty who came to the US to work with one of my pharmaceutics colleagues at my prior university. Vicky is another pharmacist who stopped by to see Winnie and was surprised to see me. She also came to the US to work with me in the Pharmaceutical Care Experiential Training Program I ran at Wilkes University when I was there. Of course, the first person I ran into was my oldest collaborator, Professor Richard Odoi. He and I began to communicate by email back in 2010 when I had reached out to inquire about the possibility of bringing pharmacy students on an experiential rotation to Uganda to learn and work with his pharmacy students and his interest in partnering on a water research project. He welcomed all of my suggestions with open arms and together we have sustained our collaboration for almost 12 years.
The photo above is of Herbert Bush, another faculty in the pharmacy program at Makerere. His interest is in Antimicrobial Resistance and appropriate antibiotic use. Unfortunately, microbial resistance is very prevalent, in part due to the lack of controls on dispensing antibiotics. Technically, antibiotics are in a class of drugs that requires a prescription but there is no enforcement of these rules so any person can request and be sold and antibiotic at the pharmacy. There are also small convenience stores, called Drug Shops, in the villages that do not even have a pharmacist. In an effort to reduce child and infant mortality, many years ago, the government made antibiotics and antimalarials available in these drug shops, because the time and money it took to get to a pharmacy could mean life or death. At that time, the employees of the drug shops were trained on how to appropriately sell these medications to make sure there were no safety concerns and that the patient really needed an antibiotic, but over the years, adherence to guidelines has probably waned and antibiotics are given for every little sniffle and cough, even though those conditions are usually caused by viruses or even allergies, neither of which is treatable with an antibiotic. This is one of the key points I have included in the curriculum developed with my Ugandan colleagues: How to talk to a patient and ask the right questions so you can determine if antibiotics or antimalarials are needed or if the patient is sick enough to be referred to a higher level of care where the appropriate tests and diagnosis can be done. Other contributing factors to microbial resistance are the use of antibiotics in livestock feed, and the extremely limited variety of antibiotics available in the government health system so the same ones are prescribed over and over again, even when a different antibiotic would be best and cause the least microbial resistance to emerge. It’s been a great day but time for sleep. I expect to feel much less jet-lagged by tomorrow.