12 August 2022

The time has come for my return to the USA. When I came here I had specific plans but I knew that lots of things could potentially disrupt them. I was on a short time-line but was hoping I could complete the work of creating the Pharmaceutical Care Training Videos. My hopes were far surpassed. The training videos are complete and I’ve seen drafts of some. They are excellent and I believe they will make an even bigger impact to the student’s learning that I had even imagined. They even made an impression on the film crew director, David. He, Winnie, and I had a very candid talk today about how what we are trying to teach the pharmacy students is not in line with the current cultural hierarchy. When he watched the hospital video where the pharmacist had found a way to improve the patient’s drug therapy and interacted with the physician to explain what he recommended, David felt this was not what would happen in real life. To him it seemed like the pharmacist was telling the physician what to do but the physician is supposed to know everything, right? Winnie and I explained that the state-of-the-art in medical education is to treat the patient using a team approach. All of the healthcare workers have their expertise and when all work together the patient outcomes will improve. I explained how this is called Interprofessional Education (IPE) and at Binghamton, we have medical, nursing, pharmacy, and social work students interact in the classroom to learn what each other is trained to do and how we can contribute to the care of the patient. When they go on their experiential learning rotations, they interact together on real patients. For example, as a pharmacist I might want to know how the patient is doing over night, such as how well the pain medication was working and I will ask the nurse. The physician may want to know how many days of antibiotics the patient has been on from me, the pharmacist, so she knows if it can be stopped. Or I might identify an abnormal lab result which I can convey to the physician because it might have been caused by one of the drugs the patient is on. I work with the social worker to determine if the patient can afford the medication when they go home and if this is a problem, together we seek a solution. David will finish up producing the videos and get them to me next week via Google Drive. I’m eager to see them and use them in my classroom in the USA to teach my students about the Ugandan culture, as well have Winnie use them in her Pharmaceutical Care Skills Lab here.

This trip I have also met new friends and reunited with old friends. Although >2.5 years elapsed, since I was here last, it didn’t feel like that as I greeted my colleagues and friends. Everyone remembers me and we were able to pick up the conversation that we started back in January 2020. There have been changes to the roads and to the Mulago guest house, but almost everything else is the same. COVID took many Ugandans, one of them a physician I had worked with at Mulago National Referral Hospital, but the resilient Ugandans have bounced back.

I leave here with lots of new ideas for research and collaboration and a renewed vigor to continue the work we’ve started together. Improving health care in Uganda is an extremely slow process. We take several steps forward but then there will be a step back, however progress is moving forward. Winnie, Kalidi, Professor Odoi, Sam Opio and are doing great work here to further pharmaceutical care but what we need now is young Ugandan pharmacists and pharmacy students to get involved with our work and carry it on with us. This is going to require a deep dedication and passion to the work and most of the time there will be no compensation. The work truly brings its own rewards and down the road, the efforts you use to help improve the lives of others will always pay off. Winnie and I spoke today about how many of our pharmacy students don’t seem to have that internal drive and motivation to make the world a better place by working above and beyond what is paid for or required by coursework. Of course there are many compassionate students out there but to affect change, takes more than that. Every US pharmacy student that is accepted openly on ward rounds by the medical doctors is walking on the backs of those pharmacists who laid the paths for clinical pharmacy a very long time ago. Uganda is in the very beginning of clinical pharmacy. They need pharmacists to step up and go find physicians who want to work with us. No, they are not going to pay you. Yes, the work is hard and you will not always be appreciated, but there is someone who will- the patients. If you want a better life for your countrymen and your children, step forward. Seek out Winnie and Kalidi and tell them you want to join the effort. They will explain what they had to do and teach you the necessary skills. You are taught in years 1 and 2 in university alongside the medical, nursing and allied health students so go find a peer in one of those professions and tag along with them in the hospital. Learn about their challenges and find small ways you can help. Interact with their patients to do a medication history and if you find any issues, communicate them in a polite way and always a provide a possible solution. Talk to their patients and explain how to take the drugs and explain that a chronic illness like hypertension needs to be treated every day, even if you don’t feel sick. I think that often the nursing and medical staff don’t think pharmacist care about patients the way they do because we don’t go to the floors often. Show them you are different. My passion clearly shines through this lengthy message but if you have read this far, you get my message.

Today at breakfast I met a new friend, Benjamin Mukumbya. Ben is an amazing young man who is Ugandan but studying for his Masters in Global Health at Duke University in the US. He is here doing research regarding neurosurgery care in Uganda and aspires to become a neurosurgeon himself. I love to meet and talk to new people and Ben was the 2nd person to arrive at breakfast today after me so we sat together. Of course I asked how he came to study in the US and I was totally unprepared for his answer: Chess. Yes, that is right, he came to to US to study Chess. Now if you are a Ugandan or anyone who has done work here, this statement probably brought to mind the acclaimed movie hit that was filmed in Uganda back in 2016: The Queen of Katwe. So of course, I had to see if he was related to this movie. And he actually was. He is the young boy in the movie who was the librarian for the chess team—he kept the records. He graciously told me his amazing story. His chess mentor, Robert Katende, was using a sports ministry to reach kids through football (soccer) but noticed many didn’t aspire to play. So he decided to see if they wanted to learn chess. One of the girls he trained, Phiona, became a chess prodigy and even went to Russia to play in the Chess Olympiad. The original story takes place in 2009 so Ben was much older by 2016 but he said it was an amazing experience to be on the set while filming. As he was the person on the chess team that kept all of the records, the movie producers came to him for those records so Ben can vouch for the accuracy of the movie, regarding the chess tournaments. There was some additional stuff added like the dancing and the flood scene wasn’t as accurate as their floods usually were (their floods were worse), but overall the movie was quite accurate. I told him that I had a new found appreciation for those in the movie or journalism business from my work this trip filming the videos. The small cuts we see on the news or even full length movies take so much more effort and skill to create than I had imagined. Fast forward after the movie was made, Ben was offered the chance to go to Seattle with Phiona for more chess training at no cost to them. This was through the sponsorship of a company that trains children to play chess. Through this experience, Northwestern University in Washington State offered Robert a scholarship to do his Masters in Community Development and Phiona was also given a scholarship for university. Then, as Ben was in the right place at the right time, the President of that university also offered a scholarship to Ben. He went on to get his Bachelors in Biology and Pre-med. Wow! I was so pleased to have met Ben at breakfast today. We will keep in touch as I do with so many of the people I meet here. I know he will be very successful in his career.