29 September 2016

All ready to get to Ward Rounds at Mulago Hospital. The pharmacist in the middle is Winnie, whom I’ve known and worked with for years. She is teaching the Pharmaceutical Care Skills Lab this year.

Today was our first full day in Kampala and we participated in Pharmacy Rounds with some of the 4th Year Makerere University Pharmacy Students.  We saw a patient in the Neurosurgery Ward as well as patients in the Pediatrics Ward. All had very complicated situations and our role was to try and find out if any of the disease states or issues could be caused by any of the medications that the patients were taking.  The medical charts are all handwritten and are in quite disarray and the first thing we needed to do was to put the chart in chronological order so we could start to review the patient’s data.  The few Physicians we interacted with were very glad for any recommendations we could offer.

Overall, though, the situation at Mulago regarding the availability of drugs and healthcare personnel right now is really horrible.  Normally, the bulk of the work and patient care is given by the Nursing, Medical and Pharmacy Interns. These students all have graduated from University and then spend their next year doing a mandatory Internship. But, right now there is a dispute between the Government and the Interns because they have significantly decreased their pay and thus they are taking the Government to court and are not working at all right now. In fact, they haven’t had Interns in the hospital since about at least July, maybe even since before that. The old salary was 800,000 shillings/month (about $235/month) and now they want to pay them only 600,000 shillings (about $177/month). That is only $1.10 per hour. And these are the people who deliver all of the basic healthcare to the thousands of patients at the hospital and outpatient clinics. The other current issue, which isn’t a new one, is that many drugs are not available. It is so bad right now that most of the patients have to go purchase their own drugs at the local pharmacies and bring them back to the hospital so they can be treated. This includes IV medicines as well. The hospital has been out of the workhorse antibiotic, Ceftriaxone, for the past 2 weeks and oral Amoxicillin for the past 3 weeks.  I was told that Ceftriaxone came in last Friday but it still hadn’t been brought to the patient units and pharmacies yet even though today is almost a week since the supply was delivered, but “hopefully” that would happen today. The reason for this is that there are no Pharmacy Interns to do the grunt work of going to the storeroom (called simply “the store” here) to pick up the medications. So the Stores staff will have to eventually deliver the drugs to the rest of the hospital. There is no doubt that patients have gotten worse and even died due to the lack of medications right now, but although it sounds super terrible to me and the students, this is the “state of normal business” here in Uganda. It is actually pretty sad that most healthcare practitioners don’t get overly upset about this. They have learned to do the best that they can do given the situation. Although the Government-provided healthcare is supposed to be free, in many cases it is really not at all free. When drugs aren’t there, the patients must go and purchase it. When they can’t afford it and can’t raise money from family and friend then patients die- seems like a really high price to me…..

OK, I don’t want to end this post with a bad flavor in your mouths. Sometimes it is easy to get frustrated and I sure gave my friend, Winnie, a Ugandan Pharmacist whom I’ve known since 2012, an earful this afternoon about how much worse the situation seemed today than ever in the past. But as I was talking with her I realized that the situation isn’t really much worse, it is just that I am becoming more and more familiar to those I work with and the more experiences I have here, the more I am privy to the “real” situation. People don’t hide the situation as much as may to one-time visitors because they can’t begin to understand the “behind-the-scenes” stories. It is easy to just to the conclusion that healthcare in Uganda is horrific and think poorly about the country. But, my experience helps me to put the situation into perspective. I encourage my friends to be extremely candid with me because I know nothing can get better until we know the full extent of the situation. And despite the given the situation, most people do get better-this is really amazing. The healthcare system here certainly could be better, but it could be a whole lot worse. The healthcare workers here are under great stress now with the lack of all of the Interns that usually help out, but those practitioners that are here are extremely dedicated to their patients. They are doing the best they can and many patients are helped and get better. As I’ve said before, we just need to keep things in perspective and try to keep on keeping on and improving the situation one step at a time.