Welcome to Dr. Nicol and a Relaxing Saturday

Posted on April 23, 2016 by kbohan

April 23, 2016

 

The Wilkes students reunite with our Kampala driver, Haji

 Today we all woke up late, on purpose, looking forward to a day where we had to do nothing in particular but relax. It was a gorgeous day with a blue sky and a bright sun.  I actually had time to read some Washington Post news articles as I lingered over a delicious breakfast of a fruit plate containing mango, pineapple, banana, and watermelon, Ugandan coffee brewed in milk (called African Coffee), and scrambled eggs on toast.  This breakfast wasn’t unusual as it is what we everyday, but the lengthy time over which I ate it was a luxury.  At around 1pm we greeted Dr. Melanie Nicol, a pharmacy professor at University of Minnesota, who has joined us for the remainder of the trip.  She was with us in Kampala but stayed there for 1 week to work on her research but will now be with us in Masindi to meet my partners here.  A bonus from her arrival was that we got to see our Kampala driver, Haji, once again.  He is so good to us and was really happy to see the students. He brought us 2 big bunches of delicious yellow bananas as a treat.

Later in the afternoon, a few of the students and I walked to town to check out the shops.  Even though the stores look nothing like ours and are without large flashy signs, you can find just about anything you need.  They are all just small concrete rooms next to each other and you have to kind of peer inside to figure out what they sell at times.  Sometimes it is easy to tell because they might have clothing or fabric hanging outside but to find the grocers you need to peek inside.  Anyway, we were on a quest to find nail polish remover and after failing at about 3 stores, we were referred to a store that carried it.  On our way back we found ice cream in a grocery store and two of the students checked it out.  

 

Dr. Melanie Nicol is pictured in the middle in the back row

 In the evening, we took a walk u the street to the Masindi Hotel for dinner.  There menu is much more limited than the New Court View but we all found something and all of our meals were really tasty. I had a delicious grilled steak with mushroom sauce and a huge mound of mashed potatoes. 

Tomorrow we get to go Rhino Trekking and we are all excited about that.  

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Babies!! And TASO And Baboons!

Posted on April 22, 2016 by kbohan

April 22, 2016: A Blog Post by Makenzie

Today was baby day at The Masindi Kitara Medical Clinic (MKMC) and it sure was a baby filled morning. While the clinic normally operates under a fee for service model it holds a free vaccine clinic for infants to children 6 years old each Friday. They also track the children’s growth, give basic counseling on nutrition and offer mosquito nets for malaria prevention. We had the opportunity to be involved with the documentation and administration of some of the oral vaccines as well as helping weigh some of the children. Some of the mothers were very eager to let us hold their babies and we were just as eager to do the holding.

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The students helped the Nurse Midwife, Brenda, record all of the data on the baby such as the weight and the vaccines given.

While they do receive some of the same vaccinations children receive in the Unites States there are also some differences. Currently Hep B and the rotavirus vaccine are unavailable from the government, which leaves a large gap in the care of these children.

They also receive BCG, a vaccine aimed at preventing complications from TB BUT does not actually prevent the recipient from getting TB, oral vitamin A and a deworming agent. The staff was curious if deworming was typically done on all children in the United States and seemed surprised to find out that it is not routine practice for us. While intestinal worms can occur in the USA it is much less likely given our food preparation and sanitation processes. We are already looking forward to baby day next week!

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This is how they weigh the babies- it is a pretty simple but effective system.

In addition to visiting MKMC we have also been working with The Aids Support Organization (TASO) the past few days to see the various services they provide to the community.

These are the SUV’s that TASO takes to the field. They are needed to weather the rough roads.

On Thursday we had the opportunity to ride along with the group to observe and assist with a 6-month medication review out in one of the villages. After about a 45 minute drive through conditions that felt like Nascar on a backcountry road we safely arrived at our destination. The community was very welcoming and the process began immediately. Patients were weighed, had their arm circumference measured and blood taken to measure their HIV viral load in addition to some general health questions to assess well-being. Everyone also pays a very modest fee to the organization to continue to have the drugs delivered and the peer support group continued. Requiring the fee, as is the thought with MKMC, causes patients to value the service more and not take what they are receiving for granted. Once these steps were all complete each person was given another 3 months, to the day, worth of their antiretroviral therapy. The exact measurement is done to ensure patients come back to get their refill when TASO returns to the village. We left the group at this point as they were traveling much farther away from Masindi and would not be back till late in the day. Our journey home was much smoother, and we were able to see a group of baboons including little ones inciting a photography fest from the car.

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TASO had a Drama Team where they act out scenes to teach how to prevent spreading HIV to others. The group also performs cultural dancing and drumming

TASO also holds on site clinic days where patients go through a very similar process in order to receive their medication although there appears to be much more health education occurring. One way TASO attempts to educate their clients is through a “drama show”. Our group was very interested to see how this would play out and attended one of the shows. Armed with a translator and an open mind the show began. Through a series of scenarios involving boyfriends, girlfriends and myths about HIV medication the drama show received tons of laughs and audience participation. With one show and a good turnout (about 30-40 people) I was pretty convinced this was a worthwhile way to get people to listen to the important messages TASO wants to get across. Depending on our schedule next week we may attend another clinic day to dig further into the pharmacy and dispensing aspect of their operation. With only a week and some change left we’re looking forward to what the last bit of time has left, and to sleeping in tomorrow.

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Baboons and their babies scurry along the roadside on the way to the TASO community visit.

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A Makerere University Pharmacy Student Comes to MKMC & A Visit to Masindi District Hospital

Posted on April 21, 2016 by kbohan

April 21, 2016

Today I sent the students with my driver, Sam, to go out with the TASO group (The AIDS Support Organization) on a community visit to deliver HIV medications and check up on the patients. I will let them tell you about that at another time. But today I got the chance to invite a Makerere University 3rd Year pharmacy student to come visit me at the Masindi Kitara Clinic (MKMC) and go on ward rounds. I met John last fall when I came to Kampala to teach the Pharmaceutical Care Skills Course. I knew right away he was a very bright student and he expressed an interest in Pharmaceutical Care (PC). The students and I ran into him again at Makerere University last week when they gave their presentations for the pharmacy students and he said that he had a job at Masindi Hospital and would actually be in Masindi while we were here. We agreed to  meet up- he thought he could show us Masindi Hospital and I could show him the MKMC. I asked permission at MKMC and with that granted, invited him to round with me and the Clinical Officer, Vincent, today on ward rounds.  MKMC is such a wonderful environment for great patient care and I want to share this model with any Ugandan healthcare worker I can find, so that they can see how their healthcare system can be improved and realize change is possible and great patient care can be a reality. MKMC is a system where all healthcare providers (HCP) work together to make sure their patients get the treatment needed so they improve. All healthcare providers are valued. Unfortunately, in the government system, especially at Mulago National Referral Hospital, there is a true hierarchy of “who is most important” in patient healthcare and physicians are at the top. Now, there are definitely some HCP who value pharmacists and want them to be on ward rounds and provide advice and suggestions about patient care, but it is not universally accepted.

John not only was able to rounds with us on the wards, but it turns out that he knows the local language, Runyoro, and could help with translation and was able to do the medication histories as we rounded. I was impressed with his willingness to speak up and he made several important comments.  I really hope that he and MKMC might develop a mutually beneficial relationship of some sort in the future, since he is going to be working right here in Masindi after graduation.

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Lauren, Makenzie, Casey, Assunta, the nurse, and Dr. Bohan

In the afternoon, John invited us to Masindi Hospital. He showed us around the outpatient facility and asked a nurse, actually an ophthalmic specialist, to walk with us to show us the rest of the hospital. The structures were somewhat similar to Mulago Hospital, although the drug supply situation is much more dismal- and I thought it couldn’t get worse. Although the staff try to order for the drugs they need, they are constantly being shorted, hence supplies aren’t there when the patients need them. With my optimistic attitude I try to think that this must be a process problem and one that could be fixed if the government was aware, but I’m often told that they “just don’t care”.  But, one thing that was evident at Masindi Hospital that sometimes seems lacking at Mulago, is that the nurses and other staff really seem to care about the patients. Despite the limited drug supply, they try to do the best they can. I was assured that the nurses show up on all shifts and administer the drugs ordered on time.  John attested to their committment and passion. They even have a really nice poster on the wall in one of the nurses stations that reminds them of their duty to care for the patients. imageAnother interesting facility design is that the women’s ward actually has double rooms instead of a ward just filled with beds. There is a concrete barrier between each 2 beds so that the patients have privacy.  Perhaps this was because a doctor had given the money and designed it in honor of his late mother or wife.  All in all it was another GREAT day!

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Lauren, Casey, John, Makenzi and Dr. Bohan

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Pharmacy Student Presentations At MKMC

Posted on April 20, 2016 by kbohan

April 20, 2016

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Lauren talks about Sepsis to the staff at MKMC (nurses, physicians, clinical officers, cleaners, lab techs, etc.)

Well, we are off to a running start with our work at Masindi-Kitara Medical Center (MKMC). We only arrived on Monday but had volunteered to give some presentations, so they said, “how about Wednesday?” which is their normal CME (continuing medical education day). Of course we said yes. So right away Monday and Tuesday the students began preparing talks on Antibiotic Use, a review on the use of Antibiotics and Infectious Diseases seem to always be desired.  Due to a couple of glitches, no power for the projector in the new Education Wing, and not being able to open up one of the power point presentations on my computer, we ended up having only 2 of the students present. But, we can finish next Wednesday.  IMG_6982So Casey talked about Antimicrobial Prophylaxis before Dental Procedures. She suggested this topic herself, since we had just found out that the clinic would be opening up a dental visit part soon. Antimicrobial Prophylaxis is where you give 1 dose of an antibiotic prior to the dental procedure to prevent the development of a serious heart infection called Endocarditis. Only some patients are at risk of this and are primarily those with pre-existing heart conditions of certain types or if you had endocarditis in the past.

Lauren’s talk was on Sepsis. When a person gets a really serious infection, his/her body can overreact as it tries to manage the infection and this causes the blood pressure to become to0 low, causes increases in respiratory rates and confusion and if not treated appropriately, this can lead to death from the shutdown of organs.  This is called Sepsis. It is very important to identify patients who might have Sepsis along with their infection very early since the sooner targeted treatment is given, the better the chance for a good outcome for the patients. Recently the guidelines for diagnosing Sepsis have changed and Lauren reviewed this with the group. But there still is a problem in that these guidelines were derived using patients in studies that took place in the USA and Europe where all kinds of lab tests are available and the treatments are almost unlimited, at least they seem so as compared to what is available in Uganda and other parts of the developing world.  We had a discussion about this at the clinic and it is even more important that sepsis is identified early so that basic treatments, like fluids and antibiotics, can be given before the patient gets worse.

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This is my lovely view from the cabana at the New Court View Hotel where I am writing this blog. It is so peaceful here and there is beautiful foliage

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This is the view out the other side where you can see the indoor seating for the restaurant.

 

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First Days At Masindi-Kitara Medical Center

Posted on April 19, 2016 by kbohan

April 19, 2016

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When we got to MKMC on Monday, we found two 4th Year Medical students were working there as a Global Health Experiential Rotation. We will just overlap with them by 1 week, but it is great to hear their perspective and learn about what they’ve been doing. (left to right): Casey, Dan, Kassi, Alex, Makenzie, Lauren

It was clear from our first steps on the site of Masindi-Kitara Medical Center (MKMC) or also called by the locals, Kitara Clinic, that this was a different type of healthcare center.  The buildings were very clean, the staff begins the day with a worship service, and each staff member is equally valued.  We were introduced to the clinical officers, nurses, lab technicians, and cleaning staff. As we participated in Ward Rounds for the first time, we noticed that it is clear the nurses care about the patients and are attentive to them and the doctors value the nurses opinions.  Each bed had a mosquito net and there are some private rooms available if patients desire and can afford them. This is a unique model healthcare center that was started by Palmetto Medical Initiative (PMI) from South Carolina back in about 2009 or 2010. PMI had been running quarterly outreach mission trips to the Masindi District Area for a number of years before that but to achieve quality, sustainable healthcare for follow-up visits for people in the region, they decided to start the MKMC. It is a fee-f0r-service clinic with both an inpatient hospital, operating theater (this is what they call the operating room), and an outpatient clinic.  The goal was to be financially stable by having all operating expenses covered by reasonable patient fees.  They have now met this goal of self-sustainability at MKCM and so PMI also started similar clinics in other parts of the world, like Nicaragua.  They have been so successful that they have now 2 clinics in Nicaragua and 2 in Uganda and more planned. Recently they’ve changed their name to OneWorld Health (OWH) and made the CNN news for their excellent work. Although the clinics themselves are self-sustainable for operating expenses, OWH still helps with large expansion projects. They currently have a USAID grant that is funding a a medical education building, radiology center and dental clinic at the MKMC. (I’ll post some pictures of those in another post.) They have also partnered with the band, NeedtoBreath who wrote the song, Brother. There is a nice music video of this song on the CNN news site linked above. You can hear the song and watch photos of patients in Uganda who are being helped by MKMC and the outreach programs.

Below are a few pictures of the New Court View Hotel, our Masindi home for the next 2 weeks. It is so different from Kampala- we eat all 3 meals here but they have a large and delicious menu.  And life is a bit calmer- we all enjoy spending time sitting out in the cabana working on presentations or talking or catching up on email. The gardens are also beautiful!!

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One of the cabanas where we spend a lot of time is in the foreground and a sample of the hotel rooms are the “huts” in the background.

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Each “hut” is a fully self-contained room. There is a bed, desk, and bathroom with shower. The water is solar-powered so hot showers are the norm.

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This is a picture of my room- note the mosquito net that we put down each night and you can get a glimpse of the bathroom.

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The “hut” rooms have a split door so you can open the top half to let in the sunshine and a nice breeze, before the sun goes down. After sunset, or even at dusk, this must stay closed to keep out the mosquitoes.

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Successful Blood Pressure Screenings in Masindi

Posted on April 18, 2016 by kbohan

April 18, 2016

imageSunday was our first day in Masindi and our time here got off to a busy start with conducting two Blood Pressure Screenings at 2 churches. I think this is the 4th time a team and I have done a large-scale BP screening for the Church of Uganda here in Masindid. imageThe 2 churches were chosen by the Healthcare Education Missionary here in Masindi and we’ve continued to come to those same 2 churches, St. Matthew’s and All Saints Cathedrals each year.  The reason we don’t move to different churches is because this way we can achieve a sustainable service, with BP monitoring once a year. Even so, we get many, many new people each year. The children love to watch what we are doing and we will pretend to take their BP. We do this both to interact with the adorable kids but more importantly, so that they lose their fear of healthcare workers and learn to accept this very easy and important monitoring tool to identify patients who are at risk for heart attacks and strokes.

 

We started the day at 8am and ended at 3pm. We split our group and I placed 2 students at each site and I spent some time with the first team to get them started and then when things were going smoothly,  I went to the 2nd team. I ended up staying at St. Matthews because it was pretty busy but both teams saw large numbers of people. The All Saints Cathedral group checked the BP for 128 adults and the team at St. Matthews saw 161 adults which is a grand total of 289 adults.  Overall, 25% (72 patients) of them had elevated readings and were advised to have their BP rechecked at a medical clinic to confirm high blood pressure within the next few weeks to month. But 29 patients had such high readings they were strongly advised to see a physician this week. So it is clear this type of health screening is really needed and useful.

BP screenings are very simple to conduct and if you use automatic cuffs, there would be little training for the workers. This could be done in large scale in Uganda at a relatively low cost.  We used manual cuffs that you pump up yourselves but if the sounds were hard to hear or if the reading was high, we confirmed this with the automatic BP cuff. Today we start at the Masindi-Kitara Medical Center Clinic and it will be interesting to see if any of the patients with the high BP readings come to see us.  Overall it was a fantastic albeit tiring day, and very fulfilling.

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Goodbye Kampala- Hello Masindi

Posted on April 16, 2016 by kbohan

April 16, 2016

  Our last day in Kampala was bittersweet and for me, this is always the case. We had such good experiences and thoroughly enjoyed working with all of the pharmacy students, interns, and pharmacists and any other people we came across.  A very common question I receive is “why” do I keep coming back to Uganda. The reason is first and foremost – the people who are so welcoming and appreciative of anything we teach them-  and then second of all, I keep coming back and bringing American pharmacy students because I think we have gifts to share.  I could do the same thing back in the USA – work in underserved areas, and sometimes I do- but lots of USA pharmacists are doing that. Not so many are willing to share their abilities with those in developing countries and since I can, I do.  And finally, we really gain so much more than we can give. 

Our last Friday in Kampala started with a presentation to the Clinical staff at the Infectious Diseases Institute (IDI). The students and I (but most of the work was done by the students) had done a small chart review to look at medication safety issues in patients with HIV but who also have Renal Disease (kidney disease). The information was well-received and I believe they now have the baseline data they need to initiate a pharmacist review of those patients to help assure the patients are on the right drug doses and drugs.  

  Then the students set off with our trusted and friendly driver, Haji, for a road trip to the Equator.  There is not a whole lot to see once you get to the Equator, but it is cool just to go there and straddle the Northern and Southern Hemisphere at the same time. There are a lot of craft shops, though, and a really cool water experiment.  

 The guide dumps water into a cylinder and when you are on one side of the equator, it swirls down the drain one way and then the opposite way on the other side. When you are right on the equator, it goes straight down without swirling at all.   

 
   

  

 In the evening we went to the Ndere Troupe Show, a cultural music and dance show, which is super lively. The night got even better when 2 of the Pharmacy Interns that the students had been working with showed up- Kevin and Daniel.  It was their first time to Ndere and Kevin said he was learning a lot about his own culture. It was fun to talk to them about the dances and find out that many of them they had learned in primary school. We are all so glad they joined us. It really made for a fantastic night. We got back pretty late and then had to pack to go to Masindi.  

   

  

 In the morning we were all dragging and most slept a good part of the drive to Masindi.  Arrival in Masindi was great- the hotel we stay at, The New Court View, is wonderful. Each room is a building of its own that is meant to look like a hut. It is a very peaceful environment with lots of great landscaping with beautiful plants.  The food here is also very, very yummy!  It was nice to see all the people who work here and who remember me. It felt like I was coming home.  The first impressions of the students are that they really like it.  Tomorrow we jump right into our work with a massive Blood Pressure Screening at 2 churches in Masindi.  So our time in Kampala is over, but we will be having many wonderful experiences ahead here in Masinidi.  Stay tuned…. 

 

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Last Day at Mulago and Pharmacy Student Presentations

Posted on April 15, 2016 by kbohan

April 15, 2016

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The Makerere 3rd and 4th year pharmacy students and faculty who attended the presentations with the Wilkes students.

Our time in Kampala has flown by and Thursday was our last day working with Interns at Mulago Hospital. It seems clear that both the Wilkes students and the Mulago Interns benefited from this experience.  In the afternoon, the Wilkes students gave presentations for the pharmacy students at Makerere University. The talks were well-attended and the women did an EXCELLENT job!! The Ugandan students were really attentive and asked great questions.

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Kassi leads the other Wilkes students in a role-playing activity to teach the Ugandan students how to interact with the healthcare team to make a recommendation about drug therapy for a patient

Kassi included some role-playing in her part which was about how to become an integral part of the medical rounding team. She asked her fellow Wilkes students to play the “medical student” and “attending physician” and then asked for volunteers from the Makerere students to make a recommendation based upon their knowledge and skills given the patient case scenario.  Everyone did a great job!

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Lauren gave a talk on Antimicrobial Stewardships (how to use antibiotics appropriately to avoid resistance)

I think that Makenzie might have a career as an actress ahead of her if she ever gets tired of pharmacy. Kassi had asked her to role-play a physician that just didn’t want to listen to the pharmacy student. She was to ignore the student’s suggestion and just say “I want what I want, now do it”. She was so good, that she actually scared the pharmacy student who was trying to answer and I think he even jumped when she raised her voice. The student, Sam, was a good sport about the whole thing. The idea was for the Ugandan students to realize that not all of their good advice will be accepted and that is OK. You just need to work with the situation the best you can to help the patient.

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Makenzie and Casey presented on the role of the pharmacist in taking care of patients with mental health issues

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Casey’s turn to present her content.

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The Makerere students were clearly engaged throughout their presentations

In the evening we had a delicious dinner with Eva and Dr. Mohammed from IDI (Infectious Disease Institute) where I was able to explore further the possibilities of collaborating on research.  Our time in Kampala has been fantastic, but tomorrow we head to Masindi for another new adventure.

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Eva, one of the pharmacists from IDI, and me after giving a presentation to the group of clinicians. The students and I conducted a small chart review project to look for drug therapy problems in patients with impaired kidneys.

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“Mengo Wednesday”

Posted on April 15, 2016 by kbohan

April 14, 2016: A Post By Kassi

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Mengo Hospital Pharmacy Interns: Hassan, Hilda, Robin, and Henry with the Wilkes Students: Lauren (back row), Casey, Kassi, Makenzie

Today was Mengo Wednesday, which was unsurprisingly less manic than Mengo Monday. We spent most of the day back at Mengo Hospital and we reunited with our intern partners on Monday. I worked with an intern named Robin on both Monday and Wednesday. He is one of the smartest and brightest future pharmacists I have met, and his knowledge base and patient communication skills continuously amazed me.

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Robin and Kassi

We formed a dream team and did pharmacy rounds together in the Luke Ward, a male medical and surgical ward and we followed up on several patients we rounded on from Monday. On Monday we went through 3 patient charts and we were able to leave notes with recommendations for 2 of those patients. We had spent over an hour on one very complicated patient. This elderly male patient presented to Mengo about a week before we saw him on Monday with a working diagnosis of an asthma exacerbation and a possible pneumonia. Throughout his next few days at Mengo the diagnosis changed from an asthma exacerbation to a possible NSTEM (a mild heart attack), to peptic ulcer disease, and finally to a COPD (lung disease) exacerbation. During his week stay he had been prescribed several different antibiotic regimens, antihypertensive regimens and many different bronchodilators (drugs for lung disease).. His final diagnosis was a COPD exacerbation, however he wasn’t prescribed any inhalers. We left a note in the patient chart recommending starting the patient on a LABA/ICS inhaler and also giving him a rescue inhaler. We also recommended creating a consistent antihypertensive medication regimen because he was currently getting different antihypertensives every day and he was very confused about what regimen he was supposed to be taking.

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Henry and Makenzie

When we returned on Wednesday to check on this patient, Robin and I were absolutely thrilled that the physicians took all of our recommendations and started the patient on Symbicort, a salbutamol inhaler and a consistent regimen of amlodipine and losartan/hydrochlorothiazide. We had a great conversation with the patient and his caregiver discussing all of the patient’s medications and also their concerns about his treatment. Robin and I also demonstrated appropriate inhaler use and the differences between a dry powder inhaler and a metered dose inhaler.
I don’t think I have ever been happier to see a physician accept my recommendations. In America, and especially during my rotations, I have rarely had a physician challenge or ignore my recommendations and they are accepted without hesitation. During my time here, it has become apparent that some physicians are very reluctant to clinical pharmacy and pharmacy recommendations and I have previously blogged about the healthcare hierarchy here. It was an incredible feeling to know that our work with the pharmacy interns at Mengo has led to the beginning of more collaborative practice between the pharmacists and the physicians.

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Hassan and Lauren

To make this moment even better, we were actually consulted by a physician to review another complicated patient’s chart and to give our feedback. This patient was a 25-year-old male who presented with hypertensive emergency with a blood pressure of 220/160, and over the past week they found an intracranial hemorrhage and he suffered a STEMI. We reviewed the patient’s medications, specifically the antihypertensives, and we had a great conversation with the physician regarding the patient’s future treatment and possibilities for a home regimen.

After these rounds with Robin I felt extremely optimistic about the future of clinical pharmacy at Mengo. These pharmacy interns are so committed and dedicated to patient care, and I have no doubts that they will continue to use these skills after we leave Kampala. We leave for Masindi on Saturday and as much as I am looking forward to it, I am going to miss Kampala and working with all the wonderful pharmacy interns and students here.

We also spent time with a new member of our team, Dr. Melanie Nichol, who is a pharmacologist from University of Minnesota. She fits in incredibly well with our group and we have lovingly named her Doctor Doctor. She has been working on follow up research to a recent publication in the New England Journal of Medicine and my best friend Zack coincidentally presented the original research during a journal club this week. She is an excellent addition to our team and I am very excited to have her review antiretroviral pharmacology with us to help us study for the NAPLEX.

After we left Mengo, Casey and Lauren spent the afternoon at Gonsha Rehema’s community pharmacy and Makenzie and I went back to the Mulago Guest House to work on our lectures for tomorrow. We relaxed and had dinner at a local Mexican restaurant called Que Pasa and it was surprisingly very good. We ended our night at the Guest House watching our new obsession on Netflix, proving that despite being half a world away, some things never really change.

I can’t wait to present my lecture on appropriate rounding behavior tomorrow to the students at Makerere and I’m sure there will be a blog post tomorrow describing how we did so be sure to check it tomorrow! I have also really been enjoying your emails with questions, comments and feedback so please continue to email me – kassandra.bugg@wilkes.edu.

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Monday at Mengo Hospital, Kampala, Uganda

Posted on April 13, 2016 by kbohan

April 12, 2016:  A Blog Post by Lauren

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Pharmacy Interns and Carole, Head of the Pharmacy, with the Wilkes Students and Dr. Bohan

It’s Mengo Monday! This was our first day at Mengo Hospital, a private hospital with a fee-for-service model. Each of us went to a different ward with one or two of the pharmacy interns to demonstrate how we learned to provide pharmaceutical care. We showed them how to review patients and what information is most important to look for in the charts in order to identify drug-related problems. The interns were very interested and excited to practice clinical pharmacy and use some of the skills and tools they learned from Dr. Bohan like I ESCAPED CPR. In this hospital, I was happy to see more accurate notes in the charts, documented vitals, medication administration records, and especially curtains around the patients’ beds to provide more privacy. Kassi, Makenzie, and Casey went to the women’s, men’s, and pediatrics wards.

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Lauren, Makenzie, Kassi, Casey at Mengo Hospital near the Pharmacy building

I worked with an intern in the private ward at the Sir Albert Cook building. The first patient we reviewed was admitted for heart failure. The intern and I discussed the new medications with the patient and also gave non-pharmacological recommendations. The second patient was admitted for cervical lumbar pain, and we wrote a note with recommendations for adjusting her pain medications. This patient was 87 years old, which is the oldest patient we have seen so far in Uganda. When I was talking to the patients’ caregivers, I was surprised that they knew English but still could not understand me because they said I had an accent. The intern had to “translate” what I said, but he just repeated it again in English.

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Wilkes Students with Paul, the leader of the 3rd Year pharmacy class at Makerere

Then, we went to Makerere University and had the chance to meet some pharmacy students there. Everyone was so welcoming, and it was interesting to compare our pharmacy programs and opportunities available after graduation. Later, Makenzie and Kassi went to Gonsha’s community pharmacy. Casey and I went to the Uganda Cancer Institute (UCI) to meet the oncology pharmacist, Benjamin. This institute provides outpatient chemo to adults and children and performs some minor surgeries. UCI is very new and modern, and Benjamin said even the patients do not want to go home. Although it seemed very similar to hospitals in the US in many aspects, we were surprised by a few things that Benjamin told us. Instead of using a hood, intrathecal methotrexate is just drawn up at the bedside. Also, the radiation machine at UCI recently broke, and it will not be able to be replaced for 2-3 years. This was the only place in East Africa with affordable radiation so people from all over the area came here for treatment.

Through interacting with the pharmacists, interns, and students today, I discovered a general theme that they were all motivated to improve and advance their practice, provide direct patient care, and overcome the obstacles of their healthcare system.

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This is Lauren’s lizard friend. She was a little scared of it so she stayed far away and it photo is blurry, but you can get the size of the beast. (it was way bigger than Makenzie’s lizard, fondly named Terry.)

I also have a story from one night last week. Anyone who was near my room heard a loud scream around 10:30pm. I came back to my room to find a large lizard on my ceiling! I am the worst person to deal with any kind of bugs or reptiles.

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This is a picture of the lizard in Makenzie’s room, which occurred before Lauren’s lizard sighting. It was smaller than Lauren’s but the photo is a bit clearer. Makenzie named him Terry.

Luckily Makenzie came to help me get the lizard out. The ceiling was too high to reach so she swung my mosquito net towards the lizard. First it ran in the opposite direction of the door and was hiding in the curtains. After a lot of net swinging, it finally fell off the wall and ran out of the door. I need to officially thank Makenzie for rescuing me from the lizard, and I hope I don’t have another lizard attack anytime soon!

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