A Productive Day in the Office

4 August 2022

Winnie and me in the office at the pharmacy school

I spent the day in the office at the Makerere University School of Pharmacy writing the case scenarios and scripts for filming the pharmaceutical care training videos. It was wonderful to have Winnie by my side to answer all of my questions. I want to make sure these are realistic scenes the pharmacy students will encounter in their pharmacies in Uganda. I needed to think about the way a Ugandan patient would respond to questioning versus how an American patient would answer. Even the way we describe symptoms could be different. For example, would a Ugandan patient know the word mucous? I think most patients would know the term mucous, if I were to ask an American patient if mucous came up when they coughed. So is this the same in Uganda? Winnie thought the English speakers would understand but she described the Lugandan word or phrase for this as “bringing up secretions”. Another interesting cultural difference is that the pharmacist will dispense over the counter products like acetaminophen (Tylenol) in pre-packaged strips and they will give the patient only as much as they can afford. What I mean is that there may be a package of 10 strips of 10 tablets each in the original package but the pharmacist will take out 1 strip and put it into a paper packet so it is sold without the original packaging, however the blister pack does have the drug name and dose, usually. The only thing they typically write on the outside of the paper packet is the drug name and how many times the patient should take it a day. By the way, they use the British name for acetaminophen which is paracetamol or brand name Panadol. They do not use the amber (brown) vials we Americans do when we dispense prescription medications. We take the proper amount from a stock bottle of loose pills and package them into an amber vial and then print a complete label and affix it to the vial. The label has the drug name, using the generic name, if it isn’t a branded product, the dose, the full directions spelled out so a patient can understand (take 1 tablet by mouth twice each day), the number dispensed, the drug expiration date, and the number of refills authorized by the prescriber. It also contains the patient name, prescriber name, and the name and address of the pharmacy. If it is an antibiotic, the prescription will state the number of days the patient should take the medicine and this is typed on the label. Very rarely will an American patient refuse to purchase the whole amount prescribed. This is in part because health insurance usually covers a lot of the cost. However, in Uganda, patients frequently will tell the pharmacist how many they can afford and only take that amount of the drug product. Even if the medication is for the chronic treatment of high blood pressure and the patient should be taking it every single day for the rest of their lives, patients will commonly only be able to pay for three or five tablets at a time. They say they will come back and get more but frequently that is not the case and many days may lapse before the patient comes and gets more of the medication. Once we go to the pharmacy to film, I will take photos of the medication packaging and post them for you.

Another interesting fact is that in Uganda, a pharmacy can be open and medications can be sold even if the pharmacist isn’t there. Every pharmacy must have a supervising pharmacist but sometimes, the pharmacist only goes to the pharmacy once or twice a month to place drug orders and check on things. Also, even though there is a class of drugs that are supposed to only be sold if prescribed by a physician, there is no regulatory body with the human resources to hold pharmacies accountable for this practice so most of the time when these drugs are dispensed, it is NOT on a prescription. Rather either the pharmacy staff recommends the patient take this medicine because of the symptoms they complained of or the patient just comes in and asks for it and the pharmacy staff sells it to them. I’m speaking of medication such as blood pressure medications, diabetes medications, medications for sleep medications and especially antibiotics and anti-malarials. I’ve been told that one of the most common drugs patients will ask for are medications for erectile dysfunction and those are also dispensed without a prescription.

Working at my desk at the pharmacy school

My faculty colleagues at Makerere University and I are trying to improve patient care by training the pharmacy students to have the communication and decision-making skills to effectively interact with the patients so that medications are only dispensed when appropriate. We also want them to recognize when a patient should be referred to a higher level of care, such as to a clinic or hospital, and avoid selling drugs just to make a profit as this can adversely impact patients and result in harm. These videos will show the students both good and bad examples of how to gather information from the patient, make a correct assessment of the situation, and recommend appropriate therapy or referral. They will be accompanied by classroom activities that help the students learn and practice the correct skills.

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A Meeting with the World Health Organization and National Drug Authority of Uganda

3 August 2022

An engaging meeting with the WHO, NDA, and faculty at Makerere University School of Pharmacy

Greetings! I woke up today to bright sunshine and I just knew it would be a good day. When we arrived at the pharmacy school, I was invited to attend a meeting between the World Health Organization (WHO), the National Drug Authority (NDA) and the Makerere Pharmacy Faculty. They are developing a country-wide curriculum to teach all healthcare providers and healthcare students about Pharmacovigiliance (PV). PV is the work of identifying, rectifying, and preventing adverse drug events (ADE). I was keenly interested as this is something I teach to our pharmacy students at Binghamton University and I was eager to see the plans. The NDA is equivalent to the US Food and Drug Administration (FDA) and for many years they’ve been tracking ADE’s and encouraging healthcare providers to document any issues they find with drug but it is very hard to get people to comply. In part this is due to lack of recognition that ADE’s are occurring, but also because people can be too busy to fill out forms and think that reporting has no benefit. But what they don’t realize is that until everyone reports, drugs causing ADEs are kept on the market and more and more patients are affected. Even in the US, it is very hard to get people to report ADEs. This new curriculum will help all HCPs and all pharmacy, medical, nursing, etc students to realize the importance of PV and give them the skills to recognize, treat, and prevent ADEs. What was extra interesting is the process that my colleagues at Makerere University went through to come up with a curricular plan. They completed a Needs Assessment. A Needs Assessment is when you investigate the perceptions of the problem and potential solutions from all parties that will be involved. Often we want to solve problems quickly and neglect to slow down enough to include the view and advise of all stakeholders. When you omit the Needs Assessment, you end up with solutions that may end up failing to work because all sides of the issue were not thoroughly investigated. When a Needs Assessment is used to determine solutions, you end up with solutions that work for all parties. I know a little about Needs Assessments because that is the process I went through as the first step in developing the Pharmaceutical Care Skills Lab curriculum that was the outcome of my Fulbright project back in 2014.

The rest of the day was spent working with Kalidi on the development of the plan for the pharmaceutical care training videos. We were so much more productive in a couple of hours in a room together hashing out the details than we’ve been all year in our monthly zoom meetings. This is a perfect example of why you have to show up in person to do projects like this. We certainly have had some great planning meetings by zoom and we can analyze data a half a world apart, but the in person back and forth and brainstorming was much more effective at this phase of the project. Also, even though we communicate in English, both of our accents are strong to each other and in person, it is always easier to understand and be understood.

Arthur and Me, March 2016

I ended the day with a wonderful treat. My good friend and Uganda tour guide stopped by the Mulago Guest House to see me. Arthur runs Econestim Tours and Travel Uganda and he has taken me and my US pharmacy students on many safaris. He has also taken my son, Christian, when he was here a few years ago as a medical student doing a clinical rotation at Mulago National Referral Hospital. Arthur has comfortable and reliable vehicles and he know so much about the flora and fauna of Uganda. He also does tours to Tanzania and Kenya now as well. It was great catching up with him. I wish I had time for a quick game drive while I’m here but I will be keeping too busy for that on this short trip. Seeing him reminded me of the fun and experiential learning I’ve had here with many students in the past. Hopefully I will be able to develop a program to bring students again here soon. Talk to you tomorrow.

Mulago Guest House, my current lodging
The Cabana on the right is the place where we get breakfast every morning- a fresh made cappuccino, fruit, sausages, bread, and eggs are included in the room price.
Posted in Kampala, Ongoing Uganda Projects, Research, Teaching | Tagged , , , , , , , | 2 Comments

A Warm Welcome from Old Friends

2 August 2022

Professor Richard Odoi

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.

Herbert Bush

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.

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Arrival in Uganda

1 August 2022

Entebbe Airport Guest House
Breakfast began with coffee, passion fruit juice and fruit.

Greetings from Kampala, Uganda and Mulago Guest House. The flight arrived late last night around 11:30pm and so I planned to stay in Entebbe at the Airport Guest House. I’ve been a guest here many times and arriving here is a comfort after an extremely long journey (31 hours total with about 17 hours in the air). It is a lovely place with beautiful gardens and a yummy breakfast of fresh made passion fruit juice, sweet pineapple and watermelon along with toast and a Spanish omelet.

Mulago Guest House- it has a nice balcony
The pink ruffled thing above the bed houses a mosquito net
Nice modem bathroom

My regular driver, Haji, picked me up this morning and brought me into Kampala. I was so happy to hear that Haji and his family are safe and didn’t get hit hard from COVID. I’m now checked in to my home away from home for the next 11 nights- Mulago Guest House. The rooms are nice, as I remembered, but it is under new ownership and there are many changes. I guess that’s to be expected. It has been 11 years since I first stayed here. It is very busy now as they have a conference center. There is even a child bouncy house set up so I think they are having a party. The road, a hill, up to the guest house is amazingly fixed! It has been full of ruts and potholes for years. They are doing a lot of construction around here and it seems like everything has bounced back from the COVID shutdowns. Tourism is definitely back here and was apparent throughout my travels. Planes were full and airports were crowded. I will have a slow day and to bed early tonight. I hope the jet lag is very short this trip —I have a lot to do in a very short time. My faculty colleague and friend, Winnie, will be over to see me later and I’m eager to catch up.

Shoebill Bird
Shoebill Bird at Mabamba Swamp

I have a treat for you. I was in touch with my wonderful tour guide and friend, Arthur of Econestim Tours and Travel Uganda, this morning and he was at Mabamba Swamp and sent me these photographs of the rare Shoebill bird. This prehistoric looking bird eats mostly fish with its large beak although it occasionally eats rodents. I’ve seen them in Murchison Falls National Park here in Uganda. Arthur told me I could share his pics. Thanks Arthur!

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A New Journey

30 July 2022

Friends, family, colleagues, and students from around the world, greetings from New York!

It has been more than 2.5 years since I have written this blog and traveled to Uganda and much has happened while I’ve been away. Namely, COVID-19 and subsequent variants have interrupted our lives at the least and taken many lives at its worse. The USA has lost more than 1 million and the World more than 6.4 million people to COVID. We have all come to be familiar with mask-wearing and social distancing. Where available, we’ve been vaccinated and boosted multiple times. COVID is becoming the new normal and we’ve grown tired of the COVID talk, masking, distancing from others, and some now are even refusing vaccines because COVID seems like it is never going away and thus, erroneously, believing that we are no longer prone to serious death and illness. However, COVID is still wreaking havoc. As of July 28, 2022 there were > 2000 daily deaths to COVID and > 977,000 daily cases. This data comes from Worldometer which is a cool database collecting all kinds of information so we can have access to statistics like this. We shouldn’t forget, though, there are other awful situations that affect many people of the world such as >14,000 deaths from hunger TODAY and > 780million people without access to safe water.

Getting ready to embark on this journey from Syracuse, New York.

I’m excited to let you know that I am traveling back to Uganda today to work with faculty colleagues from the Pharmacy School at Makerere University. I have been helping them build capacity to teach pharmaceutical care skills to provide patient centered care since 2014. I initially received a Fulbright Specialist Grant to cover 3 trips to Uganda in 2014 which resulted in the development of a Pharmaceutical Care Skills Lab (PCSL). They are still teaching it but now they are interested in enhancing this curriculum for their Bachelor’s of Pharmacy, which is the entry level degree for pharmacists in Uganda. We aim to develop some demonstration and training videos to augment the skills lab. Since I first started working with Makerere their enrollment has grown without a corresponding growth in clinical faculty (35-40 students per class year in 2014 to 70-85 students now per class year). Although the interest in clinical Pharmacy practice has grown in Uganda, there are still few pharmacists around to model these skills for the undergraduate students. Soon, though, Makerere will offer a Master’s of Clinical Pharmacy The ultimate goal is to help develop advanced pharmacy practitioners who can work with other healthcare providers and directly with and for patients to improve safe medication use and patient health outcomes. For more information about my prior trips both with and without U.S. pharmacy students, you can scan my past 11 years of blog posts. This trip is 2 weeks long so much more to come regarding my adventures! Please feel free to post questions for me.

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Fond Farewell to Uganda

14 January 2020

The time has come for me to say “see you later” to Uganda and all of my old and new friends. I knew the 2 week trip would fly by and I’ve been so busy that I am returning home a bit exhausted. But, that is OK. The work was productive and has moved all of my projects along. I can accomplish so much more when here for a couple of weeks than months of email and WhatsApp phone calls from the USA. Those are fine with current partners whom I’ve worked with for years and know my motives and motivation, but to bring someone else on board, an in-person meeting is really necessary. How can they know much about me, this white lady, who has such grand ideas about improving pharmacy education and practice in Uganda when they hear from me by email? When in person, they can listen to my story and I can listen to their story. They realize I am sincere and have been working with Ugandans for years and I wish to have only mutually beneficial projects.

The leaving this time is very pleasant because I know I am coming back soon, for the Regional World Health Summit at the end of April. At this conference, I will be presenting along with others on the role of the pharmacist in improving patient outcomes in NCD’s (non-communicable diseases such as Diabetes, High Blood Pressure).

Sometimes the traffic jam, or just usually called “the jam” by Ugandans, is often bad when traveling from Kampala to Entebbe Airport. I have gotten in the habit of leaving Kampala early in the day when the jam is less and then I get to spend the day at the Entebbe Airport Guest House for the afternoon and evening. They have day rooms available to be able to take a nap or clean up and they have a delicious dinner served out on their beautiful lawn if the weather is fine. They will also take me to the airport at just the right time and from here it is just a 10min. The Uganda National Road Authority has now built a fast highway linking Kampala to Entebbe so the travel back and forth is much better, at least for the time on the highway. Right now they do not charge a toll, but the toll booths are built and the locals say the toll is coming. They don’t let boda-boda’s (motorcycle taxis) on this road and pedestrians aren’t allowed to walk beside it. And, even the matatus’s, the van taxis, don’t go on it because there wouldn’t be people to pick up and drop off. You can still run into jam on the way to the highway, but it is much less than before the highway was built. I definitely think this is progress!

My friend and Kampala driver, Haji, brought me to the 1000 Cups coffee house this morning on the way to the Airport Guest House. I’d been so busy, I didn’t have time before now to go out and purchase coffee beans to bring back. I love Ugandan coffee, as does the rest of my family and it has become a staple in my house. I can’t link to their website at the moment because they told me it is undergoing renovation but if you are in Kampala, and love coffee, you should try it out. You can reach them by phone: +256 772 505 619 (0772505619).

As I was getting back to the car with the coffee, guess who I ran into? An old Makerere University pharmacy student of mine, Sam, saw me and came over. I think I had called him Andrew but as I looked through my old blogs, I realized his name is Sam. During March 2014, when I was here for the Fulbright work, I had taken Sam, Linda, and Edel to Masindi to help me organize a blood pressure screening clinic. They were 3 of the most motivated students I was teaching at that time. Sam is now working primarily in community pharmacy but is still interested in the provision of pharmaceutical care to his patients/clients. Currently my projects on PC are within the hospitals in Uganda, but branching out to community pharmacy is very, very important, as they see many more people than the hospital pharmacists. They could positively impact the health of patients from NCDs if they provide pharmaceutical care. A challenge is that patients/clients don’t know how the pharmacist can help them and often are too busy to stay and learn about the medicines or the importance of adherence. Hopefully, once PC is implemented in the hospital, where patients are acutely and severely ill, we can start a project to train community pharmacists and a campaign to advertise to regular people about how a conversation with a pharmacist could help improve their health.

It is about time to leave for the airport, so farewell Uganda for now!

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A Visit to the Mulago Neurosurgery Ward

13 January 2020

These 2 weeks have gone quite fast. I’ve come to my last full day of work in Kampala and I packed it full of excellent meetings. This morning Winnie and I had the opportunity to present the research we worked on last summer to the Neurosurgery Department at Mulago National Referral Hospital. The title of the project was:  Phenytoin Dosing Practices in the Absence of the Availability of Therapeutic Drug Monitoring. It was a retrospective medical chart audit to characterize the current prescribing practices for this anti-seizure drug being use to prevent seizures in patients with traumatic brain injury. The work was well received and we were able to learn a little more background about how the drug doses were chosen which will be helpful when writing up the paper.

IMG_2184We then went to meet with the Dean of the School of Health Sciences, Dr. Freddy Kitutu. He has been in this position only a few months and we had a great discussion about the upcoming pharmaceutical care research project and the status of our current collaborative efforts relating to research, training/education, and community service. I’m not sure when I first met Dr. Kitutu, but it was either 2012 or 2013 on my first or 2nd Global Health-Uganda APPE (advanced pharmacy practice experience) trip with students from Wilkes University. He had finished with his Master of Clinical Pharmacy training and was one of the clinical faculty and now, just recently he achieved his PhD!

Then, while on the medical campus of Makerere University, we went to see Dr. Charles Ibingira, the Principal of the College of Health Sciences who I met back in 2014. He is the husband of my friend, Lydia, with whom I had Sunday brunch with last week. Dr. Ibingira is also the President of the International World Health Summit, and he is the host of the Regional World Health Summit in April, here in Kampala. I was also able to meet with Dr. Charles Batte, who is head of the organizing committee. They had just put up a beautiful banner announcing the conference so we were able to get a photo in front of it.

Then we trekked over to the main Makerere University Campus to the Pharmacy School to meet with the Head of the Department, Pakoyo Kamba and to also meet with Professor Odoi for the last time this trip. I was also able to briefly talk with Pamela Blessed who is a pharmaceutics faculty. She also spent 6 months in the US working with an old colleague of mine, Prof Art Kibbe, working on her PhD project of isolating a pharmaceutical excipient from banana. We forgot to take a photo today but I’ll add one from her time in the USA.img_6101

I ended the day having dinner with Vicky, who one one of the pharmacists who came to the USA for the short-term Pharmaceutical Care Training Program back in 2013. It was great to catch up with all she is doing. Currently she is the Pediatrics Pharmacist at Mulago Hospital. We also talked about our new puppies. This was a little unusual because most Ugandan’s do not have any use for animals as “pets”. They use dogs as  guard dogs and cats to eat the rats and other rodents. But Vicky has had both cats and dogs as pets and recently acquired a new puppy who is so cute!IMG_2201

I can’t believe my time here has come to an end. I will head back to the states tomorrow.

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A Day of Successful Writing

12 January 2020

My primary focus for today was to stay at the Mulago Guest House and WRITE. My collaborators and I are working on a manuscript regarding our projects Building Capacity for Pharmaceutical Care Education, Practice and Research in Uganda that is due in a couple of days. I just needed to do some last minute editing like make sure the references are formatted correctly and tidying up the tables and figures, but it took me all day long. There are 9 of us writing this paper and we’ve been working on it for months. It is gratifying to have it done!

On left:Dr Godson and son, Ethan, KarenBeth; On right Winnie, Dana, Racheal

Winnie in the Simulation Center at Binghamton University

The USP 797 Certified Sterile Compounding Room

Our unique DNA Sculpture in the Atrium of the Pharmacy School

Binghamton University Mock Community Pharmacy

Since I don’t have anything else new to report, I wanted to take this time to tell you about Winnie’s trip to the USA back in September. Dr. Dana Manning and Wilkes University School of Pharmacy sponsored her short, 2-week trip, to learn more about Pharmaceutical Care in the USA but I was grateful to have her spend time with me in Binghamton over a long weekend. On Friday she participated in a lecture about the different roles of pharmacists in a colleague’s first-year pharmacy school class (P1). Last year Winnie participated in that class by video conference on a day when Dr. Riley and Dr. Spencer had asked several pharmacists from all over the world to speak to the P1 class so it was great fortune that Winnie just happened to be in the states and could participate in person. On Monday, Winnie met with my Complementary and Alternative Medicine class and taught them about how herbal medicines (called traditional medicine) play a major role in the healthcare of many people in Uganda, even though they also use western medicine.

Here are some photos from her trip. Dr. Godson and his  wife, Racheal, are Ugandan and he is here doing an Internal Medicine residency with UHS healthcare system in Binghamton. I had first met Godson when he was the physician at Masindi Kitara Medical Center in Masindi, Uganda. I always enjoyed working with him and when he expressed interest in coming to the USA to pursue medical residency training, I gave him all the support I could. It is a miracle that he was placed with my local hospital and so when Winnie was here, we all got together for dinner.

KarenBeth’s husband, Jeff and Winnie

I also took Winnie on one of my favorite site-seeing trips—to the New York States wineries in the Finger Lakes. We all had great fun and Winnie got to experience the unique practice of bridal showers via tour bus through the wineries. These women were really happy to pose for a photo. I think they were as excited to interact with a Ugandan as Winnie was to see what kind of crazy fun American Bridal Showers can be.

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Visiting Friends

11 January 2020

This afternoon I had the pleasure of going out of Kampala to Entebbe to visit with Winnie and her family at her parent’s home. It is located right on the road to the airport but once you enter through a very tall gate, it feels like you are far away from the city. It was so lovely sitting on their porch. The flowers and greenery are beautiful!

We had a delicious meal of matoke, which is the mashed green banana, rice, macaroni noodles, Tilapia fish right from Lake Victoria, fried chicken, and red beans.  It was all delicious and even now I am still full! One thing about the local Ugandan food customs is first, they give you lots and lots of food, and second, it really sticks with you. I had a really great time talking with Winnie’s father, Edward, who is a retired physician. While we sipped wine, we spoke about all kinds of things. He was interested in what a usual meal would be in the USA as compared to the Uganda local foods. He asked if we purchased all of our food at the grocery store, which for me and my husband, is true for most foods. I mentioned we do like to go to the farmer’s market on Saturdays for vegetables and sometimes for free-range, organic chicken. He then said, “like the chickens we have running around here?” Yes- exactly. In the US, we pay a premium for organic, free-range chicken but in Uganda this is less expensive. He said they have a garden which he really enjoys and it provides a large amount of their daily food. Our garden provides us mostly herbs, but we did have success with our cherry tomatoes and peppers this year. He said that the little tomatoes grow wild here. We also spoke about the President Trump and all that is going on in the states. I’m always amazed at how the Ugandans follow our politics—much more than a lot of Americans. He knew all about the Impeachment proceedings and had watched it all on TV. He wanted to know what I thought would happen next and if Trump would win another term. Edward also wanted to know about how the flora and fauna in the USA differed from that in Uganda. I was able to show him pictures from my son’s wedding in Grand Teton National Park in Wyoming in 2018 so he could see how different the mountains are. We spoke about how climate change is affecting Uganda and the rest of the world. Currently, it should be dry season and very hot with only a little rain. Although it didn’t rain today, there has been a rain shower on many of the days since I’ve been here and the temperature is quite pleasant. I will have a rude awakening when I get back to the cold of New York, I’m sure.

It was a wonderful day and I sincerely thank Winnie’s parents, Edward and Rose for their hospitality. When my son Christian was here back in March, they met him and were so happy he is now a physician and in his Neurosurgery Residency. They want all of my family to come visit!

Left to right: Rose, Christian (now Dr. Bohan, MD), Dr. Edward Ssebatya, Winnie

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A Visit to Lubaga Hospital & Learning About TeleMedicine in Uganda

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.

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