4 August 2022
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.
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.
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.
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 
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).
We 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!
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.
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 
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.
Out of the Pharmacy Classroom and Into Africa 