Moving Up and Down, All Around Kampala

3 January 2020

Winnie and her Pharmacy

In deep discussion about the appropriate use of Antibiotics

Jamir, Pharmacy Technician

My driver, Haji, has a saying when he’s been driving me all over Kampala. He’d say “we’ve been moving up and down and all around” and that is exactly what Winnie and I did today. But let me start at the beginning of the day. I was fortunate to meet with Dauglas, Dr. Godson’s brother here at the Mulago Guest House.

Dauglas, Dr. Godson’s brother and KarenBeth

Dr. Godson is a physician who I first met many years ago while working with Masindi Kitara Medical Center in rural Uganda. He is currently a 2nd year internal medicine resident with UHS, which is a local healthcare system back home in Binghamton, NY. He had asked me to bring his brother a few things and we met up today to hand them over. It was nice to talk to Dauglas and learn more about the road system and transportation in Uganda. He is a civil engineer working with the Ministry of Finance overseeing road construction in the country. The Chinese have been very active in building capacity for infrastructure in Uganda and providing workforce. Dauglas’s job is oversight to make sure all of the road projects are coming along. He has to travel the country very frequently to do this interesting work. Fortunately, the Chinese capacity building is paying off and recent projects have been designed and implemented independently by Ugandans. For those unfamiliar with the term, “building capacity”, as I was when I first came to Uganda, it means helping Uganda or any low and middle income economy country (LMIC) to build up their workforce to improve conditions in any sector. So my overall project and work here in Uganda is building capacity for pharmacists to provide pharmaceutical care for the goal of improving safe medication use and ultimately patient health outcomes. My expertise and focus is building capacity by improving and expanding education, particularly in clinical skills and working directly with the patient and the healthcare team. I have worked with pharmacy students as well as pharmacists in Uganda and have also led pharmaceutical care training programs for Ugandan pharmacists in the US. This short 2-week trip to Uganda is for the purpose of developing a research project regarding the implementation of a pilot pharmaceutical care program at 2-3 local hospitals. We want to see if patient outcomes improve when the pharmacist becomes involved with direct patient care working alongside physicians, nurses, and other healthcare providers by the provision of pharmaceutical care. This is a role that has evolved over time in the US and high income economy countries and is in demand because it was shown that pharmacists providing pharmaceutical care can improve patient health outcomes and reduce costs. Examples of patient health outcomes are patients able to leave the hospital early because a pharmacist helped make sure the correct antibiotic was given at the right time, a patient may have a lower risk of recurrent heart attack (myocardial infarction) when a pharmacist makes sure the patient is on all the correct medications that have been shown to reduce subsequent MI, and diabetic patients may develop better blood sugar control with less low blood sugar episodes when the pharmacists works with them to determine the cause of side effects and finds the most appropriate dose of the medication to treat diabetes for a given patient.

Winnie and I had plans to visit a hospital this morning to meet with the head pharmacist to discuss the project but before we could head over to Lubaga Hospital, Winnie got an urgent phone call about a lost key at the pharmacy she supervises. This detour proved to be very interesting for me. While she worked out the key issue, I had the pleasure of talking with the pharmacy technician who does most of the dispensing at the pharmacy. Yes, you heard me correctly. In Uganda, it is pharmacy technicians, and sometimes untrained workers, who dispense and sell drugs. Every pharmacy has to have a supervising pharmacist but that pharmacist doesn’t have to be on the premise for drugs to be sold and in fact, in many cases, the pharmacist only checks in on the pharmacy from time to time and does ordering and such. There are pharmacists who routinely stay at their pharmacies and dispense but it is not required by law. The biggest reason for this is lack of capacity. Until recently, the pharmacy workforce wasn’t large enough to service all of the pharmacies required to serve the needs of the country so pharmacists could supervise more than one pharmacy. The idea initially was the pharmacist would be in one or the other pharmacy during working hours but somehow without appropriate over-site, it evolved into a situation where often pharmacies run without pharmacists. Recently, though, the Pharmaceutical Society of Uganda (PSU) has declared that pharmacists can only supervise 1 pharmacy because the workforce is growing. But old habits die hard and until over-site and accountability is initiated, pharmacists may continue to be absent. I digress…let me get back on track. Jamir, the pharmacy technician, told me that it takes 3 years of college to be trained as a pharmacy technician. Then he applies for licensure but there isn’t an exam as with pharmacists. I asked him what the most expensive drug he had was and this led to a great conversation about drug quality and pricing and appropriate use of antibiotics. At one point I asked him about drug concentration time curves, don’t worry if you have no idea what this is, and I was amazed he had learned about this in school. What I asked him about is pharmacokinetics and related to how fast the drug is absorbed into the body and how high the drug level gets in the blood. This is a concept that all pharmacy students learn but I’ve never heard of an US pharmacy technician knowing this detail about drugs. It is possible this is included in college pharmacy technician curriculum but I have no experience with this. Jamir’s goal is to work as a pharm tech for a year or two to earn the money to go to pharmacy school. He wants to go into the drug industry and develop new drugs. I believe his goal is attainable if he keeps his focus and works towards it. It turns out the most expensive drug is an antibiotic called Cefixime. He had 2 brands in stock, The one manufactured by Torrent in India, cost 6000 shillings ($1.62) for a 200mg capsule while another brand made by Sance in India, cost only 1500 shillings ($0.40) for a 400mg capsule. Wow what a difference! A normal dose might be 400mg a day for 7 days so with one brand a patient might pay 10,500 ($2.80) for the course of treatment while using another brand, a patient might pay 84,000 ($22.68).

Later in the day we went to Lubaga Hospital but were unable to meet with the pharmacist so we made another appointment for next week. We then spent at least a hour at the Africell store trying to fix my phone and wifi router SIM cards. Finally, they are working. At the end of the day, Winnie and I had a nice dinner at Cafe Java’s, a local coffeehouse and food chain, and worked on the project protocol for a few hours. It was a productive day but maybe not exactly in the way I thought it would be when I woke up this morning. And, despite the many times I’ve visited Uganda, this is my 13th trip, I always underestimate the time it will take to get from one place to another. Even though Kampala is not a large city in terms of distance from one end to the other, the roads are poor, there are too many cars on the roads, and the boda-bodas (motorcycle taxis) weave in and out and this all adds up to major traffic congestion. Maybe I’ll time each of the trips next week, but for today, I would guess we were on the road for about 2 hours over the course of the day going “up and down and all around” and only had to cover about 10 miles.

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First Full Day in Kampala

2 January 2020

I had a wonderful night’s sleep at the Entebbe Airport Guest House and a delicious breakfast of scrambled eggs, bacon, and fresh fruit: the tiny bananas which are so good, watermelon, and papaya. I also had fresh made passion fruit juice. Yum! My friend and regular Kampala driver, Haji, picked me up around 10:30am and we headed to Kampala. There is a new highway which makes the travel much faster. Also, the roads weren’t too busy because a lot of people are still “upcountry” or “in the villages” for the holidays and will start returning today and tomorrow. Just like in the USA, if possible, Ugandans get together with their families and the gathering always includes a feast of their favorite dishes. I’ll talk more about this when I have a Ugandan meal. It only took an hour to get to the Mulago Guest House which is on the grounds of the Mulago National Referral Hospital.. Right now am in the lower house and am the sole occupant which is nice because I have the wifi to myself. But, it is always nice to meet and talk with other guests so maybe some more will join me before I leave. After unpacking and taking a quick nap, Winnie, my friend and collaborator came to pick me up to run errands, the first being the Forex, the foreign exchange, to change my US dollars to Ugandan Shillings, abbreviated UGX. Since I come back and forth regularly to Uganda I always have some UGX which is quite helpful for buying bottled water at the airport and the first night’s hotel stay. The hotel could have taken US dollars but prefers UGX, which I was able to provide. Next we headed to a shopping center, Garden City Mall, to go to the Africell store, which is a Cellular Service, to get my Ugandan phone lines and wifi router fixed. Unfortunately, the lines are still not fixed but hopefully are in the process of being fixed. Then we had to go to a grocery store for water. My students and I always use bottled water in Uganda, even to brush our teeth, so I buy it in bulk. I’ve been told that the water leaves the water sanitation plant clean and perfectly fine to drink but unfortunately the water pipes and infrastructure is not kept up and bacteria inevitably invades the water supply before it comes out of the faucet. One of the things I forgot to mention yesterday was the “smell of Uganda”. As soon as I exit the plane, the air wafts of boiling beans over a wood or charcoal stove, which is the most common mode of cooking here. Even though we were within the jetway, this wonderful aroma penetrated. Winnie and I had a nice dinner at an Indian restaurant and then came back to the guest house for a work session to plan the pharmaceutical care research project we want to start in June. Well, I’m exhausted and need to go to bed. Tomorrow we plan to meet with two of the local private hospitals to interest them in participating in the study. I’ll explain more about that later. Below are pictures of my lovely accommodations at Mulago Guest House.

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Safe Arrival in Uganda!

1 January 2020

Wow-2020! Happy New Year! It’s the start of a new decade and it’s going to be great!! Well I’ve arrived safely to Uganda after a 26hr trip. All went very smoothly with the flights. My seat mate is with the WHO and we had a great conversation. I told him all about my work and he gave me some good ideas going forward. We are planning to meet up this week and talk more. He may be able to connect me to others with similar interests. The only bummer upon arrival is that my Uganda phone lines aren’t working, although my colleague checked on them before I left and put some airtime on them for me. But, I’m grateful for the Wi-Fi at this cute hotel where I’m staying tonight and I’m sure I’ll get things worked out tomorrow. So after a nice hot shower, I’m snug under the mosquito net and ready to get some sleep. Talk to you tomorrow. The pics below are my room at the Entebbe Airport Guest House. I highly recommend this bed and breakfast!.

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Destination: Uganda

31December2019

Merry Christmas and Happy New Year’s Eve!  It’s been quite a long time since I’ve written upon return from my last trip to Uganda in June 2018. That wasn’t my intention but life stateside has been busy for me. The Binghamton University School of Pharmacy and Pharmaceutical Sciences is hopping with 3 classes in now, which is a total of about 230 students, and I’ve been teaching a lot—and enjoying every minute! However, I am thrilled to let you know I am headed back to Uganda today. What a wonderful way to start the new year, and new decade! It is amazing to realize I have now been working with Makerere University School of Pharmacy in Kampala since 2010, by email, and in person since 2011! I will probably take some time to re-visit the past 8.5 years with you via this blog during this trip. The main purpose of this short, 2-week trip is to lay the groundwork for my next research project and put the finishing touches on 2 papers I’m writing with my Ugandan colleagues. It will be a trip packed full with meetings and work sessions and in between those, I will also be busy preparing my teaching materials for the next semester at Binghamton University. Classes start less than 1 week after I return to the States.  For now I’ll say goodbye as my first flight will be boarding soon. I will be arriving in Uganda at 10:30pm their time, which is 2:30pm on New Year’s Day, eastern standard time. I’m looking forward to sharing my journey with you again. Stay tuned to tag along on my adventures!

Elmira Airport, NY

Bags Packed and Ready to Go at the Airport

Gabby in Car

I had to say goodbye to my young pup, Gabby-5 months old and I wanted to share her cuteness with you all. She has brought so much joy to my life! She will be in excellent hands with my husband, to whom she is a constant companion.

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Surprise! I have a Medicinal Garden in my Yard in the USA!

Sunday, July 8, 2018

I just love my new dress from Kampala Fair, Kampala, Uganda!

I’ve been home in Upstate New York for a week now and am still excited about how wonderful my recent trip to Uganda was! One of the things I’ve been pondering a lot since returning is herbal medicines. As I mentioned before, I’m teaching a new elective on Complementary and Alternative Medicine (CAM) this fall to our 2nd year pharmacy students at Binghamton University and I’ve been doing research and preparing for the course. Because of this new area of interest for me, while in Uganda, I asked many of my friends, students, and collaborators about the role herbals play in their quest for health maintenance and healing. I knew I would find people who sought relief from common ailments with the use of herbs before trying western medicines, but I was surprised to find that every signal person I asked had regular use of herbs for health maintenance including all of the Pharmacists and healthcare practitioners I spoke to. We would speak of their gardens at home, the plants they grew, and how they used them. Everyone had medicinal gardens and I got to see two of them in person- Winnie’s parents and Gonsha’s. There were plants that I’ve never seen or heard of but there was also rosemary, thyme, and Italian parsley. Well, guess what, I have those growing in my own garden right now!

ROSEMARY

We Americans call them spices and use them all the time in cooking, but when my Ugandan friends talked about them they could also tell me about the ailments that these herbs help to treat or prevent. Yes, they also cook with them like I do, but they were so much more knowledgeable about potential medicinal uses. Besides use in cooking, it is common to pick a bunch of an herb, such as Rosemary, and steep in boiling water like a tea and to drink this daily. And, they don’t even sweeten it! I tried it out, just using a small sprig, and it was different but not unpleasant. But the longer it steeped, the more bitter it became, so I’ll be sure to drink the tea fairly quickly. I have now looked up the herbs in my garden and have found out they all have some medicinal uses! There is a fantastic natural products electronic reference called Natural Medicines by Therapeutic Research Center that I have access to through the Binghamton Libraries. It is rather expensive to subscribe to personally, but if you work at a University or Hospital in the USA, check and see if you have access to it. There is a new free database from the USA National Center for Complementary and Integrative Health called HerbList. It is also very helpful. It is written in simple language the public can understand but also provides the medical references to support the statements in the monograph. I definitely recommend downloading it to your smart phone or tablet.

THYME

It turns out the thyme, one of my medicinal plants, has some effectiveness for cough and since coming home, I’ve developed a several viral cough. I decided to investigate how to use thyme for cough and found a simple recipe that just calls for steeping a big bunch of thyme in 2 cups of boiled water for about 10-15min and then adding 1cup of honey after removing the thyme. This makes a couple of cups that can be stored in the refrigerator for a month or so. The dose is 1-2 teaspoonfuls as needed for cough. I’ve only tried it once and it tastes pretty good! I think it helped a little. For a viral infection like acute bronchitis, there is not much that can be done to hasten the healing. Antibiotics are not effective for viruses and using them unnecessarily can cause harm due to adverse effects and contributing to increased Antimicrobial resistance rates. So supportive care is all we have to recommend to patients. This includes recommending consuming plenty of water, getting enough rest, using cough syrups, and analgesics or decongestants if needed. So why not try some thyme from your backyard?

ITALIAN PARSLEY

BELOW IS OREGANO

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Starting My Trek Home

Wednesday, 27 June 2018

It’s been a fantastic trip but it’s time to head home. It was productive and fun in all the right ways and seeing so many friends and colleagues was really special. Here are some pics from my last day.

Eating a delicious meal on the lawn at the Entebbe Airport Guest House with Winnie and her husband, David– the best way to spend my last meal in Uganda!!

Getting to meet Winnie’s parents at their lovely home in Entebbe–what a wonderful treat. They served me a delicious fresh made juice of pineapple and the weird fruit below which is supposed to have anti-cancer activity. It was really good!

Meeting by chance with a current Pharmacist, Babra, whom I taught at Makerere a few years ago and her Pharmacy Intern, Ian, from Kampala International University. I stepped into her store to check out some packaged herbal products. We both remembered each other and I was thrilled when she started to tell me about how she still uses SCHOLAR, a tool to ask patients about their medical condition that she learned from me!

Visiting with Patrick, one of the first Pharmacists that studied with me in the USA.

My last coffee at Cafe Java’s while discussing our current research and planning our next project.

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MOU #2 Accomplished & the Tale of an Anthropologist

Tuesday, 26 June 2018

I’ve had a great day and now have a signed MOU with the Pharmaceutical Society of Uganda! This has been an extremely productive trip for me. The pace was kind of crazy with running around and going “up and down and up and down”, as the Ugandan’s say regarding my two back to back weekend trips out of Kampala, but I had so much to do in only 2 and 1/2 weeks.  I’ve kept Winnie very busy working on the research and going around town to meet with collaborators. Her assistance has been invaluable and I’m so grateful for a wonderful colleague and her partnership with me on this quest to advance pharmacy practice in Uganda! She is a calm presence whenever there is a snag in our plans, she grounds me and assures me things will work out alright.  But I think she will be glad to get back to normal after I leave. 🙂

You’ve been hearing all about my research and capacity building project over the past 2 weeks but now I want to tell you about an interesting young woman I met in Masindi—she truly goes all out for her research.  Julia, is a social anthropologist from the UK who is studying disabled people in rural Uganda. She is particularly interested in how they manage economically. The title of her project is “The disability rights movement in Bunyoro, Uganda: human rights, value, and negotiations of belonging.”  She came to Uganda to study the disabled because Uganda has a very unique law that requires the election of Ministers of Parliament (MP’s) to specifically represent persons with disabilities.  What I know about anthropology is small but I’ve heard of researchers who have lived with indigenous tribes/local people to get to know them and their culture better. I couldn’t imagine what that was like until I met and talked with Julia who does this in a place I have come to know well. Julia is a PhD student and when her research here in Uganda started somewhere around 18 months ago, she first had to learn the local language. Runyoro is quite a difficult language and is constructed much differently than English. This took her 6 months. To help you understand the significance of this feat she accomplished, none of the non-Ugandans that I know now living in Masindi for much much longer than 6 months, has learned Runyoro. They may understand and speak some phrases but no one actually can converse for hours on end in Runyoro. I’m not sure if Julia started living in the village while learning Runyoro or after but for the last year plus some, she has been living side by side with the disabled Ugandans she is observing. Her accommodations are meager, to say the least.  Some people are amazed that I have had to use traditional toilets (holes in the ground) on occasion, but this is nothing compared to Julia using pit latrines all the time. She lives in a small block of houses built from red clay bricks covered with cement. She has a 1-room home that is split in two by a hanging curtain. She does have a bed to sleep in with a government issued, insecticide-treated bed net, but her only cooking implement is a small charcoal stove. She has no running water. She either collects rain water from the roof via a gutter downspout or pays 100 shillings per jerry can of water from the local, government provided well that is a 4-5 min walk from her home. She says she is lucky she is this close.  Regardless of the source, she still uses a ceramic water filter before she can drink the water.  I forgot to ask if she has electricity but I would venture to guess the answer is no.  At first she did her own cooking using the coal stove but found it took a lot of time away from her research. She is now grateful that her neighbors are cooking and providing her food. Another question I asked was if she actually had a door to her 1-room house—I’ve seen these types of dwellings before and many Ugandans only have a curtain to cover the doorway. But Julia does have a door I’m happy to say.  When I asked her about her research, what I mostly remember is her passion and enthusiasm for her work.  She is going home to the UK in September but when one of the muzungos (white people) at the restaurant table asked if she was ready to go home, she stated that she was actually not ready to go home—she still has so much she wants to accomplish.  So, the next time I’m feeling deprived because I’m eating beans and rice every day or not staying in a regular hotel, or I find a bug or two in my room, I’m going to remember Julia and how she happily lives in poverty conditions deep in the village to accomplish her research. I have nothing at all to complain about.  Actually, I rarely feel this way and know I am really blessed to be able to be here in Uganda working with dedicated pharmacy practitioners who want to gain more skills and practice at the top of their field! Sound familiar? I think we all want this as pharmacists…to be challenged in our work, to be valued by other healthcare practitioners, and to provide care to patients that improves their lives.

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MOU Accomplished!

Monday, 25 June 2018

My day got off to an excellent start when I met with Professor Richard Odoi and hewas able to hand me a signed MOU (memorandum of understanding) to formalize the scholarly partnership between Makerere University College of Health Sciences and Binghamton University School of Pharmacy and Pharmaceutical Sciences. Yay!! Although I have been working with Professor and the School of Pharmacy for 7 years, the partnership needed to be sealed with this MOU to make obtaining future research approvals go more smoothly. Speaking of that, we had a great conversation and planned our next project in building capacity for pharmaceutical care to improve patient health and safe medication use.

I also met with Winnie and Kalidi, both pharmacy faculty who are applying for a unique opportunity for a 1-yr fellowship for junior university faculty to jumpstart a research agenda while being mentored by a senior faculty. They are both excellent ideas that would help improve drug use and patient outcomes in Uganda. I won’t reveal them as they are competing for this opportunity with many other faculty.

Later in the afternoon, Gonsha, one of the Ugandan Pharmacists who studied with me in the USA back in 2015 brought me to see her pharmacy and to her new house. The last time I had seen the house it was basically a pile of bricks! She now has basically a compound house with 2 Full and separate living areas. She also has her own medicinal herb garden which was especially interesting since I’m teaching a complementary and alternative medicine course this fall. She showed me all of the herbs she has and explained their uses. We also shared a delicious meal of chicken stew, rice and matooke (mashed banana). Her maid had purchased the chicken at the market today, prepared it, and cooked it. Talk about fresh food!!

Last evening, after returning from Masindi, a friend, Lydia, took me to dinner at a beautiful restaurant in the sky–at least it seemed like we were way high in the sky over Kampala. The view was spectacular but unfortunately with the dim light and only a phone camera, I couldn’t get a photo to express what I was seeing. The hotel and restaurant is actually called The Skyz–a very appropriate name!

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Back in Kampala with No Power (Electricity)

Sunday, 24 June 2018

Arrival back at Mulago Guest House; this is my driver, Sam, and his new car

When traveling in Uganda, a very nice cultural norm is to warmly welcome back visitors upon arriving back home or arriving to the place you are going. In fact, Janine told me that the Anglican Bishop had returned to Uganda from abroad yesterday and the church was having a welcome back party today. I don’t know how long he was gone but even if it were just a week or two, they would want to celebrate safe arrival home. So, I have returned safe and sound to Kampala and Mulago Guest House. But guess what? There is no power. Apparently it’s been out since last night and it appears to not just be the guest house and the Mulago area, but reaches beyond. It’s unusual for Kampala to loose power for such a long time. It’s not uncommon in Masindi but this trip there were no power issues. This is the reason you must come with a power bank to Uganda. I will have to conserve the power in my electrical devices but should be able to charge them somewhat with the portable power bank. I really, really hope it is back on by tomorrow.

Janine and KarenBeth at the New Court View Hotel

I had a really great time visiting with Janine this weekend as well as Sallie, the owner of the New Court View Hotel. Most of the time when I’ve been there I’m the past, I’ve been too busy to socialize but this time was more relaxing. I was able to both meet with the people I needed to talk with, to learn about herbals in Masindi, and talk with friends.

Update to yesterday’s blog: One of my past Ugandan students, currently a pharmacy intern, saw my blog yesterday and informed me that the NDA (like the USA FDA) is now requiring all packaged herbal remedies to be registered and since he is interning there now, he was able to check on the brand I posted. Unfortunately it is not registered. He did inform me about a reputable herbal product line that Professor Dr. Patrick Ogwang, the Head of the Mbarara Pharmacy School and President of the Pharmaceutical Society of Uganda, has developed called Jena Products. These are well researched and supported with medical literature and available in Kampala. I plan to check them out in a pharmacy here this week before I go home.

Update to the Lack of Power Situation: I now have power–Yay!!

Enjoy some photos of the Ankole Cattle in the Masindi region.

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A Wonderful Day in Masindi

Saturday, 23 June 2018

IMG_1767

Bird of Paradise

It’s been a beautiful day in Masindi—blue skies, sun, and no rain!  The New Court View Hotel has lovely gardens and I’m including a bunch that I took today.

Besides working on the phenytoin research today, Janine and I took a trip around town to talk with herbalists.  I am teaching a complementary and alternative medicine course in the fall to the pharmacy students, and I was interested in learning more about the herbs that are used in Uganda and what illnesses they treat. We went to 3 herbalist shops. I think the practitioners were a little skeptical about a “muzungo” (white person) asking them about their trade but all three were willing to talk to me. We did need to use a translator, though, and Janine’s usual driver, Moses was willing to help.  It turns out that I was completely unable to find out what plants are used in the preparations.

img_1792.jpg

This was the shop of the 1st Herbalist

Janine and I both agreed that the first herbalist we spoke to, a woman, was most knowledgeable. When I asked how she trained, she pointed to a photo on the wall of her mentor, who is an herbalist in a town about an hour away from Kampala. She told us that she treats diabetes, high blood pressure, sickle cell, malaria, colds, etc. but she would not tell us what plants she uses. She just laughed and said she uses flowers and stems and all parts of many plants.  She had a bunch of bottles of liquid on the shelves which she pointed to as the products she recommends for the different illnesses. These were not manufactured in a industrial plant—she actually made the herbal preparations herself.  Janine asked if she ever adds sugar to the products to which she answered yes but also said she doesn’t add sugar to the meds for diabetes.  The second herbalist seemed like a quack. He wasn’t too interested in talking to us and his shelves held lots of bottles of colored liquids that looked like they were put into reused water bottles. He said he didn’t make them himself and told us to treat malaria he would tell the patient to take a couple of capfuls after meals but that he would sell them two 16oz bottles.  With those directions, the person would be treating malaria for at least a week or more, which is crazy, considering the severity of the disease and the fact that the medications for malaria all are taken for just 3 days.

The 3rd herbalist clearly did not know much about her medications. Her shelves, though, were filled with labeled manufactured herbal products. Each had a photo on the label to give an idea what it was for and directions that said what it was for in both Luganda and English. I think she just read the labels and sold the product that matched the patient’s symptoms.  She said the 2 most common complaints were malaria and men needing more “power”. We looked at bottle with a picture of a lung on it and asked if she recommended this for TB (tuberculosis) and she said yes. This is kind of scary—to think there might be a patient with TB who is only taking this herbal product and probably spreading the disease to everyone around them.  When I was speaking with Janine and Moses about the general use of herbals, it seems like there are some patients who will ONLY take herbals and some that have died because they wouldn’t take western meds. But, many patients do take some herbals but also believe in western meds.

Tomorrow morning, I head back to Kampala. I’ve thoroughly enjoyed my time in Masindi and glad I took the trip to see old friends.

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