Ziwa Rhino Sancturary, Uganda

Posted on September 23, 2012 by kbohan

Today we went to the Ziwa Rhino Sanctuary, which is about 1 hour outside of Masindi towards Kampala.  The Rhino’s there are called White Rhinos but not because of their color. The animals are actually grey and the name is really describing their “wide” mouths.  When they were originally named, the pronunciation of “wide” sounded like “white”, hence the name.  Rhino’s are no longer living in the wild in Uganda due to poaching which led to extinction during the reign of Idi Amin. This sanctuary is building a herd, which can eventually be released in Murchison Falls National Park so they once again can inhabit their native land. When it says we are going to go Rhino “trekking”, they aren’t kidding. Following a guide, we hiked into the bush for about 30min or so through lots of swampy areas.  For this reason we had to put on wader boots prior to the hike (notice the attractive footwear in the picture of the students).  This made it just a tad more challenging to navigate the uneven ground in the wetland areas. In addition, the sun was bright and hot so we were all drenched in sweat by the time we found the Rhinos. But, the site was amazing once we got there and saw the small family of about 4 (maybe 5). We are eagerly took lots of pictures while these enormous animals rested peacefully in the shade. Eventually a couple got up and moved around so we were able to get some standing pictures. 

Besides the Rhinos, the area was filled with many birds.  The Weaver Bird in the pictures below makes these really interesting round nests that hang from the trees. The birds enter from below and often just hover there passing grass or food up to the birds inside the nest. 

We finished up the day with a delicious meal in the restaurant.  Most of us ordered the chicken (we placed our orders ahead of time) and as many chickens were “free-ranging” all over the yard, we had joked that they were going to go catch a fresh one for our lunch.  All in all the experience at the Ziwa Rhino Sanctuary was terrific and the students all agreed that it was well worth the cost of $30 USD per person (plus $15 for the guide) and recommended that it be another regular event for future pharmacy students participating in this global advanced pharmacy practice experience (APPE).  On the way home we came across a young cowherd (probably about 12 years old) driving his Longhorn Ankole cattle across the road. We had to wait for the road to clear before we could pass which gave us a great photo-op.  From the horns of these creatures, local artisans make bowls, jewelry, and other crafts by either using as is or softening the horn in boiling oil and re-shaping into many different forms. 

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Arrival in Masindi, Uganda

Posted on September 22, 2012 by kbohan

Hello from Masindi, Uganda!  After getting the car loaded in Kampala, we started to head down the lane when one of the other guests, a pediatrician from the UK, ran down the hill to catch us before we left.  She had just been escorted from town where she was walking by a police officer who said it wasn’t safe for her to be out because of a recent threat against the U.S. Embassy by Muslims angered by the recent video.  The threat was against Americans but pretty much any white person (or “muzungo” as they say in Uganda) would probably be presumed an American and at risk.  Since we don’t have regular access to WiFi, we didn’t yet get the email from the Dept of State about the warning.  Fortunately, the car was already loaded with fuel and we were headed in the opposite direction and came across no troubles as we left Kampala.  When I could get up my computer we were able to see the warning and also saw that Kampala was able to mobilize police forces ahead of potential riots and was ready.  Again, though, we were headed in the opposite direction and although the warning is a general one for all of Uganda, our driver assured us that Masindi is mostly Christian with very few Muslims. Also, we know it is not all Muslims that hate Americans and hopefully they realize that the video is definitely not the viewpoint of most Americans.  We arrived safe and sound yesterday evening around 6:30pm.  The sun was already setting and our rooms were a little dark. When we  switched the light on, no light appeared.  As I mentioned in my previous post, the electricity is still off in Masindi and the New Court View generator doesn’t go on until 7pm and then remains on until 11pm.  Darkness was easily overcome by our flashlights, which should definitely be part of the packing list, and when the generator started, it also brought WiFi. Yea!  Having internet access at our hotel, even if for just a short time, will be an added benefit because in Kampala, we had to go to dinner to find WiFi so the students and I can receive email on our smart phones and iPads.   We had a nice meal at the Court View and all when to bed early.  This morning it is bright and sunny; there is a bush with light orange flowers out one of my windows and a palm-like plant with some red “flowers/leaves” out my other window.  Each room is a cozy little cottage and contains a bed and a bathroom with shower.  Of course mosquito nets are provided and it will be important for us to use them properly as well as apply bug spray and continue to take our anti-malarials while in this rural area.  Kampala is a large city with lots of development and the incidence of malaria is actually fairly low. But, in Masindi, malaria is very common so we will be sure to adhere to precautions.  Today we are off to the Rhino Sanctuary to track the White Rhino.

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Presentations & More Presentations

Posted on September 20, 2012 by kbohan

It’s been another very productive day.  This morning started off by arriving at Mulago Hospital where at 9am, I (Dr. Bohan), was to present a patient case and discuss the pharmaceutical care issues and how to resolve them.  We were on time but the classroom was in use so we ended up having to wait until 10:30am when it was free. But, the students and I made really good use of the time. There was a canteen (small eatery) next door on the same hallway and we gathered with the pharmacy interns and got to know each other.  We spoke about how pharmacy practice can be improved and the obstacles that will need to be surpassed to achieve that reality.  When the classroom was free, I walked the pharmacy interns through a patient case involving a diabetic wound infection.  Many people participated in the conversation and asked good questions.  Afterwards the Wilkes students and I took a lunch break at some local craft vendors.  It is easy to get addicted to purchasing all of the wonderful craft products available here.  Stephanie proved to be quite the bargainer going from shop to shop to get the best deal.  We also had coffee at a shop called 1000 Cups Coffee House, which makes Ugandan coffee, along with other kinds- quite delicious!  The afternoon was spent at Makerere University School of Pharmacy where the students and I both gave our presentations.  Once we got started at around 3pm, we kept going until 6pm.  The attentiveness of the students, faculty, and pharmacists from the community was wonderful. We had some great discussions and I’m so excited about the future for improving pharmaceutical care in Uganda and hopefully Wilkes, along with D’Youville College of Pharmacy in New York and Notre Dame College of Pharmacy in Baltimore, Maryland can be part of the process!

It is so hard to believe that our 2 weeks in Kampala are up and we move on to the rural district of Masindi tomorrow.  Our time in the big city has been great and although we are sad to move on, we are looking forward to our new adventure.  Because of our travels, the next blog post may be slightly delayed. But we hope you all stay tuned….

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A Trip to the Uganda Cancer Institute

Posted on September 19, 2012 by kbohan

This morning we got up early to meet with the Pharmacist of the Uganda Cancer Institute (UGI), Benjamin at 8am.  We were a little late because we had a hard time finding the center amidst all of the buildings of the Mulago Hospital Complex.  By the way, we do a lot of walking here. It is a 30min walk between Makerere Pharmacy School and Mulago Hospital and if we are going towards our guest house on the Mulago campus, then we are going uphill.  The UCI is at the upper end of the campus way on top of the hill and has a great view of the city of Kampala.  Benjamin is fully of energy and excitement and so much fun to talk to about the UCI.  He has worked tirelessly to improve pharmacy services at the center and his passion for helping the patients and assuring safe and effective chemotherapy use is clearly evident.  His chemotherapy mixing pharmacy was small but well organized, clean, and had up to date equipment- see the photos (the extra guy on the left is a pharmacy student from Univ of British Columbia).  In the morning we were invited to attend the morning conference where a woman who has been studying the history of the UCI since 2009 gave a presentation. It was really interesting to hear about how much progress has been made in the care of cancer patients over the years.  Dr. Burkitt, the name sake of Burkitt’s Lymphoma, a common childhood cancer in Uganda that is caused by the HPV8 virus, practiced here.  Dr. Ziegler brought the first chemotherapy here to treat it and found that if caught early, the response to drugs was remarkable. The healthcare providers of the UCI have overcome many obstacles over the years but their dedication to fighting cancer through research and patient care has persisted and has made a difference in many lives.

Fun Stuff:  A visit to a the Garden City Mall seemed a lot like the U.S.- there was a food court and lots of shops.  But, when you go to eat at the food court, you don’t go to the counters to order.  Instead, you sit at a table and representatives from each food vendor pounce on your table and hand you about 7 different menus. They hover until you decide what you want then take your order.  If you look like you are looking a kabobs on one menu, a different restaurant rep will point out the kabobs on her menu trying to get your business.  There was an athletic shoe store with all the national brands we have in the U.S. and with similar price tags (or even more expensive)- but they look a lot worse. A pair of Nike’s was priced at 450,000 Uganda Schillings (about $180). I wonder who can buy these….

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A Visit to the Uganda Equator

Posted on September 18, 2012 by kbohan

Today we took a long drive (about 1.5hr each way) to visit the Equator!  It was really cool to be able to stand in both the Northern and Southern Hemisphere’s at the same time. Watch the video for a demonstration of how water flows differently depending on which hemisphere you are in.

 

 

 

Although we have been having lots of fun and taking interesting trips the past few days, we have also been busy engaging in activities and discussions with Pharmacists and Pharmacy Interns at Mulago Hospital and Faculty and Students at Makerere University School of Pharmacy.  For the students this is a Global Advanced Pharmacy Practice Experience but for me it is the start of a project to help Uganda improve and implement pharmaceutical care to their patients.  The students prepared a talk on Pharmacy Practice in the United States and have presented it twice already and this has led to really rich discussions and comparisons between pharmacy practice and healthcare in Uganda to that in the U.S.  We have all been impressed with the Ugandan student’s and pharmacy intern’s attentiveness and great questions.  Currently the entry level degree for Ugandan pharmacists is a 4 year Bachelors of Pharmacy degree as compared to the 6 year Doctor of Pharmacy degree in the U.S.  We have learned about their curriculum and although it does contain curriculum to teach therapeutics (the treatment of diseases) and pharmaceutical care, it focuses more on the basic sciences, research, and preparation of pharmacists to practice in Industry, as well as community and hospital pharmacy.  It is really impressive that all of their graduates have to conduct original research as a requirement of their degree!  We heard a little bit about some of their projects and were amazed.  One student was testing a local plant’s effectiveness against Neisseria gonhorrea, one actually radio-labeled bromocriptine with Technicium and injected it into rats to see if it would go to the brain to potentially be used as a diagnostic, and one student assayed the nuclear medications prepared in Mulago Hospital to determine radiochemical purity.   Many of the Pharmacy Interns and the graduate students expressed an interest in coming to the U.S. to participate in higher experiential learning, such as completing a residency.  Unfortunately there are not enough residencies to go around for the U.S. students that want to participate and also candidates for residency usually need to be qualified and licensed as a pharmacist- which in the U.S. means they need a Doctor of Pharmacy degree.  Maybe something “out of the box” could be worked out. I will definitely be exploring this when I return.

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Uganda Birds & a Waterfall

Posted on September 17, 2012 by kbohan

The movie clips shows you the beautiful waterfall at Ssezibwa Falls, one of the stops on our trip to Jinja.  

On this trip, so far we have observed a number of animals that aren’t common in the wild back home in the States.  First of all we have monkeys that live on the Mulago Guest House lawn.  The picture isn’t clear as the monkeys are quite fast and hard to capture on film.  Also included is a picture of Steph on the porch trying to catch the monkeys with her camera.  We were warned when we arrived that the monkeys are not very shy and if they try to come towards us, we should act bold and “pumped up” so that they scurry away.  I tried to take a picture of the many we saw swinging through the trees on our boat ride on the Nile River but they are just too fast.  I am also posting a few bird pictures in honor of my friend who writes the Accidental Bird Watcher Blog.  I know the name of the first bird- again seen from the boat ride. It is the Malachite Kingfisher.  The next two pictures are of this very, very large pelican-like bird that roosts in the top of trees on the Makerere University campus, right outside the Pharmacy School.  I couldn’t find the name of this bird, so if anyone can help, please leave a comment.  NEW:  Thanks to a comment, I found out that this is the Marabou Stork.

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Pharmacy Practice in Uganda

Posted on September 16, 2012 by kbohan

This past week the students and I spent 2 and 1/2 days at Mulago National Referral Hospital in Kampala talking to the pharmacy interns and going on bedside rounds with the team of physicians and medical interns to learn more about the common healthcare problems and methods of treatment.  The hospital only has 5 full pharmacists so most of the day to day work of dispensing the proper medications and assuring safe medication use is handled by the pharmacy interns who have graduated from a School of Pharmacy and have passed their eligibility exams to practice pharmacy.  They have to put in 1 full year of service before they can finally take their licensure exam and practice completely independently as pharmacists.  Mulago is definitely a “teaching” institution. While I was on rounds with the Chief Neurologist, he had a captive audience of about 15 people, including me and 2 of my students, and was actively engaging us all in conversation about the diagnosis and treatment of the patient.  It turns out that the boy of 16 had a pituitary tumor and required hormone-related medications to survive but he had stopped taking them 3-4 weeks earlier because the family ran out of money.   We also had the opportunity to visit a Community Pharmacy in Kampala where one of the pharmacy interns works as well as one of the students of Makerere School of Pharmacy’s Masters of Science in Pharmaceutical Supplies Management.  As you can see from the picture, it had a well organized and appealing design. Two things that were different from our pharmacies is that all of the medications were behind glass- clients have to ask for everything- and there doesn’t need to be a pharmacist present for dispensing to occur. Each pharmacy must have a supervising pharmacist but because there are too few pharmacists too fill the needs, each pharmacist can supervise 2 drug stores. This means that they will need to split their time between each.  In addition, right now there is no ability to log prescriptions into a computer and electronically create a label.  All medications are dispensed in envelopes with a handwritten label.

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Time Off to Explore Jinja

Posted on September 15, 2012 by kbohan

Hi all- this will just be a really quick post as it is after midnight here so now it is officially 16Sept12 in Uganda. Anyway, we’ve had a very full day on our excursion to Jinja.  This is town just about 70 km northeast of Kampala which is famous for being the source of the Nile River which flows out of Lake Victoria.  The Nile River then flows northward and eventually reaches Egypt. Today we saw the source point which used to be a big waterfall until the 1950’s when the first dam was built.  In the picture, we would have been standing at the top of the falls with the falls flowing from behind us to in front and to our right down the river had this been earlier than 1954.  We took a small wooden boat powered with an outboard motor to this point. Later we took a larger double-decker boat cruise on the Nile river further north.  The day in Jinja ended with a trip to the Ssezibwa Falls, a little known gem which our tour guide hadn’t even been to before.  In fact, most of the visitors we saw at the falls appeared to be locals.  I consider it a real treat that we got to see it. Later in the trip we will see Murchison Falls which is much larger, but never before have I gotten so close to the top of the falls, right where it falls over and splashes down the hillside.

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Appreciating Uganda’s Culture

Posted on September 14, 2012 by kbohan

On Wednesday evening we had the opportunity to attend the Ndere Troupe Cultural Show of African dance and music. It was fantastic!  It was held in an outdoor amphitheater (see video for the beautiful setting prior to the show- no taping allowed during the show).  A complete 2.5 hours were filled with lively colorful dancers and music showcasing the different regions of Uganda.  In addition, a buffet of traditional local foods were served and the students had their first taste of Matoke- mashed, boiled then steamed banana on which you pour stew or beans.  I’ve included a couple of other pictures. Wilkes Students Join the Dance!Can you recognize anyone in the picture below?

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Opportunities & Challenges for Uganda Pharmacists

Posted on September 13, 2012 by kbohan

The post below was written by one of my students, Ben.

In my short time at Mulago Hospital I have become extremely impressed with the pharmacists here and their passion not only for the patients but for their profession.  They are completely aware of the issues that they face including limited staffing, supply chain issues, concerns about drug efficacy and quality, and documenting and making interventions.  Despite all of these issues, the pharmacists aspire to get to a point where they believe pharmacy is in America, providing valuable input with doctors to improve patient care and make a greater impact on patient health.  While we have made great steps towards this in the US the idea is idolized and sought after by this group of pharmacists at Mulago.  They encourage all pharmacists and interns to read the patient chart and encourage the pharmacists to make independent decisions and also institute best practices.  They want to move to the point where the prescription is a recommendation and the pharmacist is able to make appropriate choices.

On my time rounding with one physician he was extremely interested in having a pharmacist there helping to assure pharmaceutical care is appropriate and all drugs prescribed have an indication and purpose for the patient to be taking them.  This is an excellent opportunity that the pharmacists have worked to achieve, and the 3 pharmacists are working to do this in a large 2000 bed hospital.  The intern pharmacists are in the process of learning the clinical knowledge and are working to improve in that respect and improve patient care.

There are a few more minor areas that the pharmacists are able to make a great impact on patient care.  They have started to work on delivering the medications to the bedside to see that it is taken by the patient, because only IV drugs are given by the nurse and the remainder of responsibility falls on the patient’s care giver.  By ensuring medications are taken properly, these pharmacists and interns are helping patients improve, and at a faster rate.  The team is also working to address the over use of antibiotics in patients, with the concern that if it continues it could lead to drug resistance.  On the floor they were checking to see that the antibiotics were appropriate and if they took the opportunity to implement more of a cultural move towards the use of culture and sensitivity tests, they will continue their success.

The issues that face this team are no small problem.  Once you meet the staff and come to understand their goals and their passion for reaching them, one can see that although the path will be difficult and arduous, this group of professionals will be able to accomplish the changes that they seek to make.  It is not going to be a quick fix or an easy solution, but ultimately they will be able to improve the quality of care for their patients.  It is the passion of these individuals working together to make improvements at their own professional level that will help to improve the hospital as a whole.

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