Out of the Pharmacy Classroom and Into Africa

11 April 2017

This week we are fortunate to be spending time helping young Ugandan Pharmacists implement a new Clinical Pharmacy program at Nakesero Hospital. Dr. Erin Pauling and I, with assistance from Dr. Emily Flores, presented a program to teach Pharmaceutical Care Skills to 19 Ugandan Pharmacists at the Pharmaceutical Society of Uganda last Friday.  These Pharmacists have a keen interest in Pharmaceutical Care and have volunteered to start Clinical Pharmacy services at local hospitals. Over the past several years there has been much more interest in developing and implementing pharmaceutical care to help improve safe medication use and patient health outcomes.  Winnie, the Ugandan Pharmacist who I’ve been working closely with over the past couple of years has been volunteering in the Neurosurgical Ward at Mulago Hospital for about the past year and now there are private hospitals in Uganda who are recognizing the critical role a pharmacist can play on the patient care team.  When Winnie told the Medical Director at Nakesero Hospital that she now has 4 trained pharmacists who want to volunteer to start a Clinical Pharmacy program, he said to have them start on Monday (that was yesterday).  This was perfect timing for our trip because not only did we just train them so the skills are fresh, but I have a team of 5 who can help mentor these pharmacists this week as they get off to a running start.  

I had never been to Nakesero Hospital before Monday and boy what a treat to work in such a clean, organized, and patient-friendly hospital.  Unlike many of the government hospitals, the medical charts had all of the documents in the correct order and in specific sections. We were able to quickly find what we were looking for.  Also, the hospital has MEDICATIONS!!! You might wonder why I’m surprised, but significant lack of essential medicines is the government health system is a given. Nakesero is a private institution so patients pay for everything, so we should expect the medications to be there. But it was still a pleasant relief to know that the patients there will not have to leave the hospital to go purchase medications on their own.  We also found the medical and other health professional staff to be interested in our project and receptive to our comments about drug use.  Of course, there are many ways to improve drug use which is to be expected since pharmacists haven’t been routinely reviewing the medication orders for all of the patients, but I think Nakesero will be a great place to start this Clinical Pharmacy initiative. They have the right infrastructure to support it and hopefully when they show improvements in safe medication use, all of the hospitals in the country will want their own Clinical Pharmacists.  I still have a desire to improve drug use in the public sector, but I think that implementing these services in the private sector where there is more support and stability with the medication supply will help us figure out the kind of program that will work for Uganda. Then we can expand it to public hospitals.

This afternoon, Dr. Pauling and I presented a seminar for the Faculty and students at Makerere University School of Pharmacy.  Dr. Pauling discussed Interprofessional Education and Collaboration- the importance of working as a healthcare team to provide excellent patient-centered care.  The faculty were very interested in this concept. Makerere University has been training all healthcare professions students together for their basic science courses for years and they also go on community based education and service (COBES) experiences in the summer where they go to villages and live together for a month and learn and serve at the local clinics.  But, most of these experiences aren’t truly Interprofessional Education because the students are mostly learning alongside each other but not necessarily learning about each other’s roles and how important each is the the healthcare team. I think that when we truly teach the healthcare professions in an interprofessional way, we will no longer have licensed practitioners that are scared to talk to each other because they don’t think the other will listen. We will know each other’s capabilities and appreciate each other’s strengths.  We will want to always work together because this is what is best for patient care.

When I was asked to give a presentation for Makerere Pharmacy Faculty and asked what I should talk about, the answer was “something on Pharmaceutical Care- everyone is interested in that”.  But as I thought about it, I decided to talk about a couple of pharmacy projects that are working in East Africa, rather than focus on the US Healthcare and Pharmacy practices.  Back in 2014 I had the opportunity to go to Eldoret, Kenya with Professor Odoi and Kalidi, another faculty, to see the AMPATH (Academic Model Providing Access to Healthcare) program that Purdue University is participating in at Moi Teaching and Referral Hospital. We learned about their initiative of Revolving Fund Pharmacist and BIGPIC.  A Revolving Fund Pharmacy is a Pharmacy that sells quality medications at a small markup, less than in the community, to supplement when government supplies of essential medication is not available.  This has significantly reduced the times when essential drugs are not available in Eldoret.  I wonder if it could help the problem in Uganda.  The main difference, though, is that in Kenya, patients pay out of pocket for medications at the hospital anyway so if they have to get drugs from a Revolving Fund Pharmacy because the hospital is out of stock, it is not that big of deal that they must pay.  In Uganda, though, all medications received at government facilities are free so having to purchase drugs when the government runs out would not be favorable. But it is actually always happening now and patients have to go to community pharmacies that charge high amounts and sometimes do not have quality products, so perhaps this could be a solution. BIGPIC is an even more interesting. This is a program where community groups are developed for patients with chronic illnesses like high blood pressure and diabetes and the drugs are brought to them so they don’t have to go into the city. Along with this service, medication and disease education is provided to help patients understand how to live their best quality lives.  These groups, though, are also a microfinance program. All of the patients pay a small amount into a pot every time they go to a group meeting. From this pot, they can take loans for small projects to improve their income. For example, maybe someone wants to start an egg selling business and takes a load to purchase chickens.  They must pay this back with interest and the pot of money grows. At the end of the year, the dividends from the interest and the money left in the pot is redistributed to the patients in the groups. This AMPATH program has led to statistically significantly improved blood pressures among the patients.

At the end of the day, I took the students to visit a friend of mine who owns her own pharmacy in town. It was nice to catch up and learn about how different the laws are in Uganda as compared to the USA.