Our dreams feel real while we are in them…

Hi friends! This is Autumn writing in for a last submission on our Uganda blog 😦

We’ve been home for about 2 weeks now, and I still have trouble realizing that I really did travel to Uganda, and I really did experience so many amazing things. The idea of travelling to Africa was always a dream of mine, and now that it has become reality– I think my brain is still in shock.

Looking back on Uganda, I cannot thank the people we worked with enough for the experience they provided us.

  • Winnie, our fearless leader in Kampala, has reminded me of how rewarding it can be to take pride in your profession and to keep pushing for enhancing patient care.
  • David, her husband and our driver through the crazy Kampala streets, was the first to show us the sincere kindness that Ugandans are notoriously known for.
  • All of the students and staff at Makerere pharmacy school, they are all fighting an uphill battle, but they too take pride in their profession and have showcased the Ugandan resilience and will to power through any tough situation.
  • Gonsha, the first drug shop owner we met, will always be remembered as someone whose determination and love for her patients has helped her build an amazing business and raport with patients in her community. I hope that her dream of opening a hospital becomes a reality!
  • Janine, the angelican missionary who was our fearless leader in Masindi, is a true inspiration. She has lived in Uganda for about 10 years now, and she is a force to be reckoned with. Her community outreach projects are extensive, but every single one has had a positive feedback on the communities she reaches. Also, she was an amazing host and gave Mike and I true cultural experiences, like preparing a meal and “preparing chickens”, that I will never forget.
  • Jimmy, Janine’s right hand man, is an amazing man. He is in his late 70’s and still does everything in his power to help his community. Another amazing inspiration. Everywhere you look, there was Jimmy helping someone.
  • Arthur, our guide for the safari, an awesome dude. Eternally thankful for helping us to experience the beauty of the Ugandan country side and for making sure we had the best time seeing the majestic wild animals that you only read about in America.

At this point, I think I’m rambling, so I will try to summarize as best I can here. In the end, Uganda has changed so much about the way I think about the world, that I am eternally grateful. I find myself having “Africa moments” and acting or saying something that is appropriate in Africa, but not necessarily in America. I honestly don’t want these moments to end. They are my reminder that I was there, and I experienced these wild & amazing things.

It was an absolute honor to have the opportunity to travel to Uganda and I will be dreaming about the trip until I return. I hope everyone who has followed the blog is inspired to visit the amazing country and witness the magic first hand.

A last note about me, I hate the feeling of life “chapters” ending, so I refuse to think that I will never get to experience Uganda again. So in this spirit…

UNTIL NEXT TIME, UGANDA!! -Autumn

P.s. here are some pics I had from safari.

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Our last days in Masindi

Siiba bulungi! (Good day!) This post is brought to you by Autumn & Mike. Autumn will cover Wednesday 11/14, and Mike will cover Thursday 11/15.

Wednesday 11/14/18

Wednesday morning all nine of us hopped into a van and visited Kijujubwa, which is about 45 minutes out into the Masindi district country side. Thus far in our trip, we’ve been to city clinics/hospitals and a town hospital, so Kijujubwa was our opportunity to see medical care on the village level.  Most of Uganda is made up by small villages, so this hospital was meant to show us a true idea of how most Ugandans receive medical attention.

We started at Kijujubwa-Kitara Medical Center (KKMC) which is another private clinic funded by One World Health. This center is rated as a Level 2 medical center, but honestly performs more like a “2.5” (which doesn’t actually exist). The difference between level 2 & 3 are that a level 3 has a ward and is able to host patients overnight. KKMC is open 24 hours a day, so if a patient comes in at midnight with an injury, they will allow them to stay until morning before leaving (hence the “2.5” rating).

The staff in total (between nurses, midwife, a lab tech, and doctors) is only 8 people, and they all live on site. This hospital did not have a pharmacist on staff, but their dispensing room was still impressive. We were told that they must order enough supplies and medicine to last them a month at a time, unlike in the US where most pharmacies have daily deliveries.

The clinic itself had 2 consultation rooms, a lab, dispensing room, and delivery room for childbirth. They averaged about 5 births a month. After going through each of they rooms the doctors showed us their means for garbage/infectious material disposal. Most of their waste was incinerated and the ashes poured into underground pits, but the most interesting disposal method shocked us Uganda first timers. One disposal pit was dedicated to placentas. That’s right I said placentas. It’s biodegradable, so why not!

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After touring the private hospital, we walked down the road to the Kijujubwa government run facility. The two hospitals were honestly like night and day. Right away we could tell that most of the villagers went to the free government hospital instead of the private KKMC. The dispensing room had very little medicine, and they received shipments every 2 months. The delivery room was bigger, and they had free baby vaccine clinics monthly. Even though the facility was in the middle of some upgrades, it was physically still rough around the edges.

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Thursday 11/15/18

On Thursday, we traveled to Masindi-Kitari Medical Clinic with the automatic blood pressure cuffs. Thank you to ASHP, NCPA, PPAG, Rho Chi, and CPFI for donating the automatic blood pressure cuffs! When we arrived we prepared to greet the community drug shop owners to teach them how to take blood pressures with automatic blood cuffs and teach drug shop owners about screening patients medications to make sure they are safe for pregnancy and lactation.

We began by having Dr. Prelewicz take the drug shop owners names and shops that they owned so we could raffle off the blood pressure cuffs and prizes we had at the end. Once we had a decent number of owners, we began the presentation at 10:15am, 15 minutes after our scheduled 10:00am to try to account for those on “Ugandan time” (there were still quite a few that showed up late!). As the drug shop owners filed in, we noticed that they all sat one next to another filling front to back even though they could have spread out through the open room. In the United States, we all would have opted to spread out unless we knew someone we wanted to sit near. In Uganda, people are not afraid to sit near each other, whereas, in the United States, we often prefer as much personal space as possible. Beth and Rubi began the presentation by teaching the drug shop owners about what blood pressure is, the problems high blood pressure could cause, what questions to ask a patient before taking a blood pressure, and how to read a blood pressure result.

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After teaching about blood pressure, we all broke for a morning tea break. After the tea break, we split up the owners and did a hands on teaching session of how to take a blood pressure with an automatic blood pressure cuff. The drug shop owners were very receptive to the teaching, and, specifically, with the owners I was teaching the owners who understood me the first time would teach each other, before I could assist! This was one of the shining examples for me on this trip that showed how strong the Ugandan sense of community is compared to the United States.

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Once the hands-on session was finished, Mayi and Dr. Manning taught the drug shop owners about asking patients if they were pregnant or breastfeeding and what medications they should screen for in patients who are pregnant or breastfeeding. This presentation seemed to us like it was much need, because, when asked, most of the owners did not ask their patients this before dispensing medications. Many of the owners were very excited to learn to do these things because they want their patients to know that they have the patient and her baby’s health in mind. Once the presentation was complete, we raffled off the automatic blood pressure cuffs we had and the gifts we got for the presentation, including our close friend Katy (the chicken). It was difficult giving Katy away, just as it is when any child. It feels like it was only Saturday that Autumn and I carried Katy 3 miles, while he cuddled us. We are glad that we were able to make someone’s Christmas better with Katy’s sacrifice. After the presentation was over, we all ate lunch made with the chickens that Autumn and I helped prepare.

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Late in the afternoon, we had the opportunity to see wild chimpanzees in a Ugandan forest bordering a sugarcane field. We made a 3 miles trek through the muddy, uneven forest filled with streams to see the chimps. We were able to see two chimpanzees trying to court each other and others using tree tops as sofas. We also saw monkeys during the trek and baboons in the road on the drive back! After this busy day, we were all exhausted and retired early.

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Webale, until next time!

-Mike

Hello friends,

Today is Wednesday, 11/7/18 (HUMP DAYYY!), and this post is a tag team effort between Stacy and Autumn…. starting with Stacy!

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Yesterday (November 6th) Katy, Autumn and I (Stacy) had the pleasure of touring my old stomping grounds, the Uganda Cancer Institute! We met up with a pharmacist named Isaac who showed us the pharmacy area, mixing room, outpatient infusion center, and inpatient wards. Since I last visited 3.5 years ago they have completely finished building the new upper wards. Even with the expansion they were overcrowded. Patients had mattresses in hallways as make shift hospital beds in the solid tumor ward in order to be treated. UCI is the only inpatient cancer hospital in all of Uganda so patients travel far distances in order to be treated. All of the chemotherapy is free to patients since UCI partners with the Ministry of Health. Although it is free, they do not have as many treatment options as we do in the US since they have to stick to a strict budget and very few patients have insurance. It is impossible for them to order high cost drugs such as nivolumab or perform transplants. The pharmacists also have to anticipate the needs well in advance since they only procure drugs quarterly versus daily in the US. Despite all this they are making advancements in other areas such as enrolling more patients into clinical trials through UCI’s affiliation with the Fred Hutch Cancer Center in Seattle. They also now have a UCI mobile bus that goes out to rural areas to screen and educate patients about cervical cancer, one of the most prominent cancers in Uganda.

Isaac and I bonded over our shared love for oncology. We feel a lot of fulfillment from helping patients through some of the hardest times in their lives, but it can be emotionally difficult becoming close to patients and having them not do well. In my opinion, the oncology pharmacists in Uganda are even more vulnerable to stress and career burn out due to the limited number of successful treatments for many cancers. Unfortunately most patients in Uganda present to UCI with advanced disease due to the lack of cancer screenings, inability to travel long distances for treatment, and sometimes fear associated with coming to UCI for treatment.

Later that day we visited a private catholic hospital, Nsambya. Although they don’t have an inpatient oncology unit, they do have an outpatient infusion center. The difference here is patient’s have to pay for all of their care so they only treat about 5 patients a day. Since they have a low volume, they trained their nurses to mix the chemotherapy versus pharmacy techs and pharmacists. Physically this facility looked nicer and more organized than UCI’s outpatient infusion center, but realistically chemotherapy is very expensive so most patients cannot afford to go there. I personally wonder where I would want to be treated if I lived here in Uganda. Many of the leading experts in oncology work at UCI, so although it is crowded I may still decide to go to UCI for the physicians and pharmacy support. Ultimately I think I would have to do more research before deciding.

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The rest of the post is completed by Autumn.

After touring the cancer center pharmacy at Uganda Cancer Institute in the morning, we caught up with the rest of the group for an afternoon tour of Nsambya Hospital. Nsambya is a private, non-profit, catholic missionary hospital. Unlike the government-run Mulago Hospital, patients at Nsambya must pay for all treatment, tests, and medications.

Before touring the hospital campus, Dr. Manning led a presentation on American inpatient pharmacy to the pharmacy interns and some pharmacy staff. Our presenting skills were really put to the test because we had a lot of barriers to overcome while giving the presentation. A sheet taped to a window was used to project onto, the space to sit and view the presentation in the pharmacy was tight and highly trafficked, and a rain storm rolled through, knocking out the power in the middle of the PowerPoint. Nevertheless, we adapted and were still able to continue with a discussion about specialty areas of pharmacy as well as contribute ideas to current problems the pharmacy department is facing. Some of the issues that were brought up were:

  • How to overcome documentation errors or lack of documentation in general?
  • What are some tips for getting the pharmacist involved in rounding?
  • What are some tools that the interns can use to help them assess patients?

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Post presentation and discussion, we went on to a tour of the Nsambya Hospital campus. After spending the past 2 weeks at Mulago Hospital (a free, government run facility), Nsambya was a sight for sore eyes. My first impression was that the hospital was well kept and felt more like a walk through a serenity garden, rather than walking across a hospital courtyard. At Mulago Hospital and other government facilities, you can expect to see family members washing clothes/dishes outside the wards, people sleeping on the ground, and broken sidewalks/roads. Nsambya did not have anything like that. When we asked our guide where the families sleep, since we did not see them sleeping by the patients or outside. We were told that the caregivers have their own dormitories to sleep in while staying at the hospital.

Nsambya had many specialty departments. The Intensive Care Unit and NICU had updated equipment and was quite impressive. While in the maternity ward, we learned that 80% of the births at that hospital were C-Section, and the other 20% of women give birth naturally without any medication (NO EPIDURAL!!). Ugandan women are some tough ladies!

During the tour, we met many different department heads, and each time we were asked to come back and contribute to their ward. The conversations and offers were heart warming, but alas we regretfully had to decline and leave with hope of coming back on our next Ugandan trip.

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Wednesday, Nov. 7th

Wednesday morning we visited another private, non-profit, missionary hospital called Lubaga. We started our tour with viewing their main pharmacy and then an outpatient pharmacy up in the hospital. The main pharmacy was very impressive. There were multiple storage rooms for IV solutions, supplies, and other medications. I jokingly said that I wanted my ashes scattered in their drug storage room because I was that impressed. This was the first hospital that we’ve been to that had a computerized list of the medication in stock. Most other pharmacies use a “stock card” system where they must manually keep track of the quantity on hand.

Pictures taken while seeing Lubago Hospital’s impressive stock rooms.

After ogling over the main inpatient pharmacy, our pharmacist guide, William, took us up to a different building to check out an outpatient pharmacy. He talked with us about common medications they dispense as well as their dispensing process. This was the first time we saw a computerized record database system in a pharmacy. The database was similar to Epic or Cerner that we use back in the states. The pharmacists could receive prescription orders through the system from any place in the hospital. Later on, Dana and Winnie had the chance to speak with the Medical Administrator (head honcho), and they commented on the impressive computer system here. The administrator told them that the pharmacists currently do not have access to view ANY clinical data on the computer database. Meaning that the pharmacists were forced to dispense medications to patients without knowing disease state, test results, lab values, etc. Dana and Winnie strongly advocated for the increased pharmacist access to that data going forward, and the administrator responded positively (THREE CHEERS FOR LITTLE VICTORIES!!).

After touring the rest of the hospital, the sights were similar to those we saw at Nsambyo the day before. The facilities were well cared for and the equipment was updated and modern. This hospital was also ran by a missionary, but they embraced the Ugandan martyrs so much that they dedicated the hospital to them. The hospital campus also had a beautiful cathedral dedicated to the martyr’s and had their story told through the beautiful stained glass windows.

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Before we parted Lubago, our team split into groups and explained some tools that they can use to help them “work-up” a patient before rounding, as well as helping them communicate with doctors and other medical practitioners. We discussed the structure of a SOAP note for pre-rounding methods, “I-ESCAPED-CPR” for evaluating medication appropriateness, as well as “SBAR” for communicating to doctors.

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Mike, Britt, and Katy describing good clinical techniques to Arthur, a Lubago pharmacist intern.

 

When we returned to our homestead at Makerere Guest House, we had a small, informal social with 5 students that some of us had presented to on Monday. We sat outside in the beautiful weather and had casual conversation about their Ugandan backgrounds, pharmacy, and much more. Before we knew it, the sun was almost set and our faces hurt from laughing. “Weebalennyo” to the gentlemen that took time out of their days to come hang out with us & best of luck on future endeavors!

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Tomorrow, Thursday Nov. 8, is our last day in Kampala! Friday morning we leave for Masindi, in the northwest of Uganda. Until then, stay classy America.

-Autumn

 

Autumn Peck, Student Pharmacist Introduction

     Hello friends! My name is Autumn Peck and I am one of the seven P4 students travelling to Uganda to represent Wilkes University School of Pharmacy. Go Colonels! During the past five years at Wilkes, I have not only fought my way through the PharmD program, but also accumulated a minor in Spanish and chemistry along the way. After graduation I hope to pursue a PGY-1 Residency in clinical pharmacy. For fun I am an avid clarinetist, and have spent many evenings during my college career in various ensembles.  Besides being a musician, my passions are food, animals, travelling, teaching, off-grid camping, and Dave Matthews Band.

     Flying to Uganda will be my second time ever flying across “the pond”. In 2015 I had the opportunity to study Spanish in Spain for a month and experience their culture from this inside. Though this upcoming experience in Uganda is structurally similar to my previous study abroad trip, I foresee the actual experience to be completely different (which is good!). I wholeheartedly believe that the only way to experience a culture, is from the inside– the full immersion technique. So being dropped into a foreign country on a new continent is exactly my idea of fun!

     In the end, I chose to travel to Uganda specifically because I want to teach and be taught. I want to experience their world of medicine while sharing what it’s like in mine. Hopefully somewhere along the way, everyone will learn from each other! While in Uganda, I am very excited to interact with patients of all ages and learn about the different languages/communities we have the opportunity to treat. Besides professional events, I am also beyond excited to try the indigenous cuisine!

     So far I’ve been very upbeat about this upcoming adventure, but I know in the back of my mind that this trip may have the most challenging situations I have ever faced on my own. Besides the obvious language barrier, I think that the cultural barriers as well as the limited access to medical resources/supplies will be the most complexing in the end. I hope to learn to “think on my toes” and problem solve with a diverse interdisciplinary team. For this exact reason I believe that all students, not just pharmacy, should study abroad for their respective area of expertise.