A List of What I Miss

Hello everyone,

Everyone else has been back for two weeks now and Mayi and I are just currently returning to the states. While in Europe, I was reflecting on what differences I see in the different places we travel to, mostly Uganda. There are plenty of differences between our cultures and practice of medicine.

As everyone keeps saying, time moves slower in Uganda. People are not always in a rush like they are in the United States. Unless the timing is known to be important, it is expected that someone may show up late. I remember students coming late to class and no one even payed attention to them walking in, whereas in the United States we would be told not to do that again. I feel the United States would be a bit healthier if we occasionally allowed this practice of loose timings, because we would have less stress.

Another thing I learned from Uganda is how to work with what you have when it comes to medicine, which I feel will be an important skill in the future. There are constantly drug shortages in Uganda, and the Ugandans do their best to give treatment despite that. Sometimes you have to get crafty, but this could lead to other problems that I have seen, such as not finishing antibiotic regimens and increasing antibiotic resistance. Even with the shortages we face in the United States, I consider us VERY lucky that we usually at least have an alternative or two, which is not always the case in other parts of the world.

Family and friendships seem to be much stronger in Uganda versus the United States as well. In most Ugandan hospitals and clinics, nurses do not administer most medications and the responsibility is on the patient’s caretaker relatives. We have seen mothers sleeping on the floor on a mat next to their sick child’s bed or sons and daughters sleeping on the floor next to their grandparents to be there to feed and administer medications to the patient. In the United States, most of us are lucky to have relatives still talk to us, let alone take one hour for a hospital visit. I now see how beneficial having the support of family and friends can improve the treatment of a patient, even if they are not the one administer medications and feeding, just being there is enough.

Some things that are culturally awkward or unacceptable in the United States that happens in Uganda has also piqued my interest. One is that men are not afraid to be close with their other male friends. It was not uncommon to see a man lead another man by the hand or have his hand on a friend or colleagues shoulder when introducing them or talking. In the United States, there is still a taboo on men showing any emotion to their friends, especially towards their male friends. Another thing I noticed is women were able to openly breastfeed without covering up and that was completely normal. I understand this is currently a heated topic in the United States, but, from what I could tell, the children were unaffected by this and no men would stare or say anything when it happened. These are heated topics, but I hope this may offer a different perspective to some of you who read this.

I miss all of my friends in Uganda already and how friendly everyone was, even though I am currently not even back in the United States yet! Thank you to everyone who has helped us, taught us, or befriended us on the trip. A special thanks to Winnie, David, Jimmy, Janine, and the students and faculty at Makerere University for putting up with all of us and helping us coordinate everything! I will never forget the trip and what I have learned. For those of you waiting for the safari photos, here they are and sorry for the poor quality. My phones camera is not great.

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Let’s split up, gang!

Nkulamusizzah (hello) and happy Monday!

As the title infers, today we all split up into three separate groups to see/accomplish different tasks.


The first group, consisting of Autumn, Dr. Prelewicz, and I (Mike) stayed at Makerere University to teach the students.

Dr. Prelewicz began by teaching the students an introduction to her specialty, oncology. During her lecture, the students had many questions and were very attentive. The students were also very curious how cancer drugs were prepared and handled in the United States versus in Uganda. Dr. Prelewicz also had students draw their own chemo man for the medications she presented, which is a tool to learn the side effects of oncology medications.

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Following Dr. Prelewicz’s presentation, Autumn and I presented on Free Applications for Portable Devices in Medicine, which falls under my interests. We discussed multiple applications that the students could use while they are on rounds or for when they need drug information.

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I had a great time today being able to step into the opposite side of the classroom and being able to teach. Overall, the students were very happy to have us teach in class and we were happy to be there!

-Mike


The second group, consisting of Beth, Brittany, and Rubi, rounded at a mental health clinic at Mulago Hospital.

This morning, I had the opportunity to round with a Community Pharmacist, Derrick, in a mental health clinic with Rubi and Britt. We were definitely a little bit surprised because we thought we would be seeing a lot of mental health related illnesses, but it ended up being mostly orthopedic patients who were admitted due to car accidents. Although the ward was NOT what we anticipated, the experience was highly educational and allowed us to use our clinical knowledge to assess patients. We had the opportunity to see two patients this morning, both of which we spent roughly 45 minutes with. Derrick did a fantastic job of pushing us to use the visual appearance of the patients to initially develop questions to ask. We had no lab values to make any form of a clinical decision with, so our strong counseling skills were necessary in order to best help our patients. Derrick acted as a translator for us and gathered information from either the patient or a family member in order for us to assess the situations. I was honestly surprised at how easily we developed questions that were necessary to understand what our patients were feeling. Both our patients had pain as their primary complaint, so it was clear that Dr. Franko (our pain management professor) prepared us to be capable to assess our patients. A constant theme I know we have all mentioned in our posts is the difference in resources available here. Clinical data and medications are limited, so we are constantly learning from the pharmacists we round with. Derrick told us that he wanted us to “share a leaf” with him. By that, he meant that he wanted us to share with him how we would assess and treat patients in the states. This way he could use our experiences and knowledge to best formulate a plan that is realistic based on the resources available in Uganda. I think we could all agree that it was great to be able to collaborate and learn from each other today.

I wanted to highlight a key difference in the treatment of patients and mental health here in Uganda that was emphasized through today’s endeavors. A unique aspect to the culture of Uganda is how much patients rely on family and their community. The support that Ugandans provide each other with is very heartwarming and makes me sit back and realize how lucky I personally am to have such a strong support system when I am home. The patients are taken care of in the hospitals by both health care providers and family members. When you walk into a ward, you see patient beds tightly packed in order to maximize space. In between the beds, you will find family members camping out on the floors. Food, drinks, clothes, etc are all provided by family. Could you imagine walking into a hospital in America and seeing a patient’s mother and brother sleeping on a hard and dirty floor in order to be there for the patient? That type of support is consistent throughout the various villages in Uganda. Counseling is a HUGE aspect to mental health in the States. We were very surprised by the fact that, in Uganda, most “psych” patients only seek help when the diseases progress to the point where family members feel urged to take a patient to a hospital. Otherwise, the illnesses are combated through the consistent support of family and the community.

Lastly, I wanted to focus on how I felt after reflecting on today. We were really able to feel the impact that pharmacists could have in hospitals here. The first patient we saw today was there with his brother who acted as our primary source to gather information from. At the end of our meeting with him, he thanked us and said “May god be on your side”. The second patient we saw slowly began to develop trust with the four of us. This lead us to not only discussing the primary complaint of pain, but also diving into very deep and personal issues the patient was experiencing. Although we are not qualified to treat the issues he mentioned, it was amazing to see how his trust developed with us. You really do not realize how much your work can impact someone’s day or even life. It is so important to remember to be open-minded and listen to your patient. Spend extra time with your patients and their families. Help them to feel comforted and have someone they can trust. It is easy to get caught up in the stress of work, but putting your patient first and going above and beyond for them is so rewarding. I felt like today really showed me why I wanted to be a healthcare professional in the first place: To help people. You never know who you can impact in a day 🙂

Beth


The third group, consisting of Katy, Dr. Manning, and Mayi, rounded in the pediatric ward at Mulago Hospital.

Today we broke into groups in order to get multiple tasks accomplished. Katy, Dr. Manning, and I met with six pharmacy interns in the pediatric ward. Just to give you a little bit of background, the pharmacist interns here are different than what we consider interns in the USA. In Uganda, they are finished with their pharmacy degree and are then required to practice as a “pharmacist intern” for a year, but they have the ability to verify orders, dispense, and round with other healthcare professionals. In the USA we are all “pharmacy interns” for all 4 years of pharmacy school, but we are under the direct supervision of the pharmacist. The role of the interns here is similar to the role of the pharmacy residents in the USA. Now, back to this morning. Our main goal was to learn from and to teach the interns about rounding with physicians in an inpatient setting. In Uganda, pharmacists are not used to going up to a physician and making a recommendation. Katy and I role played a scenario using the “SBAR” technique (THANK YOU carelab and Dr. Ference). We demonstrated how we go about making a recommendation and the important aspects of using SBAR properly. The interns were really happy to learn this.

Unit 1

Among other things, we discussed the many other roles a pharmacist has. For example, besides medication ordering and dispensing we should also be in the lookout for the proper use of drugs in any capacity. Moreover, we spoke a little bit about the various resources available in the United States and how this makes our profession a bit more manageable. The interns were not aware of the free phone applications available so we told them about the ones we know, however, most of them have an annual fee. On the other hand, I really wanted to help them develop a systematic approach to gather and process information. When looking through the charts it was difficult to figure out if medications were actually given to the patient or if they were just ordered. They rely on the nurses, they assume the nurses gave the proper medication at the proper time, but there is no record of that. This scared me a little bit as we know how often mistakes occur in the USA with AUTOMATED systems, let alone assume a human being is taking care of others properly at all times. I hope they do implement a way to backtrack when medications were given and at what time. Also, pharmacists do not write on the medical charts. I was shocked by this as we document every intervention we make. They said that only physicians write on the charts, but we are hoping to slowly improve the way pharmacy is practiced in Uganda. I pointed out that the weight was very difficult to find in the chart, it was actually located in a separate document. So how are we assuring that all doses are calculated correctly? They did not have an answer which was also scary especially since they are working with the pediatric population. I explained to them the importance of having the weight readily available in order to prevent harm to the patient and make sure the drug does its job! They nodded and seem to be open to the idea. I am extremely happy at how enthusiastic the pharmacists are to learn despite the hardships they have to overcome.

Unit 2

Another big topic was how there is only one pharmacist intern dispensing, verifying orders, and rounding with physicians in the pediatric ward that I will estimate has approximately 50 patients. Having to take care of so many patients makes rounding very difficult. Usually the pharmacist intern will mainly focus in the dispensing of medication. We proposed that they encourage the doctor to ask medication related questions. Additionally, sometimes the government may not pay them for multiple months, and so they are then working to gain more knowledge and to help patients and not for a salary.

All in all, it was a very eye opening experience and I enjoyed every second of it. Not only did I get to spend the morning in the pediatric ward which is where my heart lies, but I also had the opportunity to learn from the Ugandan pharmacists. Noah and Derrick were so eager to learn that they are actually meeting us later today for dinner to discuss more about pharmacy practice in the USA.  I think they are amazing and they are doing an incredible job at taking care of people even when the environment is difficult!

-Mayi


Have a great Monday and Sula balungi (Good night)!

Michael Hummel, Student Pharmacist Introduction

Hi everyone!

My name is Michael Hummel, and I am currently in my final (P4) Year at Wilkes University pursuing my Doctorate of Pharmacy with a minor in Computer Science. After graduation, I plan to pursue a residency for two years, and I plan to specialize in Pharmacy Informatics during my PGY2 year. I would ultimately like to work as a clinical informatics pharmacist and possibly get into pharmacy software development at some point.

Reading my career goals probably has you understandably questioning how a rotation at Uganda fits in my career goals. I believe that practicing in Uganda will provide me with both new perspectives and a unique education that would benefit me as a clinical pharmacist. I hope to gain new cultural perspectives, practice with patients that speak different languages, and learn new disease states. I also wish to gain experience working with minimum resources both to gain experience and to also learn of pervasive healthcare problems that I may be able to fix in the future with technology.

While in Uganda, I hope to do all of the things that I cannot do in the United States. I want to see all of their different plants and animals and see their cultural events and music. In my free time, I write music, and I hope that I can pick up some new things from this journey. Below is a picture of me (on the right with the saxophone) playing with my previous band:

While I am In Uganda, I hope to come away with plenty of new cultural experiences, and I cannot wait to keep all of you updated on our experiences!