Traveling in Uganda

Transportation in Uganda is scary at times. We took a taxi most of the time and loved our driver, Haji! But essentially there aren't very many rules of the road.

As you can see it's much like a free-for-all. I believe we only saw a couple signal lights in the main city of Kampala and I don't recall any stop signs either. I do remember that there were speed bumps throughout many streets to prevent speeding.

The picture above was on our way back from the safari. The road was narrowed to one lane up ahead due to road construction so we had to wait for our turn to pass. While waiting, car lines started forming almost everywhere and it was a mad dash to the free lane. It was nuts. 

Often times I would be sitting in the middle of the taxi and flinch and squirm so frequently I would scare everyone else. I do have to say our driver Haji (who calls me his son and the girls his daughters, which he expects 100s of cows for when they get married) was excellent. He never got in an accident for 30 years, or so he says. :)

This is the only picture I took of some boda-bodas. They are like a motocross bike of sorts and completely dangerous. People would ride around on them without helmets and with various women and children on the backs of them. Haji told us he did not approve of them and insisted we not try riding on them. 

Outpatient Pharmacy

Today Candace and I spent part of our afternoon the outpatient pharmacy located in the Medical Outpatient Unit. The Medical Out Patient Department serves as a triage unit for patients presenting to Mulago Hospital with the highest volume seen on monday morning. The mild cases are seen by physicians and given prescriptions to be filled at the outpatient pharmacy while the patients with severe cases are admitted to the inpatient ward.

Working in the pharmacy was a unique experience. We had approximately five minutes of orientation and instructions and began dispensing. At first i had a very difficult time reading the prescriptions but quickly caught on. I did frequently ask the pharmacy intern for help reading the handwriting and interpreting the instructions as the sig language used is slightly different from ours.

For example tbs metronidazole 400 mg 1tds 5/7 =  Dispense metronidazole tablets i orally three times daily for 5 days.

In some ways reminded me of my intern days at Rite Aid Pharmacy because it was quite busy and we had patients that wanted their prescriptions filled ASAP. The average time from accepting the prescription to dispensing it was about 5 minutes. Lucky for us, some of the patients spoke English and i was able to briefly provide counseling before moving on to the next prescription.

Outpatient Pharmacy

Pharmacy in English, Luganda (native to Uganda) and Swahili

Mulago outpatient pharmacy is just as hectic as working at a community pharmacy in the US. There is really no standard way of regulating inventory past writing down what someone dispenses in a checklist spreadsheet. 

A patient is given a written paper prescription to bring to the children's pharmacy (above) or the adult pharmacy (below). In the picture Candace is dispensing while Alison shows off a drug product called Fungystin. 

There are limited counting trays which prompts pharmacy staff to use spoonfuls which are counted some of the time. Just like the hospital, the pharmacies are very busy with not a ton of staff. 

A stock cabinet with drugs for dispensing.

Additionally, I should mention that there are no copays required for the people of Mulago hospital. The Ugandan government provides the medications without charge. However if the medication is not carried by the hospital, patients must make other arrangements by purchasing the remainder medications, mostly syrups, from community pharmacies. 

Me waiting to dispense medications at the children's pharmacy. 

Babies!

Today Jamie and myself went to maternity ward rounds at 8:30am, after the rounds we broke up into individual ward rounds where we hooked up with the labor and delivery team.  We went into the labor and delivery suite where several Mamas were in active labor.  We were helping assist the doctors and midwives with exams and triaging patients, who was the close to delivery and who needed to go for C section.  They decided who needed a C section by the number of previous scars the Mama had.  If she had one scar she could deliver naturally but if she had two or more she had to go for C section because she was at risk of rupture of the previous scars.  While examining another patient, Jamie noticed one of the Mamas on the floor had a baby's head protruding out.  She was actively giving birth on the floor of Mulago!  The medical student went over and quickly delivered the baby and the placenta. We went with the medical resident to go tend to the baby who was the cutest ever.  She weighed 6.2lbs and we administered Vitamin K to her and put tetracycline on her eyes to prevent infection.  We then got a couple photos with her.

The maternity ward is so busy, understaffed, and under resourced.

Women have to give birth on the floor if there arent enough beds.  Sadly its not all happy endings either.  The team was attempting to resusitate a baby early in the morning that was unsuccessful and another Mama in the suite had a uterine rupture.  A uterine rupture can be fatal for the baby and mother, and the baby is basically floating in the abdomenal cavity. There are lots of volunteers but they are overwhelmed.

Lunch at Mulago Hospital: The Good Samaritan Canteen

Local food in Uganda is pretty basic but delicious. Lunch typically consists of white rice, beans and matooke which is kind of like a starchy banana. There are a few different types of sauces to put on your rice, our favorite so far is this green sauce that tasted just like peanuts. This entire plate of food only costs about 5,000 shillings which is about $2, not bad for hospital food!

And of course, dinner is not complete with out dessert! We went to a local cafe for dinner, Cafe Javas, and were thrilled that they had free wifi AND delicious ice cream sundaes, we were in heaven. It felt like a little piece of home. After all of the hard work we did at the hospital today we deserved a little treat. 

Babies!

I witnessed my first birth today... and it was not pretty! The patients were lined up in the labor room in beds 1-19. There were 3 midwives (2 from the US, 1 from Uganda) and there was 1 nurse. The women would come into the room, have their babies and leave as long as there are no complications.  No pain medications are given to those with normal births, an oxytocin injection is given after.  First I saw a 16 year old get examined for her centimeters dilated- this made me feel faint! I had to take a few steps back and talk myself into continuing.  I was determined to see a baby being born! I hung out in the labor room for about an hour, once it was time for my group to go to lunch, 3 or more women were ready to give birth.  I was a little late to lunch but I made it through the experience of a lifetime! I was a little anxious at first but once the baby came out and was crying I was all smiles!

P.S. The pizza in Africa is delicious!!

First Day at Mulago

Today we visited Mulago hospital for the first time.  We learned that we will be shadowing the pharmacy interns (there are almost 70 at Mulago).  We will also be collaborating with these interns to present a patient case to other interns; we will be evaluating the patient's medication regimen. I am so excited to do this because it allows us to share ideas with the Ugandan interns and to discover what they have learned. My first presentation will be on hypertension in pregnancy which allows me to work in the maternity ward- something that I have always been interested in!  A few things that we noticed today while touring the hospital include: Family members can come and stay at the hospital but they cannot be around the patient while they are being treated.  They set up camp in the hallways and outside of the buildings to stay until their family member is well. Also, the pharmacy interns have more responsibility.  They work at the satellite pharmacies in the different wards.

We also visited the Uganda Cancer Institute. It was so interesting to me how sophisticated the medical system is here. Their process of treating cancer is to begin with chemotherapy to isolate a boundary around the tumor for surgery, then surgery, radiation, and then back to chemotherapy as needed based on success of previous treatments. There are 36,000 patients and 3 pharmacists. Labs only take 30 minutes. Patients come from all of the surrounding countries to be treated at this institute. Oral morphine is unlocked and readily available. The pathology unit was air conditioned. They use similar medications for chemo induced nausea. The infusion center is a small room with chairs, the IV flows by gravity and instead of bags, they use bottles. 

Tomorrow will be our first day working at Mulago!