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!

Mulago Hospital: Day 1

Today began with a very cold shower. The Mulago guest house at which we are staying at has no hot water. It's a small price to pay for the trip of a lifetime. Following a breakfast of scrambled eggs, pineapple and toast, we set off for the hospital.

Mulago Hospital is known in the country as one of the main sources of health care. My initial thoughts were that I was more concerned about the sweat was dripping down my back and making me uncomfortable. After getting past my own issues, I realized what s great country Uganda was. There were families and patients willing to sit, sleep, stand, and essentially live in the Mulago hospital just to receive health care. They did not seem hopeless at all, but rather hopeful for the care.

We traveled around the various floors and areas we will be working over these two weeks and it's rather exciting. There are areas of endocrinology, pediatrics, nephrology, cardiology, and oncology. It all makes tomorrow seem very exciting.

Were about to eat as I type this, so....to be continued....

0. 
   

         May 24, 2014: Jinja, Uganda and the Amani Baby Cottage

   
   

 Giving away our first ball at the Amani Baby Cottage

May 25, 2014: The Source of The Nile River and handing out the 

One World Futbols to children in Jinja

Pied King Fisher

The Nile.

Today we saw the source of the Nile.

After leaving beautiful Surjio's guest house this morning we went to see the Source of the Nile in Jinja, Uganda. We pushed off in a wooden boat with a canopy and an engine on a two hour boat ride around the Nile, the Source of the Nile and Lake Victoria.  We spent some time finding all different types of birds along the forested edge of the water.  We saw Ibises, King Fishers, Storks, Pelicans, Egrets and a monitor lizard. Then we went to the source of the nile where the lake and underground water springs feed into the Nile.  Since a dam has been built several years ago, a lot of the source of the Nile has been submerged under water.  Several of the houses in this area have had to be relocated due to the rise in water level.  The level has even risen since DYCSoP visited the source of the Nile last year.  We all stepped off the boat into the Nile river (the longest river in the world and one of the only rivers that flows south to north.)  We took pictures at the source of the Nile sign and then took the boat into Lake Victoria.

At Lake Victoria, we could see Kenya in the distance! Our guide showed us several fish farms that are in the lake and we saw several more birds while there.  We docked at the shore and then drove around Jinja to distribute the soccer balls we had brought for local kids.  We had brought one world futbols that are virtually indestructible. We then made the trip back to Kampala.

Tonight we had dinner at Piato with Professor Richard Odoi from Makerere University School of Pharmacy and planned a visit to the school tomorrow afternoon.  Tomorrow morning we will begin working at Mulago Hospital.

Arrival in Kampala and Amani Baby Cottage in Jinja

First blog post!

Yesterday we arrived into the whirlwind that is Uganda. After landing in Entebee and finally getting through customs we took the hour drive to Mulago Guest houses in Kampala, Uganda. Along the ride my eyes were opened to the bustling city life that is Kampala.  Boda boda motorbikes, vans full of riders, cars, trucks, bikes and pedestrians all share the road and squeeze by each other by mere inches at most. The roads were a red dirt that was still slightly wet from the morning's rain. Along the ride to Mulago we stopped at a local fruit seller and were served some ripe mangos from the road side stand. We purchased some mangos and bananas and learned about the names of some of the other fruits. After settling into the guest houses we went about errands (grocery shopping, exchanging dollars for Ugandan  shillings and activating some phones). We ate dinner at a local Thai restaurant Tamarai recommended by our amazing driver.

After getting back to the guest houses we unpacked and turned in got the first night under our mosquito nets.  I honestly had one of the best nights of sleep but this is probably because we hadn't really slept for the two days of traveling.

Early the next morning we woke up to breakfast provided at the guest house with fresh squeezed passion fruit juice, tea, eggs and toast with special plum jam. We them headed with our driver on about a two hour drive to Jinja, Uganda. Along the way we saw more busy streets, fields of tea and sugar cane. We arrived in Jinja at the Amani Baby Cottage. We had brought toys and supplies from the US to give to the children of the orphanage. We got to play with the beautiful children which was wonderful and heartbreaking at the same time. We also did some yard work and re varnished  a jungle gym as volunteer work. After eating lunch there we departed for Surjio's Guest House in Jinja where we will stay the night. We have a few hours of relaxation by the pool before dinner.

More to come soon!

The journey begins...

Our flights are leaving in less than 24 hours! This is our flight schedule:

May 22, 11:20am Flight ET 503 Toronto, Canada to Addis Ababa, Ethiopia. Arrival 7:40am.
May 23, 10:55am (local time) Flight ET 811 Addis Ababa, Ethiopia to Entebbe, Uganda. Arrival 1:00pm.

We are all very excited, follow this blog for updates about what we're up to once in Uganda! We'll be there for two weeks, returning home on June 7, 2014.