Sauntering through Kampala

Trip Start Aug 19, 2012
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Trip End Ongoing


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Where I stayed
Makarere University Guest House

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Saturday, December 1, 2012

Back to civilization!  That's how we felt when we arrived back in Kampala.  

Fortunately, Adrian noticed Mulago Hospital as we passed it, which made us realize we should hop off the Post Bus early to get to our guesthouse at Makerere University (fun fact:  the #1 ranked university in Uganda, and 736th ranked university in the world).

So at the last minute, we said a quick goodbye to our new Canadian pharmacist friend from Lacor Hospital, Jennifer, grabbed our big bags, and hoofed it to our guesthouse.  By the time we got there 20 minutes later, we were drenched in sweat and covered in a thin film of dust.

Makerere University campus is quite a pretty campus.  Ignore the non-existent or broken up sidewalks and mismatched buildings, and look instead at the beautiful indigenous fauna and flora (huge exotic trees, storks and cranes flying overhead constantly), and you'll be amazed that this is a school.

I got to visit the Pharmacy School department at Makerere University as well as Mulago Hospital through the hospitality of Dr. Richard Odoi (thanks Kyle!).  I was supposed to teach a class  to some of the post-grad pharmacy students, but that was cancelled last minute (3 days before) as the students were in exams already.  Fortunately, I know enough about African culture that I was prepared for this possibility, and didn't waste any time preparing much in advance.  Here's to cultural awareness!

So instead, I spent some time at the out-patient pharmacy, one of the general medicine satellite pharmacies, and the pediatric acute care satellite pharmacy over the following two days.  The main interests pharmacists/interns had was what pharmacy practice was like in Canada.  It was a very interesting and enriching experience to observe pharmacy practice in action, while having open conversations about the differences of practice between the two countries.

Some major differences I observed about African practice compared to Canadian at Mulago Hospital:

- Interns run the show in terms of dispensing meds, and have no guidance from day 1.  It's assumed that their 4 years of training should be enough to equip them to practice in hospital immediately...scary.
- Patients' family/friends are the primary administrators of medication, unless a nurse is available, so almost all drugs dispensed are given directly to the family/friends.  You assume the patient gets the med, and takes it correctly.
 - Staff pharmacists essentially deal with procurement and inventory management of drugs, as well as more managerial responsibilities.
- Pharmacists rarely participate in rounds or know what is going on with the patient, including diagnoses.
- Technicians do most of the dispensing and counselling in out-patient settings.
- About 50% of drugs are not available in the hospital, even some that we consider basic.  Patients are then behooved to source them out from other pharmacies themselves, and pay for them out of pocket.  Many are too expensive to purchase.

Essentially, there is a lot of role reversal in African pharmacy practice.  But it somehow works.

Oh, and there are about 500 pharmacists in the ENTIRE country.  To put things in perspective, UBC Pharmacy alone graduates about 150 students per year.  Retention in lower paid government hospital and academic positions is difficult as a result, especially when pharmacists make more in community (reminiscent of Canadian dynamics only a handful of years ago), or at NGOs (up to 5 times more).  

On a lighter note, we had a fun time soaking up "civilization" at Garden City (not to be confused with Garden City in Richmond, BC), watching the new Bond movie, Skyfall, and having dinner at a nice rooftop indian restaurant.

Adrian even got to drink BEER in the movie theatre and our tickets included free sodas.  And we had an entire leg of goat at the indian restaurant.  I have no idea how we finished it.  There was enough meat for 4 people.

And Adrian also had a fun day on a boda boda tour with a well known local who runs a safe ride around the city.  By safe, I mean he gives all passengers helmets and goes at less than insane speeds through the crazy traffic here.  I on the other hand, spent my day, sweating in a non-air-conditioned hospital.  I think he had a more fun time.  :)

We also walked to the Uganda National Museum, which turned out to be more entertaining that expected.  Walking is paramount here.  We braved the matatus (beat up mini-van taxis that drive crazily), but they don't go everywhere.

Sauntering is also paramount.  I realized this every time I walked to and from Mulago Hospital.  I felt like I was speed walking past people all the time, even though it was my slow walk.  So, as the good tourist/"Mono"/"Mzungu" that I was, I tried sauntering too.  

Realization?  I cannot for the life of me saunter as slowly as the locals.  They craaawwwllllll along.

On one of my saunters home from the hospital, I also encountered something very sad and ironic as well.  I saw a double amputee (no legs below the knees), selling shoes.  It was almost jolting to witness. 
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