"I can't believe we learnt all that in one day"

By Prosperity Eneh

As we sat down to have dinner today (Monday 5/28/18) at one of our favorite restaurants so far (Cafe Javas) Sara exclaimed, "wow. I can't believe we learnt all that in one day". She made this statement as we were recalling our experiences from the day. As our colleagues in the U.S took the day off to celebrate Memorial day, it was a busy day for us in Kampala. We opted to take the day off June 15th when it will be a public holiday here in Uganda to celebrate Eid (end of Ramadan).

Front entrance of IDI -Mulago

We split up today for clinical experiences. Sara and Dr. Nicol were in the Infectious Disease Institute (IDI) and were part of the virtual rounds with the Cryptococcal meningitis team. It was a virtual round because the team travels a bit far away everyday for physical rounds at Kiruddu General Hospital since the New Mulago hospital (close to IDI) where the patients would normally be located is still under renovations. They did not make the trip because Sara had to shadow a medical officer at IDI later in the day and the Kiruddu team will not be back in time for her. On Wednesday they will get to participate in the physical rounds.

Kunkun and Winnie at Nakasero Hospital main entrance

Kukun and myself went to Nakasero Hospital. We met with Esther (the pharmacist) and Winnie (another pharmacist). We went on rounds at the general ward with Winnie and the rest of the  inter professional team (physician, nurse, physiotherapist, and patient advocate) and visited with many interesting patients and cases. We were privileged to work with an enthusiastic endocrinologist that loved to teach his colleagues and asked many questions. Now we have so much to look up and prepare for tomorrow.




After the rounds, the students immediately met with Eva, the pharmacist at the Prevention, Care and Treatment Clinic within IDI in Mulago. We had previously met with Eva and talked about some goals and objectives for working with her. Today she introduced us to two medical officers that Sara and Kunkun would each shadow for a few hours today and tomorrow. They both got to sit in on medical visits as a way to get some context for working with Eva on the clinics' ongoing antimicrobial stewardship program pilot. This clinic is often used as a place for pilot projects prior to rolling out to other clinics and hospitals and the students are brainstorming ideas with Eva and the other pharmacists on strategies to incorporate patient and physician education on the rational use of antibiotics.  Sara and Kunkun expressed that they were amazed by how many patients the medical officers were able to see and the time shadowing them was  a great learning experience.

Here are some other details we have learnt so far;

Uganda is divided into three main categories when it comes to provision of healthcare.
1) Government hospitals and clinics (with a bottom up referral approach moving from health centers > district hospitals>regional hospitals>referral hospitals)
2) Non-government or private (for-profit) hospitals and clinics
3) Faith based or donor sponsored (not for profit) hospitals and clinics

Mulago hospital and Kiruddu General hospital are examples of government hospitals.
Nakasero hospital is a private for profit hospital.
The infectious Disease Institute PCT clinic is an example of a donor sponsored (not for profit) clinic.

The patients that visit government hospitals mostly receive basic care without paying but there is often shortage of some supplies and drugs. Sometimes patient families are responsible for purchasing medications and labs if not available in the hospital. The private non-government hospital are for paying patients and can often times be better stocked with supplies, medical/lab equipment and essential medications. The donor sponsored facilities can also provide free care with occasional options for patients to pay for added convenience.

It is interesting to be plugged into these various settings as learners and we have had such warm welcome from everyone we have met so far. We look forward to more days filled with wow moments!