Kunkun's APPE Reflections

By Kunkun Wang

I can’t believe this rotation is  coming to the end and we are leaving. It is hard to summarize and reflect on this unique APPE experience because it’s just so different from anything else and I have learned so much from it.

It’s a perfect rotation that composed of almost everything possible: research, hospital pharmacy, clinic pharmacy, public health areas such as policy making and health system administration, and the coolest part, going to the morgue and watching autopsy!

My favorite part is the antimicrobial stewardship. When I knew that I would be working on an antimicrobial stewardship project, I thought it was going to be a very complicated process. I thought I might need to know all of the infections and what were the appropriate drugs for them. After Eva (pharmacist working at IDI) explained the background and needs of IDI, we decided to make a quick reference for clinicians and some educational tools for the patients. The tools we made were actually very simple and straightforward. I also enjoyed the patient interactions when we tested our tools on patient representatives. We had so many lectures in pharmacy school talking about patient education: how you need to be patient friendly, avoid technical terms, use simple language, clarify questions, etc. I thought our tool met all the requirement with simple words and pictures, but we still confused and scared our patient. We jumped to antibiotic resistance issue right away and told our poor patient that you might get some bad bug and no drug would work. Some term we thought simple enough: antibiotics, virus, bacteria might not be simple for them. You really can’t make any assumptions. Learned our lessons from the first patient, the second patient interaction went more smoothly. Patient preferred Luganda so we had an interpreter with us. There was one question asking about getting immunizations when our interpreter couldn’t find the correct word in Luganda because adult immunizations was not a thing in Uganda. People get childhood immunizations but there are no annual vaccines for adults. Overall, I love this process so much that we can apply our knowledge to improve patient’s understanding of antibiotics and prevent misuse. I am very excited to see our tools can be used in IDI after the pilot and help with global antibiotic resistance awareness.

The rounds we did with meningitis team, neurosurgery ward at Mulago and Nakasaro were also the best part. I never got bored because I almost had different things to see every week. I had the opportunity to learn about diseases and corresponding treatments that are rare in the US such as TB and malaria. Knowing how important it is to consider the most appropriate drug therapy in the local context with limited resources and medications. I still remember how shocked I was when I saw the management plan was so different from the US guidelines. Once I understood the reasonings behind it and more familiar with the situation that certain drugs or labs might not be available, everything seemed appropriate and the best option for the patient. I feel very fortunate to see the difference private and public hospitals and to know more about the health care system in Uganda. Meanwhile, I was comparing it with the health care system in the US and also in China, where I grew up from. We did a presentation on pharmaceutical care in the US to Ugandan pharmacy interns. We introduced and basics of pharmaceutical care process, how pharmacists’ role was evolving and expanding, what pharmacists can do in different settings in the US. We have a lot of question about how this care process is possible in a resource limited country when you recommend certain drug, but it may not be available, or it may not be possible for patients to keep appointment or certain equipment is not available for IV compounding. The situation right now is In Uganda, the pharmacist role just started shifting from dispensing to pharmaceutical care pharmacist work with health care team in the hospital. It reminds me that no pharmacist was working in the hospital in China 10 years ago, but now clinical pharmacy is developing very fast. It is very interesting throughout this rotation, I have been comparing what I have seen in different countries.

At last I have to mention that the Safari, Entebbe zoo visit, and Nile river rafting were awesome bonus to this rotation that I wasn’t expecting at all. This rotation is indeed an unique experience and I enjoyed it so much.