Since we have been in Uganda for the past weeks, we have continued to observe the healthcare system. One aspect of the healthcare system in a developing country like Uganda that is very much different from what I have experienced in U.S. health care is the role of family and friends in care provision. In each hospital setting we have visited while here, family is everything to the patient. In the absence of family, chances of positive patient outcomes are greatly reduced. The family of the patient is so important that at Mulago Referral Hospital, patients with no family or friend with them receive a special yellow blanket wrapped around them to identify these patients. These patients are less likely to overcome the illness that brought them to the hospital.
Why is this so? Well your family is so vital to your recovery process here. With limited resources, there are limited amount of nursing care that can be provided. Each nurse is in charge of so many patients that they cannot provide intimate care for each one of them. The family fills this role. At least one family member of the patient or a friend essentially comes to live in the hospital with the patient. They bathe, change, clothe, buy needed medications and advocate for the patient. In some cases where professional healthcare provider shortage is more pronounced, the family member can even be taught aseptic techniques for changing IV bags for the patient. From a pharmacist's point of view, the family or friend the patient has with them can truly influence medication compliance while the patient is in the hospital. The family member usually determines which medicines the family can afford based on the doctor's prescription list, and the education level of this family member can be critical in ensuring that the patient takes the medication the right way as outlined by the doctor. One role of the pharmacist that we have observed here, especially in the government hospitals is education of family or friends to ensure appropriate medications are purchased and provided to the patient accordingly.
Economically speaking, the burden of healthcare can be very catastrophic for many families here. While the cost of healthcare may seem minimal when compared to the U.S. cost of healthcare, having a sick family member can wipe out savings for many family members. A one night stay in the ICU can be as high as 500,000 shillings (approximately $135) and this might not seem like a lot of money but it can take several months for many families to get this kind of money. Medications are often purchased in little doses, (3 days, 5 days, 7 days etc.) and not all that is on the list can be purchased at all times. Furthermore, the patient and another family member or friend have to stay in the hospital and hence they are both loosing potential income while in the hospital.
It is often difficult to truly understand from afar and when one is not in another person's shoe. As a pharmacist in this setting, it is hard to think only of guidelines and following a set of guidelines for practice. You have to consider so many other angles in helping the patient on their road to recovery. You have to consider patient's educational level, family involvement in care & social support, financial situation, likelihood of return to follow up, medication and lab supply issues etc. These all play a part in your clinical decisions and often times I find myself asking the physicians and pharmacist why they made one choice vs another and finding out that they had to consider all these aspects in making a decision. It is humbling to see this.
I am amazed by the resilience I have seen in many patients considering the situation. It also gives me hope to see the dedication from family and friends in care provision.
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| At UWEC |
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| Beach front - Lake Victoria |
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