Limited resources, numerous experiences

A post by An Le, PD4

IDI Clinic Building on Mulago campus

After being in Uganda for a little over a week, my two classmates and I are still having a hard time believing that we get to have this learning opportunity in Kampala, Uganda. For the past few days living in a different country, every single experience has been truly rewarding, whether it’s a trip to Gaddafi National Mosque or a rotation at the Infectious Disease Institute (IDI).

The three of us rotate through several different sites including IDI, Kirrudu General Hospital, and the neurosurgery ward within Mulago Hospital. My first rotation is at the IDI, which is located on the campus of Makerere University College of Health Sciences. This institution provides care to approximately 8,000 patients living with HIV and other comorbidities. After one of the pharmacists, Eva, gave us an overview of IDI, I was amazed by how much research has been devoted to different areas to ensure patients in this particular population receive the most optimal care. In spite of the limited resources, the pharmacists and pharmacy students are extremely eager to learn about the U.S. healthcare system and explore various research areas to improve patient care. In Uganda, HIV patients receive isoniazid (a medication for tuberculosis prophylaxis) when they come to the pharmacy to pick up their HIV medications. Tuberculosis is the most common opportunistic infection in HIV patients. However, not all patients have tests done to monitor their liver functions before taking this medication. This was surprising to me because in the United States, we learned that liver function is tested prior to isoniazid treatment since this drug can lead to hepatotoxicity. In order to ensure the medication is safe, Eva and her team are planning on a project, where they are figuring out the most effective method to monitor medication safety and promote the importance of medication adherence. After sharing with the team about how this follow-up process is usually done in the United States, I’m excited to see the outcomes of their project in the next few weeks. 

IDI Education Building, where ATIC is housed

During my rotation at the IDI, Joe, Melanie and I got to visit the AIDS Treatment Information Center (ATIC), which serves as a call center for all health providers and patients in Uganda. Here, we were able to help the provider come up with the plan on how to approach a case study for a patient living with HIV and various other comorbidities. This experience allowed us to learn more how healthcare providers communicate with each other and with the patients in Uganda. One interesting piece of information that we learned while discussing the case with the provider is that there have been a few cases on hyperglycemia as a side effect associated with the use of dolutegravir.

I have now started my next rotation at Kirrudu General Hospital, where I get to round with the cryptococcal meningitis team and monitor each patient in the ward. Rounding with the cryptococcal meningitis team has been a unique experience for me, as I have gotten to see the integration of clinical research and patient care. The majority of the patients in the meningitis research trials are taking anti-retroviral therapy and some of them are also taking medications for tuberculosis prophylaxis. While reviewing these patient’s charts, I was shocked by the low CD4+ counts in these patients, which indicates that they are extremely immunosuppressed. Dr. Nicol, Joe, and I had a good discussion on different topics including drug-drug interactions between dolutegravir and rifampin and between fluconazole and rifampin. These discussions are very helpful for me, as they give me an opportunity to recall what I learned during my didactic courses and see how well I can apply it. While at Kirrudu General Hospital, one thing I noticed was how welcoming the provider was. He was very excited when our group asked if we could join and round with him. He also frequently turned to us and checked to see if we have any input for each patient and was very patient in answering our questions. Joe and I also got to see a lumbar puncture procedure done on one of the patients. A lumbar puncture is performed to collect a cerebrospinal fluid sample for a CrAg test for cryptococcal meningitis diagnosis. This procedure is also conducted on patients with cryptococcal meningitis when their intracranial pressure is too elevated. Looking back on this experience, one thing that surprises me the most is how most the time, the medications might not be adjusted to patient’s kidney/liver function. Most patients usually get the same dose regardless of the kidney/liver function. Although the healthcare providers are aware of the importance of the kidney/liver function when dosing, they don’t have a lot of resources to achieve this goal. Moreover, it’s usually cheaper for the Ugandan hospitals to purchase medications in bulk, which can be challenging for healthcare providers to adjust doses for each patient.

Besides these incredible learning opportunities, Joe, Melanie, and I also spent some time visiting different places around Kampala. At the Gaddafi National Mosque, we got to learn about the history of the mosque and the Muslim religion within Uganda. We also got to see a whole view of the city from on one of the mosque’s towers. Last night we attended a culture troupe show and learned about different traditions across Uganda.

 

Ndere Cultural Troupe Show

Climbing the tower at Gaddafi National Mosque

That’s a wrap for now. I seriously can’t wait to share with you all more about what I get to experience in the future blogs. Stay tuned!