Cultural competence in a potpourri of clinical settings

A post by Joe Corbino, PD4

If there is one lesson I have learned during my three weeks in Uganda so far is that there is such a thing as “Uganda Time”. You can do your best to have your day planned out, but this country always seems to throw a curveball at you somehow! Nevertheless, even with adjustments made to our daily schedules we are all having the best time. This past week has been full of varying clinical experiences, a journal club covering cryptococcal meningitis therapy, patient case presentations, and time exploring more of the capitol city of Kampala.

This week we were joined by Prosperity Eneh, a recent University of Minnesota pharmacy fellow and member of the Nicol lab, who will be spending the remaining two weeks with us. We were also informed at the beginning of the week that Eid would be occurring, marking the end of Ramadan, at some point during the week. This was entirely dependent on when the moon was sighted in Saudi Arabia, which made it a bit challenging to make plans for the rest of the week. Luckily for us, the holiday fell on Tuesday meaning that we all got to enjoy a four-day weekend due to an additional public holiday on Monday! After three great weeks we had to bid farewell to Dr. Nicol as she returned to the United States. 

Shubh Community Pharmacy

On Thursday, An, Melanie, and myself were paired with three Ugandan pharmacy students that had also just finished their third year to travel to three separate pharmacies located in communities across different districts of Kampala. These pharmacies are part of a unique program supported by the Infectious Disease Institute (IDI) and Kampala Capitol City Association (KCCA). It is meant to provide easier access to medications to individuals that are currently receiving first line antiretroviral therapy, are currently controlled on this regimen, and have adherence greater than 95%. During visits to their respective community pharmacies, patients meet with a nurse to go over any issues that they are currently having with their medications, have questions answered, and receive a two months supply. With our respective pharmacy student, we were able to speak with the patients to get a better understanding of their experience in the program and areas that there could be improvement. The overwhelming majority of individuals shared that they enjoyed the personal relationships they had developed with the nurses and the reduced wait time to receive their medications.

It was extremely interesting to get a better understanding of how community practice works in a foreign country. While a pharmacist will own their respective pharmacy, often the only individuals that you will find working there are technicians and possibly nurses. These individuals are able to dispense medications, counsel, and make recommendations to patients. This has been a difficult concept for me to grasp as there is a clear delineation in the United States in what a pharmacy technician can and cannot do. When I brought up this difference with the Ugandan pharmacists at IDI, they shared that it really came down to the ability of pharmacists in the country and what their defined role is for the population. While integration of pharmacists into the above-mentioned program would be a great progress for the profession, I keep reminding myself that it is important to think about the logistics that need to be taken into consideration. The cost of a pharmacist is substantially higher than that of the nurse as well as the training that is required in order for them to fulfill this role.

After a schedule change due to rain storm and other unforeseen circumstances, I spent the morning at Nakasero Hospital with Melanie and Prosperity. This is a private hospital where patients come and pay for the services that they receive. This was much different from my exposure at Mulago and Kiruddu as Nakasero resembles hospitals that I normally see in the United States. Melanie and I were able to attend rounds with a Medical Officer, who is much like a physician’s assistant back home, and see a wide variety of patients. We also had an excellent discussion  on a complex patient case that had been referred in. I am really excited about spending more time in this setting during the last week in Uganda as I believe it will give me a wide exposure to several different disease states. 

Nakasero Hospital

Nakasero Hospital

As we were getting ready to leave Nakasero, we were informed that there was a case for an autopsy study that Dr. Nicol is currently conducting. Melanie and I jumped at the opportunity as this was something we had never been able to experience before. Walking into the morgue was a humbling experience making me reflect how fragile and special human life is. The individuals performing the autopsy took the time to explain to us all of the samples that would be taken during the procedure for the research study as well as the process for the actual autopsy. It was interesting to hear about how the consent process is carried out with families and what the beliefs are surrounding death and autopsies in general in the Ugandan culture. This was another great opportunity to reflect on how important it is to always remain culturally competent when providing care as individuals approach situations from a multitude of different angles.

It is hard to believe that my time in Uganda is already half way over. I have learned so much during my time here and I feel that it will have a lasting impact on my life moving forward. I am excited for the remaining two weeks and for all that they hold in store! An, Melanie, and me are heading to Jinja this weekend to the source of the Nile river to go on a white-water rafting excursion. Stay tuned for pictures and updated on how that adventure went in a few days!!