Meet Alec Helmke, PD4

 

I’m Alec, and I’m a now-fourth-year pharmacy student currently on rotation with Dr. Melanie Nicol in Uganda. After a COVID-related hiatus, this APPE rotation is now being offered again, so I’m privileged to be able to participate as well as excited to share a few brief snapshots of my experience. Let’s dive right in!

Only a couple of days after my arrival in Uganda, another student living in the Minnesota House asked me: “What has been your biggest surprise since arriving in Uganda?” Still jet-lagged from the 18-hour, transatlantic flight, I offered the only paltry responses my brain could muster. For one, I was surprised by my living quarters. As I mentioned, I am living at the Minnesota House, which is offered to visiting students, faculty, and researchers connected to the University. When I opened the door to my bedroom for the first time, I nearly ran smack into the bed. My room—"the closet” as many in the house affectionally call it—was perhaps smaller than I anticipated! But more pleasantly, the house surprised me with its beautiful front deck, from which I spotted a vibrantly colorful Ross’s turaco within the first few days. With such unique beauty so close at hand on the breezy front porch, I am glad to trade away a few extra feet of living space.

I was surprised too, I commented, by the differences I had discovered between Uganda, home, and some of the other foreign countries I have visited. After spending Memorial Day weekend with family in Northern Wisconsin, I was thrilled to find the mosquitoes are much smaller here—even though Ugandan mosquitoes’ malarial punch is not something to take for granted. I also kept finding myself walking towards the driver’s side of local taxis, as Ugandan vehicles are driven from the right side, per British custom. Finally, although there is great food nearly everywhere, the widespread availability of cheap, delicious food here has been a very welcome discovery.

It wasn’t until my first day rounding with the infectious disease team at Mulago Hospital—the largest public hospital in Uganda’s capital of Kampala—that being surprised took on a new meaning. As I shadowed the local physicians caring for patients with cryptococcal meningitis and tuberculosis—two comorbidities commonly associated with severe HIV—one of the doctors looked up from his chart and turned to me.

“If a patient is taking PISA, would they need metronidazole?”

“Uhhh,” I stammered. “Let me check.”

Quickly checking on a friend’s phone, I refreshed my infectious disease knowledge, which had collected a semester’s worth of mental dust. Recently having learned that piperacillin-tazobactam was referred to as “PISA” in Uganda, I found that this common antibiotic’s broad spectrum covers the anaerobic bacteria for which metronidazole is indicated. After imparting this information to the doctor, he caught me off guard yet again:

“What about ornidazole?” He asked.

“What?”

“Ornidazole,” he repeated. “O-R-N-I-D-A-Z-O-L-E.”

I returned to the online spectrum I found, but to no avail. I had never heard of this mystery drug, and it was not listed in the online resource either. Slightly ashamed, I Googled the medication and saw that it is in the same class as metronidazole and kills the same types of bacteria. However, the drug is not even available in the United States. I explained to the doctor that this medication is not much different than metronidazole, so unless he wanted to treat a parasitic infection, piperacillin-tazobactam should be sufficient.

My first surprise at this moment was the doctor’s confidence in my abilities. To him, my white coat and identity as a fourth-year pharmacy student meant I could be trusted to provide reliable information about medications. After years of being expected to learn, I was now expected to apply and share the knowledge—a truly daunting task. Second, I was surprised with the depth of knowledge one must obtain to be an effective clinical pharmacist. Although the pharmacist board exam emphasizes the top 200 medications as the most important drugs to understand, this is different than practice. On hospital rounds or in the pharmacy, it seems the most important medication is the one right in front of you, whether it is in the top 200 or is not even used in the United States.

Although I was able to muster a reasonable answer to the physician’s questions, our brief discussion was a reminder of the challenges that lie ahead in my year of rotations. It will be a year of growth and learning, that’s for sure, but also a year during which I will face uncertainty and will be expected to apply knowledge rather than to simply memorize information. I look forward to building my clinical acumen so that the trust providers and patients have in me is not misplaced. And I can think of no better place to begin my APPE experience than Uganda. Here, I am immersed in the unfamiliar—exposed every day to new medicines, new places, and a new culture. I hope that, by the end of this rotation, I will learn to thrive in this environment, and I will be better prepared to meet the new challenges offered in each of my upcoming rotations.

Over the next few days, I will finish rounding with the infectious disease team. I will also embark on a much-anticipated safari to Murchison National Park in Northwest Uganda. So, I certainly will not lack in content for future blog entries, but, for today, I’ll sign off!