Saying Goodbye

 By Alec Helmke, PD4

I write this blog entry from 38,000 ft. I’m somewhere over Quebec, but I still have Uganda on my mind, and my initial feeling is one of deep gratitude. Despite being in the country for just over three weeks, I take many memories home with me. From days spent on the wards to nights spent in the savannah, the trip was truly jam-packed! And my last few days were no different.

As I mentioned briefly in my last post, I was fortunate to watch a traditional Ugandan dance troupe performance. Along with Melanie, we drove to a cultural center in Kampala, where we were treated to a nearly four-hour performance, with dinner and dessert included! The dances were beautiful, and it was interesting to see how the performances differed across regions of the country. With over 50 tribes occupying a space about the size of Minnesota, Uganda possesses striking diversity. In some performances, dancers balanced drums or pots on their heads, somehow failing to drop them as they moved across the stage. In others, the dancers stomped their feet, shouted, and did flips in the air. And in between performances, a Ugandan MC narrated the meaning behind each of the tribes’ dances, pointing out how dance is a form of cultural expression. During the show, I tried some traditional Ugandan foods, including matoke, a mashed banana dish that many locals had encouraged me to taste. I also tried to dance. The MC told us that if we didn’t join the troupe on the stage, then we must be against world peace. So, the blackmail worked, and Melanie has some potentially compromising photos of my dance moves to prove it.

Melanie returned to the United States the following day, but before she left, we jumped on an opportunity to visit a local HIV clinic. There, the director told us about the many amazing programs they offer to Ugandan HIV patients. One of the projects they are focusing on most heavily right now is the provision of HIV post-exposure prophylaxis in community pharmacies. This form of treatment is given to folks who may have been exposed to HIV through unprotected sex and is intended to prevent the user from contracting HIV. The current approach of the clinic outreach is to offer this prophylaxis to young women who visit community pharmacies seeking the morning after pill. Young women are at very high risk of contracting HIV due to the high prevalence of the disease in Uganda, and post exposure prophylaxis is highly effective, so this program promises to greatly benefit the health of the nation.

The clinic also leads a number of other programs centered on marginalized patient populations and harm reduction. The director mentioned how the clinic has earned the trust of LGBTQ and transgender populations, which is very difficult to do in a country where one’s sexual orientation may be punishable by death. The clinic supports needle exchange programs and offers HIV treatment for illicit drug users. They also conduct outreach for communities of sex workers who, like LGBTQ folks and illicit drug users, are at very high risk of contracting HIV. I was deeply impressed by this clinic. Although the clinicians are constrained by socially conservative laws, they continue to act in the best interests of highly marginalized patient groups. In many respects, the care offered at this Ugandan HIV clinic exceeds US standards.

Although Melanie returned home, my rotation continued. I had a wonderful conversation with a Ugandan emergency response pharmacist named Peter. His story was one of diversity and impact. Although a trained pharmacist, Peter is deeply involved in epidemiology, health policy, and disaster preparedness. In fact, he continues to expand his global health skillset in hopes of one day becoming Secretary General of the United Nations! Peter encouraged me to set my sights high like him and do all I can to pursue my global health passion.

During my final weekend in Kampala, I met with a local guide to do a walking tour of the city. Miti, our guide, peppered our walk with tons of information about Ugandan history, including the colonial era, independence, and modern-day politics. We also took in a number of beautiful cultural sites during our tour, including the parliament building, national court, several monuments, and the national mosque, which towered over the city. The view from the top of the mosque’s minaret was simply stunning. From the vantage point, you could clearly see each of the original seven hills that formed the historical city of Kampala. You could also visualize the great growth of Uganda’s capital, which has expanded far beyond the bounds of the original hills. After leaving the mosque, we walked into the largest market in the city, which was an assault on the senses. The vibrant colors of second-hand shirts mixed with the hues of herbs and flowers. The sounds of bargaining meshed with Afrobeats. And the smell of smoke from roasting meats combined with aerosolized peanut powder made me preemptively reach for my Epi-pen. It was certainly no Costco. Seeing the local market was a wonderful experience, as it allowed me to connect more closely to the lives of average Ugandans. I was glad to have the chance to explore Kampala a bit more as well because—although my walk to the hospital in the morning was beautiful—it definitely did not encompass the entire scope of one of Africa’s largest cities.

My final week in Uganda was spent at Kiruddu Hospital, which is about a 45-minute drive from the Infectious Disease Institute. Opened in 2016, Kiruddu is a newer public hospital designed to provide internal medicine services to Kampala’s lower income population. For several specialties—including cardiology, burns and plastic surgery, and dialysis—Kiruddu is the national referral hospital, implying that it offers the highest-level care in the whole country. In this new hospital, I shadowed several pharmacists. Abert showed me how pharmacists verify orders and communicate with physicians, and his keen eye helped him detect several medication errors during my shift. Saviour oversaw the central pharmacy, meaning he managed the medical supplies for the entire hospital, which is a truly imposing task. The scale of his work became clearly apparent when the hospital received an order for two months of supplies. Trucks dropped off literal tons of medications and materials that filled the pharmacy and spilled into the driveway of the hospital administration building. I helped to inventory the products—which had been shipped from the national medical repository—and got quite the workout as I moved boxes. Next, Immaculate instructed me in how the hospital conducts antibiotic stewardship for the burns unit. She let me tour the lab and showed me the antibiogram, a tool that clinicians use to select which antibiotics will be most useful to treat certain bacteria. Finally, a pharmacy rotation would not be complete without shadowing in a dispensing pharmacy. On my last day at Kiruddu, I spent time with Mr. Kiseka, who showed me how medications are distributed to patients and how dispenses are recorded in their hospital software.

On my daily drives to Kiruddu, I was surprised to hear some songs that I never thought I’d hear outside of the United States. The clinicians I was riding with loved listening to the same classic country songs that my grandparents would play over their radio: Clint Black, Don Williams, Dolly Parton, and Kenny Rogers. When I asked them how they came to like this quintessentially American music, they told me they appreciated the slow melodies, which differ greatly from upbeat, energetic Afrobeats. And I understand why these healthcare professionals may have needed some relaxing music in their lives as, much like the United States, Uganda struggles with severe staffing challenges. In fact, a strike of pharmacy interns had led to Kiruddu pharmacies operating at 1/6 capacity. To help cover for the shortage, one of the pharmacists I shadowed was even working on an entirely volunteer basis. He knew the hospital needed support and that the strike threatened to harm patients, so he stepped up to cover the gap, which deeply impressed me.

And this pharmacist’s dedication will be something I take home with me to the United States. As I look back, I can clearly visualize the challenges that afflict the pharmacy profession in Uganda. On a daily basis, pharmacists struggle with drug shortages and staffing constraints that prevent them from working at the top of their license. Patients suffer from these systemic issues too, as, in many resource-limited healthcare facilities, they are unable to receive optimal healthcare. However, Ugandan pharmacists show up every day, working long hours, sometimes for free, to serve their patients. And, using their skills and experience, they do all they can to offer the best possible care. As I mentioned in my second blog post, the problems we face in healthcare here in the States are not that different than those they face in Uganda. So, I want to confront these problems with the same steadfast dedication as the pharmacists and other healthcare professionals I met at the Infectious Disease Institute, Mulago, the HIV clinic, and Kiruddu. It’s the same dedication I saw in a local pharmacy student I met for a brief conversation as well. Despite the nascency of oncology pharmacy in Uganda, he was committed to making an impact in this space and to offering patients the pharmacy services they deserve to ensure the safety and effectiveness of their chemotherapy regimens.

Although I say goodbye to Uganda, I leave with a great sense of gratitude for my experience. I offer heartfelt thanks to all who supported this experience, especially my preceptor Melanie. And I also leave Uganda with a sense of motivation. Motivation to be like the pharmacists I met abroad and to dedicate myself to the service of my patients despite the challenges I will surely face.

It was a pleasure to share my experience with you all in this blog, and I sincerely hope that future pharmacy students follow my lead to Uganda so that we won’t have to wait too long for new content. Thanks for reading!