The past couple days have been crazy busy with hospital orientation and catching up on logistic stuff for traveling and our rotation. I had my first experience showering at the IU House. To get heat for the shower, we have to flip a switch on the wall. To adjust the heat, we have to turn the dial on the shower for more or less water – less water equals more heat? For breakfast, I have been having avocado toast, and the avocados are actually the size of my face.
Today we met Sara Fletcher at 0845 to walk to Moi Teaching and Referral Hospital together. It is a short walk, probably less than a quarter mile, just past a local Hindu Temple. It is on Nairobi/Uganda road depending on which way you are traveling. When we got there, we were separated into 2 groups. The first day, we shadowed in the Nyayo Pharmacy, while the others shadowed at the AMPATH pharmacy. The Nyayo Pharmacy is similar to a retail pharmacy in the US. It’s a small, L-shaped room, with small boxes of medications filling the table in the middle of the room. If the boxes are empty, that means the medication is completely out of stock. They also post an inventory report each day to let the team know what is available. There were also a few medications that we don’t use regularly in the US. It was interesting to learn that one of the most common causes of death by suicide is due to organophosphate poisoning or paracetamol (acetaminophen). Organophosphate poisonings are not as common in the US, so they have more of a supply of pralidoxime on hand. Patients crowd the window during the busy hours to get their medications, pay at a separate billing area, then come back to the pharmacy to pick up their medications at the outpatient window. This pharmacy also keeps their main door open, and the few controlled medications they have are not locked in a safe, unlike the US. All the record keeping is done on paper except the prescription entry process. IVs are not compounded in the pharmacy; most IVs are hung from the vial or diluted at the patient’s bedside. There is one pharmacist that works in the pharmacy at all times, and four pharmacy technologists. Julie is the lead technician in the pharmacy, and she has a totally different personality than most of the people in Kenya. She is an older, spunky lady, whereas the majority of Kenyans are very soft spoken. Technologists are in charge of gathering medications written on T-sheets to take to the wards. Nurses or pharmacy students will drop off the T-sheets at the window around 11 AM, the technologist fills it, then puts the medications in baggies that go into a large cart. The large cart is wheeled into the hallway for nurses to grab medications when needed. They also have an insulin room. Eli Lilly funds an insulin program that provides donated insulin to patients. The hospital also has clinics for anticoagulation, diabetes, mental health, and HIV/AIDs.
We also met five different Kenyan pharmacy students on their internship at the hospital. Emma and Anita were the two students that toured the wards with us. One of the pharmacists asked us to go on rounds with him, and we weren’t supposed to do that until Monday, so we all freaked out a little at the thought of doing big girl things. The wards are separated into male and female wards, each has 96 beds.
In the afternoon, we had a tour with Sonak, who is another Purdue-affiliated pharmacist at the hospital. Sonak graduated from UNC, with an MPH from Harvard, and he has worked with AMPATH since 2008. Throughout the tour he explained the history of the program, what the program does for its patients, and he asked very insightful questions. His view of global health really changed my perspective on the way I think of global health. Global health is about what you give back to your patients, and not necessarily what country you live in. For example, we wouldn’t really consider most of the pharmacists in the US to be global health pharmacists, however, a common opinion is that pharmacists residing in other countries are all global health pharmacists. He also stated that 60% of Kenya’s population lives on less than $2 a day, 40% of those live on less than $1 per day.
A little history on AMPATH…
Dr. Joe Mamlin, a physician from Wishard Memorial Hospital retired in 2000, then came to Eldoret, Kenya to participate in the IU-Kenya partnership. Him and his wife, Sarah Ellen, stayed for another 19 years, and he started the AMPATH program in 2001. AMPATH stands for “The Academic Model for Providing Access to Healthcare.” It is a global partnership between Moi Teaching and Referral Hospital in Kenya, Moi University, Purdue, Indiana University, Duke University, and many other universities from the US, as well as the Kenyan Government. The goal of AMPATH is to lead with care, and then work to combine that with nutrition, education, jobs, and self-sufficiency for patients. AMPATH builds programs in the public sector that eliminate health disparities and deliver essential healthcare services. Training of new medical students and residents, as well as advancing research are also parts of the AMPATH program. Besides my desire to work with underserved patients in the future, there are also world-renowned pharmacists and physicians who work to train students at this hospital. AMPATH has a focus on patients with HIV/AIDs. The program has since expanded to most of Western Kenya, and now treats more than 3.5 million people. Imani is the workshop that AMPATH organized for patients to make and sell clothing, jewelry, journals, stuffed animals, and figurines. We plan to go here to support their business. To learn more information about this incredible program, visit:
On another note, it started raining while we ate dinner. Then, all the ginormous slugs came out, literally the size of my hand.
PharmD to Be 