Link to presentation - Leslie Dan Faculty of Pharmacy, University of

Uganda PSF Internship
Program 2013
Stephanie Lui, B.Sc, PharmD Candidate 2015
Where is Uganda?
http://daneenleidig.blogspot.ca/2009/09/where-is-gulu-uganda.html
A bit of History
  Uganda is a nation made up of 50+ tribes
  Civil unrest due to nepotism of ruling parties following independence
from Britain in 1962
  formation of the Holy Spirit Movement in 1986 which later became the
Lord’s Resistance Army
  Shrinking numbers and support lead to abduction of child soldiers and
pillaging of villages for food and supplies
  Lead to the creation of internal displacement camps in 1996
  Increasing pressure from the Uganda People’s Defense Force lead to
peace talks in 2006
  Peace treaty was signed in August 2006 where the LRA agreed to retreat
to the Democratic Republic of Congo
Life In Northern Uganda
St. Mary’s Hospital Lacor
Lacor
•  Founded in 1959 by Comboni
missionaries
•  Private referral hospital
•  ~300,000 patients/year
•  3 peripheral health centers in
Opit, Amuru, Pabo
•  Nursing and laboratory
technology schools
http://www.weinformers.net/wp-content/uploads/2010/04/Lacor-hospital-Gulu.jpg
http://www.toponymie.gouv.qc.ca/ct/chroniques-toponymiques/semaine_2006_11_29.html
Patients
•  daily household income of
$0.50
•  Pregnant mothers and children
under 5 make up 53.6%
•  Top 5 causes for admissions:
Deliveries, malaria, Injuries,
AIDs, TB
•  Top 5 diseases in the area:
Malaria, URTI, Intestinal
worms, pneumonia
Life at Lacor
Pharmacy Practice at Lacor
Main Pharmacy
•  Pharmacy manager,
pharmacist, 2 pharmacy
interns and pharmacy
assistants
•  Inventory control
•  Drug information
•  Chemotherapy review and
preparation
•  Non-sterile compounding
•  Stock counts
Out patient Pharmacy
•  Serves the adult, OB/GYN,
young child clinic outpatients
•  HIV patients attend the Aclinic pharmacy
•  Pharmacy assistants dispense
medications and counsel
patients on medications
•  Pharmacy assistants have no
formal training but learn on
the job
•  No pharmacist is physically
present in the pharmacy
Outpatient clinic
Arrival in
hospital
30mins Registration
with nurse
2hrs
Physician/
Clinical
Officer
examines
patient
1hr
Billing
1 – 2 hrs
Outpatient
pharmacy
What exactly did I do there?
ARV Research Project
  ~12,000 patients enrolled at the Aids Clinic (A-clinic)
  ~450 of these patients are children under the age of 16
  WHO recommends using weight-band based dosing
protocols for antiretoviral (ARV) medications in resource
limited environments
ARV dosing Project
  Weight-band based dosing simplifies ARV dosing at the expense of
precision
  Multiple studies have shown that weight-band dosing yields good
results in pediatric patients with HIV
  However, others have shown consistent under-dosing in this
population
  Study objectives
1) How are weight-based dosing protocols being used to determine
dosing of antiretroviral therapies in children aged 0 to 16?
2) Do the current dosing protocols result in under- or over-dosing
of ARVs and what are the clinical outcomes of improper dosing?
3) Are drug shortages a frequent problem at St. Mary’s Hospital
and are they affecting the clinical outcomes of patients?
ARV dosing project
  Retrospective chart review of ~450 of patients under
the age 16 on active ARV therapy
  Collected patient demographics, height/weight,
presence opportunistic infections, other clinic visits,
reasons for not dispensing medications
Results
Main Pharmacy
  Fielded DI questions from physicians
  Participated in stock counts and inventory management
  Non-sterile compounding
  Chemotherapy calculations
  Sterile compounding training/implementation
  Health Centre audits
Outpatient Pharmacy
  Educated pharmacy assistants
  Filled and dispensed medications
  (tried to) counsel patients
  Identify DTPs and worked with physicians to resolve
them
  Fielded questions from pharmacy assistants
Outside of the Pharmacy
  Participated in rounds
  Watched surgeries
  Ambulance ride alongs
Outside of Work?
Murchison Falls National Park
At the end of it all……
Steph’s pearls of “wisdom”
  Be prepared to work hard
  Always be vigilant about your safety
  Be aware that you will always stand out!
  Have realistic expectations
  Expect to meet amazing people
An unforgettable Experience
I would like to extend a sincere thank you to all the staff and
colleagues at Lacor. In a place with so little they showed me how to do
a lot and opened my eyes to a world that is so vastly different than my
own. I will be forever grateful for all the lasting memories and
friendships that I have forged during my stay there.
Of course this trip would not have been possible at all were it not for
the Leslie Dan Faculty of Pharmacy Student Experience Fund, the
University of Toronto International Health Program and the UPS student
initiative fund!
APWOYO MATEK
Questions?
  See my blog at http://stephinuganda.wordpress.com/
  Contact me [email protected]