The Student Perspective - Lisa Zagroba

Overall I really enjoyed my 8 week rotation in Kenya. This is not to say that there were not challenges along the way, but I do believe everyone that comes here makes a profound impact. It definitely took some adjusting, but after the fist few weeks I felt like I was able to contribute on rounds. We rounded with a team of physicians, nurses, and pharmacists in the Moi Teaching and Referral Hospital (MTRH) wards on a daily basis. This was a good learning environment because there are so many opportunities to use your clinical judgment to impact patient care and educate staff members. I often found myself question physicians about drug regimens, helping fellow pharmacists’ dose medications, educating patients on how to properly use inhalers, and educating nurses about various medications. I really enjoyed getting to work with the vast array of medical personnel from all over the US, Kenya, and other parts of the world. This truly was a global and very uniting experience. Sonak did a great job of helping us adjust and learn from this unique environment. I got to see many different areas including outpatient oncology, the diabetes clinic, and some of the rural clinics. In each of these very different practice settings pharmacists were making an impact.
I also really enjoyed the opportunity to do presentations and complete projects. I assisted in developing antiemetic regimens for chemotherapy treatment, helped make pediatric ARV handouts, and worked with IU medical students to complete a morning report presentation. My favorite project was a presentation about the treatment of chemotherapy induced side effects. This was a good chance for me to review the treatment options, especially since my next rotation is in oncology. This is also an area that I am considering specializing in, so it was very pertinent. It was interesting to see how their oncology program is developing, since it is still in the early stages of organization. It was frustrating, but educational at the same time. They do not even mix the chemotherapy drugs in any kind of a flow hood, just next to an open window.
I think I learned the most at our afternoon topic/ patient case discussions with Sonak and the other pharmacy students. These were great opportunities to learn from each other and better the care of our patients. Plus Sonak did a great job of asking us questions and making it a learning experience. I also enjoyed our fireside chats that related to public health topics. This was a great opportunity to lean more about the world and understand different perspectives. We discussed different topics ranging from the street kids in Eldoret to contrasting the health care systems of the US and Canada. These were good discussions because they involved people with different backgrounds and from different parts of the world.
Lastly, I enjoyed the opportunities to see some of the non-pharmacy related work that is done through AMPATH, such as the Orphans and Vulnerable Children (OVC) program, Sally Test Center, and farming. OVC was a great opportunity to see people helping each other. The stories of these families were amazing and really moved me to want to help. I met a grandmother that was caring for 11 of her grandchildren because two of her daughters had died from AIDS. The organization had helped her find a small one room home for her to live in with her grandchildren. She was incredibly grateful; the experience was very moving. The Sally Test Center was such an enjoyable environment where we could play with the children from the pediatric wards. The kids always greeted you with a smile and were ready to have some fun and forget about the hospital. I also enjoyed learning about the farming initiative, because with out food, the patients ARV regimens would useless. AMPATH tries to look at the big picture when caring for patients. Honestly, adjusting to life here was not as hard as I had expected. I had many opportunities to grow both as a pharmacy student and as an individual. I hope I was able to make as much of an impact here, as I this experience has made on me.

The Student Perspective - Serena Harris

As my first flight, of many, was about to take off I had a mixture of emotions running through my head. This would be my first experience outside of the US for longer than a week and I knew I was about to be immersed in a new culture. Everything would be different from the food and living arrangements to the lack of medical resources and healthcare facilities. I’m happy to say that although I had my worries, this experience has helped me grow both personally as well as professionally.

My experiences at the Moi Teaching and Referral Hospital were very different from any other hospital experiences thus far in my 6 months of rotations. As I walked into the hospital my first day there was a distinct, overwhelming smell that nearly took my breath away. This was only one of the many things I would become accustom to over the next 8 weeks. Multiple patients to a bed, medication not being given, unreliable lab results, and lack of resources were encountered daily. It’s indescribable the feeling you get when you know a patient will soon die because they either don’t have the money to pay for proper treatment or it simply is not yet available here. I sometimes found myself near tears during rounds and frustrated to the point of almost walking out. These were the bad days. The most rewarding experiences came when I improved quality of life for my patients and watched the transformation of the sick into the healthy. Whether it is managing glucose in a newly diagnosed diabetic or changing anticonvulsant medication to control seizures, the potential role of pharmacy in Kenya is immense.

Through my interaction with Kenyan and American physicians and medical students on rounds, it has become clear the effect we can have on patient care when working closely together. The Kenyan interns are often responsible for over 25 patients a day, a truly mind boggling thing once you understand the amount of work required in each patients care. I found my role on the team often changing from typical pharmacy related medication issues to recommending appropriate labs, calling attention to electrolyte disturbances, and addressing untreated medical problems. Purdue pharmacy students have a unique opportunity to truly make a difference in all aspect of patient care. Once you earn the trust of your team, they will look to you as the expert in all things related to medication. I not only recommended dosing, but also specific agents we should use based on patient and disease specifics.

Learning did not end with ward rounds. We had daily patient discussions with Sonak that enhanced not only our medication knowledge, but also our critical thinking skills. We used this opportunity to present difficult patient cases and determine the best management for each patient. Other unique learning opportunities came from our interaction with Kenyan pharmacy students. They made the transition from work in America to Kenya much easier. As I looked down at a treatment sheet for the first time, I had no idea what half of the medications were treating. Disease such as typhoid fever, PCP, malaria, toxoplasmosis, and tuberculosis are a common diagnosis here rather than a rarity. We were able to share our knowledge base with each other and form friendships along the way.
My eight weeks in Kenya have offered much more than just a learning experience.
The opportunity to experience a new culture and meet people from around the world has been amazing. I’ve tried new things and stepped outside my comfort zone. I clearly remember my first time walking through town. I felt like an outsider for the first time in my life. All eyes were on me as I walked through the dirt streets of Eldoret. To my surprise, I was greeted with smiles, waves, and best wishes for the duration of my stay here.

There’s a sense of camaraderie and respect for one another found here that we’re often lacking in the US. I’ve met a lot of amazing people here and I’ll never forget the kindness and generosity they’ve shown me. I’m grateful for all of my experiences in Kenya, the good with the bad. I hope that in some small way my stay in Kenya has made a difference because it sure has left a lasting impression on me!

The Student Perspective - Shauna Santare

After completion of the Kenya rotation, I have been able to better evaluate the impact pharmacists can make to improve patient care. As my first experience with clinical pharmacy and also within any hospital setting, I had to quickly learn to adjust to following many patients with different disease states and following up on their care daily. I gained a lot of experience in multidisciplinary care rounds, which definitely influenced my interest in clinical pharmacy. MTRH was the first opportunity where I have had involvement in important (life or death) patient care decisions and in-depth discussions with physicians. I felt as though my opinion and knowledge were respected, and that confidence boost provided self motivation to continue my efforts.
I enjoyed this rotation for more than the obvious perks of weekend trips, new friendships, and cultural broadening. Reviewing charts may have felt tedious at times, but I learned to filter information for pertinent lab results. This skill is necessary at my new rotation site, where I am “rounding” in a different ward every day of the week and have many more patients.
I felt very intimidated in the beginning of the Kenya rotation because we were immediately thrown into the experience and had to learn to fend for ourselves. Looking back, I realize this was the only way it could be done. As for the rotation itself, I cannot recommend anything to be changed.

The Student Perspective - Tobie Rogers

Before arriving in Kenya, I was very apprehensive about the experiences that I would have. I had heard horror stories about the sights and smells in the hospital. I was also still slightly nervous about the environment that I would be living in, especially after the post-election violence. However, I knew that Purdue would not let us go if we were not going to be safe. The first week or so of rounds, I was very overwhelmed. I was fortunate enough to have rounded on a medical team before; however, I had never covered a patient load of this magnitude. The charting and lab reporting system is very different from what I am accustomed to and made thumbing through the charts somewhat challenging at times. I was also not used to being a member of such a large team, which reached over 20 people occasionally. Fortunately, the sights and smells were not nearly as horrible as I had envisioned them in my head. Eventually, I was able to somewhat adjust to their system and become more at ease with my role. Looking back on the experience, I was able to identify some of the challenges and benefits associated with it.
In the beginning, rounds were very trying for me, in that I often felt useless and unhelpful in many ways. One major barrier was actually hearing the Kenyan medical students and doctors as they tend to be very soft-spoken. This coupled with the fact that I was at the very back of the pack of students made deciphering what was going on very challenging. However, as I began making pharmacological recommendations to the team, I began to earn their respect and a spot nearer to the front. As time passed, I found that the interns would seek me out while they were admitting for recommendations. At the end of my time with my team, I felt I was a very vital member of the team.
Another major frustration stemmed from not knowing which medications were carried by the hospital and the lack of medications available for use. We were given a ‘formulary’ at first, but it was never updated over the course of the rotation. It may be beneficial to actually develop a formulary and printout a list of stock outs either daily or weekly for the entire medical staff including pharmacy, nursing, and medical students and interns. Another alternative for the pharmacy students is to hold a brief meeting every morning to give updates on current medications that are not available. I found often that I was halfway through rounds before it was brought to my attention that a medication was out of stock, which required me to go back through all the treatment sheets to change those medications on the patients that had already been seen.
Finally, the nursing staff is overworked in that there are not enough nurses scheduled to work for the number of patients that are in the hospital on any given day. This leads to less than exceptional care for the patients; which means that medications are often not given appropriately. I feel that it may be beneficial for the pharmacy students to present brief in-services to the nursing staff on a weekly or bi-weekly basis. It is important to discuss the treatment of infections and disease and emphasize the importance of compliance and receiving the medications at the time they are ordered.
Although the rotation was challenging at times, there were positives as well. First, the pharmacy students from Nairobi are a great addition to the medical teams. Their knowledge of the name brand medications and standards of care in Kenya are invaluable to the team. Also, their ability to speak Kiswahili is an added benefit. Communication with patients would have been much more challenging without them. I feel that we learn just as much from them as they learn from us.
This experience also exposes us to various disease states and infections that are not often seen in the United States, offering a great learning experience. I felt that I learned a great deal of information that will help me as I pursue a career in clinical pharmacy. A large amount of information that we were exposed to is applicable while practicing in the United States, while the rest is merely a great learning experience. I also enjoyed venturing to the clinics to work in the pharmacy. It was great to interact with the patients and practice speaking Swahili.
I have been home for a week now and looking back this experience was more than I ever thought that it would be. Although it was frustrating at times, it was also very rewarding. My most memorable experience at the hospital was with an HIV+ woman who was experiencing symptoms associated with zidovudine-induced anemia. I went to the AMPATH pharmacy and switched her zidovudine for stavudine and took it back to her. A few days later, I was standing at the nurse’s station reading charts and she came up to me to tell me that she was feeling better and that she would be going home. She said thank you, shook my hand, and walked away. A week or so later as I was walking through the hallway in the AMPATH clinic, someone grabbed my arm. When I looked down, it was the same woman. She told me that she was there for her follow up and thanked me again for helping her. I felt amazing knowing that I helped someone and made a difference in their life, even if it was only that one person.
I learned a great amount of medical and pharmacy information in the time I was in Kenyathat will help me professionally. However, I also was able to learn a lot about the people of Kenya and its culture through talking to the Kenyans that live and work at IU House and to the pharmacy students from Nairobi. It was definitely an experience that I will not soon forget. My hope is that after graduation, I will be able to go back to work at Moi and visit with the friends that I have made. Who knows, maybe one day I will be the first psychiatric pharmacist in Kenya!! I am quite certain Sonak is counting down the days until my joyous return!!!