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!!!
