Feeling Crafty!

In true tourist fashion Kristin and I went to the craft market set up on Sundays at a local shopping mall and the Kabwata Cultural Village. At both of these places Zambian artists were very eager to sell their artwork to us. We honed our price negotiation skills as we tried to get the best deals on the souvenirs we wanted. We even traded a few hairbands with brothers who wanted to give them to their sisters to wear in their hair for school. Many of the people at the craft market travel to Lusaka from Livingstone which is about 6 hours by car and 7.5 hours by bus. In contrast, the people at the Kabwata Cultural Village live there year-round in traditional straw-topped huts without electricity. Kristin and I managed to make some friends along the way and found some treasures that we can't wait to share with our friends and family!

Crashing the Classroom

Yesterday Kristin and I had the pleasure to attend a lecture being given by one of our pharmacists, Martin Kampamba, to the fifth year student pharmacists here at the University of Zambia. The class was learning about how to develop a pharmaceutical care plan by working through various patient cases. This style of learning is very similar to how our classes our structured at the UNC Eshelman School of Pharmacy. Students come prepared to classes ready to apply previously obtained knowledge in case-based lectures. Martin was very engaged with his students, including Kristin and I, calling us out by name to contribute our thoughts. He emphasized the role of the pharmacist to correct actual medication-related problems and prevent potential medication-related problems. I am confident that this group of UNZA student pharmacists will continue to advance the role of the clinical pharmacist in Zambia and will apply the skills we learned in the classroom to their practice sites.

We were thankful that the power came back on right in time for class to start. In the time leading up to the lecture power had gone out at the hospital for about 20 minutes. It would have been difficult to present the lecture content without projecting the slides Martin had prepared. During the hot and dry month of October there is often power outages. The weather has consistently been in the 90s throughout our time here and it has only rained one afternoon. We were told that Victoria Falls was more dry than usual this year because they were pumping the water for power! Kristin and I will just miss the rainy season that should begin in a few weeks which should provide some much needed water for Zambia.

CDH

Yesterday, we spent the day in the Cancer Diseases Hospital, also known as CDH. CDH was first created in 2007 and just a few months ago they expanded the building to include an additional 250-bed hospital. CDH is the only hospital in Zambia that provides comprehensive cancer care. Cancer is a disease state that was never that prevalent in Zambia until recently, which may partially be due to increasing life spans in the country. The most common types of cancer seen are Kaposi sarcoma (usually due to HIV co-infection), breast cancer and cervical cancer. The main downfall to the pharmacy department in CDH right now is man power; there are simply not enough pharmacists to complete the amount of work that needs to be done. For example, there is only one clinical pharmacist at CDH. This pharmacist verifies chemotherapy doses daily but, because he is responsible for all patients that come through, he does not have enough time in his schedule to do a further work-up of the patient such as assessing interacting drugs and other co-morbidities. There is also not a pharmacist that verifies the chemotherapy doses as they are being prepared. One technician makes all the chemotherapy batches in a day.

The good news is, with the new expansion recently opened, CDH is working to grow and improve its site. It may take a little bit of time for pharmacy to catch up but the department is aware of its weaknesses and is working arduously to overcome them. Observing CDH was another reminder of numerous resources we take for granted in the United States.

The Falls

Unrelated to pharmacy, we got to take a quick trip to Livingstone this weekend to visit Victoria Falls. We were warned that the falls are quite dry at this time of the year but that didn't stop us. We still thought they were absolutely stunning!

Hillary in Zambia

In the spirit of election season, look who we found on a plaque in Zambia! The United States funded the building of the Pediatric Centre of Excellence. This building is one of the nicest in the hospital, second only to maybe the cancer disease hospital section. The Pediatric Centre of Excellence focuses on the care and treatment of children living with HIV. Amanda and I had the pleasure of working in the HAART clinic there for an afternoon. Unfortunately, there is a negative stigma associated with the building, as Zambians know this is where one goes to get HIV treatment. Sometimes this can lead to embarrassment and lack of a patient to receive care. Nonetheless, it is quite an exceptional clinic that takes great care of this special population.

Side note: Zambians love to ask us who we are voting for in the upcoming election and they are never shy to voice to us who they think we should vote for.

The Pediatric Nephrologist

On the schedule this week, we have been working in the pediatrics ward. Specifically, we have been rounding with the clinical team in the pediatric intensive care unit. The PICU holds nine beds and overall feels much calmer than the crowded internal medicine wards we were in last week. Common disease states encountered include acute renal failure, complications of malnutrition, and severe septic infections. The consultant this week was a specialist in pediatric nephrology, which worked out in our favour as almost all the patients in the ICU this week have had kidney problems. After completing a renal rotation at Moses Cone Memorial Hospital, I was intrigued to draw comparisons between care in Zambia versus in the United States. One of the patients was a fourteen-year boy on hemodialysis due to end stage renal disease secondary to steroid-resistant nephrotic syndrome. One of the greatest barriers to his long-term care was the fact that there are only four hemodialysis centers in the whole country of Zambia. (There are at least that many dialysis centers in Greensboro alone, if not more!) Each of the centers is located in a major city in Zambia; however, this child lived in a village far from the city. His family did not have the money to pay for the transportation into Lusaka three days a week. The only true solution to solve his kidney problem is a transplant but there is not any hospital in Zambia that does transplants. The consultant stated that if someone can pay, they will send them to India for a transplant. This was terribly saddening to me because I knew that that also would never be an option for this child.

My next thought was, if hemodialysis is not an option, how about the use of peritoneal dialysis in Zambia. We do not seem to use peritoneal dialysis as frequently in the United States as hemodialysis but I have heard that peritoneal dialysis is quite common in the European countries. Peritoneal dialysis is nice because it allows the patient to have more flexibility as they do not have to come in multiple times a week for treatment, which would be especially optimal in Zambia when hemodialysis centers are not conveniently located in the rural villages. The consultant informed me that the limiting factor to PD is hygienic conditions. Many patients’ living environments, specifically those in the villages, do not meet sanitation standards to accommodate the resources needed for peritoneal dialysis. For example, many do not have access to clean water at their homes. It’s an extremely tough situation and one that I was very saddened to hear about. It makes you extremely humbled for all the resources that we have available to us at home. Don’t forget to be thankful.

Jolly Juice

The inpatient internal medicine wards at UTH can get VERY crowded with all of the patients, their caregivers, healthcare professionals and sanitation staff members. During our first few days in the wards I found myself observing my surroundings and trying to take in every little detail. Next to each patient's bed you can find a small cabinet that doubles as a bedside table. On those cabinets you can find many items brought to the ward by caregivers such as pots and bowls for meals, bottles of clean drinking water and often other drinks the patients may prefer like orange Fanta. One special drink that I noticed almost all patients had on their stands in the wards was Jolly Juice. I asked my preceptor about the drink because we don't have this available to us in the U.S.

Bottles of Jolly Juice 

He told me that the Zambian people believe that because the liquid is a dark color similar to blood that the liquid provides health benefits and "is good for the blood". I found this very interesting as anemia is one of the most common conditions we encounter on the wards. The common causes of anemia seen at UTH are chronic illness, malnutrition and pregnancy.  Most patients that we cared for on the internal medicine wards required a blood transfusion and/or iron supplementation and the pharmacy team played a major role in monitoring the hemoglobin level for improvement in their anemia.

While the Jolly Juice may not have any direct benefit on improving the anemia or the blood quality of the critically-ill patients, I bet patients had a little more energy after consuming Jolly Juice due to the sugar content and additional calories in this drink!