Frustration & Opportunity

The past two weeks have been an absolutely hectic blur. I have been struggling to find time to write a blog the past two weeks, but I think this is coming at a good time, as, up until now, I have been working in tandem with one of the clinical pharmacists here, while this weekend serves as the transition into my independent role as the sole pharmacist for my rounding team at MTRH. 

Frustration.

That would be the word that sums up so much of the aura that envelops me at Moi on a daily basis. Frustration with the constant disorganization--hours are spent on a daily basis tracking down information that would readily be available back home. Frustration with the lack of resources available--medication availability changes day-to-day, resulting in the status of patients' wellbeing remaining stagnant or deteriorating in some cases solely due to external factors. Frustration with the inability to entirely trust the word of the healthcare personnel--tasks/medication administration records are checked off only to be discovered that they were never completed upon talking to the patients myself. Frustration with the apparent lack of concern--suffering and death are so commonplace here that it appears as though everyone has become desensitized to the reality of what it means to the Loved ones left to fend off the void left in their lives as a result of the loss.

Opportunity.

On Day 1 of being here, the lead clinical pharmacist told us that we will get eaten away with frustration over the course of our time here and that, rather than letting it lead us down a path of cynicism and detachment, we should let it be one our greatest motivating factors while here. Prior to experiencing the hospital firsthand, this forewarning did not hold much weight for me because I had nothing with which to associate it. However, over the past two weeks, it has been a constant murmur in the back of my mind as I attempt to not be downtrodden by the environment within which I am finding myself. All of these frustrations truly do lead to increased opportunities to learn, grow, and impact the care of individuals in a way that pharmacists traditionally cannot have in most settings back home. 

To give you an idea of what exactly my roles and responsibilities are here, let’s do a run through of the typical day/week for myself and the other pharmacy students here with me. Each morning we wake up around 5:30am to get ready, eat breakfast, finish researching patient-specific topics, and make the 15-minute walk to the hospital by 7am. For the following two hours, we make adjustments to the drug availability list so we have a better idea of what medications we have at our disposal, rewrite T sheets (Treatment sheets—the patient’s list of medications paired with their instructions as well as instructions for nursing on how to administer IV medications to reduce adverse events), confirm that patients received all of their medications the previous day as well as that morning as frequently as they were supposed to receive them (I am not sure this has ever happened), check vitals of the patients for whom I am caring directly, and review T sheets for medication issues to discuss with the doctor during rounds. When rounds finally start at 9am, we spend the next few hours going walking around to each patient’s bed, receiving daily updates on their statuses as well as receiving the results of the labs and tests that were conducted the day prior. The doctor discusses his plan while providing teaching to the med students. The pharmacist’s role during rounds can vary slightly depending on the doctor leading rounds; however, in my case, the doctor on my team seemingly holds the discretion and opinion of pharmacists in high regard. For that reason, I am able to make a variety of medication-related recommendations as well as recommend a variety of labs that are necessary to monitor for adverse effects. Occasionally, we are even able to contribute to directing diagnosing, as we spend a large amount of time reading patient charts and tend to be more familiar with the patients’ stories and statuses than the Kenyan med students. Once rounds end, we spend the next hour or two completing additions to T sheets and following up on pertinent patient issues. Around 1pm, we walk back to our compound for lunch, relax briefly while also researching patient-related topics if necessary as we do not have internet access at the hospital, and finally head back to the hospital to follow up on additional issues the rest of the afternoon until about 6-6:30pm when we walk home for the evening. The 7am to 6:30pm workday lines up with dawn and dusk, as we are not allowed to walk outside of the compound when it is not daylight. When we arrive home for the evening, we eat dinner and then spend the majority of the rest of the evening researching and studying in order to improve our ability to care for the patients present on the wards before heading to bed around 10-11pm.

Thus far, I have felt the full spectrum of emotions while working here—entirely overwhelmed, underprepared, utterly devastated, proud, etc. Several of my patients have passed away (20% of patients who enter MTRH for care ultimately pass away during admission), one of which left me paralyzed briefly after attempting to get him in stable condition before failing. Another patient that has been in the hospital with acute renal failure as a result of an unidentified etiology had a hypertensive emergency this past Friday, who I, with the help of other clinicians available, was able to get in stable condition prior to the start of the weekend, a moment which has been my proudest up to this point, as continuous blood pressure monitoring was impossible due to the lack of availability of a bed in the cardiac care unit. For that reason, I spent the next few hours administering a potent anti-hypertensive medication while monitoring blood pressure and other vitals myself manually on a continuous basis. Again, one of the greatest frustrations as well as most rewarding aspects is the lack of resources available—resources in terms of medications and items as well as in terms of personnel. After rounds the vast majority of the Kenyan doctors and med students leave the hospital, and the pharmacists and pharmacy students, the few American med students and doctors, and an occasional Kenyan doctor are left at the helm of patient care for the entire adult wards at MTRH. For this reason, we are left to pick take care of all that happens post-rounds, allowing us the opportunity to do much more than would typically be asked of us back home while additionally contributing to the stress as there are a variety of circumstances that arise that would best be handled by an interdisciplinary healthcare team that has been following the patient all along rather than by a few individuals who may or may not be familiar with the patient’s history as all of the patients in the adult wards are split up between 8 healthcare teams.

Frustration and opportunity. Those are the two conflicting and somehow synergistic themes that have characterized my brief amount of experience within MTRH. Nothing about this has been easy up to this point; however, I am finding myself growing more and more familiar with the hospital and its procedures, which is making the responsibilities and roles I am filling relatively less overwhelming. I have a long way to go, but I am pleased with where I have come even in the past two weeks.