Wind Blows Deeply

Unpacking

There are two quotes that I often think of when I return from Africa or any far away adventure.

The first: Coming home from very lonely places, all of us go a little mad: whether from great personal success, or just an all-night drive, we are the sole survivors of a world no one else has ever seen.
~John le Carre

I always find it difficult to sum up my experiences. This trip seemed to be fairly normal. I returned to familiar friends and colleagues, to familiar housing and transportation, to an ever increasingly familiar culture. Things happened more or less as expected.
Teaching the country’s first-ever class of pharmacy technicians was both an honour and a memorable experience. Being quite ill for half of my first week was frustrating but a good (forced) reminder that I need to slow down occasionally. ‘Remembering’ how to drive a) a standard, b) a LandRover, and c) in Africa was undoubtedly memorable for my passengers.

The second: Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.
~Margaret Mead

There was a mix of returning and new volunteers on this trip. Old friends who just ‘know how it is’. New friends who remind me to be excited and amazed at things that have become familiar.  The two University of Manitoba pharmacy students who began my trip with me remain in The Gambia for another two weeks.  They will be wrapping up their stay with some more continuing education sessions for pharmacy staff.


Class of 2013

One of my main projects in The Gambia was to teach the first set of lectures to the very first class of pharmacy technicians.  I shared on a variety of topics from ‘history of pharmacy practice’ to ‘pharmaceutical and medical terminology’ to ‘introduction to palliative care’.

Planning for this technician program has taken many years and I am very excited to see this first class graduate in a few years.



Recognition

I was honoured to receive a Commitment to Care and Service award in the category of ‘Charitable Work’ on November 29, 2011.
The award is “presented in recognition of exceptional volunteer work, contributions to charitable organizations, creation of a charity program, performance of a humanitarian deed or overall commitment to charity work by an individual or team.”
Visit the Commitment to Care and Service awards page to read more about my entry and the other award recipients.



Lend a Hand

It’s good to be back

I arrived in The Gambia one week ago.  Getting off the plane was the all-to-familiar smell of ocean, dust, diesel and burning garbage.  Perhaps not the most inviting of smells, but the familiar can be comforting.  Of course there was also the heat and humidity.  Fortunately, it has cooled done from a Humidex in the high 40′s to high 30′s.

It has also been good to see so many familiar faces.  Several past volunteers are also here, making it a bit of a family reunion.  My Gambian friends and family are also here — so wonderful to be seeing each other again.  There is my African grandma, the housekeeper and her energetic 4 year old, those living at or associated with a community development project, and many staff at the hospital (pharmacy and other departments).

Time for work

At the hospital, I spent a few days with the two pharmacy students (from the University of Manitoba) observing local hospital pharmacy practice.  One student began providing continuing education classes for existing staff on Wednesday.

Due to illness, the other pharmacy student and I have been at home the latter of this week.  Although we are much improved with the help of prayer and some antibiotics, neither of us our quite back to normal.  Walking a few blocks this morning was a bit too much for both of us.  Hopefully we will be in full health on Monday when the second student can begin her classes and I can begin teaching the inaugural class of Gambian pharmacy technicians.  It is so exciting to be a part of this program which has been in the planning stages for several years.

The importance of relationships

The more I volunteer in The Gambia, and hear the stories of other volunteers, the more I am reminded of the importance of relationships.  I have been returning to the hospital and The Gambia since 2006, and it is incredible to be welcomed back so warmly each time.  The Gambia, and much of Africa, is highly relationship focused rather than task focused.  At a basic level, there is great importance on proper, and sometimes lengthy, greetings — inquiring about all number of things before getting to the item at hand.  Likewise, time invested in a person or community is an essential component to bringing change.  Of course, other things like money, supplies, technology, and human resources are valuable.  Lasting change requires relationships.

I have seen real change in the pharmacy department.  Several suggestions/discussions that I was a part of in previous trips are now being routinely implemented.  One is the labelling of repacked medications — this helps to tell one white round pill from another.  The other is set stock days for the hospital — rather than departments picking up stock from the pharmacy on any day or time they wished, they are now limited to two set days per week.  This allows the storekeepers to update their inventory records and replenish their stock from the national stores.

Culture clash

We have been able to highlight the huge differences in culture that exist in The Gambia to the new volunteers.  On our second day, we ventured down to the pool at a local resort hotel along with a Canadian surgical resident.  (CVM has collaborated with Medicos en Action – a charitable organization associated with the Canadian Society of General Surgeons (CAGS).  Most of the team had left, except for this resident who was departing quite late the next day.)  While living at the CVM residence is more than comfortable, the sight of green grass (think of the water requirements), the variety of food and drink options, and the sight of tourists supposedly experiencing The Gambia was a significant contrast.  We did enjoy our time at the pool (free with purchase of a drink) and the opportunity to cool off.  Unfortunately, the ocean has been off limits this past week due to dangerous currents.

Our second culture clash was more of the same.  After remembering how to drive standard again, I drove our group to an upscale hotel/resort to hear members of the band Baatin play.  (I heard them play at the same location in 2009.  Watch the video)  One of the Canadian volunteers is good friends with the group and was able to play with them.  A bit more opulent than the first hotel/resort, our group was certainly aware of the difference from typical Gambian life.

Support a pharmacy student

You can still join the team supporting a Gambian student studying to become a pharmacist in another African country.  Emily is currently in her third year of studies.  I spoke with her mother earlier this week.  After this semester, the family no longer has funds to pay for tuition.  The total amount required for the remaining one and a half semesters is just under $17,000.  I know that it sounds like a lot of money — and it is.  But I am also so very thankful for those that have already contributed to the tuition support fund.  It’s not too late.  I will accept donations for as long as they come in, but would prefer them by early December to allow the student to continue into the second semester.

I hope to have more details from Emily about her studies and experiences as a student soon and will forward them to you.  I know that she does plan to return to The Gambia as a pharmacist on completion of her studies.  She has already volunteered (without pay) at the hospital pharmacy during her summer’s off.

This past weekend was cold! Well, not nearly as chilly as Canada (-47!) but really quite cool for African standards. Fortunately, we also took things at a bit of a slower pace. In a house with 24 other people, things get a little hectic at times. More than anything, I’ve been finding it difficult to find a quiet space for myself. (The sun did come out yesterday and things are starting to warm up again.)

The shelves are coming along slowly. Tools are not of the same quality as one would find in Canada. Finding a circular saw, drill bits, screws, nails etc. was also a bit of a challenge. The wood we purchased is fresh (from Senegal) … it was cut and planed from new timber over the weekend for us. I’ve learned that fresh wood is a bit challenging to work with. We do have some shelves up along the perimeter of the room on brackets and have begun placing items on them. Half of the first main shelf was completed today. To the amusement of the pharmacy staff, I became the ‘carpentress’ today while hammering some nails into the top shelf.

Christina and I also helped start getting the inventory straightened out before we left the hospital yesterday. We found requisition slips from August onwards that have not been entered onto their tally cards. It’s probably a 5 inch stack of papers that needs to be entered. Hopefully I can make some good progress on this aspect as well as moving stock back into the storeroom (once the shelves are ready).

Wednesday afternoon, our neighbours came over to tell us that a woman in the next compound was having a baby. The four nurses in our group, a grandma, Christina (the other pharmacist) and myself went over to help. The room was about 10 feet square with a single window and doorway with only cloth coverings. A thin double sized mattress lay on the floor and two wardrobe cupboards were against the walls. There was no light/electricity in the room — only what limited light would come in through the window. Although seemingly minor, my role as flashlight holder was important.

One of the nurses is here to teach at the hospital about neonatal resuscitation … the perfect person to have around. After a couple of contractions, the mom figured out how to push correctly. Childbirth was further complicated by the baby being born in posterior position. A good sized baby boy arrived at 5:10pm. There were a few concerns about mom, so she was taken to the local health centre. I got to hold the baby for a few minutes while we were waiting for the taxi to come. A beautiful head of hair and perfect tiny fingers and gorgeous brown eyes.

To celebrate Valentine’s day, I grabbed some ice cream earlier and am now joining some others with some homemade cookies to watch The Lion King … what else would you watch while in Africa?

Last weekend was fairly touristy: markets, monkeys and crocodiles. On Monday, it was time to get down to work.

My first impression of the hospital pharmacy was not quite as bad as I had anticipated it to be. Of course, it was still chaos with boxes stacked to the ceiling, larger than life dust bunnies and a mishmash of items found on any available floor space.

Monday was spent explaining the project to the pharmacist-manager, Essa. Essa is the last remaining pharmacist at the Royal Victoria Teaching Hospital. There were two other pharmacists when I was here in 2006 but they have since left. Essa is on multiple management hospital committees, in charge of training pharmacy technicians/assistants, and tries to have a clinical role. Unfortunately, being a hospital pharmacist doesn’t pay well. After his shift of 8-4 at the hospital, he works at a retail pharmacy until 11 to support his family. Imagine being in charge of all the medications aspects of a 550 bed hospital (also consider there may be more than one person per bed at times) … ordering, inventory, distribution, DUE, research, clinical, training and protocol development/management … now imagine the things that you simply won’t get to because there aren’t enough hours in the day.

While doing a survey to assess the appropriateness and feasibility of implementing a computerized inventory system, I learned more about the process through which the hospital procures their pharmaceutical supplies. The pharmacy department puts together an annual proposal for items to be ordered from the National Pharmaceutical Services (NPS). Similar to health regions in Canada, the NPS sets contracts with vendors for all items to be ordered by the hospital and health centres. The pharmacy department is in charge of procuring pharmaceuticals, surgical supplies, and x-ray supplies. That proposal is then negotiated with NPS and the items are adjusted according to budgetary constraints. Currently, the pharmacy department’s budget is approximately one quarter of that needed (~$250,000). Once ordered, items are only shipped to NPS (and then in turn to the hospital) when the respective companies feel they have enough to warrant shipping the items. Thus, items arrive in a haphazard fashion. As you can see by this procurement process, the drug supply is often lacking.

I also had a chance to visit the NPS on Monday. While there, we noticed some metal shelving (similar to that found in many a garage in Canada) that was not being used. The pharmacist in charge of the NPS anticipated significant government bureaucracy in giving us the shelves but agreed to look into it for us. On Tuesday, I met with Baboucar (the Public Relations Officer, PRO, at the hospital) who wanted to go to the NPS. So, off we went. Again, the NPS pharmacist stated she would look into providing the shelving to us but, this time, we were able to get the name of the contractor.

Tuesday, I completed another survey in the pharmacy department to assess the existing inventory system. Preliminary results suggest that the inventory records are 4% accurate. Many of the tally sheets were last updated in November. I hope to sit down with Sarjo, who is in charge of the pharmacy stores, and find a way to improve the inventory system. One idea is that all the tally sheets are kept in a single location and are updated weekly. I will see if this is something that Sarjo might be agreeable to trying.

Wednesday we continued moving and sorting boxes. Michael, an electrician at the hospital who I met in 2006, stopped by to fix a broken refrigerator. Michael and Darcy (a team member helping with construction) managed to track down a hammer drill for Thursday so that we could start putting up some brackets on the walls. By this time a substantial part of the storeroom had been emptied and things were looking really quite manageable. After work, we went down to the beach and swam around in the ocean for a while.

Thursday, most of the shelving brackets were assembled in the storeroom. Christina, the other pharmacist and I, began making a list of the expired drugs and surgical supplies we had sorted out. Lorna is also a part of our team and has a passion for organising. After another talk with Baboucar, we got in touch with the shelving contractor. Unlike most Gambians, he showed up peculiarly early, took some measurements and promised to get back to us with a quote later that day. The quote came back — and was far above our available budget so we opted to continue with our plan to build with wood. That afternoon, we returned to the house for measurements for the dresses we are having made. Hopefully, they are ready for when we leave.

Yesterday, we picked up some plywood before heading to the hospital. Darcy and Mike ripped the plywood into strips to place on the brackets for shelves. The shelves went up above the fridges and along one of the main walls. The 2×4′s we ordered should be in next week so that the rest of the shelves can be built. Christina, Lorna and I continued our inventory of the expired stock.

It was nice to have a bit of a break today — I definitely needed one! This morning we went for a boat cruise along the Gambia River. It was a fair bit cooler today but still nice enough to lay above deck and relax. This afternoon we went down to the beach and spent time with the Smile Team — a volunteer group from the UK we met on Monday.

Everyone with a delayed flight has also arrived (finally), along with some of the folks who were supposed to arrive this week. We have a fully house of 23 right now … with more to arrive this week. Thanks again for all your notes and well wishes!

I have switched the video locations; all videos to date can be found below. I anticipate more will be posted soon for your viewing pleasure.

Tour of our House
Bijilo and Cachikaly
Driving through Bakau
Sunday Service at the Redeemed Church of God
Pharmacy Storage (Hospital & National Stores)