Wind Blows Deeply

Yesterday evening I was awarded CSHP‘s New Hospital Practitioner Award. The person who introduced me, Donna (the coordinator of my hospital pharmacy residency), made it quite short and sweet. Essentially, “you can read about her in her modest bio but what you would read is the importance of faith in her practice.” Fortunately, my acceptance speech [see continue reading] highlighted that point nicely. Afterwards, one individual commented that it was nice to see that I wore my faith on my sleeve and on the fact that I chose to include faith at all.

Later in the evening, I uncovered a suspected but unwanted fact about an old acquaintance … in a relationship in which I’d worn my feelings on my sleeve. I affected me to the point where I walked back to my hotel. Thirty odd blocks. In the big city. On slush covered sidewalks. At 10:30 at night. In my boots with the pretty heels. I made it back safe and sound … albeit my feet were rather sore and my mood not really that improved. Time to let go once again.

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While yesterday was our first official day at the hospital, it was mainly touring and meeting with the directors. Today was the first work day. We met again with the head pharmacist, Essa, got some ideas on what the processes were in place and worked out what we’d be working on for the next week and a half. Then we decided to organize the donated medications located in the main pharmacy. Everything was covered in a thick layer of dust, in random order and most certainly set up for errors to happen. Initially we were a little daunted with the task ahead of us, so we went for lunch. Beans on a bun and a coke cost us 18 dalasis … or about 75 cents.

After a lunch in the hot afternoon Gambian sun we sorted and cleaned and classified. (I do have to say that I find myself increasingly able to tolerate the heat and humidity … it may even be growing on me.) We only got about 3/4 of the way through the first large shelf but I think Mel, Tim and I all left with a good sense of satisfaction at the end of the day.

One of the new items on my list of “pharmacy-related things to be empassioned about” it that of foreign medication donations. Now that I have been able to see the variety of agents that are donated (without generic drug names, in foreign languages, opened containers, old prescriptions from patients, expired stock) I hope to “let the world know” how much of an issue this is. Simply the time that it takes to sort through all the individual boxes and sort it into some reasonable system would be overwhelming for a country or local clinic/hospital/pharmacy. The WHO recommendations are certainly something to bring to people’s consciousnesses.

Once these medications are sorted, we will likely spend time in the various satellite pharmacies to observe the processes in place and make recommendations for improvement. At the moment, there is only one full-time pharmacist and two part-time ones. Pharmacy assistants (not technicians) do all of the day to day work: recieving prescriptions, filling the medications, checking their own work, giving to patients and limited counselling. The pharmacist simply does not have time to be involved in any of these steps. Already we have observed many potential concerns. (One thing we heard was that medication errors account for about one third of all deaths in the hospital.) In addition to sorting and observing, we may spend some with the physicians (mostly Cuban) on the wards.

Hopefully we can also put together a plan for the hospital’s medication store room. The room is of average size with cartons stacked floor to ceiling and very little space to walk around between them. I’m sure they cannot have a good idea of what is actually inside the boxes. Once we have a better sense of how big the problem is, I hope that we can find pharmacists and pharmacy technicians that would be interested in coming in the future.

Friday and Saturday will be spend putting together a medication kit for a rural health worker and doing the training for this. I think we will be able to procure the medications from the community pharmacy where Essa (the hospital pharmacist) also works. Community pharmacies are a bit of an interesting thing here in The Gambia: no prescription needed — just walk in and request whatever it is you think you may need. Sleeping pills, antibiotics, pain relievers … pretty much anything you want.

That’s enough ramblings from me right now. I’ll be sure to get on my soap box again soon.

OK, here it comes. Before I start, I should mention I’m thankful for a few ‘God-interventions’ this week:
1) I was taking the elevator at work one day this week (up to the ICU floor) – all alone in the elevator – when a man got on. As he selected his floor, he noticed my own selection, and probably glancing at my white lab coat, he asked if I worked in the ICU. I said yes, and he responded by saying something like ‘it takes a lot of heart to work up there’.
2) Another day this week, the -70 degree freezer in which I was storing 300+ samples for my major research project for this residency began alarming. I was a tad stressed with other things, so it was a panicky hour while I searched the hospital for another department with freezer space I could beg/borrow. It turned out our freezer was fine. The samples are ok. I could have used a few more deep breaths.

Now on the other side of things …
I need to figure out the rest of my life pretty soon. I have the opportunity to sign a contract to stay here for a year once I’m done – which means extra money. I am not sure if I want to stay here or go back to home (or somewhere in betweeen). Then there’s also that missions stuff I had postponed for this year.

I’ve really been trying to look for God in the everyday stuff. If I see Him in the small stuff, it might be easier for me to see Him in the big stuff too. I just thought it would get easier at some point.

Caro was recently writing about future career choices. I felt like commenting, but in the end decided to write my own blog entry.
If you (a) know me or (b) have been a regular reader of my blog or (c) all of the above or perhaps even (d) none of the above, you may know that I have struggled with this ‘when I grow up …’ question. At the moment I am a pharmacist. I deal with (not in) drugs, patient care, healthcare teams, life, death, moral issues, bureaucracy issues. It is only on a few (count them on one hand) occasions where I have been passionate and excited about my job. I’m still not sure what my vocation is, but over the past few days I’ve begun to get a sense of it all.
Now, I feel I should mention that up until this point I didn’t see being a pharmacist as a part of my calling — it was simply a really good fall back plan. Things are starting to change. I think my vocation, is much bigger than my practice of pharmacy — yet still includes pharmacy. [Was that a gasp from some of you?] I started looking into ‘volunteer’ opportunities … related to pharmacy. I’ve looked at Doctors Without Borders (Médecins Sans Frontiéres) and VSO … and I received the most interesting reply from VSO. They sent along an old job description:

Royal Victoria Hospital (The Gambia, West Africa.)

Key Duties and responsibilities of the volunteer:
*To offer training and re-training to all staff in Pharmacy Department
*To improve clinical pharmacy practice at ward level
*To assist in the local production of eye drops and Intravenous Infusions
*To assist in setting up a drug information system
*In collaboration with VSO accounts trainer, to assist in the conversion of manual store records to computerise records
*Together with the VSO accounts trainer, to develop further systems of stock control

Really, the key tasks are not all that glamorous. But as I was reading over the job description, I became excited about the possibility of something similar. Both MSF and VSO require 2 years experience within one’s field … so I wouldn’t be going anywhere just yet. But I have been looking at education to prepare me for such a role. (e.g. McMaster’s MIEH program)

Enough thoughts for now. I’ve have much reading to do for Monday. And (horray) my small group is starting tonight.