Nick and Tessa in Kisiizi

To records keeper:  “Really? I can just take this stack of patient treatment charts home for the weekend to make some stats?”

To secretary: “The Medical Superintendent would have time for a chat? I just go and ask him myself? Right. Good, good….”

To self, shuffling through files in a shelf in pharmacy: ‘I wonder if this cupboard containing the class A drugs should be locked…’

Since arriving, my role here has…evolved. Orginally, I imagined I would be helping a team of people develop excel sheets for the hospital pharmacy.  I soon discovered I was the sole (and extremely inexperienced) undertaker of this task. Within the first week or so I battled with my non-computer inclined brain to develop excel sheets for the HIV drugs, which I have completed. Wise-minded folk around the hospital, however, quickly made me see that excel sheets in pharmacy would be a very short term shallow remedy for a multiplicity of problems concerned with drug management….. the plot thickens…What is needed, it transpires, is an analysis of the current hospital drug system, its problems, and a plan of attack for improvement!

SO. My task here is to research, make a report for the newly formed Drugs Committee, get feedback on recommendations, and play some sort of role in helping things happen.

 For the last three weeks I have felt like a detective, talking to people at all levels, understanding the systems, drawing flowcharts, and doing some mini audits with records.

While perhaps you are yawning and feeling sorry for me, I feel in my God-given element; very excited and challenged with this work! Of I course a complete newbie, learning how to do this as I go, stretched beyond my current skills. But that makes me just like a lot of people here who learnt on the job…

I am constantly amazed by the complete lack of confidentiality, security and strict systems here…as the snippets above indicate, I am completely at liberty to bowl up to however I need to, access any files I need to. I have found that people at all levels are more than happy to sit down with me for an hour and talk me through their part of the system, their fustrations…sometimes personal fustrations!

Some drug problems at Kissizi:

Doctors often don’t know if a drug is available or not, so they prescribe it, only for the nurse who walks to pharmacy to pick it up to find that it is not there!.That could mean a patient gets no drugs for a day.

They don’t measure the quantities of drugs used, which makes it pretty hard to make good orders! They used to try to keep more of such records in 2006, but had to stop because they didn’t have time for the paper work, the photocopier kept breaking down, oh, and they ran out of paper.

Because we are so extremely rural here, acquiring drugs for the hospital is a big challenge. This challenge is heightened by the fact that our (multiple) suppliers are prone to running out of stock themselves, and also frequently delay our orders. When they finally have our order ready for us, we send a ‘driver’ on a nine hour bus ride to Kampala to pick them up (packing them in the store of the bus!!). Sometimes these drivers forget to check expiry dates, and lab reagents have expired on the bus…

It is truly incredible how people here battle obstacles and keep the whole place running!