Written By: Gloria Rinomhota, Third-Year Student Pharmacist
During the summer, I participated in a three-week interprofessional global health project in Lusaka, Zambia through the UMB Center for Global Education Initiatives. Joining me for this experience were fourth-year student pharmacist Dana Valentine, nursing student Katie Doyle, and medical student Alexandra Laps. We worked under the leadership of two faculty members from the School of Pharmacy — Emily Heil, PharmD, BCPS AQ-ID, AAHIVP, assistant professor of pharmacy practice and science (PPS), and Neha S. Pandit, PharmD, BCPS, AAHIVP, associate professor in PPS — to evaluate antibiotic administration at the University Teaching Hospital (UTH) in Lusaka.
Upon arrival at UTH, I could not wait to get started. Throughout my three weeks there, I participated in hospital ward rounds, afternoon lectures, presentations, and adult and pediatric HIV clinics. My most enjoyable moments came from the afternoon lectures. Although I was familiar with most of the topics presented, it was intriguing to think about those topics in different clinical settings. What drugs are currently available? What interventions should or should not be used in different clinical situations?
The Human Touch
As different scenarios presented themselves, I came to understand what “resource-limited” truly meant. During one of the adult clinics, a patient showed signs of non-compliance to her HIV medications and was reluctant to accept her medication regimen due to the number of pills. After the patient left, I asked the doctor about her behavior and what interventions might be best for her and if her preference as a patient was prioritized. The doctor explained, “We treat patients based on what’s available.” The more time I spent in the clinics, the more evident that statement became.
Another patient I vividly remember was a 21-year-old, vibrant young man who was diagnosed with aplastic anemia. I saw him a couple of times during our morning rounds with the infectious diseases team. The last time I saw him, he was sitting in a chair in his private hospital room listening to music, talking, and looking much better than he had at his previous appointment. His care team had tried administering blood with little to no improvement. There were limited options for him, with the exception of a bone marrow transplant, though I came to learn there was no bone marrow transplant service in Zambia. When one of our professors asked what could be done, the doctor raised his eyebrows in a way that said, “We just wait.” Although another doctor wanted to prescribe a special medication that might temporarily prolong his life — his body had turned against him and was sucking all the blood he had — we discovered that it would take a week or two for the hospital to have it delivered. He did not make it.
One of the Best
While we encountered a number of patients for which few interventions were available, I was highly impressed by how organized the hospital was and how different departments operated. UTH is one of the best health care systems I have experienced in Africa. Before traveling to Zambia, I spent time in several pharmacies at the teaching hospital in Zimbabwe and attended a pediatric clinic at another hospital in Nigeria. Comparing my previous experiences to my time at UTH, the progress that I saw in Zambia was inspiring. I was also very happy to learn that the government covered most, if not all, patient medical expenses, with the exception of imaging and laboratory tests. In some instances, the government even covered expenses for citizens to obtain treatment in India if it was not available in Zambia.
A New Appreciation
As part of an interprofessional team, I highly appreciated and valued the expertise of my peers. From our student nurse, I learned the importance of preventing pressure ulcers in hospitalized patients. I also learned that pressure ulcers take time to heal, which can cause excruciating pain. To prevent pressure ulcers, nurses will occasionally manually turn patients. Before this experience, I would never have considered this important issue.
I was also able to gain a lot of exposure to direct patient care in a hospital setting, where I saw and learned about different disease states, including some rare diseases. Although there are still challenges that must be overcome in terms of resources and training, I think Zambia is heading in the right direction and making remarkable progress in the field of patient care.
This experience truly offered me a different perspective on how health care is delivered in an area with limited resources. As I finish my last two years of pharmacy school, I have started to think more about our local community, especially the residents who don’t have access to the health care that many of us take for granted. This trip, combined with my experiences at home, have influenced me to leverage what I have learned as a student pharmacist to become more involved in my community and volunteer to serve those who are underserved in the local area.