No two days are ever identical to be honest, but there is some kind of routine established now.
So my day starts with the dreaded alarm at 6.30am. Closely followed by a cold shower – no hot water here but to be honest, after a night in the early 30s, a cool shower is just what you crave! Despite the bright mornings – it’s lovely to wake up to blue sky and sunshine 90% of the time – I am still a zombie at that time in the morning!
At 7.30am I walk up to the hospital, about 100 metres away, for our morning prayer/devotion time. This includes singing in French, with varying degrees of tunefulness (don’t be tricked into thinking that all African’s can sing well, as I once thought.....believe me, they can’t!!). The songs tend to be fairly old and traditional. Some I recognise as direct translations from old English hymns such as ‘To God be the Glory’ and ‘What a friend we have in Jesus’.
8am is the official work start time for most staff. It is the changeover time for the nurses and midwives and the start of the day for everyone else, apart from the two guys who work in triage who start at 6.30am and screen every outpatient. At 8am all staff meet for a morning meeting, where any information pertinent to everyone is shared. This usually lasts about 10-15 minutes
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| Outside la pharmacie - obviously not open at this point!! |
I usually start in the pharmacy at about 8.15am and greet Elisabeth and Cleopas, my two fellow pharmacy workers. Generally speaking, Cleopas is the dispenser for all drugs to outpatients and Elisabeth ensures all the stock records (on paper, no access to computer stock records here!) are up to date and goes into town to buy drugs from various sources. Sourcing and buying of drugs is a blog topic all of its own, so watch out for that update in the future! Let’s just say there’s no broadband internet connection to the local wholesaler, who’ll deliver twice a day.......! Ensuring we don’t run out of essential drugs is a time-consuming and sometimes frustrating task. It is also one big juggling act. At the moment we’re in the peak of malaria season, so making sure we’ve enough anti-malarial drugs has been a challenge. So far we’ve managed to have a continuous supply but the drug supply chain as a whole in Chad is fairly precarious, with things in and out of stock nationally on a regular basis.
My role here is to try and exert some sort of control
over what medications and sundries (urinary catheters, cannulas, bandages, scalpels,
NG tubes, syringes, needles, plaster of paris, IV infusions etc etc) are
released from the pharmacy. Previously,
nurses and midwives would come to pharmacy and write an order for what they
required. It was often quite a random
list with random quantities – this is a culture where you don’t forward-plan
and you crisis manage. So the concept of
thinking ahead as to what drugs etc you may need over the next day or so is not
one that comes readily to your average Chadian.
That’s just the way they are and it isn’t anything against our staff, it’s
how Chadians ‘tick’. A kind of ‘live for
the day’ mentality – often borne out of extreme poverty – they often don’t have
money to forward plan, they only have enough to live on day-to-day and hope
that something comes along after that.
So my role is to devise stock lists and ensure that each area of the hospital
– maternity, emergency room, operating theatre, adult wards and paediatric ward
– have their allocated stock level each day.
So far maternity, emergency room and the operating theatre are up and
running and I’m in the process of sorting out the inpatient wards. The storage of drugs on the inpatient wards
is ok at present but could be vastly improved.
I’ve just designed a drug trolley which we are going to ask a local
carpenter to make. A drug trolley will
reduce the potential risks of medication error that are currently a possibility
with the existing system of drug storage on the wards. In the interim Sue (nurse here) and I have
found a cabinet on wheels that will suffice as a drug trolley until my prototype
is made. Drugs here come like they used
to in the UK – either loose in tubs of 1000 or as strips of ten in boxes of
1000. So no individual patient packs to
neatly sit in a drug trolley! We have to
be pretty inventive with storage solutions here in order to segregate drugs on
the wards and stop them being mixed up (which is what can currently happen).
So, each morning I go to each area, count the drugs they’ve
got and then top them up to the allocated level. Pretty straightforward stuff, although you
try doing it in rooms of around 40°C!
Another of my roles is to work with Elisabeth on the drug orders she
needs to collect from town. As I said,
that’s a blog entry all of its own and is a very time consuming process. I also give Mark (doctor here) monthly statistics
on drug availability and, at the moment, the level of anti-malarial usage. I also ensure we always have a spare gas
cylinder for the pharmacy fridge (gas powered, and I’m getting good at
predicting when it’s going to run out!
There’s no way of telling exactly when the bottle will run out, which
can be tricky in this heat if we miss it and the fridge is off for a few
hours). I also help Cleopas at the
outpatient counter when it’s really busy, getting medication ready for him to
dispense. Unless the patient speaks
French, I can’t dispense drugs to them as I can’t explain how to take what they’ve
been prescribed. Most patients at our
hospital speak Arabic and I can’t! So
that stops me being able to have any patient contact in terms of dispensing
drugs to them.
Talking of languages, the official language of the
hospital is French. So I am immersed in
French all day, which doesn’t tire me out as much now as it did at the
beginning! I can make myself understood
and can run the pharmacy on a day-to-day basis so my French is bearing up and we’ve
had no major miscommunications yet! I’ve
had to learn the French words for loads of what I consider basic medical and pharmaceutical
words, such as tablet, cream, syrup, gloves, water for injections, hydrogen
peroxide, scalpel, crepe bandage etc etc.
The most confusing thing to me is that IV cannulas are ‘catheter IV’ in French
and urinary catheters are ‘sonde urinaire’.
That took a lot of getting used to and remembering because as a British primary
care pharmacist, a catheter is usually referring to a urinary catheter. Simple things can be really confusing!
Another role I have is ensuring the lab have enough
reagents, test strips and so on. As I
had in my last blog entry, you have to learn to step outside of the ‘usual’
pharmacist’s remit here and help out where you can. Fortunately for me, the head lab technician
is on the ball and lets me know when they’re getting low. I just have to check the quantities he’s
ordering sound reasonable and sign off his order. One test we have had to buy lots of at the
moment are the malaria finger-prink tests.Our day officially ends at 3.45pm, and we usually get a break at lunchtime. However if there are a lot of outpatients, we sometimes end up staying until 4-4.30pm to enable them to get their prescriptions before they leave the hospital. As well as bringing in revenue for the hospital, our prices for drugs are a lot less than if they took their prescription into town to a pharmacy there. So it’s a win-win situation! There’s no NHS-equivalent here, all patients have to pay a fee to consult a nurse or doctor, a fee for lab tests and a fee for their prescribed medication. If they are hospitalised, then flat-rates per night are paid depending on whether they’re medical or a surgical case. This covers all their care and their drugs given on discharge. We are fortunate that kind individuals from the West often send money to the hospital which we put into a benevolent fund, so that if a person really can’t pay, we can subsidise their hospital costs. We endeavour to keep our prices as low as we can and just ensure we cover our running costs.
So there we have it, an account of what I get up to out
here! Elisabeth and Cleopas both have a
good sense of humour which means we often have a lot of laughs in the pharmacy. One such example was the other week. It was really hot in the pharmacy (I know,
the drugs, there’s not a lot we can do as we’re not on city-power so have no
means to run air-con – we have the fridge for items that must remain
cool). I was feeling the heat after a
morning of walking around the hospital checking on stock levels and
distributing drugs and other sundries.
We had a lull and no patients were at the counter for prescriptions, so
I was sat by the fridge, longing to get in it!!
I then had a little brainwave – I explained to Elisabeth and Cleopas
that in the UK when it’s cold, we have something called a hot water bottle to
warm us up. So I thought to myself, I
need a cold water bottle at the moment!
In the freezer compartment of the fridge we keep ice packs, so that if
drugs are taken out of the pharmacy in cool bags, we can add an ice pack to
keep them cool. I took one of the ice
packs out of the freezer and hugged it like a hot water bottle!! It was sooooooo good! Below is a photo of me in the pharmacy
hugging my ice pack J
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| In la pharmacie with my ice pack! |
