Male Medical Ward and ICU

We began our day by meeting with Zinhle and processing prescriptions when the pharmacy opened.  Zinhle had us verify patient weights to ensure the gentamicin dosing was correct.  We followed up with Dr. Mtjali on renal dialysis in the ICU.  Next, we visited the male medical ward and did rounds with Dr. Gazagne.  It was mostly a tuberculosis ward, as well as some HIV/AIDS patients with opportunistic infections.  It was extremely interesting to finally connect real patients with the topics we have been learning about in school.  Some of these disease states we may not have had the chance to see in the US. This included severe cases of tuberculosis, cryptococcal meningitis, oral candidiasis, as well as many others.  We also got to see a patient on isonaizid who was developing peripheral neuropathy in his right foot.  Dr. Gazagne asked us to reccomend something for a patient on Efavirenz, an HIV medication, who was confused (as this is an adverse effect of this medication) as well as a reccomendation for and HIV patient who had developed a severe case of oral/esophogeal candidiasis (thrush). 

 

In the afternoon, we visited the ICU to check in on our diabetic ketoacidosis patient.  When we arrived they brought in a head trauma patient who had been hit by a car on foot.  This is very common as most Swazi people get around the town by walking.  We were able to see the patient being brought in and mechanically ventilated.  This was a new experience for both of us.  After the patient was stabilized and adequately sedated, we discussed the status of the patient with Dr. Kinsala.  We went through the medications used for this patient.  This included midazolam for sedation, morphine for pain, and dexamethasone for the brain hemorrhage.  The patient’s PaO₂ was less than 60 mmHg at 40 mmHg which helped us determine that the patient was hypoxemic.  We followed up on our DKA patient who had unfortunately not shown any signs of improvement but was stable.  Just like most days here, many family members were waiting outside all day to see their loved ones.

We have also had the opportunity to visit the Central Medical Stores.  This is similar to a warehouse you might see in the US; however they provide medications to all public health facilities throughout Swaziland.  We met with the pharmacist, Brenda, who explained to us their role in Swaziland health care and discussed some of her concerns.  A major problem they are faced with is quality assurance for the medications.  Swaziland does not have any drug manufacturers within their country, and have to order drugs from other countries such as South Africa and India.  She allowed us to look at some drugs they received that were not up to standard.  Some of these included a liquid suspension that was solidified upon arrival, questionable drug ingredients in IV solutions, and inappropriate packaging.  Central Medical Stores does not have the equipment necessary to test the ingredients of the drugs, and is worried that some of the drugs they are sending to pharmacies are counterfeit and may be harmful to patients.  One step they are taking to improve their quality assurance is having manufactures send drug samples prior to purchasing large orders of the drug.  Dr. Schafermeyer spoke with Dynalabs last year, who were interested in partnering with Brenda to send drug testing equipment to Central Medical Stores in Swaziland.  We are going to follow up with Dynalabs to see if this offer still stands, as Brenda expressed great interest in having proper quality assurance equipment.  She gave us a tour of the warehouse, and explained delivery, storage, and procedure.  We will be keeping in contact with Brenda, as she plans to provide us with a list of medications she finds to be most troublesome and counterfeited. 

 

We've been having a fantastic time so far and have already learned so much.  The Swazi people have been very welcoming to us and we have made many friends along the way. 
The weather has been beautiful and we have enjoyed driving through the mountains (despite the terror of driving on the opposite side of the road).

 

 

 

 

One of the local pharmacists named Willie graciously invited into his home to meet his family and enjoy some traditional African food.  They were so kind and very open to answering any questions about pharmacy in Swaziland and were also very interested in pharmacy in the US.  We had great conversation over similarities and differences in not only pharmacy, but the culture as well.