New beginnings

Today was our first day of work in the hospital.  We began our day getting aquainted with the hospital staff and got to do some hands on work in the outpatient pharmacy.  The hospital is very different than anything you would see in the US.  It is open with a lot of walking outdoors to get to the different units.  In contrast to the US, all the wards are seperate buildings and only one floor.  Most of the people live in rural areas in poverty without means of transportation and either walk or take public transportation to get to the hospitals.  Dozens of family members and patients camp outside the hospitals and wait in long lines to be seen.  Most stay overnight for days and sometimes even weeks rather than making the long journey back to their homesteads.  They bring mats and blankets and sleep on either the ground or benches.  Below are some pictures of the typical homestead community:

After taking a tour we met with the only two pharmacists in the hospital.  In contrast to our 6 year doctorate program, they become licensed after only 4 years with a bachelor’s degree in pharmacy.  Also of noticeable difference, pharmacy technicians must go to school for 2-3 years to become certified; whereas we do not require schooling for our pharmacy technicians in the US.  This allows pharmacy technicians much more power and they are able to dispense drugs without a pharmacist present.  We were able to do some hands on work in the outpatient dispensary.  It was very frustrating trying to adapt to a new system but extremely interesting to see all the differences between Swaziland and US pharmacy.  They do not rely as heavily on computer systems and there is no data entry process.  All prescriptions are dropped off by the patients in a cardboard box and the drugs are pulled and labeled and handed off to the patient through a window.  If something is out of stock, the technicians will just replace it with something similar.  For some drugs, they use different names than what we are used to in the US.  For example, sulfamethoxazole/trimethoprim 800/160 (commonly known as Bactrim DS in the US) is called cotrimoxazole 960 in Swaziland.  There is a steady flow of patients throughout the day and they wait outdoors on benches waiting for their prescriptions to be handed to them.  Rather than counting each prescription out and putting it in a bottle, they use pre-packaged baggies of commonly dispensed doses to fill prescriptions.   On a busy day, the outpatient pharmacy can dispense from 700-1000 prescriptions per day. 

The last part of our day consisted of working with Sarah who is a clinical pharmacist in charge of the Southern Africa Nazarene University (SANU) pharmacy technician program.  She went over the current program with us and we will be working with her to help improve the curriculum.  Their curriculum currently is a certificate program and they are trying to boost it to the next level and make it a diploma program.  In addition to their typical pharmacy courses, it was interesting to see that they also have to take religious courses such as “Introduction to the Bible.”  Currently, the program is having difficulty finding qualified professors to teach at SANU.  In addition, they are trying to find the most efficient use of the 100 hour of time allotted for the program per semester.  We will be assisting by designing additional practice problems and suggestions based on our curriculum and experience.