I am volunteering five mornings and two afternoons a week at the pharmacy in the referral hospital in Rundu. As with most health care positions in the area, the pharmacy is grossly understaffed when it comes to pharmacists. I work with one other pharmacist, Chakanyuka (pictured), who hails from Zimbabwe, and we have 5 pharmacy assistants. We are to manage the medications for a 300 bed hospital, plus all the state outpatients (usually over 300 daily), plus administer and manage all the HIV medications for the thousands of patients in the area.
There are many challenges, as you might expect, but the nature of these challenges actually surprised me. Due to the generosity of foreign donors and programs such as USAID, there are sufficient supplies of antiretroviral medications (ARV) to treat the HIV/AIDS patients in the area. I was also surprised to find the pharmacy was actually quite well stocked with most of the basic medication, as well as secondary therapies for treatment. What I hadn’t counted on was the lack of empathy and poor work ethic that pervades the staff of the pharmacy, and most of the hospital as well. Even though we are chronically understaffed, the assistants routinely disappear from the dispensary without notice or warning. Two or three hour lunches seem to be the norm, and there is this unspoken idea that I am not there to assist the staff in there work as we try to improve the poor standard of care, but rather that I am there to do their work so that they can leave to go shopping or other stuff. I have often returned to the dispensary from an errand to find the outpatient window abandoned with a huge queue unattended to, and have had no option but to try my best in broken Rukwangali/charades to assist the patients. My attempts to address these problems have proved to be unsuccessful up to this point.
There are also challenges with the medical staff and physicians, who hail from a number of countries, including the old Soviet Union and Cuba (Cuba apparently has some program whereby they exchange doctors for food, and so these Cuban doctors come for 2 year terms to Africa). While I can speak and communicate in Spanish, that doesn’t mean I understand what some of these Cubans are attempting to do, as many of their approaches to medicine are not based on evidence or good practice or rationality. Fortunately the majority of my suggestions about ways to advance patient care have been received positively, and improvement in prescribing patterns have been noticed.
There still remains a lot to do, especially when we are so occupied with the basic tasks and there isn’t enough time to address all that we should be. I realize that my training and expertise and experience will probably go underutilized due to the “tyranny of the immediate”, but that change can be introduced, even if it is done very slowly. I am continuing to build friendships with my colleagues, which enhances communication and allows me to make more of an impact. I do feel that my presence is appreciated, and there are small victories along the way.