Saturday, August 30, 2008

My Life in a Namibian Pharmacy

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.


Thursday, August 28, 2008

Pizza Party!

On Saturday night we decided to honour our twelve OVC volunteers by hosting a surprise pizza party and movie night. We told everyone that there was going to be a project meeting at our house, so after choir practice we were going to drive all of them back to our place for the “meeting” then drive them all home. They entered into our house to find the furniture rearranged and a projector that we borrowed from the hospital projecting up on our wall. The kitchen was a flurry of activity as the four of us aimers had been working all day to produce homemade pizza (definitely what they call white peoples food)! The dinner was well received and we made fresh popcorn, cookies, fudge and cinnamon rolls - so desert was also a hit.

We showed them the first of the Lord of the Rings Trilogy, The Fellowship of the Ring. All but one had seen a movie before but most could count on one hand the number of times. At the beginning of the movie we were concerned that they weren’t going to understand it as they were all busy chatting amongst themselves and not paying attention, but sure enough as the tension started to build they were sucked in! It was so much fun to hear them shout with excitement and in agreement during the action scenes and grow to love Frodo.

The next day at church they were all talking about the movie and were anxious to see the second part. They were all intrigued by the fact that the Orcs took the wrong Halflings, and what would be the result of evil King Sauruman. It was a great night and we were happy to bless them in a fun and unexpected way.

Tuesday, August 12, 2008

Leaving home.

After having been in Rundu for just over 2 months, last weekend we had the opportunity to leave this small town for the first time.

Our first destination was Etosha National Game Park. It is considered one of the top safari’s in Africa. This particular safari is one in which you can drive through in your own vehicle (or go on tour groups), and there is no fence separating you from the wild animals. We had an extraordinary first of three days in Etosha, and Kimmie (one of the nurses from AIM who we travelled with) who has been a dozen times was blown away by the number of animals we saw. On the first day we saw 23 elephants, 13 lions (!!!), a black rhino, a very rare spotting of a leopard and hundreds of zebra, giraffe and antelope.

But despite the first time seeing some of these stunning animals in the wild, it was also our first time seeing so many white people congregated in one place in quite some time. Most of these were European tourists, especially from Germany, lugging around cameras that cost more than some people’s cars. It was odd to see these families in their matching safari hats and huge rugged hiking boots (very necessary when you are sitting in your car for 12 hours unable to leave) staying in fancy hotels, ready to really experience “wild Africa“. Most of the kids at the project have never even seen any of the animals that we just assume local Africans live with, and yet here we are living in both worlds.

After a spectacular few days of being glued to the camera (to see some of our photos click on this link:, we headed off to Windhoek for a couple of days. Traveling there meant driving through a number of small towns and it was very obvious to me that “Todo, we’re not in Kansas anymore”. Rundu is a different place altogether. Rundu is the major town (actually, more of a collection of connected villages) in the poorest region of Namibia, and so in many ways it is unlike the rest of the country.

These other small towns we drove through had paved streets and sidewalks (not sand) - imagine! We even saw a little section of grass that people were lounging on. We rarely saw any mud huts on the side of the road, and instead there were lots of flashy shops and restaurants, especially in Windhoek (which you would never imagine is an African city). There are many more people, and as a result more crime - we had our car broken into with windows smashed and stuff stolen, which was a nuisance.

Language was another aspect. We have worked hard to learn some of the basic greetings in Rukwangali, the trade language spoken here - but only here. As each region and tribe speaks different languages, it was such an uncomfortable feeling to be in these other cities and having no idea how to say “please” and “thank-you” except in English, hence feeling like an insensitive foreigner.

As we were returning from Windhoek, Daryl and I noticed a strong sense that we were coming home. It’s amazing that after only 2 months we could feel an attachment to a place that we still don’t understand on so many levels. The dogs just about ploughed us over with excitement to see us again, and it was so easy to hop right back into life here. The kids at the project all missed us when we were gone, and it was really great to be back. Home, for now at least, but home none the less.