Week 4 Wrap Up

5.31.13
Ghanaians are a very interesting breed.  People are not afraid to cross the streets when cars are flying down the road, but when it rains, the city shuts down.  Yesterday morning it rained for about 30 minutes and people were running left and right looking for a dry place to stay.

Today a man came in with a prescription for a spironolactone and an aldactone suspension for a little boy with a heart defect.  Because many pharmacies are run on the sole interest of making money, most of them do not compound since there is no pharmacist present so they tell patients that they don’t have the drugs available.  The man was happy to have found our pharmacy because we were able to compound the suspension for his son.

Week 4 Highs and Lows

5.29.13
This week is going really well so far. I got to counsel a few patients today.  A woman came in to the pharmacy with a prescription for birth control pills so I was able to counsel her on the use of her pills.  A man also came in with a prescription for some medications for his pregnant wife so I instructed him on how she should take the medications as well.

Dewormers are a common medication that people come in to the pharmacy for on a daily basis; however, there has been a recent shortage of them.

I had a really sad moment in the pharmacy today.  A woman came in with a 12 year old girl complaining that the girl was very pale and seemed very ill.  The woman said that she usually buys eggs from the girl and was really concerned about her so she brought her in to the pharmacy to see if there was anything we could give her.  She didn't know the girl's name or if she had any family but she was really worried about her.  We asked the girl if she had eaten today and she said yes, but seemed really confused when we asked her more questions.  The lady begged for us to give the girl something with the little money she had and the pharmacist gave her an appetite stimulant.  The lady thanked us and made the girl drink some of the appetite stimulant right away.  It was really sad because the girl did look really sick and she did not really have enough money to buy some medication.  But I am glad we were able to give her something.

Time is winding down and soon it'll be time for me to leave.  I really wish I could stay longer because I'm definitely getting used to life around here....can you tell? :)

Halfway Point

5.26.13

Three weeks have already passed since I've been in Ghana.  Time is really flying!  This week on rotation was pretty routine.  The most interesting encounter I had this week was counseling a deaf patient.  I didn't realize he was deaf until his mother told me to give her the instructions on how her son should take his medication. I wrote the instructions down as well just in case they forgot.  This interaction was really interesting because I had never had that kind of experience.  I'm looking forward to what new experiences await me this week.

Dumso-Dumso (Lights off/Lights on)/ When in [Ghana]...do as [Ghanaians] do

5.21.13

For the past 6-8 months, Ghana as a whole has been experiencing electrical difficulties.  Fortunately, I have not had to experience too much of it since I've been here up until recently.  At home, sometimes the water shuts off in the middle of a shower, so I have learned to become much more efficient with the time I spend in the bathroom.

The food here is amazing!  Everything is fresh and you can eat once a day and be okay.  The Ghanaian diet is very heavy on carbohydrates.  Ghanaians mostly eat rice, plantain, fufu (cassava), yam, banku (blended cassava and corn dough), and different stews and soups.  Eating with your hands is not an uncommon practice here.

Fried plantain and beans

Waakye

Making fufu!!

Eating with my hands

If you ever plan on visiting Ghana in the future, don't be afraid of not being able to eat foods that you are used to!  This past weekend, one of my friends celebrated her birthday and we went for breakfast at one of Ghana's finest hotels, Golden Tulip.  I had the "traditional" American breakfast:  eggs, bacon, and potatoes. and I felt like I was at home.

My American Breakfast :)

Inside of the hotel Golden Tulip

Breakfast birthday celebration with the girls 

You can find almost anything they have in America here in Ghana, but the local foods are amazing and worth trying.

Week 2 Wrap Up

5.17.13
In the US, pharmacists in a retail setting are responsible for counseling patients about their medications and making recommendations about over the counter products--this is not the case in Ghana.  Pharmacists also diagnose patients here when they come into the pharmacy.  Earlier this week, a man came in to the pharmacy complaining that his ear had been bothering him for a few days.  I asked him if he had tried anything for it and he replied no.  He said that he'd had this problem before and was given a particular antibiotic for it but he couldn't remember the name.  I didn't feel comfortable trying to recommend something to him because I felt that he needed to go see his doctor before I could do anything about it so I sent him over to talk to my preceptor about the issue.

Another patient came into the pharmacy yesterday complaining of a bump that had just formed on her neck.  For all I know, it could have been a pimple.  After the patient talked with my preceptor, he gave her an antibiotic to treat the "bump."  I spoke with my preceptor about why he gave her an antibiotic when the patient came in about her bump and he explained to me that pharmacists are usually the first point of contact for patients.  They would rather see a pharmacist before they make an appointment to go and see a doctor.

These two interactions have really helped me to understand the roles of doctors and pharmacists as well as the importance of interprofessionalism.  Doctors are responsible for diagnosing patients, whereas pharmacists are responsible for making recommendations about medications based on the diagnosis provided by the doctor.

I'm finally getting used to life around here.  Everyday is busy with people filled in the streets and selling anything you can think of.  Time is flying by quickly, but I will continue to make the most out of the time that I have left.

Ups and Downs of Patient Education

5.14.13
Many people come into the pharmacy with an empty box of their medication wanting a refill.  If the pharmacy has the medication a patient is buying but it is from a different manufacturer, some of them refuse to buy it. Even when patients are counseled that it is the same medication, they will still not buy it.  Elderly people usually send someone to buy their medications and they do not understand the concept of "same medication, different manufacturers."  They know the medications that work for them, so if someone comes with a medication that looks "different," they believe that it will not work the same.

Same medication; different manufacturers

It saddens me when people cannot afford their medications because it is something that I have no control over.  A lady came into the pharmacy looking for a cough mixture for her son.  When we told her the price, she expressed how she did not have enough money to pay for it and left the pharmacy.

I made two interventions today!  These past two days have made it apparent to me that people in Ghana abuse antibiotics.  Yesterday a woman came into the pharmacy complaining of back pain and asking for erythromycin.  Today a man and a woman came into the pharmacy complaining of a cough and asked for amoxicillin.  Neither of them had tried anything for their cough, but someone had recommended it to them so they came in to buy it.  One of the technicians was getting ready to sell the amoxicillin to the woman when I told him that it was not an appropriate medication because the woman did not have an infection.  He argued with me about it for a bit, then sold the women cough syrup and some cough drops.  This interaction really helped me realize the importance of a pharmacist.  It is our responsibility to counsel patients on the appropriate use of medications so that they are used correctly.

Saturdays in the Pharmacy

The weekend is over and I'm getting ready to start my second week of rotation.  I went into the pharmacy yesterday from 9am-3:30pm and the time went by quickly.  A lady came in with pitting edema (swelling) in her legs.  The pharmacist helped me counsel her on hypertension and how it is important to go to the doctor and get checked, as well as the importance of eating well and exercising.  This interaction really helped me solidify my twi skills (language they speak in Ghana) and build my confidence in interacting with patients.

Week 1 Wrap Up

5.10.13
I've completed my first week of rotation already!  Last week this time, I was on the plane to Frankfurt.  Time  really flies! Pharmacy is much different from that in the United States.

The pharmacy is open six days a week: M-F 7:30am-5:30pm and Saturday 8:30am-3:30pm.  It is a mixture of a community setting and a commercial business center.  In downtown Accra, there are about twenty pharmacies on one block which they call "Drug Lane."  There are two medicine counter assistants (similar to technicians, but technicians are the terminology more so used for those that work in the hospital) and a pharmacist.  Most people come into the pharmacy looking for something to treat fungal infections and malaria.  They also come for herbal and vitamin supplements, as well as medicine to stimulate appetites.

The most surprising thing to me about how the pharmacy operates is that anyone can come in requesting a medication with or without a prescription!  If a patient comes in with a prescription written for three medications and the pharmacy does not have one of three, the patient can go to the pharmacy next door (hence the name,"Drug Lane,") and look for the medication.

The pharmacy's drugs are organized by indication.  So all antifungals are in one section, all antihypertensives are in another section, etc.  I am currently working on alphabetizing the drugs by brand name in their particular sections so that drugs are easier to find.  Brand names in Ghana are different from those in the USA.  For example, Plan B in Ghana is called Postinor 2.  There are no restrictions on who can buy it.  No ID needs to be shown in order to prove their age and no prescription needs to be written in order for someone to buy it.  According to the pharmacist, most people that usually come in to buy it are over the age of 17.

One day, some members of the Food and Drugs Board (FDB) came into the pharmacy looking for an antimalarial drug that people had been selling illegally (fake product).  The FDB is the Ghanaian government agency responsible for inspection, certification, and proper distribution of food products and drugs in Ghana (Ghana equivalent to USA's FDA).  It was interesting to see them at work because they came in as if they were regular customers and after they introduced who they were, they inspected the pharmacy to make sure that all products being sold had been regulated.

Yesterday a lady came into the pharmacy wanting to buy Amoxicillin for her twins because she ran out.  When asked why she was giving it to them, she claimed that she gave it to them with paracetamol (analgesic equivalent to Tylenol) whenever they had an upset stomach.  The pharmacist then explained to her that amoxicillin is an antibiotic that is not used on an as needed basis.

Today I watched the pharmacist compound phenobarbital for a 16 month old child.  She let me do the calculation to make sure I understood how many tablets she was using that would equate to what the prescription called for.

I created a public health project exploring hypertension in Ghana.  I hope to start it next week now that I have familiarized myself with the pharmacy and have one week of experience interacting with patients.

Humble Beginnings

5.7.13

Being here the past four days really makes me appreciate my parents and all that they have done for me.  Seeing the way people live here also makes me appreciate the things I have.  People start their days really early!  For the past two days, I have been waking up at 6:25am and don't get back home until 7pm.  People here do not have much, but they are happy.  The pharmacy is located in what can be considered "downtown" Accra.  There are shops, markets, vendors, and all sorts there.  People begin their days as early as 4am.  They sell any and everything!  And the way they can carry things on their heads is amazing.  I saw one woman carrying at least 7 boxes on her head!  Everyone must have amazing posture in order to do that.  Everyone is always on the go and the streets/highways are filled with cars and people.  People cross highways with no shame!  It's scary.  I don't know how people find their way around places because there are barely any street signs, but they make their way.  I can't even tell people where I am staying because there are no street names!  People rely on landmarks to give/get directions.  I hope to find my way around with no problem soon.

Welcome to Ghana!

5.5.13
I can't believe I'm back in Ghana after three years.  It feels like I was here just yesterday.  The plane ride from Chicago to Frankfurt was 8 hours, followed by a 7 hour layover, then an 8 hour flight from Frankfurt to Ghana.  It's HOT but it's bearable.  I can't wait to start my rotation tomorrow to see what pharmacy is like! Until next time....