Last weekend was fairly touristy: markets, monkeys and crocodiles. On Monday, it was time to get down to work.
My first impression of the hospital pharmacy was not quite as bad as I had anticipated it to be. Of course, it was still chaos with boxes stacked to the ceiling, larger than life dust bunnies and a mishmash of items found on any available floor space. Monday was spent explaining the project to the pharmacist-manager, Essa. Essa is the last remaining pharmacist at the Royal Victoria Teaching Hospital. There were two other pharmacists when I was here in 2006 but they have since left. Essa is on multiple management hospital committees, in charge of training pharmacy technicians/assistants, and tries to have a clinical role. Unfortunately, being a hospital pharmacist doesn't pay well. After his shift of 8-4 at the hospital, he works at a retail pharmacy until 11 to support his family. Imagine being in charge of all the medications aspects of a 550 bed hospital (also consider there may be more than one person per bed at times) ... ordering, inventory, distribution, DUE, research, clinical, training and protocol development/management ... now imagine the things that you simply won't get to because there aren't enough hours in the day.
While doing a survey to assess the appropriateness and feasibility of implementing a computerized inventory system, I learned more about the process through which the hospital procures their pharmaceutical supplies. The pharmacy department puts together an annual proposal for items to be ordered from the National Pharmaceutical Services (NPS). Similar to health regions in Canada, the NPS sets contracts with vendors for all items to be ordered by the hospital and health centres. The pharmacy department is in charge of procuring pharmaceuticals, surgical supplies, and x-ray supplies. That proposal is then negotiated with NPS and the items are adjusted according to budgetary constraints. Currently, the pharmacy department's budget is approximately one quarter of that needed (~$250,000). Once ordered, items are only shipped to NPS (and then in turn to the hospital) when the respective companies feel they have enough to warrant shipping the items. Thus, items arrive in a haphazard fashion. As you can see by this procurement process, the drug supply is often lacking.
I also had a chance to visit the NPS on Monday. While there, we noticed some metal shelving (similar to that found in many a garage in Canada) that was not being used. The pharmacist in charge of the NPS anticipated significant government bureaucracy in giving us the shelves but agreed to look into it for us. On Tuesday, I met with Baboucar (the Public Relations Officer, PRO, at the hospital) who wanted to go to the NPS. So, off we went. Again, the NPS pharmacist stated she would look into providing the shelving to us but, this time, we were able to get the name of the contractor.
Tuesday, I completed another survey in the pharmacy department to assess the existing inventory system. Preliminary results suggest that the inventory records are 4% accurate. Many of the tally sheets were last updated in November. I hope to sit down with Sarjo, who is in charge of the pharmacy stores, and find a way to improve the inventory system. One idea is that all the tally sheets are kept in a single location and are updated weekly. I will see if this is something that Sarjo might be agreeable to trying.
Wednesday we continued moving and sorting boxes. Michael, an electrician at the hospital who I met in 2006, stopped by to fix a broken refrigerator. Michael and Darcy (a team member helping with construction) managed to track down a hammer drill for Thursday so that we could start putting up some brackets on the walls. By this time a substantial part of the storeroom had been emptied and things were looking really quite manageable. After work, we went down to the beach and swam around in the ocean for a while.
Thursday, most of the shelving brackets were assembled in the storeroom. Christina, the other pharmacist and I, began making a list of the expired drugs and surgical supplies we had sorted out. Lorna is also a part of our team and has a passion for organising. After another talk with Baboucar, we got in touch with the shelving contractor. Unlike most Gambians, he showed up peculiarly early, took some measurements and promised to get back to us with a quote later that day. The quote came back -- and was far above our available budget so we opted to continue with our plan to build with wood. That afternoon, we returned to the house for measurements for the dresses we are having made. Hopefully, they are ready for when we leave.
Yesterday, we picked up some plywood before heading to the hospital. Darcy and Mike ripped the plywood into strips to place on the brackets for shelves. The shelves went up above the fridges and along one of the main walls. The 2x4's we ordered should be in next week so that the rest of the shelves can be built. Christina, Lorna and I continued our inventory of the expired stock.
It was nice to have a bit of a break today -- I definitely needed one! This morning we went for a boat cruise along the Gambia River. It was a fair bit cooler today but still nice enough to lay above deck and relax. This afternoon we went down to the beach and spent time with the Smile Team -- a group from the UK we met on Monday.
Everyone with a delayed flight has also arrived (finally), along with some of the folks who were supposed to arrive this week. We have a fully house of 23 right now ... with more to arrive this week. Thanks again for all your notes and well wishes!
I have switched the video locations; all videos to date can be found below. I anticipate more will be posted soon for your viewing pleasure.
Tour of our House
Bijilo and Cachikaly
Driving through Bakau
Sunday Service at the Redeemed Church of God
Pharmacy Storage (Hospital & National Stores)