The dilemma of being a pharmacist in Mulago Hospital

By Odokonyero Kennedy

At first glance, you might think this article is about remuneration of medical workers.

“Guess it was your first time, I’ve been there, gotten used and moved on. All has already been written, it will look like repetition,” that’s one response I got when I told my friends about my intention to write this article. Unlike him, who is a medical student, most of you reading this may not have had the chance to experience firsthand the dire state of affairs at Mulago Hospital. I believe, however, that what you’re going to read is not news to your ears. The difference is that, it is neither a politician nor civil society organisation writing this. It is someone who is a custodian of medicines and I speak from an informed point of view, as part of my training as a pharmacy student requires me to do hospital electives for at least four weeks thus I spent the entire month of July at Mulago Hospital.

“Our lives begin to end the day we become silent about things that matter” –Dr. Martin Luther King Jr

The Dilemma.

“This one is for buying; this one is for buying…..” that’s the song a pharmacist in Mulago Hospital sings everyday to the patients/care takers who come to fill their prescriptions in the pharmacy. It is because most of the time the drug is out of stock, the hospital doesn’t stock it or the Central Pharmacy has delayed to authorise requisitions from the ward pharmacy. It is sad to learn that most of the patients may actually not buy the drug simply because they cannot afford it.  It is even worse for a very sick patient who has no caretaker because they could end up dying.

Sometimes the drug is available but it is not the “strength” the doctor has prescribed. A case in point, the Hospital only stocks Captopril 25mg, which is one of the drugs used for treatment of hypertension. When a doctor prescribes 6.25mg, the common practice is to ask the patient to divide the tablet into quarters because there are no 6.25mg tablets of Captopril stocked. Truth be told, such a tablet is too small to divide into quarters. The implication is that the patient very likely doesn’t get the correct dose.

One of the principles of medical ethics is justice and it calls for equal distribution of resources. Because the stock available is way less than the patient need, we are required to ration drugs. Imagine rationing something that is supposed to save a life!      

It is we the pharmacists who bear the burden of the bad image. Patients sometimes don’t believe when you tell them a drug is not available. They think you are ‘hiding’ it. When you are on a ward rotation, such patients will accuse you in front of the doctors for ‘refusing’ to give them drugs.

The few times a pharmacist gets to dispense all the prescribed drugs is when the doctor diagnoses cases like malaria and upper respiratory tract infections. I wonder why a National referral hospital handles such cases that lower health facilities should be able to deal with and it cannot fully stock drugs to manage specialised cases like renal failure, hypertension, diabetes, heart diseases (cases expected to be handled at a National Referral Hospital)

I would like to see the health care professionals take the lead in advocacy for quality in health service in equal measure as they do for their remuneration.

The writer is a third year student of pharmacy at Makerere University