Ugandan Pharmacy and TASO

As our trip is heading into its last full week, this morning found us all traveling to different places to pursue information on either our major or specific research topic. Three girls interested in education spent the morning at a daycare observing the similarities and differences between those in the United States, and the rest of us enjoyed yet another breakfast at MUBS. While the rest of the group awaited a presentation from The New Vision, Uganda’s government sponsored newspaper, the five pharmacy students on the trip, including myself, ventured to the Pharmacy Society of Uganda (PSU) to speak with the secretary of the organization about the practice of pharmacy here in Uganda.
The secretary was extremely informative and walked us through the education, areas of work, and problems facing pharmacists in Uganda today. Pharmacy is a rather new practice in Uganda. The Pharmacy and Drug Act of 1970 was the first law created to govern the profession. It established the PSU and brings together all of the pharmacists in the country. This act also establishes the National Drug Authority which regulates the distributing of pharmaceuticals in the country. A Bachelor of Pharmacy degree began being offered in three Ugandan universities in 1989 with the first class graduating in 1993. Prior to this, people had to travel to other countries to get their degrees and then return to Uganda to practice pharmacy. This led to a huge shortage of pharmacists in the country since they are needed in many fields including community (where 95% work), hospital, industry, and research. Currently there are only 319 pharmacists in the entire country. This is not nearly enough to meet the demands of the population of nearly 3.3 million. Although all pharmacies are required to be owned or employ a pharmacist, many times they operate without a pharmacist present. This leads to poor quality of care for the patients as well as compromised services. However, with the number of people interested in pharmacy due to its high social status and pay this problem is expected to greatly improve in the future.
Currently the pharmacy industry in Uganda is dominated by businessmen rather than pharmacists themselves. The businessmen are in charge of importing the drugs from foreign manufacturers, and there are no regulations in place that ensure the drugs entering the country are manufactured correctly. In fact, due to the recent HIV epidemic, latex gloves and condoms are the only products that are tested for quality before entering the country. This leads to a huge problem with counterfeit drugs being sold in pharmacies, many times without the knowledge of the pharmacists. The NDA has a lot of work to do to ensure that regulations are enforced regarding the importing of drugs. Another problem with the Ugandan pharmacy industry is the fact that prescription medications are dispensed without a written prescription from a doctor. I was shocked to hear this with all of the strict regulations in place in the United States for getting a prescription. This has lead to a large amount of antibiotic resistance as well as drug abuse in the country. Although laws do exist to regulate this, they are not enforced, and people buy pills whenever they are feeling even slightly sick because they don’t understand the proper way to take medications.
Despite the obvious problems that exist in the pharmacies of Uganda, I feel that they have great potential to advance within the coming years. They are aware of the most in-demand services and have started a HIV medication factory so that they will not have to import the ever important Anti-Retroviral Drugs. Also, every pharmacy always has some type of malaria treatment in stock as well as bed nets for sale. This shows that pharmacies are working to serve their population and will hopefully continue to advance forward in the future. All of the necessary laws and regulations regarding the filling of prescriptions do exist, so they just need to be enforced more strictly in order for change to take place. This will hopefully become easier as time goes on and more pharmacists enter the workforce. Quality pharmaceutical care will greatly aid the country on its path towards development. If citizens are able to access the proper medications and receive information on their illness, they will be healthier and able to work. Also, society will begin to gain a sense of trust in pharmacists, thus furthering their ability to act as a change agent to alter the current mindset of the entire population and focus efforts on prevention of disease rather than treatment.
Our day continued with lunch at MUBS and we then began the second half of our day which included a visit to TASO (The AIDS Support Organization). This organization was started in 1987 when the current government came into power. TASO works to improve the life of victims of HIV/AIDS by providing them with the services they will need to battle their relentless disease. Upon entering TASO, we were welcomed with a song from their drama group with is composed of clients of the organization. The goal of this group is to ensure people that even if your HIV test comes back positive, you can still do something positive, so they compose and perform songs based on their life experiences.
While at TASO, we spoke with both the public relations employee as well as two medical professionals. While we only visited the Mulago branch of TASO, organizations are located in various regions around Uganda. These centers provide medical care, psych-social counseling, and social support for those testing HIV positive. Donors fund about 95% of the facility which serves over 20,000 clients throughout the country. Funding only allows for 400 clients to receive ARV drugs (used to stop HIV replication and allow blood cells to multiply) out of over 3,000 clients, so only those with CD4 (white blood cells that make up the immune system) levels below 250 get put on the regimens. Those selected for free drugs are carefully chosen based on interviews and home visits to ensure that they will keep up with the medication and take their treatment seriously. This is extremely important in order for TASO to ensure that it is not wasting any of the valuable ARV drugs on people who do not even care about their treatment.
In addition to starting people on medication, TASO also sets up a specific counselor for each client that meets with them to discuss their possible steps to overcoming HIV/AIDS and encourage continued work despite the judgments that may be passed. After the client has returned to TASO for 2 months and has no complication with their medication, they are able to get check-ups in TASO centers in the community rather than coming back to the center. TASO’s ability to extend into communities throughout Uganda shows their extreme dedication to the support of those with HIV/AIDS. I feel that TASO is an excellent organization in Uganda. It provides those suffering from HIV/AIDS with a place they can go for help where they know that they will not be discriminated against. In addition to this, its free services allow treatment for people who may not have been able to finance it themselves. It is greatly helping the country’s development by promoting practices that will stop the transmission of HIV as well as treating those who have already contracted the disease, thus allowing them to live a longer, happier life than they would have without treatment.
The TASO presentation concluded with another song by the drama group. This piece included African drums and at the end of the song all of the members of the group came into the crowd and held our hands to illustrate the world uniting in its fight against HIV. We then did some shopping at booths set up by clients of TASO to raise money for their organizations and took a brief tour of the facility. The tour guide informed us that TASO Uganda offers scholarships to students to come to Uganda from other developing nations and learn about TASO in hopes of starting something like it in their country. This reinforces the fact that TASO is a great organization that touches the lives of thousands of Ugandans, giving them hope in this time of great hardship in their lives.
After leaving TASO, we exchanged some more money and set off to purchase Ugandan football jerseys. I was expecting a leisurely time at the mall that I usually experience when shopping in America, but after all of the shopping we have done here so far I should have known better. It took us all about an hour to finally select the jerseys and correct size as well as barter with the store owner for a good deal. In the end, most of us ended up with jerseys whether they were the right size or not and are very excited to wear them to the football game later this week. The day concluded with a dinner at an Indian/ American restaurant and we then returned back to Red Chili to pack for our exciting three day journey to Murchison Falls which we will embark on tomorrow!