When the drugs don't work

I’m sure from reading our blogs you have a fair impression of the issues facing the medical staff and patients here. Funding, staffing, availability of drugs including oxygen, reliable electricity supply are but a few. Thankfully Mbarara keeps the backup generator fuelled, not the same can be said of many of the more rural health centres. 

Micrbiology Labs

An issue that only came to light in the last few weeks is being able to know what quantity of antibiotic any particular patient needs at any one time. In the UK we trust in our quality control checks that the antibiotic strength is as it says on the tin. Antibiotics arrive mainly from India and China and undoubtly from the cheapest supplier. The end result is no quality control. This was recently demonstrated by a local pharmacy research student. Multiple vials of the same antibiotic of the supposed same strength were checked and their ability to treat a particular bacterium measured. Needless to say the results ranged hugely. This leaves all physicians in somewhat of a quandary. To little antibiotic and the infection won’t be treated and can actually worsen the situation, too much antibiotic and the side-effects of treatment can be harmful and even outweigh the seriousness of the original problem.

Anaesthetic Trolley with OMV

The anaesthetic officers face a similar dilemma with the drugs used to deliver general anaesthesia. Doses quoted to us for the use of Ketamine (a common anaesthetic agent) ranged from the usual 2mg/kg up to double the dose, with some reporting little effect even then. We found that the paralysing agent used, Suxamethonium, is often left out of the fridge which diminishes its effect. Errors like this can be corrected through education, but not when it is because there isn’t a working fridge in the hospital to start with.

Oxygen storage

One of the more frustrating factors we encounter is the lack of equipment and drugs. Although we have come to expect this at times there is a seemingly simple solution. A good example is when one hospital will have a set of spinal needles but no drugs to use in them, yet the neighbouring hospital will have spinal drugs but no needles. It seems difficult to produce effective communication between the 2. Politics and budgeting at a higher managerial level seems to get in the way.

Maybe it is more similar to home than we thought....