U of T Pharmacy student reflects on rotation in Uganda

St. Mary’s Hospital Lacor, commonly known as Lacor Hospital, is based just outside Gulu, the largest city in Northern Uganda. The hospital serves over 300,000 patients per year and up to 45 per cent are children under five. Last November, PharmD for Pharmacists student Shellyza Moledina Sajwani completed a five-week rotation at the pharmacy department at Lacor Hospital.

The PharmD for Pharmacists program at the University of Toronto’s Leslie Dan Faculty of Pharmacy is specifically designed for experienced pharmacists and recent graduates who have a Bachelors’ degree (or equivalent) in Pharmacy and wish to obtain a Doctor of Pharmacy degree (PharmD). Students in the program complete four rotations including three clinical care and one elective rotation which can include global health.

Shellyza, who is an oncology pharmacist by profession, connected with preceptor Jacinta Otine who wanted her to review the hospital’s oncology pharmacy program and identify areas for improvement. Working together, they outlined a four-phased project. “We wanted to see how best to deliver chemotherapy in a safe and effective manner and how to better manage and prevent side effects,” said Shellyza.

 The four project phases included: (a) introducing a safety system to prevent overdosed of methotrexate in children; (b) the development of fourteen drug monographs to help physicians and nurses manage side effects of chemotherapy; (c) a strategy to prevent chemo-associated vomiting through anti-nausea medication administration; and (d) a new Standard Operating Procedure including training and checklist for safe preparation of chemotherapy medication.

“It’s a completely different ball game when you’re working in a low-resource setting, said Shellyza, “so we needed strategies that were suitable for the setting.” The new processes were well received by the clinical teams and soon after implementation, they observed improvements for patients including a drastic reduction in vomiting. All four phases of the project were still working smoothly six months after the project, and the project was later recognized by a poster and a merit award by the Canadian Association for Pharmacy in Oncology (CaPHO).

Doret Cheng, a lecturer at the Leslie Dan Faculty of Pharmacy with an interest in global health, originally set up this rotation in Uganda after having volunteered there for a year. She worked closely with Shellyza and the Faculty’s Office of Experiential Education to coordinate the rotation, providing orientation, guidance and mentorship.

“Pharmacists in Canada have relatively robust and consistent access to medicines, information, and man-power to manage them,” Cheng said. “Health is not equitable across the world and particularly in low-resourced countries, the role of pharmacists is untapped because of lack of infrastructure and access to the human resources. We know collaboration with pharmacists is essential to enhancing patient care and to help move this forward in other countries is so rewarding and such a privilege!”

“It’s not about the grade anymore it’s about the learning”

After four years of working as a hospital pharmacist, Shellyza felt she wanted to pursue additional education that would expand her clinical knowledge and skill set. She completed the degree in 24 months, while maintaining her full-time hospital position. She recommends students take full advantage of the rotations to gain new experience, as she did with her rotation at Lacor Hospital. “It’s not about the grade anymore it’s about the learning,” she said.

Building from this international experience, Shellyza is now the national co-president for Pharmacist without Borders Canada (PSF) a volunteer organization of Canadian pharmacists that provides pharmaceutical and technical assistance in the implementation or improvement of community and hospital pharmacies internationally.

“I feel like I am a better clinical pharmacist now and have embarked on a lifelong ambition to be involved in international development,” said Shellyza.  “My overall knowledge has improved as well as my clinical skill set. This program really opened doors for me to accelerate my career.”