Haiti diaries #5: Cité Soleil – Part 2 (THE PHARMACY)

Posted on May 1, 2014


Each medical team visiting the clinic is responsible for stocking the pharmacy for their own use, and once again, I want to say a very big THANK YOU to all the donors who helped our team with providing medications for the pharmacy. For our one week stay, we spent roughly $2000 to stock our pharmacy, and were therefore  able to supply thousands of medications for our patients.

I was the only pharmacist on the team, so naturally I was put in charge of the pharmacy with the help of 3 rotating students each day. The pharmacy was set up according to drug class, which helped us get oriented pretty quickly. Most of the medications were American branded drugs so I was familiar with them, but we had a few in kreyol which we had to have translated (e.g. diaper rash creams, iron tablets and artificial tears). Each room had a translator for effective communication between care provider and patient, and ours was named Innocent. He was of tremendous help to us, and even though I reckon a few things may have still been lost in translation, he was great at explaining to them how to take their medicine. All patients had to repeat back all drug instructions to make sure they understood each medication given, and it didn’t take too long before I learned a few things myself:

Pran avec mange – Take with food
No Tafia – No alcohol
Pran maten ak aswè – Take in morning and evening 
Pran jouk fini – Take until gone

The pharmacy was the busiest room in the clinic, we filled about 700 prescriptions in 4 days! Our most commonly prescribed drugs were: ORS packets – for dehydration,  Amoxicillin – for URI’s and  Bactrim – for UTI’s. Luckily, antibiotic resistance is not a problem in Haiti, so we made doses lower and treatment durations shorter in order to reduce risk of diarrhea side effect (Remember, dehydration is the leading cause of death in Haiti).  We also dispensed a good number of Hydrocortisone 1% cream – for rashes, Omeprazole and TUMS – for acid reflux, Ibuprofen & Acetaminophen – for general body pain, Griseofulvin – for ringworm, and a few maintenance medications such as Lisinopril and HCTZ for hypertension and Metformin for diabetes. Albendazole – for pinworms and a month pack of multivitamins were given in the triage area to everyone visiting the clinic. 

In addition to dispensing, the pharmacy was also responsible for conducting glucose tests, pregnancy tests (with urine collection cups & strips), breathing treatments, and first aid.

The pharmacy had a drop-off window where patients dropped off their prescriptions, and a pick-up window (aka walk-through) where medications were picked up. Patients usually sat on a bench in front of the pick up window until they were called up to collect their medications. Of course we had no computers, so each prescription form (usually with 3-4 rx’s) had to be thoroughly screened for age/gender/disease appropriateness and triple checked (before count, after count and during dispensing/counsel) to be the right drug before being given to the patient.

We did have one incident where two people with similar names were each given the other persons medication, but luckily we caught it before they left the compound (…phew!). To prevent further incidents, we developed a number and date of birth verification system at the pick-up window.

We also tried to limit the number of medications each patient received to three, because the more the medications given, the greater the risk of confusion or mistakes. We employed several measures such as pre-mixing ORS packets for children to ensure adequate proportions and clean water, and also made sure single-dose medications such as fluconazole, mebendazole etc. were taken at the pick up window to reduce the number of “take-home” drugs. 

Overall, I loved my experience at the pharmacy and it was by far the most enjoyable part of this trip (it has nothing to do with the fact that it was also the only room with air-conditioning :p). I had a great pharmacy team(the students and translator) and each day involved a tremendous learning curve for all of us. I had to learn to dose and administer ceftriaxone (never done that), I had never done a urine-strip pregnancy test, I had no software system to detect sub- or supra-therapeutic dosing or drug interactions so I had to summon my clinical knowledge, and I also had to use my discretion for quite a number of drug substitutions (and conversions) when we ran out of certain medications. Needless to say, we were exhausted at the end of each day! 

What are your thoughts about the Cite Soleil pharmacy? I saw some similarities between their pharmacy and mine here in the U.S. – it was extremely busy, there was no time for lunch break, I was on my feet all day, we had a few irate-impatient customers etc. From my narration, do you also see any similarities with your local non-Haitian pharmacy? Do share!

p.s – Sorry about the week-long hiatus (life called)…I have about 2 more entries to the diary series that I will try to complete this weekend. Sending love and light to the 234 schoolchildren abducted in Nigeria, I pray and hope they are found and brought home safe and sound to their families #BringBackOurGirls

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