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As a missionary and pharmacist, I have spent many years providing pharmacy care in developing countries all over the world. For instance, I have served in Honduras, Mongolia, Kenya, and most recently in Tanzania. In Tanzania, I served for six years, from 1998 to 2004, as the director of pharmacy and as administrator of 85 Tanzanian employees in Kigoma Baptist Hospital, a 45-bed medical/surgical hospital with an active outpatient clinic. This article will cover the last year I spent there.
The hospital, owned and operated by the Tanzanian Baptist convention, relies on donations from individuals and the Southern Baptists and on projects with the International Red Cross in Geneva, the UNHCR (United Nations High Commissioner for Refugees) refugee agency, and the Helimission humanitarian helicopter service.
Kigoma Baptist Hospital had only one Pharm.D. student, but there were three physician residents for the year. Our students got a taste of living in another culture and got to see whether they should plan to do this for the future and learn about tropical medicine at the same time. Our students and volunteers got the chance to make IVs starting with water (rain water in the rainy season) and dextrose powder. Filtering was done with prefilters going into an ionic filtering process to make pure water, rather than by distillation.
The war in Burundi was slowing down, and the hospital was without a surgeon, which meant we didn't receive patients wounded in that conflict during our last year there. Our previous experiences with four-year-olds getting shot and six-year-olds stepping on land mines were horrifying, but seeing these kids get well after months of therapy was very fulfilling. The hospital was within 35 miles of two civil wars and had 500,000 refugees in the area in 2003. During the past several years, the hospital served patients from the conflicts in Democratic Republic of Congo, Burundi, and Rwanda.
When I tell American pharmacists that I kept between 25,000-60,000 amoxicillin capsules in storage, they think I don't understand inventory control. But then again, maybe they don't understand going four months without a delivery or having a large number of patients. Names like furosemide and paracetamol were just a part of the relearning process. Our Pharm.D. students were given projects like substituting U.S.-donated medications on all prescriptions, since the Tanzanian staff would not be familiar with U.S. brands.
Being the administrator and pharmacy director, I was responsible for pharmacy and therapeutics. The formulary included 80 drugs, several that we do not use daily in the United States, such as drugs for malaria and parasites. No cephalosporins were on the formulary, and there was only one quinolone as a backup antibiotic. AIDS' antivirals were not available from the government when we left. Oral pain meds were acetaminophen and ibuprofen.
The six years I spent in Tanzania left a scar on my heart because I lost several co-workers to AIDS. The hospital was very involved with AIDS counseling and prevention. When a society is hit by AIDS, everything changes. For instance, we now have to put on gloves before placing Band-Aids on neighborhood children. The hospital showed love to these people in their last days when their families sometimes would not. My car was used as a hearse so many times for these people.