Sunday, June 29, 2008

Week 5

Highlights of this week include visiting the WHO office in Suva city. The pharmacist there Lakghva gave an interesting insight into the role of WHO in providing technical pharmaceutical assistance to the Pacific Island countries. WHO Pacific Office promotes essential medicines, quality assurance of medications, rational use of medications and assistance with developing a National Medicines Policy to the Pacific. All of this aims to ensure timely, affordable, reliable access to safe medications that the population need for the priority health conditions. She discussed how recently Martial Islands are in the process of developing their National Medicines Policy, Tonga is conducting a Pharmaceutical assessment survey, Vanuatu is looking at the outer island nursing posts to assess medication use, and the Solomon Islands are conducting a national workshop of antimicrobial use. It's fascinating how so much is going on in the Pacific and also very exciting. It's also a big job for Lakghva to co-ordinate all of these projects and arrange for all the visiting consultants who help these small countries.

CWM hospital arranged a morning tea for me on Thursday which was lovely! There were about 25 people (about 7 2nd year pharmacy students also) and I used this opportunity to hand over a donation from Remedy. Remedy is a group of students at Victorian College of Pharmacy who aim to share pharmacy resources with developing nations, and promote awareness of the sorts of issues that developing countries face. Before I came to Fiji, I was aware that the major divisional hospitals in Fjii were in need of reference texts such as paediatric pharmacopoeias and drugs in pregnancy/breastfeeding guidelines. Remedy kindly sponsored the provision of 3 paediatric pharmacopeias and 4 drugs in pregnancy/drugs in breastfeeding guidelines to be distributed throughout Fiji's divisional hospitals. They were very happy to recieve the books and expressed their sincere gratitude to Remedy for the donation. So I know the books will come to good use here.

My report is in it's final stages and it has turned out quite well. My recommendations and findings I will present to FPBS this Wednesday. I will try to upload a final version of my report. Diabetes is such a big problem here and it was a very interesting topic for me to research, I really enjoyed it!

It is my last week in Fiji! It is so sad because I really love this country and will miss the friendly, kind, resilient people that have surrounded me every day.

Saturday, June 21, 2008

Recently I've made friends with a group of Australian Youth Ambassador for Development volunteers (AYAD) who are working here in Suva sponsored by AUSaid. Some of them are working at the Pacific Regional HIV Aids Project Office and have roles such as monitoring and evaluation co-ordinator of the project. The project is AUSaid funded but will soon be handed over to Secreteriat of the Pacific Community, a regional intergovernmental organization. The project looks after HIV and STI funding for 14 pacific island nations. The money goes towards activities promoting awareness of HIV and STI's, and money also goes towards funding for doctors and nurses to attend health conferences. There are all sorts of AYAD volunteers here, another one is working in the Ministry of Health looking at finance and another is working for an organisation similar to RSPCA aiming to improve the treatment of animals. I went out for dinner with a group of these AYAD volunteers on Friday which was heaps of fun! There are two pharmacist AYAD's from Melbourne arriving in Suva soon...unfortunately my time here doesnt' overlap with their arrival, but I have heard they will be involved in things such as looking at drug management, stock control and drug information services.

This weekend I visited the Fiji Museum..the highlight was seeing this huge handmade double hulled canoe (or 'drua') in the middle floor of the main gallery. There were exhibits discussing the different melanesian, polynesian and micronsian influences on the ethnicity of Fijians today. I also liked the little models of traditional Fiji villages and huts. After the museum I strolled through Suva city, passing the athletes playing rubgy at Albert Park, and stopping at a free music concert in Ratu Sukuna park. I experienced my first Fiji bus ride later that day with no windows and music blasting through the radio, it was a great experience!

Tuesday, June 17, 2008

Week 4

Time flies when you're having fun! I cannot believe it is already week 4! So what have I been up to lately? Last Thursday I visited Valelevu Health Centre to compare diabetes prescribing patterns there with trends at CWM hospital and the National Diabetes Centre. The pharmacy at the health centre is staffed by one pharmacy technician, and a part time pharmacist, so a lot of the time the technician is on their own. Just to go over the hierarchy here, divisional hospitals are the bigger tertiary hospitals here (like CWM), then you have the smaller, sub-divisional hospitals, the health centres, then the nurse stations. As you go down the hierarchy, prescribing is restricted to a smaller list of medications. So things like paracetamol could be prescribed at all health facilities, but something like ciprofloxacin would only be available at a divisional hospital.

Queen's birthday long weekend just passed and I headed to Nadi again with my friend from FSM. The weather was great, we went to a few beaches, the Nadi market, a temple and looked at the shops. It was nice to get away from Suva's rain for a while!

Back in Suva this week I'm finalising my data collection and beginning to put my report together. I've interviewed 20 diabetes patients now and the results have been interesting. Today at CWM I helped out in the outpatients dispensary which was fun! It was so busy! All tablets are packaged in plastic bags, even things like digoxin which we normally put in childproof containers back home....there's no point in wasting money for fancy packaging here...

I made a brief visit to the National Kidney Foundation....It is the first and only haemodialysis centre in Fiji. It has 9 dialysis beds and it is a fully private organisation so only paying patients can undergo haemodialysis for about $250. It's quite sad that so many people miss out on dialysis here....The only other form of dialysis (peritoneal dialysis) is done at Suva Private hospital.

Tuesday, June 10, 2008

week 3

It's quiet on campus at the moment because students have exams and some also have their semester breaks. I'm still collecting data for my project...This week I have focused more on interviews with diabetes patients which has been pretty fun! I enjoy speaking to the patients....often they have very poor understanding about what diabetes actually is so it feels good to be able to conduct a bit of education on the side......I'm interviewing them with a standard questionnaire that I've developed to assess their attitudes towards medications and their compliance....So far I've noticed that if patients are on twice daily dosing they will often forget the second daily dose, a big problem!

I visited the National Centre for Health Promotion today, which is in Tamavua (about 10 minutes drive from Suva city). There are 7 staff there and although previously their role was to produce educational material (leaflets etc) to create awareness of health issues, they are now more active in behavioural interventions, targeting specific age groups to bring about better health outcomes. In terms of diabetes, they are targeting primary school and high school children to tackle obesity, one the of the big risk factors for diabetes....They are promoting physical exercise, healthy food and having regular medical check ups....They mentioned how even children between class 1 and 8 have been diagnosed with type 2 diabetes which is a bit of a shock!

Sunday, June 8, 2008

Weekend in Nadi

My second week in Fiji has been great! On Wednesday night I attended an 'emergency' student representative council meeting (SRC) at Fiji School of Medicine (FSM). The SRC comprises of representatives from each health course as well as presidents from each of the different student clubs. There are so many clubs here! There is one club for every ethnic group present on campus as well as for each religous group, the students are very actively involved in campus life. They had lively debate on a lot of issues ranging from the appointment of a new dean, transparency issues in the selection of representatives for an overseas health conference as well as SRC constitution ammendments. It was so good to see so much passionate and animated discussion!

I went on a ward round with Dr Rao on Thursday morning. He is one of the most senior medical consultants in Fiji. I was definitely impressed with his knowledge as I and several medical students, interns, nurses and registrars followed him around the ward to visit his patients. With every patient he taught the whole entourage something new! Cardiovascular disease and diabetes are definitely huge problems here! It is the diet and lifestyle that is a huge contributor to this. We met one man who is only 50 but has end stage renal disease from uncontrolled diabetes, which is so sad because it could easily have been prevented.

For my diabetes project I visited the National Diabetes Health Centre. This centre was initially set up as an institution for education of health professionals about diabetes and to conduct workshops and run diabetes related research. However, today it is more of a referral centre where treatment resistant patients from other hospitals and health centres are referred for further management. Dieticians, nurses and doctors work at the centre, and there is also a diabetic foot clinic attached. The centre also conducts most diabetes screening in the community.

A medical student here at FSM was kind enough to invite me to her home in Nadi for the weekend! Nadi is on the West side of Fiji, where it's always sunny! The coastal drive on the bus was amazing, palm trees, rolling waves...Nadi was great, it's such a laid back town...I'm totally chilled out at the moment. I just got back today and will return to work tomorrow.

Tuesday, June 3, 2008

Week 2

I can't believe it's week 2 already! So how did I spend my second weekend in suva? I actually visited some relatives which was nice! My Mum was born in Suva so she has some distant relatives who are still living here. It was nice to have some home cooked indian food!

It's pouring rain in Suva at the pouring I mean sheets and sheets of rain, the sort of rain we only dream about in Melbourne! Today is the 4th consecutive day of torrential rain....and I think it's meant to last for at least another 3 days!

Today I worked at CWM hospital in the medical records department. I'm trying to collect data on my diabetes patients such as renal function and any other lab test results...I discovered that it's quite difficult to find this information! Medical records are not as user friendly.

The afternoon was spent attending the Central Eastern Divisional Drugs and Therapeutics Committee meeting. These meetings are held bi-monthly by each division (Western, Central Eastern and Southern divisions), and then each division will be represented at the National Drugs and Therapeutics Commiteee meeting the following month. Basically they discussed slow moving drugs and fast moving drugs at the hospital. They analysed drug expenditure and identifed areas where there may be inappropriate use of medications and potential for cost savings. For example, in the slow moving drugs they may have had Pralidoxime, an antidote for organophosphate poisoning, of which was only used very infrequently in one month. However antidotes like these need to be kept even though they are slow moving/expensive, in the event that there is such a medical presentation. So it's really all about cost/benefit analysis and making best use of available resources. Pharmacy representatives did a presentation on inappropriate prescribing and issues associated with meropenem and multi-drug resistance. The committee identified strategies to tackle these problems. It was very interesting to see how each department (micro, pharmacy, surgery, medical, health centre workers) all brought something unique to the meeting, to achieve quality use of medicines.

Friday, May 30, 2008

Ratu Sir Lala Sukuna Day

Yesterday was Ratu Sir Lala Sukuna Day, a national public holiday in Fiji. It is celebrated annually in honour of Ratu Sir Lala Sukuna Day (1888-1958), the national father of modern Fiji (his death anniversary falls on the 30th May). The 3rd year medical students held a picnic to celebrate and invited me to go along. It was held at Pacific Harbour which is along the coast about 45 minutes drive from Suva. I experienced my first Fijian Barbecue and the students played beach volleyball and soccer! It was a very well organized event and the students did all the cooking for about 40 people! They have great teamwork skills here.

On Thursday I had a brief visit to CWM hospital, the main hospital in Suva to visit the pharmacy. The new wing of the hospital was built by the Japanese. There are three different dispensaries, one for paediatrics, one for inpatients and one for outpatients. Outpatients dispensary is the busiest! The pharmacy is meant to close at 4:30 but because of the long queues, the staff sometimes stay back to 6:30 pm. They are short staffed at the moment. The chief pharmacist, Vinita, was telling me that by the time patients get their prescriptions filled, most have spent the whole day in the hospital. A common occurrence is a patient presenting to outpatients at 7am, being seen by the doctor at 2pm, and then leaving the pharmacy with their prescription at 6pm! Hence there is little hope for counselling patients here as by the time they get their medication their only thought is of hopping on the bus home as soon as possible!

Stockouts are a problem here. I will be spending the majority of next week at CWM hospital collecting data and interviewing patients for my diabetes DUE project.