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.

Wednesday, May 28, 2008

Arrival in Fiji

Bula from Fiji Islands!!
I arrived safely in Suva on Saturday night and am settling in well. I'm staying on campus at the Fiji School of Medicine which is a great place to live! The place is buzzing with all different health science students; pharmacy, medicine, radiography, physiotherapy and dentistry. Everyone has been so welcoming and friendly in true Fijian style!

The students here are from all over the Pacific; Kiribati, Solomon Islands, Vanuatu, Cook Islands, Samoa, Tonga and East Timor. And then there are the local Fijian and Indian students. Most of the medical students are here on scholarships offered by AusAid, New Zealand Aid, WHO, or by their local governments. The Fiji School of Medicine (FSM) is the most established tertiary institution in the pacific for health sciences and most of the students are bonded to work in their respective countries for 2-3 years following graduation.

The city is only a $2 taxi ride from FSM which is very convenient. So far the city reminds me a lot like India, the same sort of scents and humidity in the air, but on a less chaotic scale!On a cultural note, so far I have attended a Samoan church service and the local cinema. The students have been great in showing me around!

So now we come to my international health project and my purpose for being here. With much assistance from my mentor in Melbourne, Beverly Snell and in collaboration with the Ministry of Health and Fiji pharmaceutical services, I have been able to organise a drug use evaluation project for me to complete during my six weeks here. On Monday I met with my Fiji supervising pharmacists, Muniamma Gounder (Chief pharmacist of inspectorate and regulatory affairs) and Apolosi (Acting Essential medicines pharmacist). There are problems in Fiji regarding supply and availability of essential medicines. In addition, standard treatment guidelines for various medical conditions are not being adhered to which creates great problems in terms of drug management as all reordering is based on consumption data. In such a resource limited setting it is critical for surveillance of the quality use of medicines and identifying problematic areas so that intervention and education can occur. My role here will be to focus on a topic of great concern to the Fijians- Diabetes Mellitus. It is the leading cause of mortality in Fiji and I will be looking at a cross-section of diabetes patients and assessing how appropriate their therapy has been, what their attitudes towards their medications are like and how well the standard treatment guideline for diabetes is being adhered to at the main hospital in Suva (Colonial War Memorial Hospital). At the end of my six weeks I hope to be able to make recommendations to the pharmaceutical services for improvements/interventions based on my findings.

Today I began work at the pharmaceutical services headquarters. A bit of background about the pharmaceutical services, they look after the supply, procurement and distribution of all pharmaceuticals to 221 government health facilities, three small island states and 125 retail outlets. A big job! Only medicines on the Essential medicines list ( a restricted list of medicines that meet the priority needs of the population, safety, efficacy, affordability) are procured.

At this stage of my project I am planning the design of the study and a method for how I will obtain and utilise my data. Thankfully, Fiji has a computer database called 'PATIS' which is the Fiji Patient Informaton System. It contains medical data about patients including prescriptions that have been dispensed. It can be used to develop data reports on a specific drug's usage in a given time frame and you also have access to patient prescription histories. I'm still in the process of figuring out how to best utilise this vast source of information!

I attended a Fiji School of Medicine students association meeting yesterday and I thought that it would be great for Remedy to liasise with this group of students as I'm sure there are projects that they are doing that Remedy could assist with. I'm going to try and form a link with these two groups whilst I am in here. I went out for dinner with the committee last night which was great fun!