Pharmacy Rotation - Week 2

The highlight of this week is that I finally got access to my data! This means that I begin my research project. As I mentioned in a previous post, I am looking at prescribing of the “4-C” antibiotics : Co-amoxiclav (i.e. augmentin), Cephalosporins, Ciprofloxacin (Quinolones), and Clindamycin. These antibiotics can be associated with higher levels of hospital associated infections, so it’s important to regulate their use and try to promote minimizing their use. I had fun getting trained on a new software system and starting to look into my research question.

I also had the opportunity to travel to Glasgow again and observe the New Drugs Committee Meeting (Similar but not exactly like the FDA of Scotland). This was really interesting because as part of the Scottish Medicines Consortium, the NDC reviews all the current literature pertaining to a drug’s safety and efficacy and does a cost-effectiveness analysis on the medication. The group of experts in pharmacy, pharmacoepidemiology, and health economics then meet to discuss whether the drug should be approved for use within Scotland. This approach is so different from the system in the US, where we will let whoever can pay for a medication receive it. In Scotland, on the other hand, drug companies have to prove that the benefit of the drug is worth the extra money that it costs. This is a pretty simplified version of what they do, so if you are interested to learn more, you can read about it here.

Also, while I think I still prefer Edinburgh, it was fun to explore Scotland’s largest city (Glasgow) and see some of its unique architecture.

  

Isle of Skye

This weekend, we traveled to the Isle of Skye! The weather in Scotland has been pretty cold (50-55 degrees), even for Scotland, and on and off misty rain. However, despite all of that, this weekend was one of my favorite trips ever! I had heard that the Isle of Skye was difficult to navigate with public transport, so we decided to do a bus tour.

On Day 1, we started off at the Dunkeld Cathedral, north of Edinburgh. Next, we drove into the highlands toward Inverness. It didn’t take us more than an hour outside of Edinburgh for the scenery to become completely gorgeous. We stopped for a whisky tasting and then kept driving toward Inverness which sits next to Loch Ness (obviously famous of for Nessie, the fabled monster that lives beneath its murky water). Despite the fact that it was 50 degrees outside, James decided to jump in!

As we drove to the Isle of Skye, the mountains became more and more incredible. I am quite sure that none of the photos we take of the mountains will do any of them justice, but I hope they at least convince you that you need to come to Scotland to see them yourself! We made two quick stops at the Urquhart Castle and Eilean Donan Castle.

Finally at the Isle of Skye, it was breathtaking. It’s also called the Isle of Clouds in Gaelic, so it wasn’t surprising that most of the mountains were covered in mist and fog. However, there was immense wide open spaces were so beautiful despite the rain and fog. We visited waterfalls, the Fairy Glen, Kilt Rock, and many other places.  To top it off, our hostel which was on the island looked out over the water with a spectacular view of a 12th century ruined castle with mountains in the distance.

 
On Day 3, we left Skye behind and wound back through the highlands, stopping at Glen Coe. This gorgeous valley is surrounded by 3 mountains known as the 3 sisters. We also stopped at the Doune Castle (where Outlander and Monty Python were filmed) and the William Wallace Monument. One of the best parts of this entire trip was that our guide told us traditional Scottish stories that were brought to life by the highlands so I also learned quite a bit about Scottish Culture/History/Tradition through the trip.  It was an exhausting weekend, but really unforgettable!

Pharmacy Rotation - Week 1

Time is flying by and I can’t believe a week has past! So I thought I’d give you an update on my rotation.

Last week I started my rotation at the National Health Service in Edinburgh. Most of my time has been spent in meetings with different individuals who have helped me to understand various aspects of a nationalized health care system, including data collection, privacy management, public health services, and prescribing, which vary considerably from the US System. One amazing statistic is that NHS has the ability to analyze the prescribing of around 98% of prescription medications in this country due to newer technology that tract prescriptions. Therefore, this offers a lot of unique opportunities for interventions and research that can not be done in the US where that kind of data covering the whole population doesn’t exist.  As this rotation is also serving as my practicum for my Masters in Public Health, it has been very interesting to compare the different public health approaches in this country.So far, I have been very impressed by what I am learning about Scottish Health Care because, since they have an amazing amount of data concerning their own populations, they can make very specific targeted interventions to improve health care delivery. Pharmacists also have many more responsibilities within the health care system. For example, pharmacists can prescribe in the UK, so they have the ability to make a lot of interventions in chronic disease management. The NHS also has a pretty inspiring vision for advancing pharmacy in Scotland. If you are interested to learn more, this Prescription For Excellence report details the plan for pharmacists in the UK:

I’ve also been learning a little about my project which will look at antimicrobial stewardship which will look at the use of antibiotics which are more prone to cause a hospital-associated infection known as Clostridium Difficile. Today,  I had the opportunity to travel to Glasgow (Scotland’s largest city) and attend a meeting of the Scottish Antimicrobial Prescribing Group and learn about the different approaches that National Health Service is taking to reduce inappropriate prescribing of antibiotics. It was extremely interesting to hear reports using their national data about the status of prescribing and the new projects in development to further improve it.

It’s been a great learning experience so far and I can’t wait to delve further into my research project this week!

First Week in Edinburgh

Edinburgh is a city of dual natures. It has aristocrats and highlanders; laborers and intellectuals; criminals and religious reformers. These dichotomies are even apparent in the city’s design. Edinburgh’s Old Town grew on the slope around its namesake battlement for nearly 1,000 years; in the 1600s, desperate for protection within the city walls, its people crammed together, built narrow cobblestone streets, and lived in some of tallest stone dwellings in the world. Then around 1800, Edinburgh’s New Town was designed and built with wide streets and luxurious housing—one of the best planned cities in the world. Today, both Old Town and New Town are UNESCO World Heritage Sites, and both towns are Edinburgh. It is not surprising then that Edinburgh-author Robert Lewis Stevenson’s most famous character is the two-faced Dr. Jekyll / Mr. Hyde.

This makes Edinburgh a fascinating place. With Joye at work, I have had an excuse to tour around and see some of Edinburgh’s less popular sites. In museums I have learned about Edinburgh’s history, its famous poets and authors, and even visited the gravestone of Adam Smith, “father of economics” and just one of many academics who defined the Scottish Enlightenment. Together, Joye and I went to a public lecture on evidence-based public policy that was hosted in the basement of a haunted pub.

Here are some of my favorite pictures from the last week in Edinburgh:

Update: Welcome to Edinburgh

Hello Everyone,

We've decided to continue our blog to share about our experience in Edinburgh this summer. Joye is just starting a 6 week pharmacy rotation with the National Health Services and James is tagging along, doing research and working on writing and publishing manuscripts while we are here.

Today was our first day! We arrived at 8 am to cloudy, drizzling weather, exhausted and ready for bed. However, we knew we had to stay up to get over jet lag. So after a quick nap, we went out and explored our new city! The sun came out and it really was the perfect weather. We walked past the Edinburgh Castle, saw the cafe where Harry Potter was written, and walked to Hollyrood Park where we hiked up a rock outcropping and had a beautiful view of the city. On our way back, we strolled down the Royal Mile and ended up enjoying a free concert in St. Giles Cathedral.

Update: Back and Forth, Twice.

In the past two months, we have driven from Kentucky to Michigan and back, twice, and all for very different reasons. Searching for an apartment, writing a thesis, moving, and vacationing have kept us too busy to write a blog… until now.

KENTUCKY: We mentioned in our last post that we spent a few weeks in Kentucky in May, house-sitting for some friends while finding an apartment of our own. What we did not mention was that I also had the privilege of going to Washington DC to speak at a Peace Corps sponsored kick-off event for a global partnership between USAID and Peace Corps focused on food security. Speaking on a panel to a crowd of a few hundred Peace Corps employees and other public officials, I shared some highlights of the food security work we were doing in Mali, including our task force. In addition to reconnecting with my former supervisors from Peace Corps Mali, I also met many international development professionals, including Peace Corps Director Aaron Williams (left in first picture) , who surprised me by telling me that he used to be a Peace Corps recruiter at Alma College, our undergraduate alma mater.

MICHIGAN: We then drove north, and I then spent the next two weeks subletting a room near Michigan State in order to work on my Master’s thesis. Naively, I’d hoped to finish it, but I didn’t even write a word. Instead, I spent the time meeting with professors, reading dozens of academic papers, and changing my thesis topic every other day. It was miserable, but my last day there we came up with an idea that is new, relevant, and feasible. Maybe another day, I’ll write a blog about what my thesis is about… but I’ll skip it for now.

KENTUCKY: On our next trip south involved a rental truck full with everything we owned, which was only a small storage unit worth of cardboard boxes. We moved into our apartment and discovered quickly that about half of these boxes were college textbooks, and that it did not include any furniture. So while Joye prepared for pharmacy school and I wrote my thesis, we also procured a mattress (our first with box springs), couch, television, and dining table (no chairs yet). While all this was accomplished during a heat wave, at least we got to enjoy the beautiful lawn outside our apartment window and a little creek nearby.

MICHIGAN: To beat the heat, we then travelled to northern Michigan to spend the 4th of July in my hometown of Harbor Springs, a coastal community on the shore of Lake Michigan with a population that quintuples every Independence Day with a crowd wearing khaki shorts and polo shirts. When we weren’t relaxing at the beach, we helped my folks clean out the house as they too are moving. As it was probably the last time we will visit Harbor Springs for a while, it was nostalgic week, but one that was filled with plenty of new memories.

KENTUCKY: And finally, we returned to our apartment in Kentucky today - already it feels like home. The next chapter of our life is set to begin. I will be officially starting work at the University of Kentucky next Monday as a research economist, and Joye begins classes next month. Soon we will start speaking with a drawl. While this will be very different than how we were living only a few months ago, it is a welcome change, and after so much travelling we are excited for some routine – though who knows how long that will last.

I hope this catches us up. Thanks for reading.

-James (& Joye)

Reflection: The List Blog

Since returning and starting to reflect on our service, a lot of people have asked us, “Was it worth it? Would you do it again? How was it?” Though we believe it was worth it, its always a hard question to answer because, as anyone who read our blog knows, it was a challenging experience that was a lot different than we ever imagined it would be. Indeed, summing up the complexity of our experience and what we’ve learned into any one post or conversation has proved a challenging task. However, just brainstorming made us realize how many interesting competencies we have now that we lacked prior to Peace Corps.  So instead of trying summarize everything, we started putting our memories into lists. Here’s a few that we thought you all would enjoy:

 

Skills we’ve attained in Mali:

• How to eat rice and sauce with our hands and not make a mess
• How to make Urine Fertilizer, Natural Mosquito Repellent, Soap, Improved Nutritious Porridge, Moringa Powder
• How to speak in Bambara and greet in Mianka
• How to live without electricity or plumbing …the key : a quality headlamp
• How to purify unsafe drinking water
• How to poop in a hole and take a bucket bath(these are both acquired skills!)
• How to outrun a rainstorm (though I feel like ‘monsoon’ describes it better)
• How to self-diagnosis and prevent malaria, amoebic cysts, bacterial dysentery, giardia, dehydration, skin infections, and malnutrition
• How to maintain a vegetable garden and compost when it only rains 4 months a year
• How to stay cool in the heat (i.e. wrap yourself in a large wet piece of cloth)
• How to tie a turban and a wrap skirt (pagne)
• How to cook  Toh, Rice and peanut sauce, Rice and onion sauce
• How to make flour tortillas by hand and from scratch for amazing quesadillas
• How to plan meals when you have no refrigerator, and access to fresh produce only once/week
• How to kill a Scorpion (James’  weapon of choice: a hammer)
• How to kill a rat roaming through your house (James’  weapon of choice : a wooden club)
• How to smile and tell a mother how beautiful her child is when its peeing all over my brand new clothes.
• How to give an impromptu speech in a foreign language
• How to deal with everyone staring at you….ALWAYS
• How to, as a woman,  lead a successful meeting involving 25 village elder men who do not respect women
• How to be a self-starter and work in a totally unstructured environment
• How to do my laundry by hand (and not get made fun of by the locals)
• How to strip a dried fish of its bones in order to get a small amount of protein in your diet
• How to transport myself + 100 lbs of luggage over 7 km using only a mountain bike
• How to appreciate, SO MUCH,  the importance of what I used to label “boring” topics like malnutrition and maternal health 
• How to bargain like a local (i.e. telling the vendor he eats beans in multiple scenarios)
• How to build a mud-oven, albeit a bad one
• How to identify at least 20 varieties of African trees
• How to pull down a ripe mango that is 40 ft in the air, and then cook and can mango jam
• How to build a school out of mud (using only string, a measuring tape, and an old notebook as a straight edge)
• How to plant trees without rain
• How to kill, pluck, and clean a chicken
• How to position rocks on your roof so it doesn’t blow away in a rain storm

 

Things Jim has transported on the back of his bike: at one time  and over 5 km

• 25 meters of metal fencing
• 2 live bunny rabbits in a cardboard box
• 1 full propane tank (100 lbs)
• a huge green suitcase (think of the largest luggage that you can check on a plane)
• 3 flat-rate postal boxes full of American food
• A 6-foot shovel
• A pumpkin
• Countless bags of clothes
• A 5-foot diameter bundle of thorns
• A 13-year old-boy acting as a guide
• A freshly butchered leg of lamb (ok….this one was only 1 km, but it was memorable!)

 

Proudest Accomplishments

• Learning a new language
• Completing 56 Radio Shows about Health, Agriculture, and Education
• Biking 40 km roundtrip just to buy some lettuce so that we could make BLTs with the bacon my mom sent
• Promotion of the 3 Malian food groups, training women to make healthier food for their families, and watching the health of a few children improve
• Growing Sweet Corn during Hot Season and presenting it to a very surprised village chief
• Advocating successfully for the superintendent to send high school teachers to Kongodugu
• Watching our village unite around the idea that they had power to improve their own schools, and subsequently build 3 mudbrick classrooms with only some help from Peace Corps
• James’ sustainable collaboration with his work partner : the fact that he continued the tree-planting project, distributing 2000 trees to 10 villages, without him is just so exciting.
• When our neighbor said “You guys are different, you two are married AND you’re friends. If I get a wife, I’d like her also to be my friend.”
• Baking Applecrisp in a mud oven for James’ 24th birthday.
• Getting everyone in Kongodugu to refer to us as “American” instead of “Toubab”.
• Re-writing the “Ant and the Grasshopper” fable into “The Bee and the Wasp” and broadcasting it to a Malian audience (with rave reviews in return) in order to promote the values of an independent work ethic over dependence on hand-outs.

 

Certainly these are the more positive lists, and those of you who have spoken to us know that we faced quite a few disappointments and challenges while in Mali that are not reflected here. However, with God’s help and the prayers of our family and friends, we do feel that our experience was very positive and taught us so much about development (…more on that later!).

Thanks for reading!

~Joye (& James)