First Day at Clinic

I started at the Brown's Farm Clinic yesterday. Brown's Farm, also known as Phillipi, is a small settlement about 10 minutes drive south of JL Zwane. The clinic started out about 15 years ago as a project of Rev. Spiwo's. He obtained 12 shipping containers and bolted them together to make a waiting area, 2-3 small exam/treatment rooms, a small dispensary, a rudimentary lab, and one office for the manager. ("Shipping containers" are literally the large metal containers you see on freighters. Think semi trailers if you've never seen a loaded freighter.) He was then successful at getting the government to pick up funding for the clinic. Last year, the government built a proper building on the same site, with proper exam and treatment spaces, offices, a larger pharmacy, a tea room (break room), and a larger waiting area with real chairs (not little benches). The clinic sees an average of 200 patients a day, plus local emergencies.

The clinic is fortunate to have a full-time doctor and three nurse practitioners. There are two other nurses on staff, along with 2-3 administrative personnel. It seems to be a very efficient operation. All patients are seen by about 1:00 (clinic opens at 8:00) and the afternoon is kept for walk-ins and emergencies.

The pharmacy is staffed by Thomi, a pharmacist, and Ntombikayise, a technician. They fill about 200-300 prescriptions a day, with about a 50/50 mix of acute and chronic medications. Needless to say, it's a busy place. I'm going to be here Mon-Tues-Thurs, which are their busy days. I'll be at JL Zwane Wednesdays and Fridays, plus other sites in Cape Town where Open Arms sponsors programs.

Practicing pharmacy in this setting is unlike any other I've been in. Because it's a government facility, with limited inventory and deliveries, patients don't always get everything that's been prescribed. If the pharmacy's out of stock, then the patient has to come back or do without. Sometimes another medication can be substituted for what's missing, and Thomi has a lot of latitude to make changes. I will say that everything is clinically appropriate, that no patient gets treated badly because of the shortages.

My biggest problem was learning all the new drug names and the handwriting. The drugs use European names, which means about half of them have different brand names. Fortunately, the generic names are mostly the same and the ones that are different are pretty similar to the American names. I'll also have a real language problem with the patients, as most of them do not speak English.

Yesterday was asthma day, with just about every patient getting inhalers and theophylline. Just about every patient gets Panado (similar to Tylenol) and multivitamins. Today is rumoured to be high blood pressure day - I'm not sure if they're talking about the patients or the staff. I haven't seen any HIV patients yet, but I'm sure they'll be coming through.

I did go out last night and buy some pens and markers for the pharmacy. It's the first place I've worked where I had to hunt for a pen (usually drug companies leave a few hundred when they visit. I'm guessing no drug rep has been within 10 miles of this place).

I'll take some photos later this week and post them.

More to come.