John had mentioned that there were a couple of important items that he wanted me to take a look at: A) some sort of inventory control and reports for the pharmacy and B) the broken distilling machine that they use to make their own IV saline solution.


The Pharmacy Building

At first I wanted to get a clear idea of the roles of each of the various stakeholders and what they thought were the problems that needed to be solved.  This started with John, a physician, who introduced me to Abraham who runs the pharmacy department, who in turn introduced me to Kaliba, a pharmacy tech.

John is a very busy guy with a hospital and a few different departments to run and a constantly changing staff and patient population.  There are often shortages of medical supplies, drugs and money and this often requires shifts in care and management of patients and their conditions.  He is always trying to keep up to date on what is available so that he can tailor his plans accordingly.  Further, he expresses dismay at having to discard expired medications when they could have been used if only he had known that they were about to expire.  And finally, John often coordinates the arrival of doctors from the US who sometimes bring supplies and drugs along with them.  He sometimes has specific requests for things that are out of stock or difficult to get here in Zambia.


Inside the Pharmacy

Abraham runs the pharmacy department and is also a very busy guy.  He oversees a staff of perhaps 5-8 members.  The pharmacy maintains the inventory of drugs and medical supplies and provides them to all of the other departments in the hospital.  His department also includes the dispensary where patients pick up their prescriptions.  A big part of the challenge for his department is keeping the items in stock despite a once-per-month restocking trip to Lusaka; government mandates that they can only maintain a three month supply of drugs at any given time; and the fact that they must destroy all expired medicines immediately.  He knows that occasional inventory stockouts occur and these are painful, as the order only happens once per month.  He would love to know what the situation is each day with his inventory, medicines about to expire, the cost of replacement and the cost of substitute medicines.  And in his "spare time," he also compiles statistics from the entire hospital on patient visits and conditions.


The Bulk Storage Room that supplies the rest of the hospital

Kaliba is the pharmacist technician who is "on the ground" in the stock rooms and in the pharmacy.  He manually keeps track of the inventory via paper stock status cards tucked underneath each drug or medical supply on the shelves and uses these cards to compile reports to guide the ordering process from "Central Supply" in Lusaka once per month.  He knows the system quite well and keeps track of the monthly orders in Excel spreadsheets and performs a monthly physical count of each medication.  There are "maybe 500" ("less than 1,000, more than 200") different medications that they regularly stock.  There is a lot of public and budgetary emphasis on Anti-Retro-Viral (ARV) drugs for HIV/AIDS, and natuarlly these receive attention more regularly.  As the one compling the orders, he needs to know how much to order each month, what is soon to expire, and respond to the need to distribute the medicines throughout the hospital departments.


Detailed stock accounting sheet tucked under each med

In the next installment, I'll dive further into the requirements, more details of the people and processes and a few suggestions gleaned after just the first day of meetings with Abraham and Kaliba.  Unfortunately I was plagued by a computer virus (Win32.Rungbu.a/Hijack.System.Hidden, ignored by Norton (thanks!) but finally fixed by Spybot S&D plus Malwarebytes Anti-Malware) from one of the pharmacy computers that infected my USB thumbdrive and today was largely spent disinfecting my computer.  Tomorrow I'll fix the pharmacy computers and then get back to the task at hand.


A busy day, but we still have time to get out for the beautiful sunset



The beautiful sunset (this picture was actually taken by Anna)