Welcome to the world of Pharmacy!
We, Beth Caddy and Katlego Ramagaga, are final year students in the School of Journalism and Media Studies, specialising in radio. At the beginning of the year we were told that as part of our radio course we would be based as observers within a community engagement project. We chose to work with the Community Experience Programme - because, for both of us, the world of science was something completely new. We knew that we would join the pharmacy students on their outings into Grahamstown, as they meet the people they would one day serve as pharmacists. Our job would be to capture this experience - both the ups and the downs. But for us, as students of journalism, it would also be a journey of discovery - into a world as seen by students of science. This is our story.
A journey of discovery
When we first joined the CEP as observers, we were already convinced of the importance of this project. We understood that students in this programme are required to meet patients at the local day hospital, and even to enter the patients' homes, in order talk to them about their medical conditions and how their medication should be managed. This, we thought, was service learning as it should be - that is, a process of learning which is of benefit to a the local community. Unemployment in Grahamstown is high, and the vast majority of people who live here cannot afford the necessary health care. By putting on the white coat of the medical professional, a pharmacy student can make a difference.
The project also had personal significance for us. Both our families live with chronic illness. Katlego's parents suffer from diabetes and high blood pressure, and my family knows all about asthma. We don’t personally suffer from these conditions, but we felt that it would be valuable to learn more about them, and then to share this knowledge with our people back home.
Our first interaction with the pharmacy students took place right at the beginning of the first week of term. We had been asked to attend the orientation lecture for the CEP. Wendy Wrench, who co-ordinates the programme, took the class step by step through the experience that they would be exposed to over the next semester. We were sitting at the back of the lecture hall, and looking down at the tiered rows of students, it was clear to us that they were taking it all in their stride. Then, right at the end of the lecture, almost as an afterthought, Wendy reminded the class that if they are going to participate in this programme, all their inoculations must be up to date. As she listed the different innoculations, the pharmacy students carried on as if nothing unusual has been said. This did not surprised us – these people are, presumably, used to needles. But we looked at each other - and shared a moment of pure fear. We knew that our parents had taken care of the important innoculations when we were children. But what about the rest - like the one for seasonal influenza? No ways were we going to get jabbed. The idea of that little needle brought home to us that this was going to be a challenging experience for us too...
By the end of that first week, we had a pretty good idea of where the project would be heading and what our involvement would be. There was just one problem that came to mind. We were there as observers, but also as journalists. As such, we would be expected to write stories about the people who participated in the project - including, perhaps, the patients that the students would be interviewing. This worried us. How could we guarantee that the people we spoke to understood that we might be publishing stories about them? Can we guarantee that they have given full consent to this? Many of the people we would meet are vulnerable - because they are sick, or poor, or old. We did not want to exploit this situation.
Pharmacy For Dummies
The term sped on. Back in the School of Journalism and Media Studies, we were getting deeply immersed in producing documentaries and debate shows, tutoring, and media studies. But every Tuesday afternoon, we would find ourselves back in the Pharmacy building, for the CEP practicals. Here we watched the pharmacy students grapple with the practical elements of their vocation. And we struggled along with them!
On the first Tuesday, the students learned how to take Body Mass Index (BMI), glucose levels, insulin levels and blood pressure. What intrigued us most of all was the emphasis on precision. This was very different from learning about journalism. The students sat in groups of about five to eight people round tables, and listened attentively. Each stage of each procedure was carefully explained with a constant emphasis on the importance of attention to detail. Take for example the task of demonstrating the use of an asthma pump to a patient. The students were taught how to do this with the use of a placebo. The course coordinator, Wendy Wrench, explained the procedure numerous times, with emphasis on one point: don’t let the smoke come out of your mouth or nose after inhaling! This seems like a pretty easy instruction to follow. You would never guess how difficult this can be in practice! The students tried carefully to demonstrate the procedure, only to have their attempt received with giggles as a cloud of smoke left either their mouth or nostrils. But after the fourth or fifth attempt, they were able to successfully demonstrate an asthma pump, with a little bruise to their ego.
The discussion moves from one illness to the next. We - two strangers - begin to squirm in our seats when the needles come out. The lecturer shows the students how to inject insulin - although obviously not on herself or any member of the class! She explains that you must find a fatty part of the body, ideally the tummy. Then you squeeze the fat together and inject. All the Pharmacy students sit attentively, while the two of us are quietly yelping!
One piece of information that we gained during this practical was that many patients suffering with diabetes do not have the access to a sufficient number of needles. This was really disturbing. Apparently these patients begin to reuse the needles, so that they eventually become blunt. This causes them to have to continuously jab themselves painfully, in order to inject insulin. The CEP aims to change this, by offering patients different ways to store needles. That way, patients can keep their needles sharper for longer.
We couldn’t help but relate what we are learning to our own lives. What Katlego was learning about diabetes and hypertension really resonated with her, because her parents suffered from these conditions. And these are conditions that are genetic, so Katlego may one day also have to deal with them personally. But being a bit more knowledgeable about these diseases helps her to know how to deal both with the reality and the potential threat. Prevention is better than cure!
So that was the general pattern during the first few weeks. The students refreshed their knowledge of chronic illness, and familiarised themselves with the equipment that is used for their treatment. But as the term progressed, they came to grips with a different kind of preparation – that takes them out of THEIR comfort zones: the interviews. The students were asked to develop questionnaires that they will use while conducting interviews with patients, and present this in class. For us journalism students, this was familiar territory - but we remember how difficult it was at first, to come up with the right questions, and to phrase them in the right way. It was interesting to see how nerve-racking it was for the pharmacy students. After each group had done presenting, the rest of the class critiqued them. It was clear to us that the principle of simplicity was central to these presentations. The students were told repeatedly that must be aware that they are interviewing patients who are from different socio-economic backgrounds, and that that they can't make assumptions about what they know. They must also be conscious of language barriers, particularly because the patients won’t generally understand medical terms. Simpler terms must be on offer to ensure that the interview is working to its full potential. And then, sometimes, patients also have their own terms for medical conditions. Wendy informed the class, for example, that the patients won’t generally understand the medical term ‘high blood pressure’; instead, they used to the term ‘high high’.
We end the term with a session that focuses on illness, personal relationships and lifestyle. The students discuss the role that family life plays in either helping or hindering a patient in the management of their ilness. For example, you can’t expect a patient with high blood pressure to get better if the live in a home in which deep fried food is served up every night. We also watched two videos on epilepsy, which showed how families are affected by their children being epileptic. This video helped the students (and us too) to understand the complex relationship between illness and the people in our lives.
At the end of all this, we were able to look back and see how important these Tuesdays afternoons have been, in preparing the pharmacy students for the patient interviews. And it has also been a learning curve for us, as journalism students. We followed them step by step, so that now we almost feel as ready as they are, to begin the fieldwork process!
Trial and Error
For our first field visit, we were assigned to different groups, but when we compared notes afterwards, we found that we had very similar experiences. We had been really nervous about following the pharmacy students into the private worlds of their patients. We were not sure whether they would be happy to have us there, listening to conversations about such personal aspects of their lives. However, at the end of that first field trip, we both felt hugely relieved. The people we had met were very welcoming and generous, letting both the pharmacy students and us into their homes without any hesitation. From this point onwards, we felt a lot more comfortable and confident about interacting both with the patients and the pharmacy students.
We also had very similar experiencies in our observation of the patient interviews. We were particularly struck by the complexity of the section of the interviews in which the asthma pump was demonstrated. You need to know, for example, how far to tilt your head back, how many seconds to wait in between inhaling puffs and how to make sure none of the medicine in the pump goes out the nose or is coughed out. It was clear that the patients often were not familiar with these guidelines. One of the patients had to rely on the use of their pump at least twice a week but was not able to demonstrate how she would medicate herself. We found this really alarming. Surely these patients' lives are in danger if they are not able to use their medical equipment properly? It brought home to us how important the work was that the students were doing, demonstrating to the patients exactly how to use this equipment. It was crucial that they succeeded in their task. And it did seem as if they were succeeding! Each patient listened carefully to the demonstration, and after attempting the new method a few times, they could - almost - practice the technique. The problem was that they had been used to the wrong method for so long that it was difficult for them to just correct what they were doing the first time.
What struck both of us as well was that even though many of the people that the students were interviewing had received ongoing health care, they were not always clued up on how to keep healthy in order to be able to manage their medical condition effectively. As noted already, there were already problems with the extent to which they were familiar with taking medication in the correct way. But this is only the beginning. People who live with chronic illness also need to know about proper exercise and a healthy diet. When the students spoke to the patients about these aspects of healthy living, it was clear that this was new information to them. The explained, for example, that people with hypertension (more commonly known as “high high”) should avoid food that is cooked using a lot of oil and salt. The patients seemed surprised by this information. There were also diabetic patients who did not knowing that they should avoid pure sugar. One patient's response was, “I didn’t know that, I will cut down one spoon of sugar in my tea tomorrow just to start off.” We found these incidents worrying, since they suggest that the basic medical care that the patients had received up to this point did not include education about healthy cooking and eating, even when ignorance about this could be life threatening.
Our Experience
We have now spent an entire semester with the pharmacy students, taking part in the CEP course and we must say we have really enjoyed this experience. In the beginning, we felt that going to the practicals was unnecessary for us because we felt we did not need to be exposed to all the information that the pharmacy students needed to know. However, as soon as we stepped out of the classroom and witnessed the interviews for ourselves, we were very happy that we had been included in this process. We now felt as if we could step into the pharmacy students' shoes, as they went through the interview experience. In some small way, we could see and understand what they were doing right and what they were doing wrong. For these reasons, we now really appreciate having starting with the pharmacy students from the very beginning. It meant that we were all going through it together, we were all new at it - and in this way, it allowed us to immerse ourselves in their journey.
Looking back on our CEP experience, we can honestly say that this has been a very eye opening experience. We were alerted to how the public health care system in our country works. In hindsight we can say that our government is trying its best to provide the best health care for our people but that there is still a long way to go.
One aspect of the CEP that did concern us, in the end, was that students in their final year at university could seem so unprepared for the socio-economic environments that exist in their own country. As journalism students, we are exposed from our our first year of study onwards to situations of poverty and of suffering, and over time we find ways of confronting these issues and respecting the people who live with these realities. The pharmacy students behaved very professionally in their interactions with the patients that they interviewed, treating them with warmth and respect. They adapted to the conditions in which they found themselves, and accepted that what they saw was normal to the people they were meeting. But afterwards, in their private conversations, we could see that they were distressed by what they had observed, and needed to do more to come to terms with this. Maybe the CEP should not only be something that students do right at the end of their studies, in their last year. That way, students would have more to time to prepare themselves for life outside university.
As we come to the end of our journey with the pharmacy department, we would like to thank everyone involved in the course for accepting us and treating us so warmly as if we were part of the pharmacy family. We have really enjoyed ourselves, we have learned a lot and we definitely feel like this is a very worthwhile course that every pharmacist should experience.
Also, what if the staff of the CEP programme were not happy with the stories we produced? For us, science was new subject matter, and we worried about making mistakes, so that the way we captured what we saw held inaccuracies. We knew that the CEP staff were concerned about this, and did not want to dissapoint them. We began to think that this project would be a little harder to do than we first expected.
In the end, we decided that we could protect the people we worked with by always ensuring that they remain anonymous. We would not focus on particular patients, but rather deal with the more general impact of the CEP on their lives. And we would keep consulting with the CEP staff, to make sure that we got our facts straight!
We understood that, during the first six weeks of the programme, students would take part in a series of practical sessions to prepare them for their fieldwork. As part of this, they would review the medical conditions that they would deal with during the field visits, as well as the treatment of these conditions. They would focus on three chronic illnesses: asthma, high blood pressure and diabetes. The students have of course covered all of this information before, but this would be a recap. Also, they were being prepared to step away from their books to work with real live people. The practicals would therefore also include orientation about the social environment that they would be entering into. Then, in the second half of the semester, the students would enter Grahamstown.
We were excited about getting started. It felt good to be part of a project that is designed to help so many people to understand better how one lives with chronic illness - not only the students, but also the nurses, the patients and their families.
In those Tuesday afternoon practicals, the instructors had told the pharmacy students that patients might not be knowledgeable about certain aspects of their illnesses. But seeing this in practice brought home to us the harsh reality of living with chronic illness, when you do not have access to basic knowledge about your own health. It was clear to us, for example, that some patients were not exactly sure of what happens in their bodies because of their illnesses, or what exactly causes their illnesses.
We were happy, at the same time, to find that the patients generally were not expecting the medication to cure them, and that it would only help keep their illnesses under control. In addition, they accepted that they needed to find ways of complementing their treatment with a healthy lifestyle. We could also see that many of them did some sort of exercising, be it cleaning the house or walking long distances to visit friends and family, so they were keeping healthy even though they were not aware of it most of the time.
In hindsight we feel that although these field visits represented a learning curve for the students, it is also the same for the patients. They always expressed their gratitute to the pharmacy students at the end of each visit, and commented on how much they had learned about their illness. These small comments reccurred throughout the CEP visits, which exemplified to us how worthwhile this project is to the local Grahamstown community.
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Settler's Day Hospital