“You can’t steward medicines well without preventing and controlling infections…”

World Antimicrobial Awareness Week 2020

Fleming Fund Fellowships support training and capacity building for scientists, epidemiologists and clinicians in over 20 countries across Africa and Asia. In Uganda, Fleming Fellow William Olum is bringing people together to help his hospital use drugs better.

The pharmacy, covered in bright yellow paint, juts out towards the front of the Jinja hospital campus. Benches, covered by a zinc roof, shelter patients waiting to receive their prescriptions. And two pharmacy officers peer out from small windows at the building’s front, dispensing medicines to the waiting crowd.

William Olum’s office is at the back of the building. His desk is covered with stacks of documents, pharmacy manuals and a shiny new copy of the Ugandan AMR National Action Plan. He says his passion for his work comes from his grandfather, a herbalist, who was revered in the community for his cures.

William is the Head of Pharmacy at the hospital and was hand-picked by the Ministry of Health to manage the drug supply in Jinja. Before he arrived, there was rampant theft of drugs and patients weren’t accessing critical medicines. Since he’s been in post, he’s revolutionised the pharmacy and has also initiated a full infection prevention and control (or IPC) programme. “You can’t steward medicines well, without preventing infections,” he says.

In a back room, behind his office full of cabinets and papers, is a long thin room with what looks like a chemist’s bench. This room, where William has been manufacturing alcohol-based hand sanitizer, has been the key to much of the hospital’s success. In many public hospitals, water sources are not always reliable, resulting in abysmal hand-cleaning rates. However, by sourcing the raw ingredients to make an alcohol-based hand rub locally, William has made Jinja’s hand-cleaning rates the best in the country, 51%. He and his colleague Sofia, who leads the bacteriology unit at the hospital’s medical laboratory, both agree that to save more lives, these rates must improve. But supplying hand sanitizer is only half the battle, they also have to change behaviour.

To that end, William has been breathing new life into Jinja’s Medicines and Therapeutics Committee (MTC). MTCs bring together practitioners from all parts of the hospital – physicians, nurses, surgeons, administrators, pharmacists – to review how drugs are used and prescribed. Their purpose is to reduce wastage, improve drug management and supply, review trends in antibiotic resistance and improve hospital infection control.

A few months ago, William took his MTC group to a hospital in the north of the country so they could benchmark their own activities against another facility’s. “The goal was really to improve their understanding and highlight the MTC’s importance. Since that visit people have been really engaged,” he says. “We are also trying to get a small budget from the hospital for our committee to supply tea and snacks during our meetings. Small things like this really help pass the time and encourage attendance.”

Despite William’s tenacity and focus in improving antibiotic use in hospital, he says regulations and government intervention are vital to long-term success. “I’ve got a plan for this hospital, but really we need government to control access to antibiotics. If we don’t have a disciplined approach to antibiotic use and access as a country, much of the work we are doing here will not have an effect.”

As a Fleming Fund Fellow, William also has big aspirations to improve the use antibiotics not just in Jinja but throughout the country. As part of the Fellowship, human and animal health professionals are collaborating (many for the first time) to understand how resistant bacteria move between animals and humans in Uganda. Over the next few months, William will be mentored by an antimicrobial pharmacist, which he hopes will take his initiatives in Jinja to a new level and help establish the type of cooperation needed to help clinicians and farmers use antibiotics better.

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