COMPOUND WITH CONFIDENCE: PCCA Membership, $795/month.
Stay current on PCCA news and events, market trends, and all things compounding!
by Mark Gonzalez, PharmD, PCCA Clinical Services
Uganda is a landlocked country, about the size of Oregon, located on the equator in the center of Africa. Although the ethnically diverse country of 45 million is rich in its supplies of gold and coffee, over 40% of the population lives in poverty making less than $2 a day. Within this beautiful, yet impoverished country, Emma and Josh Quisenberry started the Gem Foundation in 2014 in the capital city of Kampala.
The organization’s mission is to provide a safe place and family home for abandoned, neglected and abused children with special needs. In Uganda and many parts of the world, children with special needs are considered a curse and often end up abandoned and unloved. Over the past eight years, the Gem Foundation has taken in and cared for more than 90 children by providing them with much needed medical care, but most importantly, they have restored each child’s value and worth within the community. Both Josh and Emma have been joined by countless staff from the local community to provide this high level of care to each of their precious “Gems” who suffer from conditions such as hydrocephalus, cerebral palsy and Down syndrome.
In 2020, the foundation was able to move from its small two-story rented home to an 88-acre property outside of the polluted city of Kampala. This move not only improved the quality of life for the Gems suffering from respiratory conditions, but it also provided space for multiple homes for the children as well as farmland to increase their goal of becoming self-sustainable. The property also houses a building that will become a future medical clinic and a well of clean water that is available to the entire outside community.
In late July 2022, PCCA team members Gus Bassani, PharmD , Chief Scientific Officer, and Daniel Banov, MS, RPh, Director of Research & Development, and I visited the Gem Foundation with a goal of educating the staff nurses in the art and science of compounding to further improve the level of care of their special needs’ population. Gus originally established the relationship with the Gem Foundation and is currently serving on their board of directors. Seeing the great opportunity to implement one of its Core Values to “Care Deeply,” PCCA provided all of the equipment, materials and a lineup of compounding bases to the Gem Foundation, creating what is possibly the only location in the country to offer basic compounding services to those in need.
Below is a diary of the important events that took place on this trip.
Friday, July 29, 2022
After close to 20 hours of flying over eight time zones, Gus, Daniel and I arrive in Kampala, Uganda. Hand carrying 5 large bins of compounding equipment and bases in addition to luggage, we are concerned that some of the supplies could get detained in customs. Fortunately, everything arrives safely, and Ugandan customs does not require any additional review of the supplies. We head off for a good night’s rest after eating a local selection of game meats, including crocodile, antelope and buffalo!
Saturday, July 30, 2022
A light breakfast topped with a tasting of local Ugandan Chai tea starts our day as we wait for Josh to pick us up from the Best Western in Kampala. He arrives at 11 a.m. with three of his five children. After loading the van with all our supplies and luggage, we head to the Gem Village in Kairi, Uganda, a village on the outskirts of Kampala.
This 35-mile trip used to take hours due to heavy traffic. Recently a toll road was built that reduces the trip to about 1 hour and 10 minutes. Surprisingly, the toll road is empty while we can easily see that the main road is full of traffic. Later, when I asked why drivers do not use the toll road, we are told that at a cost of $2 per use it is simply unaffordable for most locals. The reality of the level of poverty begins to sink in as we drive by open air markets, slums with children carrying empty containers used to retrieve water from local wells, and streetside meat vendors with fresh chopped raw meat hanging in the outdoor sun on hooks.
Once off the main thoroughfare, we take a bumpy, red dirt road for several miles until we reach the new Gem Village. The sight of local children filling their family water containers outside of the village gates with the only source of fresh water is an instant sign of how this organization is impacting more than just the special needs children they have adopted. While driving into the property, we see newly built homes on our left and farmland full of a variety of fruits, vegetables and animal life on our right. The level of excellence and self-sustainability of the foundation is clear in everything that they do. We are dropped off at our home, where we unpack before the rest of our visiting team of 14 are to arrive later that night.
Josh and Emma take us on a quick tour of the property, and most importantly, to the three homes where close to 50 Gems live and are cared for. Children with a variety of special needs greet us with smiles, hugs and laughter. One of the three homes is reserved for children with the most severe medical cases. No matter which home we visit the three constants are always: dignity, respect and love. The staff is continually living out the vision established by Josh and Emma eight years ago!
Sunday, July 31, 2022
Today, we return to the town of Kampala to visit a church that sponsors the Gem Foundation. An additional part of the day includes exchanging U.S. dollars for Ugandan shillings, getting to know the entire visiting team and enjoying lunch at a restaurant in the city.
Monday, August 1, 2022
This is the day we have been looking forward to! We are blessed with the opportunity to train several nurses regarding a skill that we love – compounding. We start out the day unpacking and organizing all the supplies that have been donated by PCCA. This include, but is not limited to, an electronic balance, hot plate, beakers, weigh boats, bottles, flavors, excipients and a variety of bases, such as MucoLox™, Spira-Wash® Gel, PracaSil®-Plus, VersaBase® and much more. To see these supplies stocked in the on-campus pharmacy overwhelms me because I can only imagine the impact that these supplies will have on the quality of life of the children. This may be the only pharmacy in this country with these supplies.
Before training begins, Gus, Daniel and I need to understand what the pharmacy needs of the Gems are. John Bosco (JB for short), the head nurse at the Gems Village, walks us around to the three houses, going over each patient, the medication problems that they face and the solutions that they have used thus far. In this review, we notice that most medications are available in solid dosage forms but most of the patients they are used on are unable to swallow. The nurses have to resort to crushing tablets and placing each dose in a small cup to which water is then added. In water, the drug does not properly suspend, which in turn, causes the drug to sink to the bottom of the cup. This can result in improper doses of the medications being used. In reviewing patient cases, we also find that common issues the patients are experiencing include tinea capitis (a fungal infection of the scalp), wound care and excessive drooling. Although drooling is a major issue with many of the children, only two patients are being treated with oral glycopyrrolate at a cost of $1,000 U.S. dollars per month.
Our first lecture with the team of five nurses starts at 2 p.m. In this session, we cover the basics of what compounding is and how it can impact the patient population they work with. Each participant is introduced to the equipment, literature and the bases that were donated. They leave excited, knowing that change is about to come and that they will get to experience hands-on compounding of suspensions during our next meeting.
Tuesday, August 2, 2022
Tuesday is our first official “lab” day, which consists of one hour of lecture and one hour of hands-on training. The goal for today is to share the importance and efficiency of compounding suspensions for the Gem Foundation.
PCCA SuspendIt® is important to this organization because it provides a tested and safe vehicle for the nurses to compound oral dosage forms in bulk that can be used in multiple patients. For example, patients with cerebral palsy require the use of a muscle relaxant called baclofen. Instead of making multiple doses of this each day for each patient, a bulk supply can be made that will last the facility 14 days. If 25 patients within the Gem Village are on baclofen twice daily, that equals 700 doses of baclofen that are being made by the nurses over 14 days. With compounding, all 700 doses can be obtained from one compounded suspension. This increases efficiency and allows the nurses more time to spend with the kids that they have been charged to care for.
The lecture goes well and the hands-on lab is excellent. I am so encouraged by the looks of empowerment that are on the faces of the nurses. JB comes to me afterward and says, “I did not know that this was possible.” He proudly takes the baclofen suspension he made and labels it for use in patients the next day. I am reminded that it is often the simplest of lessons that results in the largest impact on patients.
Wednesday, August 3, 2022
After a successful lab the day before, the nurses arrive at training today eager to learn about our last lesson – the compounding of topical agents. This lab is more related to an in-depth review of PCCA’s topical bases. As I share from a clinical perspective, Gus and Daniel share some of the thoughts that went into creating each base and pass out samples of the bases to the participants. We discuss clinical applications within their patient population for each base and then I show them samples of three finished compounds that I had made earlier that morning:
As we finish the lecture, one of the teenage Gems named Caleb comes in on his electric wheelchair. Caleb has suffered with excessive drooling his entire life. We use the atropine spray on him and then monitor him over the next 4 hours. Upon follow-up, his shirt is completely dry and he smiles when we ask how he likes the spray.
-------------
The remainder of our time at the Gem Foundation was spent with the kids, encouraging the staff and truly being in awe of all the people who make this organization run. We did get to spend a day on safari in Eastern Uganda, but as amazing as that was, nothing compared to the relationships that we built with all those who we met.
In all of our lessons and instruction, we let the staff know that our visit was just the beginning of a long-term relationship. As pharmacy problems arise, we want the nurses and pharmacy staff to know that PCCA is here to support them with the instruction and the equipment necessary to move forward.
I am grateful to work for a company that lives behind its Core Values and invests in lives. Every time I share about the donated bases and products, I am reminded of how many people it took to put those bases and products in the hands of the Gem staff. Every team member at PCCA was represented in each moment that we spent in Uganda. I am grateful to be one of the people who went to Uganda, but I am even more honored to know that it was every member of Team PCCA who sent us there.
What we do as a company is needed around the corner and around the world. Caleb’s smile reminds me that the greatest payback we can ever receive for what we do comes in the form of basic human expression. The feeling that I experienced after seeing his smile and working with my teammates is one that pushes me to do more. I now know that I work for a company that not only encourages it but stands behind it.
To support The Gem Foundation or sponsor a child, please visit https://thegemfoundation.com