The Gambia – Swansea Vision 2020 Eye Link

Sheik Zayed Regional Eye Care Centre, Banjul, Gambia

Pharmacists Perspective

My main objectives were to gather information on the healthcare system, availability of eye drops and other medication, and to observe eye drops being prepared and compare this to the way we prepare them in the UK. During my visit I was able to gather this information by spending time in the ‘Local Production of Eye Drops’ (LPED) laboratory with Eliman Samba, Pharmacy Technician, as well as in the Minor Operation room which stores eye drops and is where they are distributed to patients.

The most common conditions seen at SZRECC that can be treated with eye drops are allergic conditions, infections and glaucoma. Supplies of eye drops are obtained from the National Drug Store. If eye drops are not available then sometimes the powders can be obtained and Eliman the pharmacy technician is able to produce the drops for SZRECC. He has completed a course specialising in the production of eye drops. He follows a formula to make the eye drops and sterilises them in an oven, then labels them. I was very impressed with the laboratory and the drops were made to as high a standard as possible.

The patients are seen by a doctor or nurse and given a prescription. This prescription is then taken to the window of the minor operations room, where they knock the window and are either attended to or told to wait if the member of staff is in the middle of a procedure. The prescription is handed to a member of staff in the room. If the eye drops stated on the prescription (or any oral medication such as antibiotics) are available they will give them to the patient with instructions on how many times a day to use them. There is no charge for medications dispensed by SZRECC.

I also had the opportunity to go into the operating theatres to help prepare a specific drug that we often use in the UK but is not used widely in the Gambia. It was a very interesting experience to watch the surgeons and nursing staff operating and one that I probably would not have had in the UK.

We visited the Royal Victoria Teaching Hospital (RVTH) in Banjul, and I was able to look around the pharmacy and meet the Chief Pharmacist there. Whilst there are many opportunities to train as a pharmacy technician, it is not possible to qualify as a pharmacist in the Gambia and so people must be educated in other countries.

People in the UK seem to have much more knowledge about their medication and have access to lots more information, via the internet, television, and healthcare professionals who are easily available. For example, after a cataract operation in the UK, a patient will be sent home with instructions on how to use their eye drops and to care for their eye, and are told how to obtain emergency help if they are worried. In the Gambia, patients need to stay in hospital so that their eye can be cared for by professionals as many people may not follow their aftercare instructions properly and may live far away from emergency help.

Some things were very similar to the UK; for example, they had pharmacists working in clinics seeing patients, which happens quite commonly now in the UK. They also have ideas for a computerised prescribing system that sends prescriptions directly to the pharmacy, which is something we have recently started using for chemotherapy prescriptions in Swansea. At one hospital I visited the manager was talking about automating the dispensary, and I was able to tell her about our pharmacy robot in Singleton.

Some of the suggestions I made to try and improve the pharmacy service in SZRECC included creating a central location for all drops to be stored, and ensuring that records were kept of how many bottles of eye drops were available by doing regular daily stock checks; this would hopefully mean that drops could be made on a schedule and would be less likely to run out, thus ensuring that there was always a good supply for the patients.

Prior to this visit I did not know what to expect from the pharmacy service in SZRECC and in the Gambia. I thoroughly enjoyed working at SZRECC and meeting the staff, and I hope that my visit and suggestions might lead to positive changes and assist them in their work.