We just wrapped up week 4 of our discovery phase. We spent an amazing week immersing ourselves in Kisumu, Kenya with our local fixer. We spent time researching the health care structure, mentality, patient experience and provider practices. We interviewed 2 patients who had recently taken antibiotics, 3 pharmacists, 2 community health workers and a clinician. We also visited pharmacies doing intercept interviews and observations.
Check out some highlights from this week.
We explored the local pharmacy offer by visiting around 8 different ones on our first afternoon. They ranged from bright, well organised and professionally staffed chemist chains to more lower end counters, which were often combined within other stores selling clothes or MPesa outlets. We found people were fairly open to talking to us for 5-10 mins about how they ran their business and where antibiotics fit in. Some of the issues we've been learning about for the past few weeks, around antibiotic demand and over-provision became real for us really quickly.
We also did some mystery shopping - our fixer Fender bought some antibiotics over the counter without a prescription, upon telling a pharmacist that his 3 year old daughter had symptoms of flu. He probed about whether there was an alternative to taking the drug, but was told that this was the best solution. A worrying trend we were about to see continued through the week.
Here's a summary of the best 6 interviews, with links to the short blogposts for each.
Cherie - a 24 year old qualified pharmacist in a pharmacy serving the middle classes, that's part of a small chain. She helped us understand the challenges around balancing business targets and duty of care. She let us hang out and do some observations behind the counter too. See more here
Kevin - a 26 year old patient suffering from recurring stomach pains. A self confessed expert, he feels he knows a lot about prescription drugs and is sharing advice frequently to his friends, family and colleagues. See more here
Rhoda - a Community Health Worker and Nurse with 7 years experience. They have a lab on site and test for malaria and HIV. She sees it as her job to help people stay well and always want to be seen to offer treatment, helping people get better quickly. The idea of delaying or avoiding antibiotics did not add up for her. See more here
Brenda - a clinician working in a private outpatients clinic within a local hospital. She will defer to the more senior doctor to prescribe, although if he's not around she will write a prescription for antibiotics to patients, that gets fulfilled at the on-site pharmacy. She understands AMR and does her best to educate patients, although it's challenging. See more here
Alvin - a pharmacist that owns his own pharmacy with his wife. They serve predominantly low income customers - offering credit for drugs they cannot afford - but also some middle income customers who find their long opening hours convenient. He knows his customers well - trust is everything to him and his business. See more here
Monika - a Community Health Worker who works across 4 hospitals and a Marie Stopes Clinic. She described her struggles developing trust - saying the middle income patients doubt the CHW's knowledge and the lower income ones can suspect they're out to make money. She was keen on ideas that give her a sense of authority and decision making confidence. See more here
“Patients are your friends only when something doesn’t go wrong. When a mother brings her child in with malaria, I’ll try to notice if something else is wrong, like a runny nose. I’ll give an antibiotic just in case.” Rhoda, CHW
On giving Amoxil to a ten year old : “It opens up the chest, then she can breathe again. I heard from a doctor that was the right thing to do” (About 10yo girl) Marie, CHW
“Antibiotics are meant to be prescribed, but to be honest I do sell them.” Cherie, Pharmacist
“I’m like a doctor myself, I know all about drugs. My father was in hospital a few years ago and I learned about them then. When I’m sick, I just prescribe myself some medicine” Cedric, Patient
“You need to make patients understand, because if they don’t understand they won’t accept your diagnosis. Sometimes people return and apologise to me after two weeks, because they didn’t believe me”” Brenda, Clinician
“If you give patients antibiotics in a wrong way or without them needing them, you expose them to bacterial infections. I tell them, if you take a lesser dose then you’ll get sicker” Alvin, Pharmacist
Next week we are in Bangalore, India for our second week of fieldwork - you can find our schedule here.
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--- Did you miss our previous postcards? Have a look: