The Pharmacy

My friends in the pharmacy.

I didn’t join the Peace Corps to file papers.

And yet, I have spent the better part of the last year filing papers. 

So it goes.

I have been working on and off in the pharmacy at the hospital since last May. I never thought I would work in that sector because it is the busiest, most stressful part of the hospital, or at least I think so. One day last May I went to the pharmacy hoping to find out how many people had faulted on their treatment over the previous month to include this information in a proposal. I was told that I could look at the FILAs, documents that are used to record each time a patient picks up their ARVs.  I was directed to a large filing cabinet. It quickly became obvious that the FILAs were quite unorganized. The drawers hardly shut, the hanging folders were ripped and said FILAs were in disarray. Quiteria, the pharmacy staff responsible for the FILAs, explained to me the multiple-step process she went through just to locate and fill out the FILAs, and how she was not always successful. I told her I was willing to help with the organization and potential re-organization. I quickly became her “amiga.” At that point, I didn’t realize I’d still be working in the pharmacy eight months later and that we’d still be “amigas”.

When I went back to the pharmacy the next day, Quiteria once again explained what was expected to happen and what was actually happening. She said how usually if they couldn’t locate the FILA they would just create a new one so now there were many duplicates. I had my work cut out for me. I spent pretty much all of May through August, working to eliminate these duplicates. I would find the duplicates, put them aside and then Quiteria recorded the information from both FILAs on just one of the documents. Upon eliminating all of the duplicates, we discussed how there needed to be a better way to organize all of the FILAs. We started to brainstorm. It was time for a change.

In November, we received information from the Elizabeth Glaser Pediatrics AIDS Foundation that they would be starting a study in 2014 called SMSaude, in which they would be sending out text messages to patients in the hopes of increasing adherence to treatment. With this study, they expected all hospital paperwork to be in order, including the pharmacy FILAs. They provided a layout of exactly how the FILAs had to be organized. There needed to be two filing cabinets, one labeled “current month” and the other “following month”. The four drawers were to be marked “first week”, “second week”, “third week” and “fourth week”. Within each drawer the FILAs were to be put in alphabetical order. We now had a plan to follow. EGPAF provided the new filing cabinets, folders, labels and FILAs. Tecnico Vladimir, responsible for the pharmacy, said that it wasn’t worth it to try and find the old FILAs (the ones I had been working with from May-August) as patients arrived during the month of January, but rather to open new FILAs for all patients. I try not to think about how much time I spent/wasted organizing all those old FILAs. Eek.  

According to the Ministry of Health, the hospital calendar year starts on December 21. So starting Monday, December 23, we opened a new FILA for each patient doing treatment. Mind you, over 6,000 patients are doing treatment at my hospital.  Throughout the month of January, every day I arrived in the pharmacy collected the receipts from the day before and then used them to open new FILAs. It was a long process. Quiteria was working on it with me, but she took her vacation for most of January so I was left with Sitoe. Sitoe is a character. He works hard, but loved to inquire about our potential relationship asking if I would go to the beach with him, if he could come back to America with me and when our wedding would be. Despite the countless marriage proposals, we finished opening all the FILAs.  

Starting January 23, we were able to start the new process for filling out FILAs. It goes something like this: when the patient doing treatment arrives at the pharmacy window, he/she hands in his/her hospital identification card, then Quiteria searches through the current month filing cabinet to find the patient’s FILA. The pharmacy technician then fills out the FILA when giving the patient his/her medication. At the end of the day, all of the FILAs are to be registered in the pharmacy book and then passed to the database sector of the hospital where they are typed into the system. They are then returned to the pharmacy and filed under the first name but this time in the coming month filing cabinet. That is our goal, but so far, this exact flux is still a work in progress.

 The first couple days with the new system were rough. I was really nervous because while EGPAF was demanding the change, I was the face there in the pharmacy working to change the system. The very first day I stayed at the hospital until 17h when I usually leave at 12h. The pharmacy technicians were not entirely thrilled by the new process, even though they admitted to the benefits. The wait time is already ridiculously long at the pharmacy and now we were adding an extra step to the process. The noise of patients waiting outside definitely has become more audible. But, I am always amazed by how calm and collected Tecnico Vladimir stays. I can’t say the same for the other pharmacy technician…but that’s beside the point. Tecnico Vladimir never lets the line, the noise, the number of patients get to him.

Now, three weeks into the new system, I am trying to phase out my role. I am working more directly with Quiteria to make sure that she keeps up with locating FILAs when patients arrive and that the filing cabinets stay organized. I am working to make sure the flux is in place so that the FILAs once updated are passed to the pharmacy book, the database and then filed back in the filing cabinet for next month. On February 20, we will unroll the last part of the process because this date marks the end of the month. At the end of the month, the FILAs that are left in the folders of the current month faulted/missed their treatment and need to be located. I am going to go through this process with Quiteria for the next few months to make sure the patients who have missed treatment are identified and contacted. The primary reason I first stepped foot in the pharmacy eight months ago.

Wow. Thanks for staying with me. 

I didn’t know I could write so much just about filing papers.