In the morning, I learned about the other side of the pharmacy where they process and fill prescriptions for the women who are inpatients of the hospital. I learned their system of receiving, filling, and dispensing. Their equivalent of our PCTs, "nursing assistants" come down from the floors with the paper orders, drop them to us at the window. The pharmacy technicians enter them into a computer system that then prints labels, and then the techs fill and label the medications. The pharmacist then checks them, and puts all the medications for each floor in a separate bag, and then puts these bags labeled by floor by the window to be picked up by the PCTs. When the PCTs come to the pharmacy to pick up their floor's meds, they must sign all the prescriptions which are left to be filed in the pharmacy, and they take the medications up to the nurses on the floors. Here is a picture of the inpatient side of the old pharmacy and a PCT picking up some vaccines to bring up to a floor.
Here is a picture of where the technicians type up the prescriptions to create labels. Victor is sitting at the computer on the left and typing the labels for the outpatient side, and Cristian is sitting at the computer on the right and typing the labels for the inpatient side.
Here are 2 pictures of the "gabetas" or drawers where some of the frequently used inpatient medications are stored. The first picture has mostly IV medications, and the second picture is of the oral medication storage area.
Here is a picture of the "mueble" with all the "cajitas" with the IV medications used for the inpatient side. They are in alphabetical order...for the most part.
Also in the AM I went to the "bodega" which in means vineyard/winery in Spain, so I was a bit confused at first, but I quickly learned that in Latin America, it means basically a storage house. In this bodega I saw where they keep all the extra medications to be used in the future. It looked like a warehouse more or less. It is extremely organized, and everything is labeled by expiration date so that they are used in the proper order. They also have extra refrigerators here where they store medications that need to be at a certain temperature. Here are a few pictures of the bodega:
Here is a picture of Johnny and Adrian hard at work in La Bodega
In the afternoon, we had a staff meeting about the moves that will occur Saturday from the current "old" pharmacy to the brand new pharmacy down the hall! Later in the day, Yuri, from IHCAI, came to the hosptial to talk with the director about arrangements for me for the coming week! Then I left with him and played soccer w/ Yuri and other workers of IHCAI at a public field! Yuri explained to me that the boys that work with him, who we played with tonight, Brian, Kenneth, and Gabriel, are from the lower class of Costa Rica. As such, many do not complete high school and instead have to work to help support their families. Yuri went on to explain that IHCAI is a great place for them to work because they are constantly surrounded by future doctors and students from all over the world. This serves as motivation for them to go back and finish high school or to enroll in the US equivalent of a GED. In the translated words of Yuri, "Our Thursday night soccer games are the most important thing you will do while here in Costa Rica". It was so much fun, I can't wait until next week! Here are 2 pictures of what the "conchas" look like.
After the game, Yuri brought me home to Mama Tica's house and I slept like a baby, tired out from the game.
Friday 11/8 - Saturday 11/9
Friday morning I woke up late because I didn't have to go to work in the morning! The director told me yesterday afternoon that I would be shadowing the night time pharmacist on Friday so that I can understand what it is she does that is different from the day time pharmacists. The night shift is from 10 PM - 7 AM and it is just one pharmacists, no technicians, Monday - Friday. On the weekends it is a pharmacist and a technician 10 PM - 7 AM. When I first got there, Dra. Salazar, the night pharmacist, went over all the protocols with me for their narcotic safe. Everything is done with pen and paper in terms of logging. They have special colored scripts for all narcotics. We also went over the guide of which services/doctors can prescribe which narcotics. When a MD writes for more than 1 dose of a narcotic, they only dispense 1 dose, make note of it, and then keep these "open scripts" in a special place. I also learned how much responsibility the PCTs have as it is them bringing all medications including narcotics to the floor. It is normal for the night pharmacist to sleep for a bit, or watch TV. I slept for a few hours before getting up again to start preparing for the day. Around 7 everyone started showing up for the big move to the new pharmacy! Mercedes brought in fresh bread from the bakery down the street, and prepared mini avocado, salt, and bread sandwiches were everyone. Here is a picture of her preparing the sandwiches!
I stayed and helped for a bit before leaving via taxi to go to the nearby bus station. The station cant be more than a 5 minute walk from the hospital, but it is in the "zona roja" of San Jose, or the red zone where I'm forbidden to go on foot. I arrived at the station and bought my bus ticket to Puerto Viejo for 4000 colones (8 USD). The next bus that went to Puerto Viejo was leaving at 10 AM, and it was about 8 AM when I arrived. I took a seat in the cafeteria attached to the bus station, and I looked up to see fellow gringos at the table next to me! They were 2 Americans, Rob and Jeff, from Seattle, Washington. We ended up hitting it off and chatted over breakfast for the next 2 hours. They were coming down to do mission work and build houses in the touristic destination of Puerto Viejo where there is a fair amount of poverty among those who live there. We chatted until we got up and filed into line for the bus, where we learned we would be sitting right next to each other. We chatted some of the ride, slept a bit, and watched the beautiful scenery pass us by. We climbed higher and higher into the mountains on roads that really aren't meant for 2 lanes, never mind 2 lanes of huge trucks and buses going 70 MPH! Here is a movie of the vegetation we passed although I'm not sure it will work.
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