How to Become a Pharmacist in Uganda

This in not an official U.S. Department of State (DOS) blog and the views and information presented are my own and do not represent the Fulbright Program or the DOS.

These are some of the 3rd year students who are fulfilling their dreams of being pharmacists.  They are dedicated to helping people and it has been a pleasure to work with them.  Sam, Edel, KarenBeth, Hilda, and Linda

These are some of the 3rd year students who are fulfilling their dreams of being pharmacists. They are dedicated to helping people and it has been a pleasure to work with them. Sam, Edel, KarenBeth, Hilda, and Linda

Although I’ve been here for the past month working on clinical skills curriculum for the pharmacy program, I’m not sure that I’ve told you much about the entire process to become a pharmacist in Uganda. The decision for a student to pursue pharmacy actually starts back in about the equivalent of 11th grade in the USA or at about 16-17 years old. Ok, let me back up a bit further and tell you about the entire school system. The formal school system starts with Primary school, although they do have an optional pre-primary program. Students are about 6 years old when they enter P1, which is like our 1st grade. Primary goes up through P7. At the end of the school year there are final exams that determine whether or not the students can progress to the next level. After P7, students enter Secondary school. These four years are called S1-S4 and are also called the Ordinary Level, or “O” Level for short. At the end of every year, students take their “O” level exams to progress to the next grade, but in order to progress from S4 to S5, they take a final “O” level exam that is scored by the Ugandan National Examinations Board (UNEB). If they pass with high enough marks, students are allowed to progress into S5. This starts the final 2 years of secondary school, which is also called Advanced Level or “A” Level. It is at this point that students have no compulsory subjects and have to choose whether to study Arts or Sciences. Within the discipline chosen, students will choose 3 specific courses. For example a student whose dream is to go into the medical field might choose Math, Biology and Chemistry.

At the very end of S6, which is actually the 13th year of school- one year beyond normal High School in the USA, students take their final “A” level exams, which are the qualifying exams for University. These are scored by the UNEB. To qualify for entry to Pharmacy school, students must achieve the highest scores. In fact, the scores to enter pharmacy school at Makerere are actually higher than the scores to enter Medical School.

Every year once the UNEB marks the Final A Level Exams, all of the schools are ranked and the names of the top student achievers are printed in the paper. The top score is 20.

Every year once the UNEB marks the Final A Level Exams, all of the schools are ranked and the names of the top student achievers are printed in the paper. The top score is 20.

Once a student qualifies for the pharmacy program, they also have to wait and see if they qualify for a government or private scholarship to school. University is very expensive and most students study with the help of full scholarships, which pay for tuition, room, board, and books. Very few students are self-pay. If students don’t get a scholarship to go to school in Uganda, there are many countries that offer scholarships for Ugandan students to go to school in places like China or Cuba. Can you imagine going to China for pharmacy school where you will be taught in CHINESE? This is exactly what a Ugandan faculty friend of mine did. Her scholarship included a year of language study prior to entry to pharmacy school and then she did her entire pharmacy program in Chinese.

The entry-level degree for pharmacists in Uganda is a Bachelors of Pharmacy (BPharm). It is a 4-year degree but after graduating, there is a mandatory 1-year Internship prior to being eligible for licensure. Immediately after graduating, a pre-licensure exam is taken and passing this allows a student to be placed in Internship. Internship occurs primarily in the hospital setting although some Interns are able to take a month or two of electives in Industry or the National Drug Authority. After finishing Internship, a licensure exam is taken. And finally, upon passing with high enough marks, the dream of becoming a Pharmacist is made reality.

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Continuing Professional Development at Mulago National Referral Hospital

This in not an official U.S. Department of State (DOS) blog and the views and information presented are my own and do not represent the Fulbright Program or the DOS.

KarenBeth is Presenting Information on the treatment of Hypertension to the Pharmacy Interns at Mulago Hospital

KarenBeth is Presenting Information on the treatment of Hypertension to the Pharmacy Interns at Mulago Hospital

I spent Thursday with the Pharmacists and Pharmacy Interns at Mulago Hospital and participated in their weekly Continuing Professional Development (CPD) case conference. This is an event that is scheduled every Thursday from 12-1pm where the Interns and Pharmacists and occasionally Pharmacy School Faculty gather to discuss patient cases and learn from each other. This week, two Interns presented a patient who had been admitted for the treatment of Hypertensive Emergency and Exacerbation of Heart Failure. She was only 44 years old and her initial BP upon triage was 220/150! After the students presented, I helped to facilitate the discussion of the management of this patient and also introduced the new American Hypertension guidelines, JNC-8. In addition, I had done a little research prior and presented information about how the treatment of hypertension in the Sub-Saharan African population needs to be different than the way we treat North Americans or Europeans, the people who have participated in most of the research. Fortunately, this is reflected in the new JNC-8 guidelines. Lack of research on the population that is being treated is another barrier to providing appropriate drug therapy and medical care in Africa. The students in pharmacy and medical school here use the same textbooks and references we do in the USA- ones developed primarily using research study results on North Americans and Europeans. But, Africans don’t necessarily respond to the same drug therapy. Regardless, most of the initial drugs regimens are from those textbooks. Over the past couple of decades, there has been much research in Africa regarding the treatment of some of their most common diseases like HIV/AIDS and Tuberculosis and certainly the treatment of tropical illnesses. More recently, though, the incidence and prevalence of chronic illnesses like Hypertension, Heart Failure, Diabetes and Kidney Disease are on the rise but the research hasn’t caught up yet.

The Pharmacy Interns gathered together for the Continuing Professional Development Case Presentations

The Pharmacy Interns gathered together for the Continuing Professional Development Case Presentations

At the end of the Case Presentation and my talk, a drug wholesale company in Uganda, Wide Spectrum, treated the Interns to lunch. Prior to this, three pharmacists who work for the company as marketing representatives presented information on some over-the-counter (OTC) products they would like the pharmacists-to-be to keep in mind for patients with appropriate aliments. I found this extremely interesting and similar to the drug rep talks in the USA. The main difference was that Wide Spectrum brought a whole host of products to hand out and these included both OTC and prescription products, or at least what would be available only on prescription in the USA like antibiotics. The other thing I noted, once again, was the wholesalers took great pride on the fact that all of their products were manufactured in countries like Eygpt, Jordan, and the United Arab Emirates, as opposed to India. As I mentioned in a previous blog, in the USA we just take it entirely for granted that the drugs we dispense and take as patients are going to be safe and effective. No patient or even pharmacist would know or care what country manufactured the drug on our shelves. We have full confidence in the pharmacovigilence of FDA, knowing that the regulations are very tight and this watchdog is making sure the products for sale in the USA are what they say they are. Occasionally issues arise with impure products or sub-therapeutic drugs, but again, there is a very good process in place for notification of all pharmacies that purchased the product in question and drug-recall policies that assure patients don’t receive these drugs.

KarenBeth and Gonsha, the Pharmacist who works with the Pharmaceutical Society of Uganda as a volunteer and coordinates the CPD sessions every Thursday for the Pharmacy Interns. When she was an Intern, she felt it was very important for the Interns to get together for these weekly educational sessions and started theses programs.

Patrick, one of the Pharmacists that came to the USA, and me after the presentations

Joseph is the leader of the current Pharmacy Intern class. He works with Gonsha to make sure these sessions go off without a hitch and students are organized to attend.

 

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A Visit to a Community Pharmacy in Kampala

This in not an official U.S. Department of State (DOS) blog and the views and information presented are my own and do not represent the Fulbright Program or the DOS.

Vicky in front of her newly opened Community Pharmacy in Kampala

Vicky in front of her newly opened Community Pharmacy in Kampala

On Tuesday, after the visit to Naguru Hospital, Vicky took me to her Community Pharmacy. This is a brand new venture for her. Although she had future plans of owning her own pharmacy, this one just kind of fell into her lap. A pharmacist had been trying to sell it for a while but had no luck. Eventually he lowered the price such that Vicky just had to buy it. It is in a little shopping center off of a main road, which makes it nice and safe, and also is associated with other businesses including an Indian Restaurant and a hair salon. She took me to eat at the restaurant and it was quite delicious. Indian food is something that I don’t get a chance to eat much of at home but here in Uganda, there are oodles of good Indian restaurants.

The inside of Vicky's Pharmacy. See how nice and neat it is?

The inside of Vicky’s Pharmacy. See how nice and neat it is?

Vicky employs a nurse who mans the pharmacy during the day. She has been teaching the nurse all about drugs and just about everyday she gives her a new lesson. In Uganda, a pharmacy can be owned by a businessman or woman (or a pharmacist) but they must have a pharmacist licensed as the “supervisor” of the store to conduct business. But, this doesn’t mean the pharmacist has to be there in order for drugs to be dispensed. In fact, because there are so few pharmacists in the country, they are allowed to supervise 2 pharmacies and only have to be at each one at least 40% of the time. Pharmacy technicians, but more often nurses, are allowed to dispense and sell medication when a pharmacist isn’t present.

Vicky standing behind the dispensing counter

Vicky standing behind the dispensing counter

Since Vicky is just starting her business she has had to purchase her entire stock of drugs and she goes there everyday after working a full day at Naguru Hospital to give her nurse some time off in the evening. One other thing that is quite different from the USA about private pharmacies is that they have to carry numerous brand names of the same drug products. Patients will ask for a brand by name and insist upon it. Most of the times this has to do with the country which manufactured the drugs- the more reputable the source, the more expensive the product. Drugs from Europe and the USA (although these are rare) are the most sought after by patients who have money. The cheapest drugs come from India but it is commonly thought that many of these products are sub-par. In the USA we mostly carry generic drugs and are always used to explaining to our patients that these cheaper alternatives are exactly the same as the brand name product, in most circumstances, and are safe and effective. In fact, most insurance companies won’t pay for brand name drugs when equally effective generic drugs are available. Of course, medications at all government facilities in Uganda are free and patients who have no money to pay for their care, willingly take the free drugs from India and are happy to have those.

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A Visit to China-Uganda Friendship Hospital-Naguru in Kampala

This in not an official U.S. Department of State (DOS) blog and the views and information presented are my own and do not represent the Fulbright Program or the DOS.

Vicky and Me outside Naguru Hospital- this was taken in Oct 2013 during my last visit to Uganda

Vicky and Me outside Naguru Hospital- this was taken in Oct 2013 during my last visit to Uganda

Today I spent the day with Vicky Nyombi, one of the Ugandan Pharmacists who came to the USA to work with me last fall. We started the day early as she picked me up just after 7am to head to the China-Uganda Friendship Hospital in the Naguru part of Kampala (“Naguru” Hospital).  This hospital is quite new having opened in 2012 and was build with funds from the Chinese.  It is much smaller than the Mulago National Referral Hospital, but nonetheless, it is a referral hospital meant to help decongest the large numbers of people that Mulago serves.  Naguru Hospital has a large outpatient facility along with a surgical theater*, labor and delivery and wards for OB-GYN, Adults, Pediatrics, and Surgical patients.  One of the things that Vicky has started since returning from the USA where she gained more skills in the provision of Pharmaceutical Care and pharmacy administration is a Medicine and Therapeutics Committee.  This is a group of physicians, pharmacists, nurses and other important stakeholders in the provision of patient care and the team serves the hospital by making sure that drugs and policies related to drug use are appropriate and meet the needs of the patients.  This morning I helped Vicky look at her drug formulary, the list of drugs the hospital routinely stocks, to see if there were any drugs that could be deleted so that funds could be reallocated to provide other medicines or products.  I was able to help her see that a specific combination IV antibiotic actually costs substantially more than if the single drugs were given separately.  In the USA we often try to use combination drugs when possible to increase patient adherence and decrease the number of oral tablets they have to take but this was an intravenous med which the nurses administer. Also, the two drugs separately could be combined and infused in one solution the same as with the combination product. So in this situation, the combination product is probably not worth the extra expense.  And often, in a resource-poor environment like Uganda, even oral medications have to be given in separate formulations because the cost of combination products is just not affordable.  In the USA we often use long-acting preparations as well, again to improve patient adherence, but if these are substantially more costly in Africa, they are not able to be utilized.  I’m sure the same adherence issues occur here as everywhere else so sometimes the best healthcare outcomes aren’t achieved due to lack of products the patients can easily take.   Back to the formulary, I’m sure that as she systematically reviews it over time she will find more  instances that could really help improve her budget.  One of the difficult things is that Vicky, although a pharmacist, is now actually in charge of the entire stores* for the hospital. This includes both the drugs and healthcare supplies like gloves, masks, etc.  She has to make her yearly budget cover all of the healthcare and drug supplies.  In addition, something as basic as stationery* must also be bought with her budget.  This latter item is something that we in the USA take for granted.  It would be very unusual for us to be told that we can’t complete a project because the budget for stationery has run out for the year and if we want to print something, we will need to purchase it ourselves.  So, one of the things Vicky is also implementing since coming back from the USA is a form to document her clinical interventions. Whenever she talks to a physician or clinical officer to make a recommendation about drug therapy or whenever she counsels a patient, she will write it down on this form. In this way, we can begin to gather objective data about what she is able to accomplish on behalf of patients with her new skills and hopefully this will lead to more support for future training for other pharmacists in Uganda.  But, if the stationery supplies run out and she has no more money in the budget to purchase them, or needs that money to procure drugs, she is limited to either ceasing to document or using her own funds to purchase the paper.  Patrick Opio at Mulago Hospital is also struggling with this basic challenge.

One of the purposes of my visit to Naguru today was to meet with the Hospital Director to discuss the possibility of having pharmacy students from Makerere University complete some of their clinical experiential training at his hospital.  The curriculum I’m developing will have a “practice lab” component where students learn skills in a classroom setting and then practice them through role play as they identify and solve drug therapy problems that are in the patient case vignettes they are given. A faculty facilitator helps students to identify problems they missed and works with them on skills techniques like patient counseling. The other critical component is “experiential” where the students go to a healthcare facility and are supervised by pharmacy interns and pharmacists, which is called  being “precepted” while they interact with real patients and healthcare providers to put their new skills to work helping patients.  Mulago Hospital is the traditional site for gaining clinical experience for Makerere students as it is very large and a walkable distance from campus and it will remain the primary site, but it would be nice for students to have the opportunity to see another hospital setting and work with a pharmacist, Vicky, who has had experience in the USA using these skills herself. (At Mulago they will also be able to work with the other pharmacist who came to the USA, Patrick Opio.) Anyway, the Director was wholeheartedly enthusiastic about this opportunity and will welcome the students. The primary barrier will be transportation to Naguru Hospital, which he can’t provide and I am not sure the University will be able to provide this either.  Once again, there is a non-medical barrier to implementation of a program that could help improve patient care.  In the USA, most pharmacy students have their own cars and in some cities there is low cost public transportation. This is not true of Uganda.  At this point, I’m not sure the transportation barrier will be able to be overcome but at least the Naguru Hospital site is a possibility and if we can’t implement this soon, perhaps in the future.

*Definitions:  If you are from the USA and reading this blog there may be some terms that sound “funny”.  The term surgical theater is a British term for the operating room.  Back when surgical procedures were started, they were held in an ampitheater where all of the medical students and doctors would sit on raised seating around the table in the center so they could watch and learn.  Today there is not normally “visitors viewing” for most surgical areas in the USA or elsewhere.  The term medicine or medical stores is also probably unfamiliar to Americans.  We would call our storage facility for drugs or medical supplies  the “stock area” or a “storage facility” or “medical supplies closet” or simply “Central Supply” for the term for the area of the hospital that stores no medicines but stocks all the supplies like patient gowns, equipment, etc.  The government of Uganda’s central drug storage facility from where they dispense to healthcare sites all over the country is called the National Medical Stores (NMS) and the central supply from which private facilities order their drugs and supplies is called the Joint Medical Stores (JMS).  A similar facility in the USA would be called a “healthcare supplies wholesaler”, and an example is Cardinal Health. Now another term that is not unfamiliar to Americans but its use above is unfamiliar- stationery.  In the USA this term is used in a very specific way to denote the paper you use to write letters or thank you notes.  Stationery in the USA is often fancy and has designs on it.  Paper that is used in printers is simply called paper. In Uganda this term refers in general to the paper supplies that are needed for printing, taking notes, etc.  In the USA, the term we use for this is a larger catchall phrase- “Office supplies”- or simply paper products or paper goods.

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Blood Pressure Screening in Masindi with Makerere Pharmacy Students: Day 2

This in not an official U.S. Department of State (DOS) blog and the views and information presented are my own and do not represent the Fulbright Program or the DOS.

Linda is taking the Blood Pressure of a very happy patient!

Linda is taking the Blood Pressure of a very happy patient!

Our second day in Masindi started quite early because we were going to run a Blood Pressure Screening event at a local church, All Saints Church of the Masindi-Kitara Diocese of the Church of Uganda.  Worship lasts a lot longer in Uganda than in the USA. The first service, which was led in the local dialect, Runyoro, started at 6am, but luckily we didn’t have to be there until 7:45. Then it turned out the service didn’t let out until nearly 8:30am.  Anyway, we arrived and got some tables set up and after the service was done, the crowds began lining up.

The people line up to have their Blood Pressure taken but with 4 of us participating the line moved quickly

The people line up to have their Blood Pressure taken but with 4 of us participating the line moved quickly

This was one of the churches that participated in the BP screening last fall when I was here with the Wilkes University pharmacy students so some parishioners remembered me. But many others were just getting screened for the 1st time.  Today we were only able to serve 2 services because we had to catch a bus back to Masindi but in less than 3 hours, the four of us screened 119 people.  Of these, 69% had normal BP readings but 24% had readings that could be classified as Stage 1 hypertension (>140/>90) and 7% had Stage 2 (>160/>100).  We had to refer one patient to the clinic within the next day or two to be re-checked and if still elevated, her medications would need to be adjusted.  As always, the Ugandans were very grateful for our visit and it really felt good to use our skills as pharmacists to help others. Below are some of the pictures from the event.

KarenBeth is thoroughly enjoying talking with all of the people as they come forward to get their BP taken

KarenBeth is thoroughly enjoying talking with all of the people as they come forward to get their BP taken

Edel intensely listens for the heart sounds so she can record the BP correctly

Edel intensely listens for the heart sounds so she can record the BP correctly

Sam taking a gentleman's Blood Pressure

Sam taking a gentleman’s Blood Pressure

KarenBeth taking a patient's Blood Pressure

KarenBeth taking a patient’s Blood Pressure

This is an overview of our set-up on the porch of the church

This is an overview of our set-up on the porch of the church

The BP Screening Crew: Edel, Sam, KarenBeth, Linda

The BP Screening Crew: Edel, Sam, KarenBeth, Linda

Sam and Linda play around with the kids who hung out all morning and avidly watched us- who know, maybe they are future pharmacists

Sam and Linda play around with the kids who hung out all morning and avidly watched us- who know, maybe they are future pharmacists

Edel taking a Blood Pressure

Edel taking a Blood Pressure

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Road Trip to Masindi with Makerere Pharmacy Students: Day 1

This in not an official U.S. Department of State (DOS) blog and the views and information presented are my own and do not represent the Fulbright Program or the DOS.

On the bus and ready to go: Edel, Linda, and Sam

On the bus and ready to go: Edel, Linda, and Sam

I’ve been in Kampala for 3 full weeks now and my experiences have been wonderful, but I can’t come all the way to Uganda and not go and see my friends and partners in Masindi.  I could have gone alone now that I’m familiar with the bus system since my trip to Mbale last weekend, but I just love Masindi so much that I wanted to share the experiences with some of the Ugandan students I’ve been working with here.  Last fall, when the American pharmacy students were here, we conducted Blood Pressure screenings at 4 churches.  At that time we had invited some of the Makerere students but another event prevented them from joining us.  So, when I was planning this short weekend trip, I contacted a friend, Janine who is a health education missionary for the Masindi-Kitara Diocese of the Church of Uganda, to arrange another BP screening and I was able to convince three Makerere students, Edel, Linda, and Sam, to join me.  We left Kampala on the 8:30am Link Bus, which actually departed at 9:30am, and had a safe journey to Masindi, arriving at 12:45pm.  My friend, Sam who has been my Masindi driver for 3 years, was awaiting our arrival.  It was so good to see him again!  After getting settled in at my favorite Masindi hotel- The New Court View- we had a delicious lunch.Each room at the New Court View are these little huts (banyas)

Each room at the New Court View are these little huts (banyas)

KarenBeth’s room at the New Court View. The cute quilt on the bed is made by local Ugandan in a shop that the US Peace Corp helped them start called Piece by Peace (I hope I have the words in that name spelled correctly). I have bought 2 for myself and they adorn my beds at home. They come in a great variety of colors.

I had then arranged for us to go to the main medical facility that the Wilkes University pharmacy students and I work at when we are here, Masindi-Kitara Medical Center (MKMC), for a discussion of their mission, how it got started, and a tour of the facilities.

I was briefly able to see Alex, one of the Clinical Officers. He was the only clinician when MKMC opened up. They now have 3 or 4 clinical officers, a permanent physician, and a visiting physician.

I was briefly able to see Alex, one of the Clinical Officers. He was the only clinician when MKMC opened up. They now have 3 or 4 clinical officers, a permanent physician, and a visiting physician.

Palmetto Medical Initiative (PMI), a humanitarian organization in South Carolina, started bringing medical missionary outreach teams to the Masindi District of Uganda back in 2008, four times a year, but the goal was always to develop a self-sustainable, permanent medical facility to bring quality healthcare to the region that was run and staffed entirely by Ugandans.  PMI raised money stateside for the buildings and opened the doors of MKMC

back in December 2010. Initially the center was only an outpatient facility but soon more buildings were built and today they have about 35 total inpatient beds split between a general ward, pediatrics, and a labor and delivery unit.

They have their own lab, pharmacy, and operating theater where they perform anything from minor surgeries to cesarean sections to hysterectomies to abdominal surgeries.  On average, they see about 1400 patients per month.  They currently don’t have a pharmacist but do have a fully stocked pharmacy that is run by trained nurses and technical staff. It is their hope one day to be able to recruit a pharmacist not only to manage the pharmacy but to also collaborate with the medical providers to assure safe and effective medication use.  One of the reasons I really wanted the Ugandan pharmacy students to come here was to see their project and learn about their sustainable model. The healthcare practitioners who work at MKMC are dedicated to performing their jobs to the best of their ability and they truly care about the patients. They work together in a collegial manner and the atmosphere around the clinic is so favorable.  Also, the facilities are excellent compared to what is available to most Ugandans. When I asked the students what they thought of the facility one of them stated, “It was so lovely; it was so clean!”  MKMC doesn’t provide free care like the government does; their vision is to provide high quality affordable care that is self-sustainable in a rural area.  They believe that patients should take ownership of their health. The fees are very low and when a patient puts their own resources towards the care, they value it all the more and receive great value in return.  For example, instead of waiting hours to be seen at many government healthcare facilities, most patients wait no more than 30-40min to see the clinician and MKMC purchases their drugs from the Joint Medical Stores which procures drugs from manufacturers that produce high quality and efficacious drugs.  When asked about her thoughts on this model, one student remarked, “they think differently and are making it work.”  PMI still helps to raise funds for building projects and expansion, but the day-to-day fees for service have been able to sustain their monthly budget, which means they are making their vision a reality.  Below are some of the pictures I took of the students on Day 1 in Masindi.

Enjoying delicious food in one of the outdoor cabanas- Sam, Linda, Janine, and Edel

Enjoying delicious food in one of the outdoor cabanas- Sam, Linda, Janine, and Edel

The Labor and Delivery Suite

The Maternity Ward

Baluku, the Business Manager, give us a tour of the Inpatient Ward

Walking towards the Inpatient Ward

This is the supplies closet in the Procedure Room/Emergency Room

The nurse in the Casulty Department (Emergency Room) explains the types of procedures that are done here and the types of usual patients.

Nixxon, the laboratory technician shows us around the very well-equipped lab.

Fred shows us around the pharmacy and the really nice, and well-kept refrigerator, to ensure the drugs are kept safe and secure.

 

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Ugandan Pharmacists Explore Washington DC

This in not an official U.S. Department of State (DOS) blog and the views and information presented are my own and do not represent the Fulbright Program or the DOS.

Vicky and Patrick in front of the US Capitol Building

Vicky and Patrick in front of the US Capitol Building

The day after Thanksgiving, I was able to take Vicky and Patrick to visit Washington D.C., the capital of the United States.  The pictures below tell the story.

A beautiful view of the Capitol Building from the lawn

A beautiful view of the Capitol Building from the lawn

Vicky and Patrick stand beside the monument to Sakakawea, the Indian woman who acted and guide and translator for Lewis and Clark's expedition of the Western USA

Vicky and Patrick stand beside the monument to Sakakawea, the Indian woman who acted and guide and translator for Lewis and Clark’s expedition of the Western USA

After visiting the Capitol Building, we went to the Smithsonian Natural Museum of History.

Within the Natural Museum of History, Vicky and Patrick are standing in front of an African Elephant Display

Within the Natural Museum of History, Vicky and Patrick are standing in front of an African Elephant Display

Finally, as we were walking around the museum, we came upon this picture and display in an area dedicated to African History.  Patrick recognized the photo right away.  In his words, “This was an amazing experience because the photograph of the former vice president of Uganda, Dr. Specioza  Kazibwe is in there.”

  This is a photo hanging in the Smithsonian Museum of Natural History of the former VP of Uganda,  Dr. Specioza Kazibwe

This is a photo hanging in the Smithsonian Museum of Natural History of the former VP of Uganda, Dr. Specioza Kazibwe

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