During the week (last week of the 24th) my faculty got in contact with the Dean of the pharmacy school at KEMU and gave me a chance to go on rounds with the medical students at Meru Level 5 District Hospital. This was a public hospital that is government funded that accepts a lot of patients. It was rather a shock to me when I saw two patients (no relationship to one another whatsoever) shares a twin-size bed. It is because they can not afford to pay so ended up sharing a bed (I believe that was the reason). I could not take any pictures in the wards (this is how they address departments) due to patient privacy. But let me try to explain what it looked like:
So imagine you're standing on the shorter end of a single rectangular room made of large concrete blocks. Directly across from you is another door that leads to the next room. Between you and the door, you have 5 patient beds to the left and right of you (total of 10 beds in the ward). There is very limited privacy, no curtains, no sterile IV bags (it was basically exposed to the outside air). Open windows were the only source of ventilation. The noise of running water to clean the tin cans/cups can be heard in the same room. When the medical team would round, they used paper-bounded booklets as patient records that content patient information and status of the treatment. However, these booklets were laying around on the patient's bed and the next bed. There is absolutely no HIPPA or patient privacy, which is an extreme no-no in America.
I personally found the Meru Level 5 District Hospital a sad place. It is the most affordable hospital everyone can attend but the facilities are still very limited. They can not do an EKG reading (the machine that reads your heart beat) and limited medications available. Patients are dressed in their street clothing, which makes me wonder what they would have to do if there was an emergency that required them to cut through these articles of clothing. When I rounded, there was at least 20 medical students/residents surrounding one bed. This crowd would spill over to the next bed, where medical students/residents would lean over the other patient bed to listen to the attending. I don't know how these patients of neighboring beds feel, but if it were me, I would not have been comfortable hearing what conditions my neighbor had and seeing so many people hoovering around my bed. I did feel some nausea after standing for 2 hours, barely hearing the soft voice of the attending. It could have been the bleach in the air with all the cleaning going on or the cluster of people in the room. Overall, I would not want to be admitted into this hospital.
Side note: I did not know if the people with me on rounds were medical students or medial residents. Two complete different titles.
I also had the opportunity to check out the pharmacy in the hospital. What struck me the most was the counting process. They did not use counting trays or spatula, only pouring the tablets into their bare hands and counting them out. They did not put them into a vial with a label, but rather a small brown envelope with handwritten label of the medication's name. You will see the picture below.
After visiting the hospital pharmacy, I had the opportunity to see a community pharmacy. James took us to tone of the largest chain pharmacy in the region, East End Chemists. They were huge!! and constantly busy!! They said they typically process 500 scripts (prescriptions) a day! That is crazy! Hence they had a huge volume of medication on stock and staff. I had the opportunity to work with Gloria and Carol (both technicians) in the dispensing room. They were so nice and helpful. I tried my hardest to work and help them out, but I believe I slowed them down more than anything else. 
There were very limited counting pills. Almost all tablets were packaged in blister packs that makes it easy for counting. I actually counted out some pills of amoxillicin and HCTZ (hydrochlorothiazide, water pill) with my bare hands! I couldn't help but think to myself, "so not sterile here". But at CVS, I have to admit I did use the 5 second rule a couple times when some pills 'left' the counting tray on 'accident'. 
The next day, we (my faculty and I) checked out a private hospital, which is a Methodist Church ran-hospital. (The name I had forgot). The pharmacy was must smaller than Meru Level 5 Hospital. I did not get a chance to go on rounds but we did have a long chat with the head physician who was very receptive of the idea of pushing clinical pharmacy into practice. James (the dean of KEMU school of pharmacy) wanted to make this private hospital as a teaching site for his clinical pharmacy course. It was actually exciting to see how genuine the head physician excitement was for this project. 
Gladly enough, this private hospital pharmacy had counting trays. However, they feel that the counting trays slow them down and prefer to count using hands. There is still the same brown bags with handwritten labels as their source of vial.
After the pharmacy, I checked out the different wards in the hospital, from peds to medical to surgical to outpatient department. The beds were arranged in the same way as Meru General Hospital, but each patient had their own mosquito nets and all patients were in gowns (which made me happy). The cleaning sink was thankfully in a separate room outside the main ward and there were less patient population and medical residents rounding. Compared to Meru, I had a better impression of this hospital. If I ever to have to go to the hospital, this would be the one, specifically the private block of the hospital (thankfully I do not have to). They also showed me their lab room which was very impression. They had instruments and computer in a completely clean room.
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