Sustainable Pharmaceutical Systems – Nanyonga Stella M. Karama

Many of us walk into pharmacies and hospitals expecting to find medicine! But have we ever wondered how the pharmaceutical industry has been able to sustainably serve all of us until now? We have a guest from the Sustainable Pharmaceutical Systems in Uganda;

Hello Stella, you are welcome to this episode of Words That Count. You are our last feature for the year, and there’s no better way to wrap this up!
Hi Winnie, thank you for the opportunity. I am happy to share my story with the world.

Kindly introduce yourself to our audience
My name is Nanyonga Stella Maris Karama from Uganda. I am currently engaged in full-time consultancy work in policy development and health systems research. My consultation work so far has been with the Global Fund, World Health Organization, Ministry of Health, Infectious Diseases Research Collaboration, among others. I am also affiliated with the Sustainable Pharmaceutical Systems (SPS) unit at Makerere University College of Health Sciences where I work on several projects.

Tell us about your journey from childhood to landing into Pharmaceutical work
I am the 4^th child in a family of 6 children. My parents are both teachers by profession and very passionate about education. I started my academic journey at Frobel Kindergarten in Entebbe town in Central Uganda. I then joined St. Joseph’s Katabi primary school, where my mother was the headteacher, for primary education at age six. I was lucky to hold the first or second position every term until a new student joined in primary four. That is when I started working hard academically because this girl was extremely brilliant.

I moved on and joined Kisubi Girls school in primary six where I completed my primary education. For high school, I joined Mt St Mary’s College Namagunga in senior one and studied at this institution for six years for both my O and A level education. I particularly loved Namagunga because they ensured that we got a holistic education. We were trained to be ladies, not to cross the lawn, not to litter rubbish, how to do housework, how to pray and we also had a healthy level of entertainment.

We all had to do home economics, learn a sport and do literature as a compulsory subject. These are life skills that they were teaching us because I am currently very good with a needle and thread, I can plan and cook a meal beautifully and I can write a newspaper article in 30 minutes because of this background in literature. I played badminton, table tennis, and football though I also tried my hand at lawn tennis and hockey but, I was not good at these.

My most fond memory of Namagunga must be the time we finished the Uganda Certificate of Education. We were young, happy, and excited to live the rest of our lives. I felt like I could do anything with my life. I have always wanted to be a medical doctor since I was very young at about 10 years and my father wanted me to be a medical doctor and encouraged me to study sciences. However, my older sister became a doctor and all I remember is that she studied for a very long time and when she started working, she had to work at night.

I knew this was not what I wanted to do with my life. Yes, I love patients, I love making a difference in people’s lives and I love everything to do with biology and chemistry. But this was not it for me! I had to look for a course that would still give me all of this without having to become a doctor. Pharmaceutical science was exactly what I was looking for. Unfortunately, Pharmacy required much higher points than medicine and that meant that I had to work very hard during my senior six to get admitted to the bachelor of pharmacy course.

I excelled in my A-level exams and went ahead to pursue a bachelor of pharmacy degree. Because of my love for patient care, I particularly enjoyed clinical pharmacy and dreaded pharmaceutics and industrial pharmacy. I worked as a pharmacist for one year and went ahead to join the London School of Pharmacy at University College London to pursue a Masters in Clinical Pharmacy International Practice and Policy.

The course content was well structured and the academic staff very helpful and I had the most enriching experience at this institution in 2011/2012. I joined the course when I was 7 months pregnant but I was determined to prove that being a mother does not stop one from achieving what one wants. I remember going into the labor ward with a very big book called The Clinical Use of Drugs by Kimble to read in between the contractions.

It was prolonged labor and by the time I went for the emergency cesarean section, I did not know where my books were. I did an end-of-semester presentation five days after the cesarean section. One of my classmates asked me where I get all this determination from. The answer is simple, I want to be better than I was yesterday. Recently, I completed a Masters in Science in Clinical Epidemiology and Biostatistics (2021) because I wanted to improve my research skills, grant writing skills, and scientific writing skills. The tuition for this course is the best money I have ever spent.

Over the years, I have worked in several places and have been instrumental in the development of different policies and guidelines in the health sector in Uganda including; the Uganda National Action Plan on Antimicrobial Resistance (2018), the National Medicine Policy (2015), National pharmaceutical sector strategic plan III (2015-2020), Practical Guidelines for Dispensing for higher-level Health Centers (2015), the Uganda Clinical Guidelines (2016) and the Essential Medicines and Health Supplies List for Uganda (2016).

I also participated in the development of the East African Regional Guidance document for the development and implementation of Antimicrobial Stewardship Programs in 2019 in Nairobi, Kenya.

As an African woman, I know it hasn’t been easy to achieve what you have! Tell us about your most challenging times on this journey
I have faced two major challenges along the way, the lack of willingly dedicated professional mentors and the fact that I am a woman. It is very hard to get a role model or someone to provide one with guidance and support on the career path. Everyone is either too busy or they view younger people in the same field of practice as competition, not as people who will build onto the work they have started. You end up making some mistakes along the way simply because you do not have anyone to guide you.

As a woman, I feel like we don’t have the level-playing field at work yet we compete for the same opportunities with the men. When a woman speaks out, we are called emotional and hormonal very easily yet the man is called firm and assertive for having the same reaction.

It is almost impossible to network because as the men are heading off to a bar or a gym club, you are running off to tuck someone in bed, complete the children’s homework, prepare uniforms for the next day for the children and ensure that your husband finds a sensible meal at home. When a child is sick at school, they call the mother. They will only call the father if they fail to get the mother on their 10th attempt but both the mother and father are at work and have the same job description.

Does a woman get fewer deliverables because she has children to look after? The answer is no. As a woman, I lose 3 years of my career life every time I decide to have a child. One year of pregnancy where I am working at half capacity depending on how difficult the pregnancy is and another two years raising the child to an age where I can comfortably leave them in the care of a stranger.

For my youngest, I resigned from my job because she was not gaining weight and was not hitting her growth milestone. I had decided to try working at an 8 to 5 job while raising a newborn. Quickly, I realized that I was failing at being a full-time working mother of an infant. Within three months of my resignation, she was a different child in terms of growth and health.

I vividly remember going for fieldwork with a breast pump so that I maintain my breast milk supply and continue breastfeeding my child when I return home. Traveling to the field with the baby is not an option because they fall sick. You need to move with a nanny not to mention the amount of luggage you have to carry and the cost implication.

I train health workers across the country in appropriate medicine use and antimicrobial stewardship. Often, one or two participants turn up with a child. Usually, it is because they have no one to leave the child with or they are exclusively breastfeeding due to the cost of supplementary feeding. These mothers sit at the back and are in and out of the training to care for the child. This means that they do not benefit from the training as they should.

I have also witnessed mothers who turn up with babies to residential workshops being turned away because the organizers did not make provisions for them. The fact that we have to choose between getting ahead and raising our children is simply sad. These are things we do not talk about as women or as a society and yet they affect our work and our productivity. However, despite these challenges, we still get up, show up and excel at our work.

The reality of us working as women in male-dominated fields is very sad! But, how have you been able to move forward in the middle of all these challenges?
Two people have inspired me to be what I am, my mother and my husband. I watched my mother achieve a lot with six children and an extended family to care for. If she could do it, so can I. She started with a certificate but retired as an assistant commissioner with the Ministry of Education and a master’s degree. To upgrade through different education levels as an adult and move through the professional cadres while raising a family is truly inspirational.

On the other hand, my husband believes in me. He has so much faith in me that it is enough for the two of us. I left him as a single parent to a one-year-old as I pursued my master’s in London. He did a fantastic job being both Mummy and Daddy. He always tells me to follow my dreams and he will look after the children until I return. In my world, the sky is the limit because I have such a strong support system.

Let’s talk about your prestigious moments, achievements, and awards
I have had several achievements and awards as listed below;

1. Royal Society of Tropical Medicine and Hygiene Small Grant award 2021

2. Pfizer Global Medical Grant award holder 2021

3. First Class degree in the MSc in Clinical Epidemiology and Biostatistics 2021

4. Council Member of the Pharmaceutical Society of Uganda 2021 to 2024

5. Women champions of snakebite 2020

6. Founding member of the Appropriate Medicines Use Advisory Group, Ministry of Health.2017 to 2019

7. Founding Member of the Ministry of Health National Anti-microbial consumption and use steering Group. Ministry of Health 2017 to 2019

8. Member of the secretariat for the review of the Uganda Clinical Guidelines / Essential Medicines and Health Supplies List Uganda. Ministry of Health 2016

9. Best Hospital Pharmacist Award 2015

10. Award for selfless service from the Rotary Club of Kampala Central 2014/2015

11. Commonwealth scholarship award 2011/2012

If it has nothing to do with work, how do you spend your spare time?
Outside work I am a very fun-loving person. I love dancing, cooking, eating out, watching a good movie, and spending time with my loved ones. On a sunny Sunday afternoon, you will find me at the pool or visiting a friend with the children. I spend my free time with my children and the thought of an empty nest scares me.

What is your favourite quote?
“In the end, it’s not the years in your life that count. It’s the life in your years” ~ Abraham Lincoln. I make it a point to make each day count for me. If something robs me of my happiness, I usually let it go.

What are your words of encouragement for a young girl in STEM?
Math is not difficult. My twelve-year-old daughter, Noella, must be tired of hearing this! Good news; she now believes it and has become good at math. When you work hard at something, it becomes easier with time. She started doing three-math numbers a day two years ago and her math phobia seems to have disappeared. Do not let the bad grades discourage you. Long formulas shouldn’t put you off. Do not let the basic principles that sound like Greek make you give up.

I one time scored 45% in math but I scored a distinction in maths, chemistry, and biology at O-level. If I, Stella, with such a humble beginning at St Joseph’s Katabi could become a scientist, you can become one. Just keep working at it and refuse to give up. I believe that nothing is impossible whether you are a boy or a girl. Not every closed door is locked. Push! The door might surprise you and open.

Thank you very much, Stella, for giving us part of your festive time. We are very confident about closing the year with you. Thank you for the good work you do in the pharmaceutical industry. Merry Christmas to you and your lovely family.