By Dr. Aoko Koyoson, Pharmacist, Outpatient Oncology pharmacy at Kenyatta National Hospital, Nairobi, Kenya
My name is Dr. Aoko Koyoson, a pharmacist at the outpatient Oncology pharmacy at Kenyatta National Hospital, Nairobi, Kenya. The oncology pharmacy services consist of two teams: The outpatient oncology pharmacy and the inpatient oncology pharmacy. The oncology outpatient pharmacy staff includes: one specialist clinical pharmacist, two pharmacists, three pharmaceutical technologists and one office assistant. We are situated at the Cancer Treatment Centre (CTC) building. In this article, I share a typical day in my life as a pharmacist in one of the country’s largest cancer treatment centres.
As dawn breaks over Nairobi's skyline, the Cancer Treatment Centre at Kenyatta National Hospital springs to life. It is a chilly Thursday morning, the air is crisp, and with it comes the weight of responsibility that we, the oncology outpatient pharmacy team, carry each day. Our mission? To ensure safe, timely and correct medication delivery to hundreds of cancer patients.
I arrive at work a few minutes to 8:00 am and clock into the system. The day begins with our essential morning routine. Together with the security officer, we open the pharmacy and perform our first crucial task, counting of high-cost medicines like trastuzumab, checking them against Wednesday’s closing time inventory. We also check the fridge temperatures and log accordingly and ensure our equipment like biosafety cabinets are in good working condition. We also ensure the pharmacy is thoroughly cleaned and waste is properly segregated ready for disposal. After the morning duties, Dr. Z. Kiambi, our pharmacist in-charge, heads to a brief CTC Department Quality Assurance meeting. As Dr. Kiambi heads out, the rest of the team and I begin to set up the chemotherapy preparation room.
Dr. Z. Kiambi tasks each team member with their role for today. We have two clinics today, the breast cancer clinic and chemotherapy radiation clinic. Dr. S. Machuki, a fellow pharmacist, leads chemotherapy preparation, working alongside two pharmaceutical technologists, T. Ogamo and A. Ngicho. The third technologist, P. Owino is responsible for the billing and the team lead, Dr. Kiambi, oversees overall operations. My role for the day is file reviews at the breast cancer clinic.
It is 8.30 am, we are done with the morning routines and the workflow begins. The nurses bring in Treatment sheets for the patients triaged and fit to receive chemotherapy for the day; head and neck cancer patients who had their clinical review the previous day, Wednesday. Dr. Kiambi returns from the meeting and together we carefully check each treatment sheet against our independent chemotherapy review sheets and prepare medication labels, before passing them to Dr. Machuki’s team for chemotherapy reconstitution.
At 10:00 AM, armed with my chemotherapy summary forms, sticky notes, and pens (blue and red), I head to the Pharmacists Review Room on ground floor for the breast cancer clinic. Today we are expecting 85 patients. The scene is already busy with patients settling into chemotherapy chairs, while others wait in the lounge for their clinic appointments. I settle in the room as the medical doctors and consultants begin seeing patients. Soon, the nurse brings in the first batch of ten files for me to review.
At around noon, one of the medical doctors comes into the pharmacist review room with a patient experiencing hand and foot syndrome from their medication. We discuss management strategies, and I see the relief in the patient's eyes as understanding dawns. After they leave the room, I resume reviewing the files. By 1:30 pm, I am back to the review room. Time seems to flow differently in oncology. What feels like minutes turns into hours as I review files, catch medication errors, and collaborate with our medical team. The afternoon also brings its own challenges. A patient in her second cycle of vinorelbine regimen reports injection site reactions experienced after first cycle administration. Together with the medical doctor and nurse, we discuss ways to prevent extravasation and how to ease the discomfort while maintaining treatment efficacy. These are the moments that remind me of the impact of the oncology pharmacy team—where every intervention can significantly impact a patient's quality of life.
I continue with the review until 3:46 pm. Today, we have served 89 patients—seven new warriors joining our cancer-fighting family and 82 continuing their journey with us. I identified and corrected nine medication errors—nine potential complications prevented! I head by to the pharmacy to complete my final tasks: documenting the adverse reactions and medication errors in the pharmacovigilance system (PvERS) and Red Cap tool, fridge temperature checks, counting of high-cost medicines, and reviewing patient feedback register. Dr. Kiambi also reports two adverse drug reactions that have occurred today in the chemotherapy administration area. Each entry in our systems represents not just data, but real people with real stories.
At 5pm, I clock out and head to the hospital’s gate to catch my bus home. The rain begins to fall as I board the Super Metro bus, my favorite "Women at Work" podcast keeping me company. I reflect on another fulfilling day, marvelling at the unique experiences of oncology pharmacy. For us, every day brings a chance to make treatment easier for our cancer patients. Working in the oncology outpatient pharmacy at Kenyatta National Hospital means being part of something bigger than ourselves. Whether we are preparing chemotherapy, checking prescriptions, or educating patients on their medications, each team member plays a vital role in cancer care. Together, we work to give our patients the best possible care, one day at a time.