Katie Buhlinger “is going to change the field of pharmacy”

Story by: Cailyn Derickson

See related story: UNC pharmacists are helping cancer patients in Ethiopia

ADDIS ABABA, Ethiopia — Katie Buhlinger was giving a presentation on the importance of a cancer registry to a group of healthcare professionals at Tikur Anbessa Specialized Hospital when a blood-chilling cry erupted down the hall.

She didn’t flinch. In fact, no one in the crowded conference room flinched. Buhlinger, a second-year oncology pharmacy resident at UNC-Chapel Hill, raised her voice and continued her presentation.

The cry grew louder and longer. A child in the pediatric oncology unit was enduring a painful bone marrow biopsy. The procedure punctures through the patient’s back pelvic bone and sucks up a marrow sample.

In the U.S., for a pediatric bone marrow biopsy, the child is under anesthesia. In the Addis Ababa hospital, the child is awake. The hospital doesn’t have the space or staff to administer anesthesia for that procedure.

Eventually, a nurse got up and closed the door, but the cry was only muffled. Buhlinger ignored it and continued.

Buhlinger was part of a team of UNC pharmacists who were working with the hospital to implement the first national pediatric cancer registry, which would identify patient cancers, track therapies and subsequent complications, and document outcomes.

They had about two weeks to analyze the hospital’s practices and determine how to implement the registry, which was funded by The Aslan Project, a nonprofit organization focused on pediatric cancer. But the project was becoming more difficult each day.

“Right now, it feels like the weight is on us,” Buhlinger, 27, said. “It is becoming more and more clear of how big an undertaking it was. I think we had thought that there had been more work that had gone into it and more training and more resources. And there’s been nothing.”

***

If the UNC School of Pharmacy needs a role model to demonstrate its students’ drive and passion, it’s Buhlinger.

Katie Buhlinger

When she was 4, Buhlinger’s aunt passed away from brain cancer. At that age, she didn’t understand what killed her. She viewed it almost like a ghost. Even when she was old enough to know what cancer was, she didn’t understand.

She decided to study it.

“I don’t think anyone in my family could tell you what medicine she got treated with or really the details around her treatment,” Buhlinger said. “For me now, I want so bad to know. I want to know what did she have and what did she go through.”

Buhlinger graduated from Michigan State University with a degree in biochemistry and molecular biology in 2013. She came to UNC for pharmacy school the next year and worked as an intern in UNC’s Cancer Hospital.

“When someone is diagnosed with cancer, there’s a fight,” she said. “It’s not just, ‘Oh well I shouldn’t have eaten all those cheeseburgers.’ You don’t know why you have this. It’s an immediate response as a human to fight it. I don’t think any other disease is like that. To connect with people in that fight is the main purpose of what we do.”

***

One night, Buhlinger was driving home from pharmacy school in Chapel Hill. She had gotten used to the long days, but she was still tired. She just wanted to enjoy some music and zone out, so she turned on 93.9, a country music station in the Triangle.

Instead of music, the DJ was ranting about his bad experience at the pharmacy that day. Buhlinger rolled her eyes and listened.

“He’s telling this story of ‘You won’t believe I spent so much time in the pharmacy,’” Buhlinger said. “‘All I needed to pick up was a Z-pak. I’m watching the pharmacist. It literally would take me five minutes to take it off the shelf, put a label on it. Yet, I’m standing here and of course, they tell me to step aside. I’m waiting and of course, they make me stand next to the condoms.’

When she got home, Buhlinger emailed the producers of the station. She explained why the commentary upset her and why the pharmacy profession, as a whole, deserved an apology.

“So, if you expect your prescription to get to you faster than your cheeseburger from McDonald’s, consider that the person behind the counter actually cares about your health more than you think,” Buhlinger wrote. “It’s patients like you with expectations like that that frustrate pharmacists.”

Buhlinger’s roommate at the time posted the letter to Buzzfeed, and by the time Buhlinger woke up the next morning, the letter was on Reddit. She also was interviewed by the American Pharmacist Association.

She never heard back from the producers or the host. But to this day, Buhlinger will find Facebook messages from other pharmacists across the country, praising her for the letter and her boldness.

***

Through her internship, Buhlinger met Benyam Muluneh, hospital and clinical pharmacist practitioner in the leukemia clinic at UNC. Each year, Muluneh organizes a trip to Ethiopia and brings a UNC pharmacy resident to work on a project that will improve healthcare at the Addis Ababa hospital.

Buhlinger wanted to be that resident.

Muluneh, who knew he wanted to implement a registry in the hospital this year and needed a strong resident for the project, interviewed both Buhlinger and Jared Borlagdan, a second-year pharmacy oncology resident. He took both.

“Keep in mind, the second-year residents are seeing patients Monday through Friday,” Muluneh said. “On top of that, they have a longitudinal project that they all have to work on and publish. This is completely extra.”

Early on, when the project started to unfold, Muluneh and the residents realized they had no idea what it took to start a registry. Buhlinger stepped up.

“I knew she was capable of taking something that was very nebulous and working through some of the unknowns to start building a structure or framework for what this trip would look like,” Muluneh said. “I thought it was going to be more like I would kind of instruct her specific tasks, but she took full ownership.”

And Buhlinger continued to step up while in Ethiopia.

“As the trip unfolded, we learned more information about the hospital and their practices,” Borlagdan said. “With other people, a lot of things we discovered, they would have been discouraged and give up, but she was very much willing and able to dedicate herself and put the work in to make it successful and I would try to help support her in whatever way I could.”

Left to right, a social worker, a nurse, Benyam Muluneh & Katie Buhlinger consult at the hospital.

***

It was the first day. Buhlinger, who considered four to five hours of sleep sufficient and was getting less than that in Ethiopia, was ready in the hotel lobby promptly at 8 a.m. Her shoulder-length blond hair was tucked behind her right ear. She carried her dark blue and tan tote, which she didn’t go anywhere without, and wore navy pants and a Carolina blue silk blouse.

Before eating her breakfast, she sprayed her hands with lavender-scented hand sanitizer, which was almost empty by the end of the first week, and asked the team of UNC pharmacists if they needed any.

The team had scheduled a meeting with hospital staff to educate them on the importance of a cancer registry, but when the team got to the hospital, the room was not ready, and nurses and physicians had not been invited. There wasn’t a projector. The hospital’s head of pediatrics was unaware the team was coming and insisted on canceling the presentation.

Muluneh was pulled into an emergency meeting with the department head to try to justify the need for the meeting. And during that time, Buhlinger asked for a projector. She invited nurses and pharmacists to attend, and when Muluneh got back from the meeting, the entire conference room was filled.

“Despite all of those challenges, she got up there and gave a fantastic presentation,” Muluneh said. “People were really engaged and asked questions. They gave her a standing ovation.”

During her presentation, a physician asked where Buhlinger found a certain a statistic she shared on the number of new cancer cases in Ethiopia each year. Buhlinger cited the source of the number and its date on the spot.

At the end, a data clerk from Jimma University Specialized Hospital, a smaller hospital about seven hours from Addis Ababa, said she finally understood her job after that presentation.

Buhlinger will finish her residency at the end of June and although she isn’t sure where she will be working yet, Muluneh said he hopes she will continue her work at UNC and with the Addis Ababa hospital.

“She is a mover and a shaker,” Muluneh said. “She really is going to change the field of pharmacy.”

***

To celebrate a successful first week, the team got dinner with Muluneh’s father-in-law and his father-in-law’s brother, who both live in Addis Ababa. The restaurant served traditional wat, a thick stew, served on injera, a large sourdough flatbread, and showcased dances from the nearly 80 different tribes across Ethiopia.

After each traditional dance, performers would come into the crowd and pull a tourist onto the stage.

The team had been there for only a few minutes when a woman in a white embroidered dress hopped off the stage and walked toward the pharmacists’ table. Borlagdan avoided eye contact. Muluneh nervously laughed and pointed to Buhlinger. The woman danced in front of the table. No one looked at the woman, hoping she would move on.

She didn’t. Finally, Buhlinger stood up and copied the woman’s dance moves. She swayed her shoulders side to side and laughed. The team cheered Buhlinger on.

The woman seemed satisfied that she got one person from the table to dance and left. For the rest of the night, Buhlinger gave her coworkers a hard time for making her dance alone.

***

“The interactions with the patients is what I miss, especially when you’re so close,” Buhlinger said. “They’re right there. I see them rounding. I want to know what they’re doing. But that’s not why I’m here.”

On the unit, right before the conference room, there’s a small, dark playroom, which only fit a few toys and a plastic table set. Each time Buhlinger passed the play room and saw a patient, she said, “I wish we could play with the kiddos today.”

She hadn’t spent much time with the patients except for one morning, she was able to work on a rounding team. But at the end of the first week, after working on the unit all day, Buhlinger walked out into the waiting room outside the pediatric oncology unit.

A mother and father, who were in their 20s, sat in the back row of the plastic chairs. They were tired. Their son, who looked no older than 4, stood at the front of the room and stared down the colorful unit hallway.

The child wore a light pink sweater over a dark red T-shirt, with black pants, green socks and black sandals. The sweater was a donation.

Buhlinger stopped and smiled at the child. The boy gave her a high-five. Within seconds, she was sitting on the hospital floor, playing patty-cake with the boy. Then, they were dancing. Then, hugging. Tickling. Holding hands. It lasted 45 minutes.

Buhlinger spotted a large scar across the boy’s stomach. She immediately knew. The child was recovering from Wilms tumor, a childhood cancer that starts in the kidneys. In the U.S., the survival rate for Wilms tumor is more than 90 percent. In Ethiopia, because there is no data, the survival rate is unknown.

The boy came to the Addis Ababa hospital from a village near the Ethiopian-Kenyan border, which is about a 13-hour drive to the hospital. When the boy got to the hospital, the tumor had grown so large, it entered his lungs and restricted his breathing. The tumor was surgically removed and he now lives with his parents in an outpatient pediatric cancer home associated with the hospital.

“Even once we have the registry, the patients whose data is in the registry aren’t the people who benefit from the data,” she said. “It’s the people who come after. You have to keep your mind on that. There will be people who benefit, but it’s hard. It always is hard to look at patients who are stuck in the system, who we’re just too late for.”

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