The following is an edited version of answers from William Drake, PharmD, Chief Pharmacist for the U.S. government’s Incident Response Coordination Team (IRCT), to questions from Pharmacy Practice News.
PPN: You have been deployed in earlier disaster relief efforts. How did the aftermath of the Haiti earthquake compare?
Dr. Drake: The earthquake that crippled Haiti cannot even be imagined in U.S. standards. When a hurricane hits, people ask how many days or weeks before electricity is restored. In Haiti it may be years before that and other utilities are returned to pre-earthquake levels.
PPN: I’ve heard it said that the need for medical support services will continue for many months or even years. Would you agree?
Dr. Drake: Absolutely. Haiti was challenged before the earthquake. Its needs only intensified after it. Now, delivering even the basic healthcare requirements will be very challenging. Before the earthquake, a lot of the country’s healthcare was provided by non-governmental organizations (NGOs). That need has not changed. In fact, it has probably increased. But unless countries including the U.S. decide to support the effort completely, it may take years for Haiti’s healthcare delivery system to return to pre-event levels.
PPN: The American Pharmacists Association and other pharmacy organizations have had an overwhelming response from members of the profession who are willing to volunteer their services in Haiti. As a pharmacist trained in disaster relief, what would you say are the qualifications needed for such work?
Dr. Drake: You have to have been trained in disaster response and prepared to live and work in an austere environment. There are no 7-Elevens around the corner or hotels in which to rent rooms. I have seen even seasoned team members melt down the first or second day of being in such an environment. In Haiti, I witnessed groups of independent providers “showing up,” but ultimately becoming victims or refugees themselves because they were not prepared correctly.
PPN: What role can pharmacists play in a disaster of this magnitude?
Dr. Drake: Pharmacists can pay a huge role. Resources are often limited. The huge variety of medications that we have the luxury of selecting from in the United States does not exist in Haiti. Therefore, the ability to assist prescribers in therapeutic drug product selection is invaluable. Prescribers sometimes need to be reminded that some of the older therapeutic agents are still effective. I always say, “Amoxicillin still kills bacteria” in the right situation.
PPN: Were DMAT pharmacists able to offer instructions to patients on the use of medications?
Dr. Drake: Yes, when possible our disaster medical assistance team pharmacists interacted with patients. Most of our sites had interpreters on site and could be called up if needed.
PPN: In Haiti, what medications, or medication classes, had the highest priority?
Dr. Drake: Pain meds and antibiotics were the two most requested meds. IV solutions and rehydration solutions were a close second.
PPN: Were any medications in short supply, and if so, how were they replenished?
Dr. Drake: Everything was in short supply, but that was normal for Haiti. Of course, the earthquake exacerbated the shortages. There is an established resupply process through a program called PROMESS (Program on Essential Medicine and Supplies) under the control of WHO and the Pan American Health Organization (PAHO). This process has been in place for years, and actually met the needs of the country effectively before the earthquake. Obviously there are always challenges, but there at least was a program. This is something many of the NGOs and those who just showed up were not aware of when they “hit the ground running” upon their arrival in the area. During emergencies, independent supply chains develop. Some good, some bad. Once they use all of their supplies, these groups are done and pack up and go home.
—Compiled by Bruce and Joan Buckley