Damage Control

Academic Pharmacy NOW • 2018 Issue 2

DAMAGE CONTROL

Planning for the unexpected is a smart strategy for any institution. Last year’s fierce hurricanes put pharmacy schools’ disaster planning to the test and brought these resilient communities together to support each other.

By Jane E. Rooney

Most leaders in academia have undoubtedly devoted many hours to thinking about disaster planning. Institutions must have procedures in place to ensure personal safety and maintain campus operations in the event of an emergency. But when the emergency comes in the form of a natural disaster such as a weather-related event, even the most diligent planning can’t always prepare students, faculty and staff for the worst-case scenario.

Last August, Hurricane Harvey dumped an estimated 27 trillion gallons of water on Texas and Louisiana. A few weeks later, Hurricane Irma battered Florida and Puerto Rico, and then Hurricane Maria devastated Puerto Rico. The catastrophic event there caused widespread destruction, leaving the territory without potable running water in addition to impacting more than 80 percent of the island’s power grid. According to The New York Times, early estimates indicated that the island suffered a loss of $780 million in agriculture yields. As of March, there were still 15,000 federal civilian personnel and military service members in Puerto Rico and the U.S. Virgin Islands working on recovery operations, according to the Federal Emergency Management Association (FEMA). The agency’s website notes that more than 1 million Puerto Rican residents registered for FEMA assistance.

Despite enduring personal loss and having their lives interrupted by the hurricanes, faculty and students at pharmacy schools in Texas, Florida and Puerto Rico stepped in to help their communities where they could, demonstrating great resiliency amid harrowing circumstances.

HARVEY

The University of Houston College of Pharmacy had little lead time when Hurricane Harvey approached Texas last August. “We do have emergency management procedures and policies in place that we enacted,” said Dean Dr. F. Lamar Pritchard. “But I don’t think there’s any preparation in the world that could have prepared us for Hurricane Harvey. It just rained and stormed and we thought it would never end. I’ve never seen anything like that before. That was a storm of tremendous proportion.”

The college’s Texas Medical Center facility, which housed the P3 and P4 segments of the program, sustained so much damage that the building had to be dismantled, Pritchard explained. “We had to move all faculty, staff, students and research that took place in that building to our main campus building. Fortunately we were in the process of finishing a new building, which we’re still in the process of moving into. It’s been very busy logistically and we are still dealing with the effects of the storm.”

University of Houston College of Pharmacy students box donated school supplies at the college before being transported to Harvey-devastated communities.

It took about a week after the hurricane to get everything up and running on campus. Making sure that students, faculty and staff were safe was the administration’s top priority, but communicating in the storm’s aftermath was a challenge. “Many people lost access to the Internet, to electricity, to clean water, or lost their computers and cell phones, so communication was an ongoing issue,” Pritchard pointed out. “We did everything possible to create different channels of communication. It’s one of those situations where it’s going to be difficult no matter what you do ahead of time with a storm of that magnitude. Everything is a challenge— communication, financial support, emotional support.”

Three students and a faculty member from UHCOP man the makeshift pharmacy at the first emergency shelter set up in downtown Houston.

Middle: Donated school supplies were unloaded at a damaged Rockport school gym for sorting and distribution.

Bottom: APhA-ASP school supply relief drive volunteer Callie Downs, co-organizer Kaycie Rathburn and family members transport the donated supplies directly to the impacted communities.

Pritchard said that another key focus for the college was ensuring that students could stay and continue their studies. “Some lost everything they had,” he said. “Those students took a little longer to recover and we’re still working with them to ensure they’re able to come back once their lives and finances are stabilized to allow them to continue their studies. The vast majority of students were able to deal with everything and continue with their studies.”

There was a great groundswell of support from the pharmacy community locally and beyond for students who were directly impacted. Some students lost textbooks or laptops while others lost vehicles or their entire home. Two colleges of pharmacy reached out to help by holding fundraisers and sending gift cards. And despite dealing with the storm’s disruption to their own lives and studies, two University of Houston College of Pharmacy students initiated a drive to collect classroom supplies for schools in the Rockport and Aransas Pass school districts, which were hardest hit by Harvey. The drive raised more than $40,000 in supplies and benefited 150 teachers and more than 5,100 students.

“When most people think of a disaster, they think of it being over in a few days,” he added. “We’re still dealing with Internet issues six months later and it’s still very haphazard. It’s not a quick fix where, say with a snowstorm, you may just cancel classes for a few days. In a territory you can’t generate all the support you would be able to get in the [mainland] United States. It was very difficult to get support to our San Juan campus. Overall everyone did a great job.” — Dr. Robert McGory

Students gave back locally as well, Pritchard noted. “We probably have one of the most active student bodies, especially from a community service standpoint. There are 19 student organizations that interact with health fairs, elementary schools, annual immunizations…it continues all year. An event like this does create tremendous need, but our faculty and staff and students were already very experienced with community engagement and community relationships.”

Even with emergency processes in place, everything will not go according to script. Pritchard said that while it’s difficult to prepare for an unpredictable event like a hurricane, “you learn from each episode that comes forward. You make adjustments and hope you’ve done the best job possible. We have added more counselors both at the university and college levels to help students emotionally and financially. We’re bringing in more financial aid officers. Alumni have contributed money to help with scholarships.” He acknowledged that recovery takes time, but said of the UH student pharmacists: “Their resilience and work ethic is just incredible. They are doing everything possible to move forward.”

Watch a special video that illustrates the giving spirit of the University of Houston College of Pharmacy APhA-ASP chapter: https://bit.ly/2qxCiiP.

IRMA

When Hurricane Irma made landfall in Florida and partially hit Puerto Rico in early September, it was the first Category 4 storm to strike the state in more than a decade in Florida. Nova Southeastern University College of Pharmacy, which has campuses in Fort Lauderdale and Palm Beach, as well as in San Juan, had several layers to the recovery process. “In Fort Lauderdale, we were closed for six days,” said Dr. Robert McGory, associate dean, professional program. “The storm got everything a little off schedule and we had to do some weekend classes. Our San Juan campus was down for almost five weeks. We had to postpone classes there. There were maybe two or three we had to cancel and we kept teaching the others through the first week of January. We basically took the fall semester and divided it in two.” While the Fort Lauderdale campus was able to end the semester on time, first- and second-year students in San Juan will take courses this summer to get back on track.

Within 24 hours of opening the Fort Lauderdale campus, McGory said the registrar and upper administration held a meeting to focus on San Juan and how to proceed without having a way to communicate with that campus. “We knew Puerto Rico was devastated [after Hurricanes Irma and Maria] but we didn’t know about the building students were in or if they could get back and forth to campus,” he explained. “We didn’t know when the power or water would come back on. We started planning in terms of how we wanted to approach students and how we were going to teach. We were trying to generate donations of food, money and clothing that we could send to the campus. We had a good outpouring of aid from other colleges of pharmacy.”

Communication with San Juan faculty remained hit-or-miss for several weeks. McGory said they resorted to using the radio station in San Juan to try to make contact to find out whether it was safe for students to return to campus. Fortunately, the main building sustained only minimal damage and recovered power and water quickly due to its close proximity to a hospital, but it took several weeks before people could travel safely.

“Students were trying to come into the college to get water and electricity and just to have some security,” he continued. “We found a company that could provide hot meals so we were doing that once a day for the students. The experiential staff worked to get students to volunteer to do rotations.” McGory said about eight students moved to the Palm Beach or Fort Lauderdale campuses to complete their rotations as the situation in Puerto Rico remained unstable.

McGory recommends that institutions have some kind of technology ready as a backup plan to keep students engaged in their studies during an emergency. “I asked the president of the university if we could purchase jump drives and put lectures from last year on those, and we sent those down for students to pick up,” he said. “Students could come in and use the computers on campus so they could stay involved with their education.” He also said that getting satellite phones to the San Juan faculty helped facilitate communication.

Hurricanes can increase or decrease in force overnight and change course quickly, McGory pointed out, so while everyone had a good idea that Puerto Rico would be affected, the university did not have a formal plan because of all the unknowns. “When most people think of a disaster, they think of it being over in a few days,” he added. “We’re still dealing with Internet issues six months later and it’s still very haphazard. It’s not a quick fix where, say with a snowstorm, you may just cancel classes for a few days. In a territory you can’t generate all the support you would be able to get in the [mainland] United States. It was very difficult to get support to our San Juan campus. Overall everyone did a great job.”

MARIA

On Sept. 20, Hurricane Maria, which achieved Category 5 strength, reached Puerto Rico and caused catastrophic damage to the island, wiping out vegetation and almost destroying the electrical grid. The University of Puerto Rico School of Pharmacy was relatively unscathed, suffering barely any damage to its physical structures, and power was restored fairly quickly thanks to the school being adjacent to the medical center. Classes restarted two weeks after the storm hit. “We resumed activities fairly quickly considering the magnitude of the event,” said Dr. Wanda Maldonado, dean, University of Puerto Rico School of Pharmacy. “We were able to complete the semester on time doing additional hours in between. We decided not to honor any of the remaining holidays except Thanksgiving and Christmas day, and we ended the semester on Dec. 28.”

Even though power was restored to campus promptly, many people did not have Internet access, cell phone signals or power at home. “It was a challenge to communicate with faculty and students and personnel to find out everybody’s status,” Maldonado acknowledged. “That’s when we became creative with WhatsApp groups and starting a chain of communications. Some people had to come to the San Juan area to get a cellular signal. Gasoline became scarce because the demand increased significantly as many were using gasolinepowered generators at home. There was a lot of caution in terms of how people moved from one place to the other to save gasoline, and to avoid debris from the hurricane that had fallen on the streets. We went back to other methods we have of communicating: We posted one of those flip charts and posted handwritten announcements in front of the school that said, for example, ‘We will have a faculty meeting on X day,’ or to let students know when we would start classes.”

Faculty and students from the University of Puerto Rico assisted with care and medication issues for hemodialysis patients transferred from St. Thomas after Hurricane Irma.

Left: When Claudia Hilera Botet found out her rotation was going to be canceled after Hurricane Maria, she helped a professor start an initiative to get other student pharmacists whose rotations had beencanceled to come together to collaborate with a clinic that was providing free healthcare services. She and other students helped the clinic create an inventory of donations they had received, establish a workflow for dispensing free medications and provide patient education.

University of Puerto Rico faculty and students worked in a Rio Piedras clinic after Hurricane Maria (above) as well as in clinics in Carolina, PR (below).

Because many students lacked power in their residences, the administration allowed them to stay in campus buildings later than usual. “We extended the hours they could be in our building and have Internet, be able to study, have power and air conditioning, so they could comply with their academic obligations,” Maldonado added. “Students could stay until 10:30 at night. It provided them with a place with power and basic necessities.” Faculty also supported students several times by providing them with lunch; additional water and food donations were also distributed.

Be Prepared and Have a Plan B

The school provided extra support to P4 students, in some cases finding places for students to complete their APPEs stateside. “We also developed a platform to collect donations and support them financially for the travel since that was something they hadn’t anticipated,” Maldonado said. “We received a substantial contribution through that platform so we can provide support for those students. More than half of our students did their practices here. We only had one student who left the program and that was because of family issues.” Out of the 45 graduating students, 20 completed their experiences on the mainland. But, Maldonado pointed out, before the hurricane hit Puerto Rico, 16 students were already scheduled to go to the states through collaboration agreements with other schools of pharmacy. Many of those institutions offered assistance and support after the storm, and many others followed. “There was a very generous offering from pharmacy academia in general,” she said. “They really reached out to help us in that moment of need, and we really value that.” Other schools of pharmacy immediately volunteered to provide opportunities for several students and multiple rotations, like the University of Maryland arranging for five students to complete their practicums there. Students were also hosted by the University of Colorado, Sullivan University, Thomas Jefferson, Michigan, Western New England, Johns Hopkins Bayview, and the Miami VA, among others.

Claudia Hilera Botet, Pharm.D. candidate 2018, one of the students who traveled to the mainland to complete a rotation after the hurricane, said the professors and administration went the extra mile to help P4 students. She completed a rotation at the University of Michigan but needed to get an ambulatory care rotation done that was not ready just after the hurricane in Puerto Rico. Professors and the administration at both Michigan and Puerto Rico helped arrange the opportunity for her. “I will be graduating on time,” Hilera Botet noted. “That’s one of the most important things that everyone kept in mind when arranging new rotations and finding solutions. Everyone had that as a priority—to not affect students’ course of studies so students could graduate on time. It was tumultuous but we are going to graduate.”

When she found out her rotation was going to be canceled, Hilera Botet—one of the few students who had good phone service and could communicate with her peers—helped a professor start an initiative to get other student pharmacists whose rotations had been canceled to come together to collaborate with a clinic that was providing free healthcare services. She and other students helped the clinic create an inventory of donations they had received, establish a work-flow for dispensing free medications and provide patient education. “Our attitude was: let’s try to apply what we’ve learned so far as students and help the community. During my free time, my priority became just helping others and putting myself out there to lend a hand to those in need.”

“There was a very generous offering from pharmacy academia in general,”said Dr. Wanda Maldonado, pictured far left, dean, University of Puerto Rico School of Pharmacy. “They really reached out to help us in that moment of need, and we really value that.”

Born and raised in San Juan, Hilera Botet does plan to return to Puerto Rico after completing a residency on the mainland. “We need our people to come back and help the community and bring practices and all the things they learned back to Puerto Rico, in both the pharmacy and medical fields,” she emphasized. “We need pharmacists to come back to continue to develop that culture.”

Maldonado credits the administration’s robust preparedness procedures with minimizing damage to campus facilities. “Every year we have hurricane scares,” she noted. “We know the drill regarding preparedness. We know how to prepare the buildings, offices and classrooms to make sure the computers are not damaged. We take everything away from the windows. We do all those safeguards and we have done them numerous times. We know when to send students, faculty and staff home so they can prepare. We have a team with the chancellor and deans who know what to do and when to do it.”

She said that assessing building security should be a top priority when schools think about emergency preparedness. “Just before the hurricane I called the architect that designed the building to ask about the building code,” she continued. “Not a single window broke in the building. We didn’t have any flooding. I think what’s most important is the knowledge of the building codes if we’re talking about a hurricane, knowing what areas are prone to flooding, knowing how the IT infrastructure is secured on campus and making sure it is well protected. We have a water tank in our building that provides extra water in case water is scarce, and we have a generator that partially lights up certain areas in the building.”

The other key piece to disaster preparation is having a well-thought-out communications plan. “Have a protocol in place to let faculty, students and staff know about when to go home,” Maldonado advised. “Establish a communication chain by which after the event occurs people can know who to call or where to meet to establish a plan. Those things have to be clear. We had a high degree of certainty only a day before that the hurricane was really going to make landfall in the Island, so preparations have to be made well ahead of time, and in a timely manner.”

Claudia Hilera Botet said of working in the clinic: “Our attitude was: let’s try to apply what we’ve learned so far as students and help the community. During my free time, my priority became just helping others and putting myself out there to lend a hand to those in need.”

Jane E. Rooney is a freelance writer based in Oakton, Virginia.