After hurricane, pharmacists respond across Puerto Rico

When Hurricane Maria struck Puerto Rico last September 20, crossing the island from east to west, no part of the U.S. territory was spared. “The damage has been massive,” said Wanda T. Maldonado, BSPharm, PharmD, professor and dean of the University of Puerto Rico School of Pharmacy in San Juan. While some areas in the San Juan metropolitan area have recovered more quickly, the central mountainous area faced vast destruction, and many townships still lack essential services like power, running water, and delivery of supplies.
“Health care services throughout the island have been a challenge,” Maldonado said. “Our pharmacists stepped up to the plate to provide much-needed services.” In a number of communities, physicians and pharmacists teamed up to prescribe and dispense donated medications, she added. “Our faculty and students also were immersed in relief efforts.”
Across Puerto Rico, community pharmacists served as first responders, working “tirelessly to take care of the patients in their communities, often providing medications without any guarantee of reimbursement,” according to a letter by Puerto Rico resident Nelly Conte, EdD, MMS, RPh, published online in JAPhA.

Hurricane-linked shortages expected to improve in early 2018

After Hurricane Maria struck Puerto Rico last September, FDA identified 30 drug products manufactured primarily on the island that were at risk of potential shortages. While most of those never went into shortages, current shortages involve I.V. fluids and amino acids, both made at Baxter International facilities, according to FDA’s 2017 Atlantic Hurricane Response Joint Information Center.
At press time, current shortages caused by hurricane damage in Puerto Rico included the following:
  • Sodium chloride 0.9% injection bags
  • Dextrose 5% injection bags
  • Metronidazole injection, USP
  • Amino acids
For pharmacists managing these existing shortages, FDA recommended the American Society of Health-System Pharmacists/University of Utah guidance document, Small-Volume Parenteral Solutions Shortages, which outlines best practices.
The agency added that pharmacists can continue to check the FDA drug shortage website for daily updates as new information is received from the companies.
The I.V. saline fluids shortage is expected to improve in early 2018, according to a January 4 FDA blog post statement by FDA Commissioner Scott Gottlieb. Baxter, a leading producer of I.V. saline fluids, has announced that all its facilities on the island have returned to the commercial power grid.
All other companies with products manufactured in Puerto Rico that were on the initial list of drugs at risk of shortages are now on the power grid, and “their production is increasing,” Gottlieb wrote. “The commercial power grid remains unstable in places.”
The shortage of pediatric and adult formulations of I.V. amino acids also was expected to improve.
Conte described how the island’s pharmacies—despite some having generators to run computer systems—were lacking the telecommunications to contact prescribers, third-party payers, and disaster relief agencies. Meanwhile, many patients had lost their medications to hurricane damage and hasty evacuations.
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Some University of Puerto Rico student pharmacists are completing their experiential education on the mainland, Maldonado said, while others are completing their requirements on the island. Graduation will be on time in May.

Road to recovery

“The aftermath of Maria will persist for many, many years to come on the island, particularly [in] health care,” said APhA Trustee-elect Magaly Rodriguez de Bittner, PharmD, FAPhA, a professor and associate dean for clinical services and practice transformation at the University of Maryland School of Pharmacy as well as executive director of the school’s Center for Innovative Pharmacy Solutions. Originally from Puerto Rico, she said all her family still lives there.
Although some of the main hospitals and health care facilities have electricity and water, many smaller health care settings and patients lack electricity and still need pharmacy services.
Rodriguez de Bittner called for remaining engaged and proactive. “When the news fades,” she said, “it is important that we don’t forget and that we try to stay abreast of what’s going on and identify what we can do to keep the health care needs of the citizens of Puerto Rico in the forefront of the discussion in the United States.”


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We offer our service in two locations on the great island of Puerto Rico. First Location being Hyde Park 870 Calle Las Marias San Juan PR 00927 and our second location is on the Carr #2 Villa Capparra Guaynabo PR 00966

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En First Pharmacy tenemos ENVÍO GRATIS local !! Si tiene problemas para buscar sus medicamentos, si está a cargo de un paciente o tiene un ser querido en un centro de atención, ¡podemos ayudarlo! comuníquese con (787) 763-9536 o envíe un correo electrónico a ¡y lo guiamos! Aprovecha esta oportunidad. Se aplican ciertas restricciones

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