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Cuban Refugees—Pharmacists Mobilized for Support
Cuban Refugees
Pharmacists Mobilized for Support It began as a typical day for Ezequiel Mendieta, chief pharmacist at the U.S. Public Health Service (PHS) hospital in Houston, TX. Zeke, as his friends call him, arrived at work at 7 a.m., his normal hour. There w_ere prescriptions left from the day before to be dispensed, new orders to be taken, supplies to be ordered. But today was not to be a normal day. At 10:30 the phone rang, and Zeke answered. ''How would you like to go to Florida to help the Cuban refugees coming over, Zeke ?'' asked Mendieta's boss Peter Cline, who heads all PHS outpatient clinics in the Houston region. It took Zeke only 15 seconds to respond. Once before, Mendieta had volunteered for emergency service. Mendieta, who speaks Spanish, went to Guatemala in 1976 to aid earthquake victims there. "My wife and I had talked about
42
what we would do if another call came for emergency service,'' Zeke recalls. "I had no problem saying 'yes' right away. This is why being a PHS pharmacist is so stimulating." By 11:30, Cline had called back to tell Mendieta that everything was set. An hour later the airplane tickets arrived. So, too, did Mendieta's wife, to give him a quick ride home to pick up clothes, take a fast shower, and say good-bye to the children. Then out to the airport for a 4 p.m. flight to Miami. By 7 p.m., Zeke was in the Miami airport. He gathered his luggage, rented a car, and drove off for Key West, where most refugees were then arriving. He got there around midnight, was given a quick orientation, and began work at 1 a.m. His day didn't end until 8 o'clock the next evening, when Zeke checked into a motel and fell into a deserved deep sleep.
Mendieta was one of three PHS pharmacists who responded in early May to the call for volunteers to aid the Cuban refugees. Arriving within a week after Mendieta were Estela Barry, a pharmacologist in the Food and Drug Administration's Division of OTC Drug Evaluation, and Tom Perez, a drug labeling pharmacist at FDA. All three recently spoke with American Pharmacy about their expe- , riences in Florida. .
Peeling Paint, Filthy Floors The pharmacy was in an old ·administration building at the Key West Naval Air Station. Barry said that the four-story brick structure obviously hadn't been used in several years. Paint was peeling off walls, and floors were filthy . Workmen were still setting up partitions, restoring electricity, fixing old plumbing, and installing fans when Mendieta arrived May 1.
American Pharmacy Vol. NS20, No. 8, August 1980/466
The building was located on one side of a horseshoe-shaped dock where refugees were arriving on an average of every half-hour. On the other side of the dock, about 200 feet as the crow flies or a quarter-mile as Mendieta walked, was the processing center where the refugees were first taken and examined by physicians and nurses. The pharmacy itself was set up in a small room at the end of a long, poorly ventilated, narrow hallway about 10 feet wide and 30 feet long. It shared the hallway with a treatment center for sick refugees. There were no windows and only one door. An old air conditioning compressor took up precious space and offered no relief from temperatures that daily rose to the upper 80s and 90s. When Mendieta arrived, he found two volunteer nurses and another PHS pharmacist, Paul Farrell from Miami, sorting through boxes scattered over the floor. The boxes contained drugs, other medication, and medical supplies donated by the Cuban-American community in Florida as well as local pharmacies and drug companies . " The Cuban-American volunteers were great, " Perez said. "We weren' t prepared to deal with the number of refugees who were arriving. We would have been in deep trouble without those volunteers." Setting Up the Pharmacy Mendieta's first job was to sort through the boxes and find out just what was there . Most were manufacturers' samples, still in their original packages. Some had expired, while others were of little use to the refugees . Still, without them those early days would have been much more difficult, Perez added. "We had to decide quickly which drugs would be needed most, which were for emergencies, and then find a place to put them where they could be retrieved easily," Mendieta said. "Pharmacists like to work in a structured environment where everything is stored in its proper place and can be found quickly," he added . "That just wasn't the case at
American Pharmacy Vol. NS20, No. 8, August 1980/467
first in Key West. Our job was to organize the pharmacy so that we could serve the physicians and patients." Once the samples had been sorted and organized, Mendieta had to locate sources of drugs, medications, and medical supplies. He called local pharmacies, hospitals, and wholesalers. "We knew that the donated drugs would last only a couple of days," he said . "We had to find local suppliers, set up a purchasing agreement, and then get a distribution system working." That done, Mendieta began talking to the physicians and nurses working with the refugees to find out what drugs and other medications would be needed most and in what quantities. From those talks he drew up a formulary that eventually listed about 150 drugs. Although local pharmacies and wholesalers responded quickly and sympathetically to appeals for help, they soon ran out of many drugs, medications, and other medical supplies . " It didn't take us long to exhaust the local supply," Perez said . "We didn't realize the shortage at first, but it didn't take long to hit. " In short supply were items like collection tubes and needles to draw blood samples from the 1,000 refugees arriving daily . Local stores ran out of baby formula, sunburn creams, and tampons. "We were ordering 30 cases of formula at a time," Perez recalled . Mendieta and Perez arranged to order supplies through the PHS distribution center in Perry Point, MD. By ordering through PHS, pharmacists in Key West and later in Miami could get what they needed quickly and cheaply. Soon, 80-90% of drugs and supplies came through PHS facilities . Once the formulary was set, which took about a week because of the pressure of more immediate tasks, Mendieta phoned Dr. Richard Bertin, the PHS pharmacy branch chief in Washington, DC. Bertin took the list and called the PHS hospital in New Orleans, LA. The first boxes arrived the next day.
At the same time, Mendieta enrolled Navy corpsmen to help build shelves and storage cabinets to hold supplies . This freed floor space for people to move around, allowed some drugs to be locked up, and gave the pharmacy greater order for quicker service. Orange BowlHousing for Thousands In Miami, where Perez was transferred after four days in Key West and where Barry spent one of her two volunteer tours, drug storage areas were similarly disorganized, demands were great, and local and imported volunteers responded fantastically . Refugee facilities were split between the Orange Bowl, where most Cubans were housed, and Opa-Locka airport some 20 miles away, where a processing center was established. Perez and other volunteers set up two pharmacies, one at the Orange Bowl and the other at Opa-Locka . The former was located in the stadium's locker room . As at Key West, the pharmacy shared space with an infirmary. There was no office, and the only telephone was in the middle of the floor . The scene there was hectic, Perez said. Refugees, physicians, nurses, volunteers, and suppliers were going in and out all the time. Young children ran back and forth. With just one phone, Perez had a hard time keeping a line open to call suppliers and receive prescriptions. To add to the confusion, refugees slept on cots and mattresses just a few feet away. At Opa-Locka the pharmacy was both quieter and better organized, Barry said. There, an air-conditioned trailer was used. Only medical personnel and volunteers came in and out. Pharmacists had counter space to work on and shelves to store drugs and medications. Still, Perez had to organize a supply and messenger system. "Often, we needed a drug or medication in Miami that was only at OpaLocka, or vice versa," Perez said. "The physicians and nurses didn't know what was available to them at the other site. We had to do a lot of 43
running back and forth.'' Once, some 500 refugees at the Orange Bowl were suffering from diarrhea. Perez soon ran out of the three brands of antidiarrheals the pharmacy had in stock. He found more of one product at Opa-Locka and made the trip himself to get it. Later, a messenger system was set up. Fourteen-Hour Days In Key West, Mendieta was in and out of the pharmacy all day. On a typical day he might talk to physicians and nurses at the processing center, check supplies at an old sea-
bruises, and gastrointestinal disorders. In the crowded and noisy facilities where they were processed and housed, others got headaches and couldn't sleep. Mendieta spoke of one patient who suffered from myasthenia gravis, a muscle disease. She had been treating it with Prostigmine (neostigmine bromide) for years but hadn't been able to take enough with her. After calling several pharmacies and hospitals, he finally found a wholesaler who had the drug. Usually, the pharmacies were able to stock several alternatives in each category. "We were often able to suggest suitable substitutes when a physician would order a particular drug," Mendieta said. "Two-way communications between physicians and pharmacists were vital."
effort. These pharmacists have spent one or more two- to threeweek tours of duty at the federal resettlement camps at Fort Indiantown Gap, PA; Camp McCoy, WI; and Fort Chaffee, AR; as well as several sites in Florida. Although the situation became less hectic as the flow of refugees slowed, working conditions remained makeshift at best. The drug distribution systems instituted by Zeke Mendieta and others involved at the beginning of the crisis proved to be effective models for use throughout the refugee screening and resettlement program.
Personal Welcome
PHS pharmacist Paul Farrell. plane hangar where refugees were housed, go back to the pharmacy to fill orders, deliver drugs and supplies where needed, pick up deliveries at the bus terminal or airport, and order items like shelving, refrigerators, locks, drug labels, and pencils and paper. Meals were grabbed when one could, often quickly and infrequently, given the 14-hour work days. "We often ate at a fast food place while on a supply run," Mendieta said. "It wasn't what you would call dining." Barry had to rely on peanut butter sandwiches and fruit that she kept in the pharmacy refrigerator. The medical problems facing physicians, nurses, and pharmacists in both Key West and Miami were similar. After a 14-hour or longer ride across water in a small, open boat, many refugees suffered from sunburn, dehydration, cuts and 44
Because they spoke Spanish, the three pharmacists played a personal role welcoming refugees and making them feel at home. Barry, who like Perez was born in Cuba, recalls speaking to a 26-year-old man who had been treated for leprosy in Cuba. She talked to him, located the young man's uncle in Miami, and arranged a meeting with him. "They spent 15 minutes together at the Miami airport before the young man's plane left for New Orleans," Barry recalled. "They embraced as tears flowed down their faces. It was a very touching experience for me.'' As the refugees become settled and establish homes across the United States, the role of pharmacists will not cease, Barry said. Many Cubans have been unable to get drugs and medications because of the U.S. blockade, she said. They will take advantage of their availability here. Pharmacists will have to meet those needs, print labels and instructions in Spanish and English, and explain dosages and potential side effects. Since the original assignments of Mendieta, Barry, and Perez to the Florida area, more than 30 additional PHS pharmacists have volunteered to serve in the Cuban refugee
FDA pharmacologist Estela Barry. Despite the long hours, demanding work, and families left behind, all three pharmacists found the experience personally satisfying. All said they would go back. "I left my bills unpaid at home, ran out of clean clothes, and had my wife wondering whether she would see me again," Perez said. "But it was worth it." "You have to be· compassionate and charitable in this kind of situation," Barry said. "You never know when something like this will happen to you.'' ''There were a lot of very good people helping the refugees," Mendieta added. "We were fortunate to be among the first. I didn't mind the long days so much. I was sufficiently rewarded by having the opportunity to help those people." -Jeffrey P. Cohn American Pharmacy correspondent American Pharmacy Vol. NS20, No. 8, August 1980/468
Pharmacists Mobilized for Support It began as a typical day for Ezequiel Mendieta, chief pharmacist at the U.S. Public Health Service (PHS) hospital in Houston, TX. Zeke, as his friends call him, arrived at work at 7 a.m., his normal hour. There w_ere prescriptions left from the day before to be dispensed, new orders to be taken, supplies to be ordered. But today was not to be a normal day. At 10:30 the phone rang, and Zeke answered. ''How would you like to go to Florida to help the Cuban refugees coming over, Zeke ?'' asked Mendieta's boss Peter Cline, who heads all PHS outpatient clinics in the Houston region. It took Zeke only 15 seconds to respond. Once before, Mendieta had volunteered for emergency service. Mendieta, who speaks Spanish, went to Guatemala in 1976 to aid earthquake victims there. "My wife and I had talked about
42
what we would do if another call came for emergency service,'' Zeke recalls. "I had no problem saying 'yes' right away. This is why being a PHS pharmacist is so stimulating." By 11:30, Cline had called back to tell Mendieta that everything was set. An hour later the airplane tickets arrived. So, too, did Mendieta's wife, to give him a quick ride home to pick up clothes, take a fast shower, and say good-bye to the children. Then out to the airport for a 4 p.m. flight to Miami. By 7 p.m., Zeke was in the Miami airport. He gathered his luggage, rented a car, and drove off for Key West, where most refugees were then arriving. He got there around midnight, was given a quick orientation, and began work at 1 a.m. His day didn't end until 8 o'clock the next evening, when Zeke checked into a motel and fell into a deserved deep sleep.
Mendieta was one of three PHS pharmacists who responded in early May to the call for volunteers to aid the Cuban refugees. Arriving within a week after Mendieta were Estela Barry, a pharmacologist in the Food and Drug Administration's Division of OTC Drug Evaluation, and Tom Perez, a drug labeling pharmacist at FDA. All three recently spoke with American Pharmacy about their expe- , riences in Florida. .
Peeling Paint, Filthy Floors The pharmacy was in an old ·administration building at the Key West Naval Air Station. Barry said that the four-story brick structure obviously hadn't been used in several years. Paint was peeling off walls, and floors were filthy . Workmen were still setting up partitions, restoring electricity, fixing old plumbing, and installing fans when Mendieta arrived May 1.
American Pharmacy Vol. NS20, No. 8, August 1980/466
The building was located on one side of a horseshoe-shaped dock where refugees were arriving on an average of every half-hour. On the other side of the dock, about 200 feet as the crow flies or a quarter-mile as Mendieta walked, was the processing center where the refugees were first taken and examined by physicians and nurses. The pharmacy itself was set up in a small room at the end of a long, poorly ventilated, narrow hallway about 10 feet wide and 30 feet long. It shared the hallway with a treatment center for sick refugees. There were no windows and only one door. An old air conditioning compressor took up precious space and offered no relief from temperatures that daily rose to the upper 80s and 90s. When Mendieta arrived, he found two volunteer nurses and another PHS pharmacist, Paul Farrell from Miami, sorting through boxes scattered over the floor. The boxes contained drugs, other medication, and medical supplies donated by the Cuban-American community in Florida as well as local pharmacies and drug companies . " The Cuban-American volunteers were great, " Perez said. "We weren' t prepared to deal with the number of refugees who were arriving. We would have been in deep trouble without those volunteers." Setting Up the Pharmacy Mendieta's first job was to sort through the boxes and find out just what was there . Most were manufacturers' samples, still in their original packages. Some had expired, while others were of little use to the refugees . Still, without them those early days would have been much more difficult, Perez added. "We had to decide quickly which drugs would be needed most, which were for emergencies, and then find a place to put them where they could be retrieved easily," Mendieta said. "Pharmacists like to work in a structured environment where everything is stored in its proper place and can be found quickly," he added . "That just wasn't the case at
American Pharmacy Vol. NS20, No. 8, August 1980/467
first in Key West. Our job was to organize the pharmacy so that we could serve the physicians and patients." Once the samples had been sorted and organized, Mendieta had to locate sources of drugs, medications, and medical supplies. He called local pharmacies, hospitals, and wholesalers. "We knew that the donated drugs would last only a couple of days," he said . "We had to find local suppliers, set up a purchasing agreement, and then get a distribution system working." That done, Mendieta began talking to the physicians and nurses working with the refugees to find out what drugs and other medications would be needed most and in what quantities. From those talks he drew up a formulary that eventually listed about 150 drugs. Although local pharmacies and wholesalers responded quickly and sympathetically to appeals for help, they soon ran out of many drugs, medications, and other medical supplies . " It didn't take us long to exhaust the local supply," Perez said . "We didn't realize the shortage at first, but it didn't take long to hit. " In short supply were items like collection tubes and needles to draw blood samples from the 1,000 refugees arriving daily . Local stores ran out of baby formula, sunburn creams, and tampons. "We were ordering 30 cases of formula at a time," Perez recalled . Mendieta and Perez arranged to order supplies through the PHS distribution center in Perry Point, MD. By ordering through PHS, pharmacists in Key West and later in Miami could get what they needed quickly and cheaply. Soon, 80-90% of drugs and supplies came through PHS facilities . Once the formulary was set, which took about a week because of the pressure of more immediate tasks, Mendieta phoned Dr. Richard Bertin, the PHS pharmacy branch chief in Washington, DC. Bertin took the list and called the PHS hospital in New Orleans, LA. The first boxes arrived the next day.
At the same time, Mendieta enrolled Navy corpsmen to help build shelves and storage cabinets to hold supplies . This freed floor space for people to move around, allowed some drugs to be locked up, and gave the pharmacy greater order for quicker service. Orange BowlHousing for Thousands In Miami, where Perez was transferred after four days in Key West and where Barry spent one of her two volunteer tours, drug storage areas were similarly disorganized, demands were great, and local and imported volunteers responded fantastically . Refugee facilities were split between the Orange Bowl, where most Cubans were housed, and Opa-Locka airport some 20 miles away, where a processing center was established. Perez and other volunteers set up two pharmacies, one at the Orange Bowl and the other at Opa-Locka . The former was located in the stadium's locker room . As at Key West, the pharmacy shared space with an infirmary. There was no office, and the only telephone was in the middle of the floor . The scene there was hectic, Perez said. Refugees, physicians, nurses, volunteers, and suppliers were going in and out all the time. Young children ran back and forth. With just one phone, Perez had a hard time keeping a line open to call suppliers and receive prescriptions. To add to the confusion, refugees slept on cots and mattresses just a few feet away. At Opa-Locka the pharmacy was both quieter and better organized, Barry said. There, an air-conditioned trailer was used. Only medical personnel and volunteers came in and out. Pharmacists had counter space to work on and shelves to store drugs and medications. Still, Perez had to organize a supply and messenger system. "Often, we needed a drug or medication in Miami that was only at OpaLocka, or vice versa," Perez said. "The physicians and nurses didn't know what was available to them at the other site. We had to do a lot of 43
running back and forth.'' Once, some 500 refugees at the Orange Bowl were suffering from diarrhea. Perez soon ran out of the three brands of antidiarrheals the pharmacy had in stock. He found more of one product at Opa-Locka and made the trip himself to get it. Later, a messenger system was set up. Fourteen-Hour Days In Key West, Mendieta was in and out of the pharmacy all day. On a typical day he might talk to physicians and nurses at the processing center, check supplies at an old sea-
bruises, and gastrointestinal disorders. In the crowded and noisy facilities where they were processed and housed, others got headaches and couldn't sleep. Mendieta spoke of one patient who suffered from myasthenia gravis, a muscle disease. She had been treating it with Prostigmine (neostigmine bromide) for years but hadn't been able to take enough with her. After calling several pharmacies and hospitals, he finally found a wholesaler who had the drug. Usually, the pharmacies were able to stock several alternatives in each category. "We were often able to suggest suitable substitutes when a physician would order a particular drug," Mendieta said. "Two-way communications between physicians and pharmacists were vital."
effort. These pharmacists have spent one or more two- to threeweek tours of duty at the federal resettlement camps at Fort Indiantown Gap, PA; Camp McCoy, WI; and Fort Chaffee, AR; as well as several sites in Florida. Although the situation became less hectic as the flow of refugees slowed, working conditions remained makeshift at best. The drug distribution systems instituted by Zeke Mendieta and others involved at the beginning of the crisis proved to be effective models for use throughout the refugee screening and resettlement program.
Personal Welcome
PHS pharmacist Paul Farrell. plane hangar where refugees were housed, go back to the pharmacy to fill orders, deliver drugs and supplies where needed, pick up deliveries at the bus terminal or airport, and order items like shelving, refrigerators, locks, drug labels, and pencils and paper. Meals were grabbed when one could, often quickly and infrequently, given the 14-hour work days. "We often ate at a fast food place while on a supply run," Mendieta said. "It wasn't what you would call dining." Barry had to rely on peanut butter sandwiches and fruit that she kept in the pharmacy refrigerator. The medical problems facing physicians, nurses, and pharmacists in both Key West and Miami were similar. After a 14-hour or longer ride across water in a small, open boat, many refugees suffered from sunburn, dehydration, cuts and 44
Because they spoke Spanish, the three pharmacists played a personal role welcoming refugees and making them feel at home. Barry, who like Perez was born in Cuba, recalls speaking to a 26-year-old man who had been treated for leprosy in Cuba. She talked to him, located the young man's uncle in Miami, and arranged a meeting with him. "They spent 15 minutes together at the Miami airport before the young man's plane left for New Orleans," Barry recalled. "They embraced as tears flowed down their faces. It was a very touching experience for me.'' As the refugees become settled and establish homes across the United States, the role of pharmacists will not cease, Barry said. Many Cubans have been unable to get drugs and medications because of the U.S. blockade, she said. They will take advantage of their availability here. Pharmacists will have to meet those needs, print labels and instructions in Spanish and English, and explain dosages and potential side effects. Since the original assignments of Mendieta, Barry, and Perez to the Florida area, more than 30 additional PHS pharmacists have volunteered to serve in the Cuban refugee
FDA pharmacologist Estela Barry. Despite the long hours, demanding work, and families left behind, all three pharmacists found the experience personally satisfying. All said they would go back. "I left my bills unpaid at home, ran out of clean clothes, and had my wife wondering whether she would see me again," Perez said. "But it was worth it." "You have to be· compassionate and charitable in this kind of situation," Barry said. "You never know when something like this will happen to you.'' ''There were a lot of very good people helping the refugees," Mendieta added. "We were fortunate to be among the first. I didn't mind the long days so much. I was sufficiently rewarded by having the opportunity to help those people." -Jeffrey P. Cohn American Pharmacy correspondent American Pharmacy Vol. NS20, No. 8, August 1980/468