This post is written by Dr. Jenny Truong, a community pharmacist in the United States. She works in one the most ethnically diverse cities in America – which also happens to be one of her state’s lowest-income areas. These two characteristics provide unique challenges in community healthcare, especially during our current pandemic. To see how she continues to educate and inform patients, you can find her on Instagram @jennyqpm.
In medicine, a physician’s role is to diagnose, to examine and assess a patient with the ultimate goal of saying “aha, it was an infection all along!”
Following diagnosis, a pharmacist’s job is to tailor, to scrutinize and evaluate a prescription with the ultimate goal of saying, “aha, this is the best antibiotic for the job!”
Whether in a hospital or community chain (for example, your local CVS, Walgreens, or Boots), a pharmacist always aims to optimize treatment. However, this is not always possible in the United States. As the United States does not provide universal healthcare, pharmacists are often the only accessible providers in lower-income neighborhoods.
I work in an interesting neighborhood, one of the three most diverse cities in America, as well as one of the poorest cities in California. I’m no stranger to working with a language barrier, but the recent pandemic has spawned new challenges for an already-struggling community. Part of the problem lies in the disjointed supply of information. California’s coronavirus website has multiple language options, which is essential considering our huge Hispanic and Asian communities. However, the alternate languages are auto-translations via Google which can be clunky and inaccurate. Most states either rely on Google Translate, or do not offer translations at all.
The majority of my patients speak Spanish. I’ve studied Spanish since age fourteen, and even took medical Spanish classes during pharmacy school, but a textbook can only teach you so much. Most textbooks don’t include an appendix for what to say when an international pandemic arises and you have to politely tell a patient their lupus medication is out of stock for the next three weeks. Then again, most textbooks don’t anticipate a Twitter frenzy to trigger a nationwide drug-shortage of an almost century-old medication.
Hydroxychloroquine has anti-inflammatory properties, which means it reduces swelling and irritation. It is commonly used for patients with arthritis (who have swollen joints) or lupus (in which a patient’s immune system attacks its own tissues and causes severe inflammation). For these patients, hydroxychloroquine or similar medications must be taken consistently. Patients can last a few days without the medication as it lingers in the body, but ultimately their chronic condition will require additional doses. When small trials found a chance of success with hydroxychloroquine (which has since been discredited), everyone began trying to order it. The media frenzy, coupled with the panic of patients, led to skyrocketing demands over a medication most people had never known.
What I find most challenging though, is how to help people who are trying, but just misinformed. Usually thanks to relatives and available translated materials, patients have a rough idea of what they should be doing – using masks, practicing social distancing, and sanitizing frequently. However, sometimes there is confusion over cleaning and preventing the viral spread. Many times someone will buy hydrogen peroxide just because it is sold next to rubbing alcohol in the first aid aisle.
Ultimately, people think they are protecting themselves and others, but in actuality are using the wrong products and receiving minimal benefit for their efforts. These people usually relax the measures that we know work (masks, social distancing, etc) because they think they have reduced their risk, and unintentionally increase their chance of coronavirus infection in the process. Hydrogen peroxide was never meant to be a cleaning product; it was meant to be a mild sanitizer to dab onto small cuts. It will never be as strong as rubbing alcohol because it was meant to clean human skin, not stainless steel.
Explaining this to patients can be difficult. With constant news updates and our current president’s love of Twitter, misinformation spreads overnight. Coronavirus research is much more complicated, and the whole truth often does not fit into easy-to-spread sound bites. Every lab, every pharmaceutical company, every hospital out there is searching for a solution. Everyone reports their findings as soon as possible in a race against the death toll, but all this information can become overwhelming for patients, especially those who are not native English speakers.
To my patients, and my readers, I try to clarify our situation with the concept of best practice. In the healthcare field, best practice means providing the best care you can with the current knowledge you have. Use what you know will work (masks to prevent transmission, cleaning to prevent contamination), and evaluate your options to see what has the highest chance of success (select your antiviral meds very carefully!).
At the end of the day, we are providing the best our professions can give. Trust us to do the best we can, and please continue trying your best to learn and critique the information you consume. My Spanish is limited, but my willingness to educate is not.
Todo estará bien. Everything will be okay.