Loren Bonner
After deadly wildfires ripped through Lahaina, located on the western edge of Maui, pharmacists quickly mobilized to get displaced residents their medications.
The fires left over 2,200 buildings damaged in Lahaina. More than 5,000 people were displaced, and most lost everything. Hawai’i Governor Josh Green described the fires as likely the “largest natural disaster in Hawai’i’s state history.”
After the acute care needs of the wildfire victims were addressed, a select group of pharmacists—including those from Kaiser Permanente, the Veterans Health Administration, and an independent pharmacy—were allowed to come into the area. It was apparent to everyone that one of the greatest medical needs would be getting people their medications.
“I’d say by day two we were trying to get meds to people—the critical ones at first,” said Ross Takara, PharmD, executive director for the pharmacy department at Kaiser Permanente in Honolulu. Kaiser’s main location for Hawai’i is in Honolulu, but they operate Maui Health System on the island of Maui, as well as several clinics, with pharmacies, on Maui. Their clinic in Lahaina burned down and was completely destroyed.
Crystal Tsuda, PharmD, a pharmacy manager at Kaiser Permanente in Honolulu, was physically on the ground in Lahaina working with providers to get people, who were being housed in temporary shelters, their medications.
Because Kaiser is an integrated health system, Tsuda could access patients’ records on file to look up their medications and dosages. But during the initial crisis phase, she was helping non-Kaiser members as well.
“For the rest of the community—the non-Kaiser members—the doctors on the ground were trying to do their best to figure out what dose to give them, to at least get them some meds in the interim. It was difficult, but patients were grateful,” said Tsuda.
Since cell towers had burned down, getting any kind of signal was nearly impossible and made communication hard. Physicians were handwriting prescriptions. Medications were fulfilled outside of Lahaina, and Tsuda and her team needed rental cars to go back and forth to deliver the medications.
Ayman Alholail, PharmD, a Veterans Affairs pharmacist based in Maui, was also on the ground in Maui getting medications to the veteran population.
“As soon as we got word of fires, we pulled everyone in our system with a Lahaina-based address and tried to figure out how we could get medications to them,” said Alholail. “I can also prescribe independently and that was so helpful in streamlining the process of getting veterans their medications.”
“Since phone lines were down, we’d advertise that the VA will be here at this location at this time,” said Alholail. But that didn’t work for everyone. Alholail had to track some patients down and meet them somewhere—sometimes that was at a relief station, but in some cases, he had to deliver medications right to a patient’s door.
With only two VA pharmacists on Maui, Alholai focused on medication distribution on the ground while the other pharmacist remained in the VA clinic.
An independent pharmacy is perfectly positioned
CVS and Walgreens were part of the initial response team to help expand telehealth processing from the mainland, according to Corrie Sanders, PharmD, president of the Hawai’i Pharmacists Association (HPhA).
But, in fact, an independent community pharmacy—Mauliola Pharmacy in nearby Wailuku—became the most essential pharmacy to help those in need.
“We were part of the initial response—not necessarily by choice but because the primary shelter is literally across the street from our flagship pharmacy,” said Corey Lehano, PharmD, owner of Mauliola Pharmacy, which has two locations in Wailuku. Most temporary shelters—including the main one called War Memorial—were located in Wailuku.
“Everything was being worked out of the War Memorial gym those initial 12 hours. When we first arrived, it was just a lot of volunteers and medical professionals. It was chaotic and intense,” said Lehano. “A lot of providers were there but there was no workflow or system. They were writing paper scripts, but there was no one to fill them and no way for the patients to get to the pharmacies. That’s where we started.”
Lehano said they were perfectly set up to meet the needs of the community.
“We already had free delivery service, people trained to deliver medications, and a workflow already in place,” he said. “We were able to utilize both our sites in town and were tag teaming to get things done.”
His team performed medication reconciliation for patients the first couple of days.
“At one point, I had three to four pharmacists doing med rec and calling pharmacies and providers and from there acquiring orders to fill for them,” said Lehano.
Over time, bigger organizations stepped in and Lehano handed off the service to them and moved on to what else was needed for patients. Lehano’s staff began point-of-care testing next, bringing the service to patients because their CLIA-waived laboratory is registered as a mobile lab. Most recently, Lehano has been asked to help facilitate and coordinate education classes to train culturally competent behavioral health specialists as wildfire victims struggle with mental health care needs in the aftermath.
Through an emergency proclamation signed by Hawai’i’s governor, a mobile clinic with a pharmacy was set up in Lahaina weeks after the wildfire hit. Displaced patients, who have moved to temporary housing in resorts, are shuttled back and forth to the clinic to get their medications.
Hawai’ian culture
Lehano noted that one of their state senators said something that has stuck with him: “Often times in a disaster, one of the things that is overlooked are all the casualties that occur after the immediate disaster due to medications or things like that. She said she didn’t hear any of that.”
“I think that’s a testament to the collective partnerships and networks that were created over this short period of time to support the immediate and now long-term needs,” said Lehano.
Tsuda from Kaiser noted that even though the wildfires occurred on the island of Maui, the entire state of Hawai’i came together.
“Everybody stepped in and that just reflects our culture,” she said. “You also have to understand that to help out another island you have to fly everything in.”
Or get it over by jet ski or boat—as Jodi Lyn Nishida, PharmD, noticed in the immediate aftermath.
“People from other parts of Maui as well as neighboring islands pooled their resources to get people what they needed,” said Nishida. “This is Hawai’ian culture—we take care of our own.”
Nishida, who is the founder of a keto-based diet medical practice, helped by cooking, preparing, and shipping meals to those displaced in Lahaina.
Sander from HPhA said she has never seen so many pharmacists from various groups come together. On a daily basis, she said, pharmacists and leaders spoke by phone to figure out the logistics of getting medications to displaced residents.
“I have never seen anything where in such a short amount of time, you have pharmacists from every avenue of practice all moving collectively together to get patients care,” she said. “We had drug suppliers on those calls asking how they could get manufacturers’ drug donations—it was everything from drug supply to regulations to how do we get this to Corey [Lehano].”
For Lehano, this whole experience reminded him of the depths he’d go for his community.
“As a pharmacy we will live and die by the community,” he said. “If we are not there for them, it doesn’t make sense for us to operate.” ■