2016

What a year.  It took several celebrities from us, but fortunately the great Betty White is still with us.  The Cubs ended their drought.  It was the year of the "epic" sports collapses.  It finally found me with a real job.  It was my first calendar year without a trip to Haiti.  And speaking of epic collapses, 2016 gave us Donald Trump.  #NoComment.  #EndParagraph

Judging by my social media pages and WhatsApp threads people were ready for 2016 to end and 2017 to return.  Every time the calendar turns over a sense of renewal breathes life where there may have been stagnation, anger or frustration.  For me it saw a return to Haiti! #Overdue  It also saw me take on a larger role in one of the NGOs I’ve been fortunate enough to Serve with in Haiti #ServeHaiti #SeeWhatIDidThere  But, in my new role, I was quickly made aware that the transition to 2017 also meant one other thing: countless medications in the clinic’s pharmacy were now obviously expired and would likely have to be discarded.

I get it, no one wants to take ‘expired’ anything.  No one wants to feel like they are second class, or worse.  Can you imagine what would happen if you peeped your prescription from Walgreens - the same one that just cost $300 - and it was past the expiration date?  If your answer wasn’t #FlipShit then you’re lying.  Unfortunately, that’s more the norm in Haiti than I’d care to admit.  Personally, I’ll pitch my milk a day or so after the expiration passes, but pert near anything else it’s gotta be obviously rancid before I’ll waste it.  I think I have some leftover Augmentin from before I moved to Wichita that I wouldn’t be opposed to taking if I thought it was indicated #EveryPharmacistJustShuddered #AntibioticStewardshipAtItsFinest

In Haiti, these men, women and children hike for hours, pay cash that they’ve saved up for God knows how long, and then they are often handed medication that is past its expiration date or close.  So, as the new U.S. based Medical Director I get to decide what’s ethical regarding dispensing policies.  On the one hand, I hate to see what are probably perfectly good medications burned.  On the other, how can you say you value a population if you constantly treat them like a second class citizen?

Donated meds also make for a very difficult ethical dilemma.  The best part about donated meds?  They are often the cutting edge treatments because they come out of sample closets.  The downside?  Their so novel that most physicians don't really know how to utilize them.  They are often used infrequently.  And they aren't sustainable because once that small supply runs out, we certainly can't afford to pay the premium price for a new medication.  Meds from pharmacies and hospitals are awesome.  They are a marker that people are willing to give what they can for a cause.  However, these are often short dated, so must be used shortly after delivery.  Ideally, we develop a semi-structured formulary and purchase from wholesaling companies on a regular basis and use donations to fill in certain gaps.  The first step to that is identifying what is on the shelves, what you need and then what needs to go.

Fortunately,  some amazing people have been working in the pharmacy to help with the purge #TrueOfAllPharmaciesReally.  Old doesn’t begin to describe some of the medications they found.  I’m talking meds that expired before I became a doctor.  This also meant several bottles of very practical medications barely beyond their expiration date found the flames.  I don’t remember the last time I cared for a patient in Wichita that wasn’t on atorvastatin, clopidogrel and pantoprazole.  That’s slight hyperbole… but anyone that prescribes in a hospital knows it isn’t far from truth.  Anyways… #FireEmoji 

In some instances, we valued availability over “quality” in some cases.  If we only have 10 vials of a particular IV antibiotic but they are all “expired” should we really discard them?  Again, if it were me as a patient I would take an expired medication over no medication in a heartbeat.  As an American, I doubt that I will ever have to make that choice.  #LandOfTheFreeHomeOfTheWellMedicated. 

So 2017 is here and the old meds are out.  I suppose the purge is symbolic of the renewal of the pharmacy and clinical practice in Gran Bois as much as a New Year’s resolution is for most people.  It’s a promise going forward to be better stewards and distributors of effective medication.  Fortunately, it's not like someone is going to come back to this post in five years and check our inventory in the pharmacy.