A Pharmacist's Role in the Relief Efforts in Haiti

ReachMD Announcer:
Next on Reach MD, Voices From American Medicine, featuring perspectives, challenges, and triumphs from medical professionals on the frontlines of health care. Now here's the host of Voices From American Medicine, Frank Russomano.

Frank Russomano:
It's been many years since a tragic earthquake hit Haiti, and the rehabilitation efforts continue. Joining us today is Ro Brual, Pharmacist and Associate Consultant of Medical Education at Eli Lilly and Company. But his special volunteer work and expertise outside the office setting is what brings Ro Brual onto our program today. Ro, welcome to Reach MD and Voices From American Medicine.

Ro Brual:
Thank you, Frank. It's good to be here. Thanks for the invite.

Frank Russomano:
It's great having you. Before we discuss your efforts in Haiti can you tell us a little bit about your background?

Ro Brual:
Sure, Frank. I'm a registered pharmacist and a proud graduate of the University of Cincinnati College of Pharmacy. And right after pharmacy school I joined Eli Lilly and Company as my first and only employer, 27 years.

Frank Russomano:
Wow. It's been a long time. And so your day-to-day work is in the pharmaceutical industry. Can you tell us about your current medical relief efforts in Haiti?

Ro Brual:
Our church in Carmel, Indiana just north of Indianapolis is St. Elizabeth Seton Catholic Church, and Seton has been involved in our Haiti twinning parish program for about 25 years. We've supported a variety of educational and church activities. With Haiti being the poorest country in the Western Hemisphere we supply about 90 percent of the finances for the church.

Frank Russomano:
So when did you start doing that? How long have you been...

Ro Brual:
I got involved in 2003 with our first medical mission where we brought a dozen physicians, pharmacists, nurses because of the lack of health care in Haiti. We had the talent, and the financing, and the passion at our church. So we brought a medical team down, and in the first week we were there we saw about a thousand patients. Many of them had never seen a doctor before.

Frank Russomano:
That's amazing. How long do you stay there? Tell us a little bit about the day-to-day activities while you're in Haiti.

Ro Brual:
Typically we're there for a week, sometimes a little bit longer. We bring a mission team with several dozen duffle bags full of medication, full of supplies. Our sister parish, St. Genevieve Catholic Church in Duval, Haiti is about 20 miles east of Port-au-Prince. It takes a couple hours because of the mountainous winding roads. We set up our clinic right there at the church and start seeing patients after we set up. And our church also has eight chapels spread across a mountain range where we also set up clinics at these remote chapels on various days when we're in Haiti.

Frank Russomano:
So where do the supplies come from? How are you able to gather up the supplies that you take down to the island?

Ro Brual:
We procure various medications and medical supplies from charitable organizations such as Catholic Medical Missions Board, AmeriCares, Blessings International. These organizations get donations from pharmaceutical companies, medical companies, and then we apply for grants to get free medicine and free medical supplies to bring down to Haiti.

Frank Russomano:
That's terrific. And given the current status of medical care in Haiti, are you able to leave supplies behind for the practitioners that are on the island?

Ro Brual:
Absolutely. In fact after our first medical mission in 2003 we realized that we were just a Band-Aid approach, coming every six to 12 months. There was no follow-up care. So it took a couple years, but we raised enough funds at our church to actually build a clinic and a pharmacy, and we hire a full-time nurse that lives at our sister parish that sees patients every day.

Frank Russomano:
That's terrific. It's wonderful that progress is being made. In 2010 when the earthquake hit Haiti your efforts changed a bit. Can you tell us a little bit about that?

Ro Brual:
Yes. Unfortunately that was a very, very tragic day because at our sister parish both the school and the church collapsed, with one of our good friends passing away in the earthquake, who maintained the parish. So our first effort was to rebuild the rectory and to rebuild the church. The good thing is, the clinic remained intact and was able to see patients, and it really turned into more of an ER, Frank, than a clinic. Because with that being the only health care resource in that mountain region it was literally a MASH type unit for several weeks after the earthquake.

Frank Russomano:
What are the primary medical issues that you're dealing with when you're there since the earthquake, and how are you able to take care of those issues?

Ro Brual:
There's a lot of acute infections in Haiti, particularly because of the water supply, so we treat a lot of GI infections. We actually have a clean water program where we have a water filtration system set up throughout the parish. And for long-term illnesses, hypertension is very prevalent in Haiti, mainly because a lot of the meats and a lot of the foods they have need to be preserved in salt.

So the incidence of hypertension is very high. So we truly have hypertension clinics where folks get their blood pressure checked every month and then get one to two months' worth of medication, and they're encouraged of course to come back for routine blood pressure checks.

Frank Russomano:
That's great stuff. Can you tell us a little bit about the progress that you've made since 2010?

Ro Brual:
The biggest progress is probably our clean water program. We have about half the parish that has water filtration units. Our big goal the next year or so is to bring this water filtration program, it's called the Gift of Water, it's a charitable organization based out of Miami, our goal is to bring the Gift of Water out to the rest of the parish. Because once they have clean water then you feel better, you can do more work, the kids do better in school, because they don't have the GI problems.

Frank Russomano:
So the amount of time that you've spent there, Ro, I imagine that you've made some friends and you've witnessed real individual impact from the work that you've done there. Can you tell us a little bit about that?

Ro Brual:
That's one of the most rewarding things, Frank, is the parishioners that I've seen grown up. We have translators that go with us to our medical clinics because myself and the other physicians, nurses, and pharmacists aren't fluent in Haitian Creole. However there are several young men that learned English in school or learned English in orphanages, and they've come back to the parish and they work with the parish, and in some cases for the parish.

And they're our translators, and it's neat seeing them as grade school or high school boys, now a couple of them have graduated from colleges. A couple of them are engineers or other professions in their daytime jobs, and they come back when we're in Haiti to help out their fellow people in the parish.

Frank Russomano:
If you're just tuning in you're listening to Voices From American Medicine on Reach MD. I'm your host Frank Russomano, and joining me today is Ro Brual. Ro, can you share a couple of success stories that you've personally witnessed in Haiti?

Ro Brual:
Several years ago we brought down a dental mission team which was quite an effort because dental equipment is four or five times the amount to bring down compared to medical supplies for a medical mission. We had to bring chairs, we had to bring generators to run the suction. We actually used shop vacs that were modified to use as suction. We had to do cold sterilization for dental instruments.

And in a week's time the dental mission team pulled about 500 teeth total. A lot of them were root tips where folks lost their tooth many years ago. But to see someone getting their tooth pulled after years in pain, it was instant relief and instant joy, and the smiles on their faces was just fantastic. We haven't done a dental mission since, mainly because of the volunteers that are needed for that. We needed several dentists, several hygienists, and one oral surgeon. But that's certainly in our goal down the road.

Frank Russomano:
That's wonderful. That's got to be a great feeling. So Ro, you mentioned that you're bringing medical supplies to Haiti. For the benefit of our listeners, what's the greatest need in terms of supplies or goods that might be helpful to accomplish the mission?

Ro Brual:
Despite all our efforts in getting clean water, there are still a lot of GI infections. To get the appropriate amount of any worm medication for a large medical mission is sometimes challenging. Sometimes there's shortages in the donation supply, sometimes we have to purchase it if there's not any donations available. So any worm medication is a big need. As I mentioned before, hypertension is very prevalent in Haiti because of the diet that's very high in sodium.

Getting the appropriate amount of any hypertensives, which includes of course beta blockers, _____ (10:14), ACE inhibitors, and having a consistent supply for folks to get refills on a monthly basis is sometimes challenging. We don't like to switch medications too much, especially if they're doing well on therapy, so getting the right medication for a long period of time for these patients is certainly a challenge with procuring donations.

Frank Russomano:
You've mentioned you were able to get to a thousand patients in a week. That's only a small portion of the population in Haiti. How do you see others getting care in Haiti?

Ro Brual:
Fortunately there are other mission teams that go down to Haiti with all the various churches. Because up in the mountains, Frank, there is no health care outside of these church clinics or church mission teams. That's why it's important that folks locally are hearing this and feel inspired or motivated, and they know of a fellow health care professional that works on a medical mission team at their church or a local charitable organization. By all means go ahead and support them.

You don't have to go down to Haiti. That's not made for everyone, because it's hard work, and if you don't like camping you won't like traveling to Haiti. But certainly you can support them with donations, in procuring medication, and making connections, getting contacts for folks to get the resources or to even donate frequent flyer miles to help out their fellow mission team to countries like Haiti or other third world countries around the world.

Frank Russomano:
That's great news, that there's so much volunteer work going on to help. So what's next on the horizon for your medical mission?

Ro Brual:
We also support, Frank, a hospital in Port-au-Prince called Hospital St. Joseph. It's a Catholic hospital in downtown Port-au-Prince, and we recently purchased them two big generators because when the electricity would go out they needed better generators, especially if someone is in surgery. Those generators need maintaining. We want to help build another wing at the hospital.

One thing that's near and dear to my heart, dialysis care is pretty sparse in Haiti. Hospital St. Joseph is building a new dialysis unit, and they're going to name that after my father, who passed away a couple years ago. He was a physician, and they're going to name the dialysis unit the Rolando Brual, MD Memorial Dialysis Center.

Frank Russomano:
That's great. You must be very proud of that.

Ro Brual:
Yes I am, Frank.

Frank Russomano:
I'm sure our listeners are very grateful for the work you do in helping the people in Haiti. Any final thoughts for our listeners on how they can help even if they can't personally participate in a medical mission?

Ro Brual:
If folks listening to this program are motivated or are inspired to help I would encourage them to start locally at their local church or charitable organization, because you'll be surprised, there's a lot of mission teams that not only go to Haiti but to other third world countries. These organizations need help in donations, in packing, procuring meds, picking up donations or medical supplies. There are many ways to help in addition to going to Haiti or other third world countries. So I would encourage folks to start locally and think globally.

Frank Russomano:
Ro, thank you so much for being with us today and for sharing your experiences regarding your relief efforts in Haiti. We appreciate you being on the show and appreciate all the hard work that you're putting in to help those individuals.

Ro Brual:
Thank you Frank. It was a pleasure to be here.

ReachMD Announcer:
You've been listening to Voices From American Medicine, featuring perspectives, challenges, and triumphs for medical professionals on the front lines of health care. Voices From American Medicine is hosted by Frank Russomano. And to access this program and others in this series please visit us at reachmd.com/voices.