COVID-19. Pharmacists on the frontlines. COVID-19 and our rural community

As Dickens wrote "It was the best of times, it was the worst of times...".  Well, certainly the worst part is easy to see and hear...every day in our stores, on the faces of our employees and patients and on the news and in social media.  But for many of us still out there working, things haven't changed so much...I still get up early every day, run with my dogs, work all day, go home and spend the evening with my husband, rinse and repeat. 

But things ARE different.  I'm not sleeping much and working at the store every day since it makes the staff feel better when I am there. I'm exhausted. I haven't seen my children in over a month - and FaceTime is just not the same. And I worry. I’m not normally a worrier but I worry about my staff, their health and mental wellbeing. I have one with respiratory issues and one with very severe contact allergies so all the sanitizing is particularly hard on her. Another broke down and cried in the pharmacy from the stress and I had to put physical distancing aside for a simple hug.  

I worry for my customers.  According to Statistics Canada, Westport has the oldest demographic in Ontario. We have tons of snowbirds and now despite provincial decree, we have people coming here to open their cottages.  Not that we don't want to welcome them but they make us nervous since if they are willing to disregard this edict, what other measures are they likewise not following? Plus, they strain our very limited resources especially at this time of year when we are not prepared for their very early arrival. 

I worry that my seniors are not properly isolating themselves from each other and putting themselves and others at risk. I feel more like the police every day than I do a pharmacist. “Where have you been and who have you been in contact with”?  I worry about the business. I have nothing for sale that anyone wants…you know, the by now familiar list…hand sanitizer, toilet paper, masks, gloves, Lysol wipes, alcohol, thermometers, aloe, glycerin. And I think sales are down because the store feels empty all the time but they aren’t really that much when I run the numbers – so of course I won’t qualify for any government financial aid.

I worry about the other businesses which make up my village. Will they be able to survive this? If not, will I eventually without them? Many of us struggle through the winter months on our profits from the summer. What if we don't get a summer season this year? I fear many won't survive an additional winter without income from this summer. And if they don't, will I?

But I'm not complaining and things for me are much better than they are for some, and even for most. My staff come to work every day despite their anxiety and do their utmost to serve those who come in or call.

And in our little village, we have seen some amazing things and tremendous collaboration. Very early on, one of our pastors initiated and mobilized a group of volunteers to do home delivery of groceries and pharmacy items supporting the two major essential services in our community. We had a lot of gloves donated from the community - everyone seems to have a partial pack in their garage – and the local kids’ summer camp on the lake donated their entire inventory. So, we have lots of gloves.

Masks have been donated too and our hardware store also kept me some. I supply the post office and the restaurant with 70% alcohol, my homemade sanitizer and gloves.  The grocery store keeps me Lysol wipes when they get them. The owner smuggles them to me in a banana box so no one knows he has them – they’ve become more precious than our deposit to the bank!

I was lucky to get 99% alcohol from our local printer – used to clean his now unused printing presses.  I then unexpectedly got my summer pre-book order and in it was Aloe Vera – and just like that, hand sanitizer was born. Who knew that would be a skill I would develop? We sell it and the proceeds we donate to our local food bank. Still haven’t received a single roll of toilet paper from our supplier in nearly a month. Thank God one of my staff thought to pack away a package for each of the staff and for the store when this all happened! 

Similar to all our inventory of PPE. We packed it away for our own use early on. Now that the store is closed off and entry is by pre-screening only, our risk is less, the need for PPE is less and staff anxiety is much lower. And customers like it. They feel they are getting a safe, personal shopping experience. Basket size is up as they buy more on each of their fewer trips.  I won't complain about the lack of PPE for pharmacists. All PPE is going to hospital where it should go. Our medical clinic is not getting any either.  They are 50 gowns away from closing. 

But again, with proper screening and telephone pre-consultation, their need has decreased. This week I will receive a box of masks which I will immediately donate to our clinic. I worry for Personal Care Workers who are out in physical contact with people and the people working at gas stations, restaurants, hardware stores and the Tim Horton's drive thru – they are also working on the front lines with no PPE and no hopes of getting any either but in some ways with also less ability to stay safe. So, I won’t complain. 

I worry for my son who works in patient transport. He is in and out of every hospital in the GTA as well as delivering people to their homes. He is at great risk and I am glad that the hospital gives him or the patient additional PPE when he needs it for a transport. I am happy to have all my PPE diverted there, to those who need it much more than I. Your risk can be minimized by making the recommended changes to your practice environment. Along those lines, we made the decision to close our ServiceOntario kiosk located within the pharmacy - which had started bringing in lots of people from outside our community – and that decision too has tremendously improved staff's mental wellbeing and minimized risk. I've seen great things of our business community. Many collaborating with each other on initiatives they can do to maintain some sales and the whole community is supporting our local restaurants. The local grocer added us to his webpage so we could piggyback pharmacy orders with his grocery delivery helping us keep our front shop alive. I was invited to join a group of our local leaders for weekly status meetings. Representation by the medical clinic, grocery, mayor, pastor, volunteer coordinator, etc... .this group has been instrumental in keeping each other in the loop on what is happening in the village, what is of concern, what is going well. Last week there was the suggestion that since this forum is so productive that it should continue even once this is all over. And our customers, our wonderful customers, are so very supportive and thank us at every single visit.  So, opportunity is everywhere and so in these ways, it has become the best of times bringing out the best in people.

And on the advocacy front, in my spare time, I am trying to move our scope of practice forward faster through the Emergency Act with the support of our mayor and local MPP and suggesting an alternate mechanism for financial relief of us and physicians (who btw are also independent business people whose revenue has been cut or eliminated due to closures or practice restrictions) to suspend the current ODB remittance clawbacks, and I am writing our local Medical Officer of Health to better appreciate the role pharmacists are playing during this pandemic and will play in our post-COVID19 health reality. 

When this is all over and things return to normal, will you look back at the things you did, the messages you sent, the posts to social media you made and will you be proud of the things you did and said? Will you have been the leader your staff, your patients and your community needed you to be? It's not too late to make that difference now.  There are several quotes about how adversity brings out character and defines leaders.  What kind of leader are you?

Tracey Phillips, B.Sc.Phm MBA, is owner-president of Westport Village Pharmacy in Westport, ON.