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More Than Words

Confronting Racial Injustice

A Multipart Series

Confronting Racial Injustice
More Than Words
AACP’s Actions to Move the Academy Forward

Pharmacy schools are putting action behind commitments to diversity and inclusion to serve and support communities.

By Athena Ponushis

After the killing of George Floyd, Dr. Toyin Tofade, dean and tenured professor at Howard University College of Pharmacy, emailed students and faculty acknowledging what had happened. Her community wrote back. Acknowledgment was not enough. They needed their dean to voice her own emotions, opinions and outrage to validate their feelings of anger and grief. They needed her to publicly process her emotions to help them in their process, so Tofade wrote a more personal email, attempting to channel the passion of the moment into positive action. It resonated.

“We must act by showing that we are here to lead, we are here to learn and we are here to serve,” she wrote. “We the faculty must act by intensifying our efforts to build a cadre of strong pharmacy graduates who will take up notable positions in society…I believe it is in those positions of influence that we—faculty, staff, alumni and students—can collectively change minds, share truths and reframe systems.”

Tofade held a virtual town hall with students. She asked them, ‘How can we support you?’ They asked her, ‘What do we do when we are hit with tear gas? What are the antidotes to it?’ A fourth-year student on the call who was in a toxicology rotation had researched how to treat exposure to tear gas. He shared the treatments he had found. Tofade told the students they were brave. She was transparent about her life experience: she had never protested, she immigrated into the United States from Africa, she did not descend from an ancestry of slavery. She listened to the students but did not pretend to be an expert or try to offer explanations. She simply gave them space to speak, and later circulated information to students about how to treat tear gas injuries.

Tofade also held a meeting with faculty and brought in a counselor. She led by saying thank you for working while you are home-schooling your children, thank you for working while you are caring for your families. Individuals who usually remained quiet opened up. The cathartic experience drew the faculty closer together.

Just as colleges need guidance and engagement from their deans, communities need their institutions to be deliberate and involved. Pharmacy schools are committing to outreach as the nation grapples with systemic racism and a public health crisis, working to advance pharmacy and diversity, build trust with their communities and clear misperceptions. These steps speak to the heart of Tofade’s message: change minds and change structures, starting with community.

“Schools must go out and adopt a community,” Tofade said, “make up their minds that they are going to consistently go to a community, learn and grow, not just do the touch and go, ‘I did this last year, so I’m good.’ No. Adopt a community, be consistent with your service, learn and see how else you might serve.”

Taking Action

During Tofade’s tenure as dean, the college has grown international rotation partnerships from five in 2016 to 17 rotation sites and more than doubled internship opportunities. She worked with a team to design a contemporary exchange program focused on diversity with the University of Wyoming School of Pharmacy where Howard students visit Wyoming in the winter—exposing them to rural, critical access hospitals—and Wyoming students travel to Washington, D.C., in the spring, allowing them to see inner-city healthcare systems and meet with congressional leaders.

“Our Health Equity Leadership Program has been transformational for students who grew up in predominantly white or mostly Black communities. They are able to see urban and rural health disparities, have honest conversations around assumptions and say, ‘This is what I used to think but this is what I think now.’ I think that is just beautiful,” Tofade said. She encourages schools that do not have large minority populations on campus to partner with minority schools, embark on research together and create an experiential exchange. “Those are the kinds of things that build community among us as beings.”

Closer to home, Tofade suggests that schools build a community presence through focus groups, assembling community leaders and inviting them to speak to let the community tell the school how they want them to be involved. “Sometimes we think we know what they need, but they are the ones who can tell us what they need. ‘We are here to serve you. How can we serve you?’ Those are simple questions but start from there,” Tofade said. “Start with humility and you will be surprised what might show up.”

Serving their community this summer, eight Howard student pharmacists volunteered more than 100 hours working from space in a hotel to provide COVID-19 emergency medication management services for more than 250 homeless patients. The Capitol City Pharmacy Medical Reserve Corps, based at Howard’s College of Pharmacy, partnered with the D.C. Department of Human Services, community health centers and an independent pharmacy to provide the vital service. Students provided medication counseling by phone, then delivered medications to patients. Students also ran a COVID-19 testing clinic in the basement of a church in an underserved area of D.C., testing nearly 400 people in two months.

The University of Texas at Austin College of Pharmacy, 2020 recipient of the Lawrence C. Weaver Transformative Community Service Award, has started an interprofessional initiative that responds to community needs. During the yearlong capstone program in the P3 year, students are assigned to teams, teams are assigned to community organizations and the organizations identify health-related issues for the students to address. Organizations range from Federally Qualified Health Centers (FQHC) to food banks to the Central Texas chapter of the National Alliance for the Mentally Ill (NAMI) to the Austin Parks and Recreation Department. With guidance from faculty members, student teams work with organizations to implement solutions to health-related issues.

“We’ve been doing this program two years now, and through it, our students have indirectly touched over half a million lives,” said Dr. Lynn Crismon, dean, James T. Doluisio Regents Chair and Behrens Centennial Professor at UT Austin College of Pharmacy. Working with the largest FQHC in the county, students designed an outreach program to follow up with patients and improve prescription refill rates. Working with elementary schools, students developed a nutrition curriculum to combat childhood obesity. When NAMI identified the difficulty of keeping in contact with individuals who were discharged from psychiatric hospitals, students worked with hospitals to connect discharged patients with NAMI’s support groups.

Following Through on Diversity

Crismon recognizes that schools must improve the pipeline if they are going to significantly increase the number of underrepresented minorities on campus, and if there’s no pool to draw from, they have to create the pool. Working to grow diversity and ensure a clear representation of different individuals, experiences and perspectives at his college, Crismon approved a Grow Our Own Pipeline initiative and a Scaffolding Success for Future Scientists program this year. “Another thing we did this year, and it was not without some controversy, we made the PCAT optional and we did that because all the evidence suggests that standardized exams are culturally biased. If we expect to use a holistic admissions process and increase our numbers of underrepresented minority students, I felt like it was the right thing to do,” Crismon explained. “I asked our admissions committee to study it, and again, it was not unanimous, but they decided to make it optional. Now it’s up to the students whether the exam is used in their reviews, with the intention only to help them, not hurt them.”

Dr. Skyller Walkes, assistant dean for Diversity, Equity, Accessibility and Inclusion at UT Austin College of Pharmacy, designed the Scaffolding Success for Future Scientists program in partnership with the Austin school district. Working with three schools—elementary, middle and high school—the program will expose students to STEM (specifically health sciences) and build a mentoring program, bringing student pharmacists into the community to cultivate a diverse talent pool and usher potential pharmacists through the pipeline.

It’s way too easy to get stuck in what we are doing right as a defense for how we don’t need to grow, or why we are good where we are, or we’ve always done it this way. When I hear that phrase I want to run. A lot of people hold on to that for dear life. I think that’s attached to the discomfort we can feel around change, but it also speaks to me of ego, and if you’re operating from a place of ego, you’re actually operating in opposition to change.

Dr. Skyller Walkes

“One of the things that I desperately wanted to diminish was the ‘town and gown culture,’ where UT Austin is seen as the ‘them’ and the community members are seen as the ‘us,’ or the inverse. I think that is incredibly problematic for a lot of reasons,” Walkes said. “Historically, that culture has created a chasm where a lot of community members don’t see UT as a place for them, they don’t always feel welcomed and certainly don’t feel that it is a part of the community. I wanted us to diminish that, but I also wanted us to create a very intentional way to work with learners as young as kindergarteners to expose them to pharmacy as a profession.”

To deans who are serious about activating transformation and advancing diversity, equity, accessibility and inclusion, Walkes said, “You have to do a brutally honest self-assessment. You need to know who you are. A lot of times institutions and organizations know who they want to be, but who folks aspire to be is not necessarily who they are in the present, so the first thing you have to do is assess your organization.”

Second, leave ego at the door. “One of the things that I say when I do presentations or speak to my colleagues is, ‘This is actually not a safe space. This is a courageous space, but it is not a safe place,’ because I believe people have started to misinterpret safe space as a space absent of discomfort, and if you’re really doing the work, it should be uncomfortable,” Walkes pointed out. “What diversity, equity, accessibility and inclusion work is not is always self-affirming. It’s way too easy to get stuck in what we are doing right as a defense for how we don’t need to grow, or why we are good where we are, or we’ve always done it this way. When I hear that phrase I want to run. A lot of people hold on to that for dear life. I think that’s attached to the discomfort we can feel around change, but it also speaks to me of ego, and if you’re operating from a place of ego, you’re actually operating in opposition to change.”

Finally, deans have to be comfortable with being uncomfortable and with being disruptors to transform the space into a more inclusive one. “You cannot be risk averse around this work,” Walkes said. “You have to be willing to have courageous conversations and do the work.”

Our Health Equity Leadership Program has been transformational for students who grew up in predominantly white or mostly Black communities. They are able to see urban and rural health disparities, have honest conversations around assumptions and say, ‘This is what I used to think but this is what I think now’…Those are the kinds of things that build community among us as beings.

Dr. Toyin Tofade

A Stronger Community

Situated in a rural, medically underserved area with a health profession shortage, the Ohio Northern University College of Pharmacy created a mobile health clinic to address the region’s health needs and earned the 2019 Weaver award for transformative community service. “Many people in our community don’t have a primary care provider because we just don’t have very many of them in our county,” said Dr. Steve Martin, dean and professor at ONU’s College of Pharmacy. “We offer entry into the healthcare system through our mobile clinic—that’s the anchor piece for all we have done in our community.”

The clinic started in 2015, with students going to community centers, schools and churches to provide care. In late 2016, the school purchased a 38-foot vehicle (thanks to philanthropic funds) and converted it into a mobile health clinic that can go anywhere.

Students provide direct patient care, identify and refer patients who need specialty care and coordinate social services to address social determinants of health. The school also opened a community pharmacy, which pairs well with the mobile clinic. Students deliver medications throughout the area, as nearly half of the adult population lacks transportation.

“We did a health needs assessment for our county, then we took a 10-year time horizon and said, ‘How can we change the health of our community?’” Martin recalled. Now they are starting to see the fruits of their labor with improvements in immunization rates, diagnosis and treatment of diabetes, diagnosis and treatment of hypertension, as well as smoking cessation success.

“Our students are required to engage in 50 health-related service hours. We have a direct entry program. Students enter out of high school and go through six years of our program and actually start pharmacy classes and start seeing patients in their first year, so we really engage in practice straightaway, but they don’t start marking their service hours until their fourth or fifth year,” Martin said. “To put it in perspective, we have 900 students in our program so if each student does over 50 hours, that’s 45,000 hours in service—it really makes an impact,” especially in a medically underserved community.

All of the services his school offers to the community are free, so there are no financial barriers to receiving care. “Student learners can go out and provide care at no cost to the community and that immediately draws people out who otherwise wouldn’t seek healthcare until something breaks,” Martin said. “We’ve got tens of thousands of student pharmacists in colleges across the country—not to mention student nurses, student physicians, student social workers—and that is a viable population of well-trained workers, who in gaining experience towards their professional goals, can go out and really make a difference in their communities. I don’t think that we’ve coordinated that very well nationally, but that’s an area where I think we’ve got real opportunities. We can deploy a workforce that can provide care at essentially no cost for people who avoid seeking healthcare, and that will have an immediate effect upon the entire population.”

Providing an essential service to the Tallahassee community, Florida A&M University (FAMU) has been running a COVID-19 testing site at its football stadium. More than 35,000 individuals received tests from April 25 to August 25. The site, which offers free walk-up testing with no physician referral required, operates by way of a partnership among the university, community health center, county health department and state department of emergency management. Student pharmacists and faculty have been volunteering at the testing site and a team of 20 College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health learners and professors, recruited by the department of health, helped with contact tracing over the summer months, providing another critical service in a state with surging COVID-19 cases.

The FAMU College of Pharmacy has collaborated with its Institute of Public Health, performing pharmacist-led chronic care management for medically underserved rural populations during the pandemic. The college operates a hospital pharmacy and a county pharmacy, leads a Program of Excellence in STEM for high schoolers and plans to start a summer camp for emerging pharmacists next year. Through practice, the college provides care for its community, including many people with limited means, but the school touches lives in other ways. “Because of our history and mission, people who are ethnic minorities and majority, as well, find their way to our institution to earn various degrees, in our case a Pharm.D., and they come from families where they are probably the first one to go to college, certainly the first to go into the health professions. It drastically changes the economics of that one family member, because when you step into a practice position, you are instantly middle class and that’s forever, as long as you are practicing, so there’s a transformative element that this degree program offers,” said Dr. Johnnie Early, dean of the College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, at FAMU.

Contemplating how schools can advance equal opportunities and push for racial justice, Early reflected on his time as dean at the Medical University of South Carolina in the late 1990s. “At that moment in history the African-American population in the state of South Carolina was over 30 percent, yet that was not reflected in the enrollment of several colleges at the Medical University, and so our faculty became much more present in community health fairs, including one big one that happened every February in Charleston.” Early had student pharmacists there reviewing medications, counseling the public on side effects and lifestyle factors. His faculty gave lectures on psychiatry and other topics they knew would have broad appeal. “After about the second or third year of that, what began to happen in the colleges was that every program became much more diverse,” Early continued. “And the one that was so startling, we enrolled the first African-American resident in the Family Medicine program. That residency program had been there since 1963, if my memory serves, and it had never had an ethnic minority in it until then.”

Consistent and focused efforts yielded the recruitment of 10 Black students among the entry-level Pharm.D. students matriculating in fall 1998 (55 total) and 1999 (58 total); five Black and ethnic minority residents were recruited among an entering class of 25 students; and three Black students were recruited among an entering class of five graduate students. Such outcomes were unheard of in the university’s history and Early believes it all stemmed from faculty members’ willingness to go into the community and demonstrate that the school wanted to welcome the Black community. Cultivating this diversity did not cost much, except time and energy, but that work changed lives.

“You help elevate the community by educating the people from the community,” Early emphasized. “And since pharmacy touches people from birth to death, what better way to be involved?”

Athena Ponushis is a freelance writer based in Ft. Lauderdale, Florida.

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