Speaking about the mission of ABHP today, Dr Clark says that the organisation has important historical significance. Although the American Pharmacists Association (APhA) did not specifically exclude black pharmacists, racial segregation laws meant that black pharmacists were effectively barred from participating in meetings and conventions. He says, “Laws that restricted black people were called ‘Jim Crow’ laws. Those laws went into effect right after slavery and stayed in effect in the south up until 1965. I actually grew up in it, I grew up in the Jim Crow laws and so my perspective largely comes from being in an environment where …. you had to follow certain rules or you may be killed.”

As a result of this exclusion, black pharmacists established their own professional organisations. The ABHP was formed in 1978. Dr Clark says, “In 1978 you could attend APhA meetings or ASHP (American Society of Health System Pharmacists) meetings but there were no [black] members that were in any elected position, no committee members, things of that sort, so we started trying to form groups within ASHP to promote …….. what we call now diversity, equity and inclusion. Nobody thinks ABHP had anything to do with that, but they certainly did!”

The organisation was originally known as Black Pharmacists in ASHP but as it grew, the name was changed to ABHP. “So now the goal is to foster collaboration with other groups [and] try to make sure there’s leadership on minority health issues and minority pharmacists. We want to educate to make people aware of some of the minority health issues, we want to advocate for those patients that we think are under served and uninsured and we want to promote research in those areas to basically help in trying to reduce felt disparities”, says Dr Clark.  ABHP describes its mission as CLEAR, “because people always ask, “What are you guys about? What are you trying to do? What is your mission and why do you have to exist?” ….. and we said, well our mission is clear – collaboration, leadership, education, advocacy and research”, he explains.

In future Dr Clark plans to continue working with under served populations – an area where he feels he can make a difference to people’s lives – and also continue to research and highlight the history of African-American pharmacists.

John E Clark studied pharmacy at Southern University in Houston, Texas before completing residency training in Detroit, Michigan.  He holds a master’s degree in pharmaceutical administration a PharmD. For 18 years he worked at Jackson Memorial Hospital in Miami before taking up his current appointment at the University of South Florida College of Pharmacy in Tampa, Florida. You can find Dr John Clark’s book here.

Read and watch the full series on our website or on YouTube.

Dr Clark found that there was little published information about African-American pharmacists, especially in the post-civil war period, from 1865 onwards. “So why is that? I don’t know. It’s either that it was just deliberately ignored or people did not find it interesting or they were not aware. I was not even aware that there were schools that were dedicated to training African-American people. ….. I wonder sometimes why did I not know that when I was younger? Well, those things were not taught – we didn’t even know there were black pharmacy schools”, he says. In fact, he only learned about the existence of black pharmacy schools in the past ten years.

When a student asked him who the first African-American female pharmacist was he started to investigate and soon discovered that black pharmacy schools were started in about 1870. Reasoning that the first African-American female pharmacist must have come from one such school he set about trying to find out more. “I never intended to write the book …. but I spent so much time trying to find that one black female pharmacist and so I was able to recover some records from some of those schools. There was a total of seven schools that were formed after the civil war between 1870 and 1927. …. Two of those schools still exist today as Howard University and Xavier University in in New Orleans”, says Dr Clark.

“It actually started after the civil war when they could not get treatment for the black patients – black people – coming off the slave plantations. So, many of them started dying [once] they got off [the] plantations …… they couldn’t get health care, so that disparity is believed to have started then and continues to this day. …. I can see it in my clinic. Almost all of our diabetic patients …. are all Hispanic or from low- middle or low-income classes just like it was back in the post-slavery days. So it’s just that the disease states are different but the disparities are still there”, he says. He discovered that the first African-American woman to graduate as a pharmacist attended Meharry Pharmaceutical College (Nashville, Tennessee) and was awarded her degree in 1894.

Medical history books have tended to focus on physicians and scientists with little about pharmacists. Dr Clark says that his book, Early Education of African American Pharmacists 1870 – 1975, (published in 2021) has provided “a contribution to the literature now with the focus on African American or black pharmacists that that didn’t exist before”. Having worked closely with the American Institute of the History of Pharmacy, he is confident that his book was the first to address this topic.

Asked whether the term ‘African-American’ or ‘black’ is preferred, Dr Clark says, “Our organisation prefers to use the term ‘black’, like black-American versus African American although I use both. When I use both terms, I’m referring to the same people. Now the contention with the use of African Americans oftentimes comes from black patients or black people who may be of mixed race or they may be from different ancestral backgrounds that they don’t consider to be African.”

John E Clark studied pharmacy at Southern University in Houston, Texas before completing residency training in Detroit, Michigan.  He holds a master’s degree in pharmaceutical administration a PharmD. For 18 years he worked at Jackson Memorial Hospital in Miami before taking up his current appointment at the University of South Florida College of Pharmacy in Tampa, Florida. You can find Dr John Clark’s book here.

Read and watch the full series on our website or on YouTube.

All patients at The BRIDGE are seen by appointment rather than as ‘walk-ins’. “The clinic is only open at night after normal business hours so it opens at five o’clock in the evening and it stays up until nine p.m. at night”, explains Dr Clark.  In order to qualify for services at free clinics patients have to meet certain requirements. Typically, this would mean that they have no health insurance cover. They also have to be declared residents of the state of Florida. “My whole goal is trying to help them with their with their medical care. I have seen patients that actually die and so I’m very, very sensitive and I try to avoid the politics. If they need help, we just try to get them in there. They also have to have …. an income that’s what we consider in the US below the poverty guidelines and that’s less than about seventeen thousand dollars a year. That’s total household income including two people. …… Now, I don’t check that, we have social workers who can check those things”, says Dr Clark.

From the pharmacy viewpoint, “We use the typical old medication therapy management guidelines and that includes [the stipulation that] they must be taking five or more chronic medications – they could be non-prescription or prescription meds. They have to have at least one chronic disease state that’s being managed on the long term. That’s going to be things like hypertension, diabetes and even certain cardiovascular conditions”, says Dr Clark.  Additional criteria include abnormal laboratory values and non-adherence to medication because of absence of medicines’ supplies or because of poor understanding “Health literacy and cultural differences play a big part because the majority of patients coming to our clinic is probably 80 to 90 percent Hispanic; we don’t get too many African American patients coming in, we don’t get too many white patients”, he adds.

“Now, you can imagine in this country right now, with the pandemic going on, a lot of people have lost their jobs – [they’re] out of work [and have] no insurance – and we’re seeing it now in The BRIDGE clinic.  We had a lady there just overnight – she has diabetes, lost her job, no insurance, no way to get her insulin. So, lo and behold, this medical staff comes to us and says, “John how do we get this lady insulin because she can’t afford it?” …..  Fortunately, in Florida they have … an insulin distribution program that’s run by the state. ….  Most of the time they only cover two insulins, the regular and the NPH insulin and one of the combinations and so we write the prescription”, says Dr Clark. The patient is given a referral form and directed to a State Department of Health office, some of which have on-site pharmacies and can supply insulin immediately. Alternatively, “the prescription is faxed to a state office located ….. in the capital of the state in Tallahassee and then it’s mailed to the patient’s home”, he says.

There are a number of way that people can find out about the services of The BRIDGE clinic. For example, there is an announcement on a local radio service, brochures are distributed and there is information on the clinic website, but the information is commonly spread by word of mouth. In addition, outreach clinics are run periodically. “We go out into the community at least twice a year ……. and we set up what we call health screening clinics”, he says. These could be in churches or in an open park, for example. If, during the screening process they find patients who are eligible for services from the BRIDGE then they are directed to the clinic.

John E Clark studied pharmacy at Southern University in Houston, Texas before completing residency training in Detroit, Michigan.  He holds a master’s degree in pharmaceutical administration a PharmD. For 18 years he worked at Jackson Memorial Hospital in Miami before taking up his current appointment at the University of South Florida College of Pharmacy in Tampa, Florida. You can find Dr John Clark’s book here.

Read and watch the full series on our website or on YouTube.

A major challenge for the pharmacy team at the BRIDGE healthcare clinic is trying to find affordable medicines for the clinic patients. “We are unable to provide them free medication in all cases – most of the time it’s at a discount. So rather than paying what you and I may pay for – full fees for medicine that may not be covered by insurance – we try to find discounted medications”, explains Dr Clark. To this end they have compiled a formulary for discounted drugs that are available.  One mechanism is through the indigent drug programs. These are programs run by the pharmaceutical industry that offer free or low-cost medicines to qualifying patients who lack health insurance and/or prescription drug coverage. These are commonly used for new anticoagulants, for example, says Dr Clark.

Medication adherence is the next important issue and the team tries to improve patients’ ability to take their medicines correctly. “If they can bring them in to show you what they’re taking, that’s good” says Dr Clark. The next step is to find out if a patient has sufficient supplies to last until the next appointment and, if not, to find a mechanism to supply refills.

Medication reconciliation is another important activity for the pharmacy team, especially ensuring that patients are not receiving unnecessary medications. Dr Clark recalls a patient whom he saw recently who was taking ciprofloxacin, vitamin D, omeprazole and phenazopyridine that appeared to have been started in 2015. After investigation, both the ciprofloxacin and phenazopyridine were discontinued leaving her with only two active treatments. “We do the [medicines] reconciliation every day that we come in – I have one group of students that does nothing but that”, he adds.

Patient education forms a large part of the work and involves “almost every patient that we see”. In addition, they also “try to determine if the medicine is working or not working …. and it’s not uncommon for us to find some things that appear to not be working. So, if that’s not working, we will make a recommendation to the medical staff to switch to medication to something else”, explains Dr Clark.

The pharmacy team also assists with disease management. “The most common ones we see in there [are] hypertension, hyperlipidaemia, diabetes and so forth. Now what we do there is try to provide a consultative-type service so if they want us to come see the patient too we can either see them the same night that they’re there or we schedule them to come back to see just the pharmacy team”, he says.

John E Clark studied pharmacy at Southern University in Houston, Texas before completing residency training in Detroit, Michigan.  He holds a master’s degree in pharmaceutical administration a PharmD. For 18 years he worked at Jackson Memorial Hospital in Miami before taking up his current appointment at the University of South Florida College of Pharmacy in Tampa, Florida. You can find Dr John Clark’s book here.

Read and watch the full series on our website or on YouTube.

Dr Clark is an assistant professor in the Department of Pharmacotherapeutics and Clinical Research and Director of Diversity, Equity, and Inclusion at the University of South Florida (USF) Health Taneja College of Pharmacy in Tampa.  He is also a clinical pharmacist in ambulatory care at the USF Morsani Health Center Building Relationships and Initiatives Dedicated to Gaining Equality (BRIDGE) Healthcare Clinic. He is also responsible for supervising and teaching clinical pharmacy practice at this site.

Dr Clark explains, “the BRIDGE was started by a group of medical students; it’s a non-profit free clinic that offers services to the uninsured and the under served patient population in that community around the campus…….” The clinic was set up as a multidisciplinary service involving students from the colleges of medicine, physical therapy, social work, public health and pharmacy working together to provide patient care.

“We focus on the area of access to care because we felt in this population one of the biggest issues they would have”, says Dr Clark. The key elements for the pharmacy service are access to care, medication adherence, coordination of care, medication therapy review and education, he adds.

John E Clark studied pharmacy at Southern University in Houston, Texas before completing residency training in Detroit, Michigan.  He holds a master’s degree in pharmaceutical administration a PharmD. For 18 years he worked at Jackson Memorial Hospital in Miami before taking up his current appointment at the University of South Florida College of Pharmacy in Tampa, Florida. You can find Dr John Clark’s book here.

Read and watch the full series on our website or on YouTube.