PINE BLUFF -- It's around noon on a recent Thursday and Lelan Stice is in his makeshift office in a once-vacant retail space that he's converted into a walk-in covid-19 vaccination clinic, which on average provides first and second doses of coronavirus shots to about 400 people a day.
Stice is busy organizing supplies -- syringes, vials, alcohol, etc. -- to take to an off-site mass clinic the next day at a nearby convention center where about 700 doses will be given.
The day before, Stice -- a pharmacist and owner of Doctor's Orders Pharmacy, which has locations in Pine Bluff, White Hall and Star City -- organized another remote clinic at a nearby factory where about 200 shots were given to employees.
He returned there for two more events the next week. Stice said he'd recently received a call from a company in Fayetteville asking if Doctor's Orders could help vaccinate its employees.
"We may or may not do that one," Stice said.
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Since the rollout of covid-19 vaccines began in mid-December, independent pharmacies, like Doctor's Orders, have taken on the Herculean task of vaccinating Arkansans as quickly as possible. These businesses and their employees have become an essential component in the battle against covid-19.
In many ways, they are unsung heroes, working incessantly behind the scenes to deliver the lifesaving vaccines that health officials hope will end the pandemic.
"I think these pharmacies have always been valued," said Cindy Stowe, dean of the University of Arkansas for Medical Sciences College of Pharmacy. "But I don't know that communities have ever seen them in this light, in the same way, with the same sense of urgency they do now."
Almost overnight, pharmacies around the state have added staffing, online registration systems, phone lines and other infrastructure to deal with a crush of people desperately seeking to get vaccinated. In some cases, they've had to buy their own supplies, like gloves, syringes and sterilization materials.
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It's been overwhelming.
"It feels like we are building a ship as we sail," said Brittany Sanders, a pharmacist and co-owner of The Pharmacy at Wellington in Little Rock. "There have absolutely been challenges along the way."
Sanders, who opened The Pharmacy at Wellington in 2015, added five employees -- including a nurse and another pharmacist -- to her team since vaccinations began. She's also converted a nearby space into a walk-in vaccination clinic that handles up to 500 people a day.
In August, in anticipation of the approval of covid-19 vaccines, Sanders bought an ultra-cold freezer needed for the vaccines' storage.
Such freezers cost up to $15,000 each.
"We wanted to be in a position to help the community," Sanders said.
Sanders and her team recently held a vaccination clinic in Stuttgart where 800 employees from Riceland Foods and Producers Rice Mill were vaccinated. An average day for Sanders and her team begins around 7 a.m. and ends around 9 p.m.
Her family sometimes helps with paperwork, even website issues.
"My stepmother has become very adept at changing the website on the fly," she said. "Every resource we have, we have devoted to this."
John Vinson, head of the Arkansas Pharmacists Association, said he has heard stories of pharmacists traveling to rural towns to hold vaccination clinics who have been greeted by impromptu parades, people waving to them from the sides of the streets and patients who are so overjoyed to receive vaccinations they are in tears.
"Above all else, I cannot think of anything else we could do that would save more lives," Vinson said. "I knew that there was not anyone in Arkansas who would be more excited and more intrinsically motivated to provide vaccines than these pharmacies."
Bob Hodge, a pharmacist and owner of Prescription Corner Drug, which he opened in 1981 in Paragould, said taking part in the vaccination effort has been one of the most rewarding experiences of his career.
Earlier this year, Hodge helped organize a clinic for about 160 front-line workers in Crittenden County who had not yet been able to get vaccinations.
"It was a very rewarding experience for me, maybe one of the highlights of my career," Hodge said. "We delivered a service to people who really wanted it, who are taking care of sick people and were not protected at all."
"To show up and be greeted like a hero was pretty cool," he said.
Hodge has converted part of his store into a vaccination clinic. Family members of other employees help with paperwork that the pharmacists are required to submit to the state and to insurance companies for billing, Hodge said.
"We have managed to do everything with what we have," he said.
While the vaccinations themselves are free, pharmacies are paid roughly $16 to $25 for their administration from insurance companies or from a federal program for the uninsured.
Many pharmacists said they have received little or no reimbursement yet. Submitting the paperwork is cumbersome, adding extra hours late into the night after the pharmacies close.
"Is it worth it? Yeah, it is," Hodge said. "It is not all for profit. It is worth it just to help your community, and that is what we are trying to do."
On more than one occasion, Joe Davis, a pharmacist and owner of Joe's Pharmacy Express in Searcy, made trips to people's houses to give shots that had been left over from clinics so the vaccines would not go to waste.
"I was driving out to houses in the country giving people shots," he said. "The one thing about independent pharmacies is we know a lot of people."
The pharmacist said he had only one day off for the months of January and February combined. (His pharmacy is closed on Sundays).
Davis said one off-site vaccination clinic that he organized at a school was "one of the best days I have ever had in my career with just being appreciated."
"It was probably the most rewarding day of my career," Davis said. "Now whether I made any money out of it, I wasn't sure at that time."
But Davis said getting paid is "the last thing he really thinks about" when organizing off-site clinics or daily clinics in his store.
"I know that sounds kinda crazy to think that way," he said.
Beyond waiting to get paid for the administration of the covid-19 vaccines, finances have been an ongoing battle for independent pharmacies.
Competition from major chains, like Walgreens or CVS, and low prescription reimbursement rates are increasingly forcing many independently owned pharmacies out of business.
Independent pharmacies are "facing an industry that is stacked against them," Vinson said.
"They are trying to compete against chain pharmacies and mail-order pharmacies," he said. "There is not a healthy marketplace that encourages competition. It's a broken marketplace."
Between 2002 and 2018, 1,231, independently owned rural pharmacies closed in the United States, according to a brief from the Rural Policy Research Institute. That report also found that 630 rural communities that had at least one retail pharmacy in March 2003 had no retail pharmacy in 2018.
With the vital role that independent pharmacies have played during the pandemic, some are wondering if their efforts to save lives with vaccines will be enough to save their small businesses.
"It has been an opportunity to show what we can do," Davis said. "I feel like we have been overlooked in the channels of health care by a lot of folks."
"Sometimes people don't appreciate something until it is gone," he said. "I hate to think the independent pharmacy would have to be gone before it is appreciated."
In Pine Bluff, Stice said his increase in staffing needs for the vaccine rollout has added almost $15,000 to his biweekly payroll.
He said he's considered selling his business in recent years.
"The [profit] margins have become so tenuous," Stice said. "We are at the point of looking at whether it is worth keeping our money invested in retail pharmacy when there are lots of other businesses that are not as perversely manipulated."
Stice's location in Pine Bluff is almost across the street from a Walgreens that opened about seven years ago, he said. Doctor's Orders opened nearby, Stice said, because he believes his pharmacy offers a more personalized experience with better customer service.
He spoke about the importance of independent pharmacies.
"In many small towns, they are the only source of health care," Stice said. "There is not a doctor there, not any type of medical clinic. The pharmacy is the place that people go to on a day-in-day-out basis."
"In certain areas of Arkansas, there is no pharmacy at all," he said. "So those people are on an island and don't have health care accessible to them."
It remains unclear whether Stice will eventually leave the pharmacy business.
But it was clear during the Doctor's Orders walk-in clinic, in that once-vacant retail space next to the pharmacy, that people getting their shots were grateful that the business is there.
"They are my pharmacy," said Garland Linwood, who'd just received his first dose of vaccine.
"It is a big help to the community," he said. "Whoever is responsible for putting Doctor's Orders here, I need to really shake their hand."