THE FACTS OF LICE

MICHAEL SLEZAK

The effects of head lice aren't all bad.

An outbreak of head lice in a community, while certainly unpleasant, can be a valuable time for supermarket pharmacists to form a strong bond and build store loyalty with parents and children. As August rolls to its inevitable end, children will be heading back to school, and in many areas, head lice are sure to follow them. The end of summer also can mean an active role for pharmacists in diagnosing and recommending special shampoos for treating patients with lice.

"Right when school starts in the fall, almost every day we get questions about lice," says Walter Drach, pharmacy manager at Countryside Drug Co. II, located inside Leppink's Food Center, Lakeview, Mich. "A lot of times parents bring their children straight to the pharmacy after they've been called by the school. They've usually figured out they have lice or someone has told them by the time they come in."

Sometimes people will ask pharmacists to actually diagnose their condition, a situation that can make even some pharmacists a little squeamish.

"I had a lady pick one up off a child's head, hold it up in front of my face and say, 'Look! This is it. Is this lice?' And I said, 'Yeah, that's what it looks like," Drach recalls with a chuckle.

"Maybe once or twice somebody has actually brought in a sample [of the lice or nits], but usually they don't. People feel it would be gross to make you see it or touch it," says Butch Henderson, pharmacy director at Klein's Pharmacies, located inside Klein's Super Thrift Markets, Forest Hill, Md.

Answering questions and discussing issues as sensitive as lice, and even diagnosing cases, however, can build a strong bond between pharmacist and patient.

Judson Mullican, pharmacy owner and pharmacist at J&J Professional Pharmacy inside Lewis Jones Food Market, Columbus, Ga., says he has had customers "bring lice into the store in little jars." "We'll check people. It doesn't bother us to check them. That's just a part of community service," Mullican says. "In a doctor's office, it might cost $25, $35, $45 for him to tell you, 'Oh, you've got some head lice.' We don't charge for that service.

"People look to their pharmacist even more so than their doctor sometimes. The pharmacist is readily available 24 hours a day," says Mullican. "Sometimes we recommend if the whole family has been involved doing something together, they may all need to be treated. We don't ever mind checking the whole family. We see that a lot, especially if they've got three or four kids. And sometimes their buddies will come in saying, 'I don't know how I got it, but I've got it.' " Mullican even keeps a magnifying glass handy to check for lice. "Some of my employees have gotten pretty good at it," he adds.

Pharmacists say the majority of parents are embarrassed, frightened, concerned or sometimes just ill-informed, and will look to the pharmacist for information and consolation. "I've had people really not want to believe they or their children have lice. They tell me they're clean, they can't get lice," says Allen Miller, pharmacy manager at Boyles Pharmacy inside a Broulims Supermarket in Rexburg, Idaho. "I just explain they were exposed to someone who had lice. Some of them need to have their fears alleviated. It doesn't mean you're not clean."

"Usually we suggest that it's a common problem, and that it's going around," says Henderson. "It's not they weren't clean. A lot of people aren't educated as to how lice are transferred. We tell them to avoid sharing objects like combs and hats."

Drach of Countryside eases patients' fears by telling them that "lice would prefer a clean head. They are there for the warmth, not for dirt. Even though they start in a less-than-perfect environment, they'd actually prefer a cleaner environment. It's just a matter of contact," he explains, "not a matter of poor hygiene."

Jeff Sparks, owner and pharmacist at The Medicine Shoppe, located inside Woods Super Market in Bolivar, Mo., adds, "There are still misconceptions about lice. People can't believe they've got it, because they're clean and they bathe regularly."

"It's embarrassing," explains Sparks, "so parents don't want to tell other people. If they see it on their child, they might just take care of it and not tell anyone at school about it. When people have already come in contact, the lice will just keep going around."

The stigma that head lice is a low-class, low-hygiene problem must be eliminated in order to ensure that massive infestations do not occur, says Deborah Altschuler, president of the National Pediculosis Association, Newton, Mass. The fear and a crisis-like attitude concerning head lice prevent open communication and can keep those around a lice-infested person from getting checked for lice, too.

Pharmacists, she says, can often break that cycle by offering the facts about head lice to patients.

"Our best ally has historically been the pharmacist," Altschuler explains. "They see the family face-to-face and have the ideal opportunity to advise and tell people in the community that an outbreak may be occurring. The pharmacist is the ultimate front-line person in fighting lice."

Drach of Countryside agrees. "I tell people they have to inform everyone around them. If everyone takes care of it, there won't be another outbreak. We see so many repeats because someone doesn't tell other people or they don't take care of their own problem. Friends and relatives, and around and around, that's the cycle."

Once identified and alerted to the problem of lice, proper treatment is the other main concern pharmacists say they have.

Frank Chibaro, supervising pharmacist at Pharmacy of Columbia Park inside Singer ShopRite in North Bergen, N.J., says, "Sometimes the parents will pick up on what's wrong. They may not always know the name, but they see things crawling on the scalp. They're aware. They'll ask for a product usually.

"I tell them it's not easily cured but it is curable, and with the new medications you just need one treatment as long as you're thorough," says Chibaro. "And you have to be careful until you get rid of it to make sure it doesn't spread to other members of the family. I assure them this isn't something that will last forever." "The patients' main concern is whether to repeat the treatment," says Drach. "If you follow the instructions thoroughly, you should be OK. We tell them not to re-treat unless they see live lice."

Pharmacists also try to administer preventative advice to customers.

"Children shouldn't be wearing each other's hats or sharing combs," says Sparks of The Medicine Shoppe. Advertising and printed information are also good ways to inform customers about head lice and to bring them into the pharmacy when problems do arise.

"Sometimes we'll run an ad around the beginning of the school year, but it is a situation where you have to be careful with ads," explains Drach of Countryside. "It isn't a pleasant thing people look forward to. You have to be subtle." Henderson of Klein's says his chain has distributed various pamphlets from manufacturers.

Mullican says his store also has "pamphlets we give out. We produce them and they say how to use the products, what to look for and when the problem should be retreated, if at all." Altschuler of the National Pediculosis Association said any advice the pharmacist can offer head lice victims is positive for both patient and retailer. She suggested pharmacists can even give presentations about lice to their communities.

"For the pharmacist," she says, "this is the ideal way to meet the community. They can share brochures with local schools and get out there and make a difference." Miller of Boyles agrees: "Giving advice about lice is a good way to build customer loyalty."