The author travelled to Grenada in the Caribbean recently. Here, he reports on pharmacy education and practice on the island
The three-island state of Grenada lies between Trinidad and Tobago to the south and St Vincent and the Grenadines to the north. It has a land area of 120 square miles which is about 90 per cent of the three islands combined and is also known as the "Isle of Spice". It is one of the world's chief exporters of the twin crop of nutmeg and mace, and other spices such as cinnamon are extensively cultivated. The three islands have a population of about 98,000. However, it is believed that a considerable number of Grenadians live abroad. The state of Grenada remains within the British Commonwealth as an independent nation and the governor-general represents the Queen. A parliamentary system of government operates and the incumbent Prime Minister, Dr Keith Mitchell, was re-elected a few days before my arrival in Grenada. |
The island of Grenada, as viewed from the waterfront |
For administrative purposes, Grenada is divided into seven parishes and six main towns. One of the parishes, St Georges, serves as the capital and the island of Petite Martinique is regarded as one parish.
The unforced friendliness of the inhabitants is matched by the mountainous beauty of the isles. A good view of the island can be captured from Fort Frederick or Fort George, which are vestiges of French and British occupations in the 17th and 18th centuries. A captivating landscape of mountains and valleys is evident as far as the eyes can see. In fact as one drives from Point Salines international airport in the southwesterly part of the island to Grenville in the north-east through the tortuous, if fearsome, network of roads, one ascends to about 1,910 feet at the Grand Etang lake.
Grenada has a mixed population of African, Asian and European ancestry. The conditions that tend to appear commonly in the medical community are diabetes and hypertension. Parasitoses, such as leptospirosis, dengue fever and strongyloidiasis, are also present. The British colonial influence is evident in the arrangements for prescription payments. The islanders, except children under the age of 16 and people aged 60 and over, pay for their prescriptions. Other exemptions include those with chronic conditions, such as epilepsy and diabetes, police officers and prison officers.
The Pharmacy Council regulates the practice of pharmacy in Grenada. It derives its powers from the Pharmacy Act of 1986. The pharmacy department in the Ministry of Health deals directly with overseeing the practice of pharmacy and has the following administrative officers - chief pharmacist, deputy chief pharmacist and the pharmacy inspector.
There are about 40 pharmacists working in Grenada, with 23 being in what is referred to as the public sector. These pharmacists are subdivided into various groups as follows: hospital (five pharmacists), academia (one pharmacist), administration (six pharmacists) and community (11 pharmacists).
There is a school of pharmacy in T. A. Marryshow community college, in St Georges, which runs a three-year certificate programme. According to sources at the Ministry of Health, there is currently a strong move towards upgrading it to a diploma as the curriculum justifies such a status.
St Georges university is planning to start a four-year bachelor of pharmacy programme shortly. The university is a private, American-style institution which runs a school of medicine (preclinical sciences) in True Blue, not too far from the airport. Most of the medical students here tend to be Americans although the government of Grenada awards scholarships to five Grenadians each semester to cater for the considerable expenses involved.
Continuing education is not mandatory for annual recertification (retention of name on the register of pharmacists). However some of the pharmacists, especially those in hospital, have additional training and qualifications from the Universities of Guyana, Barbados, etc, in various areas such as clinical pharmacology or herbal medicine to help them undertake extra responsibilities. There is no official pharmacy technician or assistant training programme and the Pharmacy Council determines the eligibility of foreign pharmacy graduates in a discretionary manner.
There are 18 private pharmacies registered in Grenada. Any person can own a pharmacy. However a pharmacist must be present during its hours of business.
The pharmacies are similar in outward appearance to those in the United Kingdom (one noticeable difference being that film-developing does not seem to be a popular activity). Nevertheless, they differ from one another in size and layout. Low Budget Drug Mart was of the supermarket variety with a range of confectionery as well as a snack bar, while in Grenada Pharmacies there was practically nothing available as self-selection items, everything having been cordoned off behind glass cabinets. All community pharmacies have designated prescription-handling areas.
It was interesting to see certain items such as Nuelin Liquid and Ventolin Syrup available on the shopfloor. In real terms drugs are quite expensive in Grenada. I tried to compare the prices of some proprietary products with those in the UK. Gaviscon Liquid 100ml costs 10.10 East Caribbean dollars (£2.35), Calpol 6 Plus 60ml costs EC$6.75 (£1.65) and Piriton Syrup 150ml costs an alarming EC$24.40 (£6).
The explanation for those prices may lie in the fact that all the pharmaceuticals used in Grenada are imported; there are no manufacturing plants on the island. About 80 per cent of the drugs imported by the public sector are from European manufacturers while most of those imported by the private sector are from United States-based manufacturers. Grenada has four major wholesalers, including Gittens Agencies, and Bryden & Minors Ltd. Some wholesalers from the surrounding Caribbean islands also serve Grenada.
The district general hospital is located in the Carenage area, which is the commercial as well as social nerve centre of St Georges. There is also a smaller hospital in Mirabeau on the east coast. A number of private clinics and a private hospital are also in existence.
There are 11 wards in the general hospital, as well as the accident and emergency and physiotherapy departments, and of course the hospital pharmacy!
I visited the pharmacy department, where I met one of the senior pharmacists who had been at the hospital on and off for nine years. She explained that they were short-staffed with only three regular staff: a senior pharmacist, a junior pharmacist and a pharmacy attendant. Due to various reasons they lost about four pharmacists during the previous year.
The pharmacy caters for inpatients, outpatients and patients from the psychiatric unit. The patients do not pay for their medicines except for unusual drugs that are not available through the normal supply mechanisms. The drugs in the hospital are obtained from the central medical supplies department on a monthly basis via requisitions made up in the pharmacy.
The wards order their stock by means of requisitions sent to the pharmacy. The items are supplied and endorsed against the order. For private patients, the drug chart is brought down to the dispensary and the pharmacy staff make up the bill since they have to pay for their treatment.
Usually there is a ward pharmacist covering the wards but that was proving difficult because of the staffing problems mentioned above. In terms of the pharmacy workload, records are kept of the number of prescriptions dispensed: about 550 from the wards (including discharge medicines), 60 from private wards and 25 from the psychiatric unit in a typical month.
Apart from filling prescriptions from bulk containers or manufacturer packs the pharmacy does some extemporaneous dispensing and I was told they sometimes reconstitute cytotoxic products for use on the wards.
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The exterior (left) and interior of the hospital pharmacy department at the district general hospital |
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Acknowledgments I wish to express my gratitude for the assistance rendered by Mr Benedict Newton (chief pharmacist at the Ministry of Health, Grenada), Mr Kester Cyrus (pharmacy inspector, Ministry of Health), Miss Grace Charles (pharmacy department, general hospital, St Georges), and Dr Michael Idowu (department of histology, St Georges university school of medicine).
Mr Cole is a staff editor on The Pharmaceutical Journal