Pharmacy practice in Jamaica under COVID-19 and beyond
Pharmacists are on the front line of the global response to the novel coronavirus. Like so many members of the health team, some have lost their lives. The data suggest that community pharmacists are most vulnerable. These deaths have had a ripple effect on pharmacy organisations that are expressing growing concern about the exposure of pharmacists to the highly contagious virus.
The recommendation is that pharmacists employ protective methods by adjusting customer care practices. Laws must be changed to allow for orderly emergency pharmacy care. Importantly, Jamaica must develop a medicines supply policy that balances trading and distribution with medicinal manufacturing and product development. In times like these, Jamaica is most exposed to the risk of medication shortages of all kinds for various reasons.
Pharmacy service delivery
Jamaicans have always had an informal arrangement with their community pharmacists. A community pharmacy or drug store is the first port of call for Jamaicans who may have a fever, dry cough, or a ‘”likkle bad feelings”. Pharmacists are trained to speak directly to the customer to ask a few relevant questions that may lead to a referral or recommendation of a medicine. For good measure, if a medicine is recommended or a prescription dispensed, a short “show and tell” session has proven to improve the chance that medication instructions are understood and will be followed.
Masks or gloves were never approved professional garb for this brief but intimate dialogue. I suspect this is about to change as pharmacists will attempt to follow the “six-feet” separation rule, wear masks and gloves, and engage in hand sanitation and surface disinfection after dealing with a customer. We have entered a new world of patient care and are searching for new and effective ways to communicate without putting lives at risk.
Many patients are exceeding their prescription refills. Best practice dictates that pharmacists adhere to the repeat limits set by physicians. However, under COVID-19 conditions, or in cases of other national emergencies, this is not always possible. In these situations, rural Jamaicans are at particular disadvantage.
For the past two decades, pharmacists have advocated for emergency legislation that will allow them to assist patients under specific circumstances and in keeping with international standards. The time has now come to include emergency supply provisions in the Pharmacy Act. Additionally, we need a policy that encourages pharmacists to provide services in rural underserved areas.
Averting catastrophic medication shortages
Across four decades, the country’s capacity to make medicines for national and global use has been decimated. Big pharmaceutical companies that operated in Jamaica are no longer here. The importation and distribution business has thrived but the country is almost entirely reliant on imported pharmaceuticals.
Where Jamaica once manufactured IV fluids in local factories and some hospitals, these fluids are now imported. The thinking that drove this mindset and eventually direction was “economies of scale”. Then and now, this argument is spurious at best, since those manufacturing operations left Jamaica for Costa Rico and the Dominican Republic and other similar destinations.
COVID-19 has revealed the danger in this former narrow view and offers a warning and opportunity for Jamaica to rethink its policy direction in the area of pharmaceutical manufacturing.
Two months ago, there were very few people, if any, who thought that a wily RNA (ribonucleic acid) virus would ‘run rings’ around human understanding and test fundamental concepts and beliefs about life and living. As pharmacists we accept that things must change. We ask for different thinking about the value of pharmacy services to society as we work to find new ways to provide patient-centred care under COVID-19 and beyond.
Medical experts predict that there is far more to come as the novel coronavirus replicates and spawns. Brace yourselves!
Ellen Campbell Grizzle is an associate professor in the School of Pharmacy and a behaviour change communication specialist and head of the Caribbean Institute of Pharmacy Policy Practice and Research (CIPPPAR) located at the University of Technology, Jamaica.