History of Pharmacy Practice in Jamaica and the Caribbean

The Taionos Medical System

The Tainos’ medical system was an integral part of their culture, deeply intertwined with religious practices.

Religious and spiritual belief: they believed that illness could be caused by spiritual imbalance and healing often involves rituals and ceremonies in addition to their use of medicinal plants.

Bohiques: The Bohiques were the traditional healers or medicine men of the Tainos. They also conducted spiritual rituals to heal the sick, believing that diseases were sometimes caused by evil spirits.

Medicinal Plants

(a) Tobacco and cocoa: These plants were commonly used to treat fatigue and nausea. The leaves were often chewed or smoked for their medicinal effect.

(b) Golden Apple and Hog Plum: fruits used to treat diarrhoea.

Purging Practices

Regular purging was a part of the Tainos system. They used a “vomiting stick” to induce vomiting, which was seen as a way to cleanse the body's impurities and maintain health.

Retention of Slave Society Health System 1655-1838

The health system in slave societies between 1655-1838, in the Caribbean retained significant influence from both British and African traditions.

African Influence

Medicinal care for the enslaved was often minimal, leading to enslaved to rely more on their traditional healing knowledge. They used familiar plants or substituted them with local equivalence that resembled African flora.

Rituals, chants and incantations were common components of healing practices. Obeah was a spiritual practice brought from West Africa and involved the use of ritual and herbal medicines. Obeah practitioners were believed to have the power to heal, but this also caused harm. Over time it became illegal in many parts of the British Caribbean due to the fear it’s instilled in both enslaved and the colonizers.

British Influence

The British Health system could be seen as the “formal system” as it was organized. Doctors often employed by plantation owners would visit plantations on horseback their role was to oversee the health of the enslaved population as well as the Europeans.

Enslaved individuals who became ill were treated in hothouses on the plantations. These are basic medical facilities where the enslaved could be nursed back to health. The motive behind the care was economic rather than humanitarian as plantation owners to maintain their labour force in good working conditions.

British doctors frequently trained local assistants often other enslaved people were free people of colour to act as apprentices. These assistants would learn basic medical skills such as preparing treatment, applying remedies and assisting doctors.

Emergence of KPH and Early Days of Pharmacy Training

The emergence of Kingston Public Hospital (KPH) marked a significant shift in the training and professional development of druggists and pharmacists in Jamaica. Initially, the training of these professionals was conducted within the doctor's office. However, this shifted to a more structured environment at KPH.

Doctors were responsible for the training of druggists/chemists. Druggists were trained to give anaesthetics, deliver babies, dress sores, mix medicines, and provide medicines in clinics and hospitals. Many opened their own doctor shops on graduation, mostly in rural Jamaica.

Doctor Shops (1838-1996)

The doctor shops of Jamaica also referred to as drug stores, were typically small, wooden buildings found in rural communities and poorer urban sections of Kingston, where access to formal healthcare was limited. Patients purchased home remedies, herbs, mixtures, and filled recommendations from Obeah man, despite the practice being illegal.

Support Staff of the Pharmacists

Education and Training
Pharmacist	Requires a degree in pharmacy (e.g., Bachelor of Pharmacy or Doctor of Pharmacy) and licensure to practice. Comprehensive training in pharmacology, pharmaceutical chemistry, therapeutics, and clinical practices.
Pharmacy Technician	Typically requires a diploma or certificate in pharmacy technology. Shorter training period, focused on technical skills and operational aspects.
Pharmaceutical Technologist	Requires more advanced training than a pharmacy technician but less than a pharmacist, often through a diploma or associate degree program. Focuses on pharmaceutical manufacturing and formulation techniques.

Role
Pharmacist	Conduct medication therapy management (MTM). Provide patient counselling on medication use and health conditions.
Pharmacy Technician	Support pharmacists by preparing and labelling medications. Maintain inventory and manage prescriptions. Cannot provide clinical counselling or make decisions about medication therapy.
Pharmaceutical Technologist	Assist in compounding complex formulations or sterile preparations. Play a key role in drug distribution within hospital or industrial settings.

Pharmacy assistance: Most countries require a high school diploma for a pharmacy assistant position. However, training can be completed through a certificate program. They gain their knowledge and experience through on-the-job training under the supervision of a pharmacist. They provide basic support in pharmacy operations, primarily assisting with administrative tasks such as organizing inventory, handling customer transactions and ensuring the pharmacy is well stocked.

Area of Pharmacy

Area	Roles
Community Pharmacist	The most accessible form of pharmacy practice, providing direct services to the public. Counsel patients Dispensing medication and managing prescriptions. Providing medication therapy management (MTM)
Hospital Pharmacist	Focus on optimizing medication use for hospitalized patients. Preparing and dispensing medications for inpatients.
Industry Pharmacist	Involves the production of pharmaceutical drugs and formulations. Focus on product development
Academia Pharmacist	Focuses on education and training of future pharmacy professionals. Conducting research in pharmaceutical sciences and public health.
Regulatory Pharmacist	Oversees the monitoring, and regulation of pharmaceutical products and practices. Ensuring compliance with laws and regulations. Evaluating drug safety, efficacy, and quality. Licensing pharmacies and professionals.
Administration Pharmacist	Managing budgets, staff, and resources in pharmacy settings.

Features of Pharmacy

Medication Therapy Management

Medication Therapy Management (MTM) is a patient-centered approach to optimize medication use and improve therapeutic outcomes. It involves:

Identifying Gaps in Care: Reviewing patient medication regimens to address underuse, overuse, or misuse of medications. Ensuring therapy aligns with clinical guidelines.

Patient-Specific Interventions: Educating patients about their medications and health conditions. Collaborating with healthcare providers to adjust treatments.

Promoting Adherence: Identifying barriers to medication adherence (e.g., cost, side effects, complexity).

Provision of Injections (Certification)

Vaccines: Administering immunizations such as influenza, COVID-19, and travel vaccines.

Long-Acting Antipsychotics: Providing mental health support through depot injections (medications that last longer than pills or liquids) for patients with psychiatric conditions.

Use of Technology

Utilizing tools like:

Electronic health records (EHRs) for streamlined communication with other providers and for containing patient health information.
Automated dispensing systems to enhance efficiency.

Professionalism

Commitment to ethical practice, lifelong learning, and adherence to regulatory standards. Active involvement in advancing the pharmacy profession through research and education.

International Professional Pharmaceutical Association

Pharmaceutical Society of Great Britain

This society was established in 1841. The pharmaceutical society of Great Britain was one of the first formal professional organization for pharmacies in the UK. Its goal was to regulate the practice of pharmacy and promote the interest of pharmacist. This Society later evolve in what is now known as Royal Pharmaceutical Society (RPS)

Commonwealth Pharmaceutical Association (CPA)

This association was established to unite pharmacist across Commonwealth countries with regional groupings to support cooperation, knowledge sharing and advancement in pharmacy practice.