The Tribune

By FELICITY DARVILLE

TWO phenomenal women, both forerunners in the Pharmacy industry in the Bahamas, shared their stories with me this week. We spoke of their journey to success, and the challenges along the way, including the most recent hurdle, which led them to join with pharmacists throughout the country for a shocking one-day closure of pharmacies.

Shantia Heild-McBride is the current president of the Bahamas Pharmacy Association (BPA), an organisation that has been the voice for the pharmacy profession in the Bahamas since it was founded in the 1970s.

Chargrega D McPhee is on her final lap in her quest to attain her Doctorate degree in Pharmacy, with a vision to educate and inspire the next generation of pharmacists.

“One of the main reasons I chose to pursue my Doctorate in pharmacy (Pharm D) is actually to be able to lecture, in order to further pharmacy education in The Bahamas,” Chargrega told me.

“I went to school in Jamaica (University of Technology), which has a very solid pharmaceutical programme. Their pharmacy education is one of the top in the Caribbean. I didn’t see a reason why The Bahamas couldn’t have the same. It just requires us having more pharmacy lecturers, providing more clinical knowledge, expanding and improving on our knowledge locally. I want to help push that movement. In order to do so at the University level, you have to have your doctorate degree.”

Shantia also attended the University of Technology in Jamaica. Both she and Chargrega graduated from St Augustine’s College in Nassau, prior to pursuing tertiary studies. Shantia has been in the pharmacy profession for over 23 years.

Both of these women are young women, and both are pharmacy owners. Shantia is the proprietor of One-on- One Pharmacy, which has two locations; Total Care Pharmacy and Island Care Pharmacy. Additionally, this powerhouse shares partnerships in other pharmacies throughout New Providence. Chargrega has also changed the game in pharmacy ownership. She worked for Comprehensive Pharmacy located in the Oaktree Medical Plaza for three years, before she turned around and bought the pharmacy from the owners. She has been successfully running operations for two years.

Both women are powerfully navigating an industry that has grown by leaps and bounds in the past four decades since the BPA has been in existence. Its membership comprises pharmacists, technicians, educators and supply management personnel - the movers and shakers who are propelling the profession into the future.

“We provide services that often go unnoticed because it’s a part of our training; but we do it because we care,” Shantia said.

“As drug treatment specialists, we provide, at no charge, disease and drug consultation, walk-in services, monitoring services, and more. Pharmacists are on the frontline of healthcare in The Bahamas every day.”

To become a registered pharmacist in The Bahamas, you have to earn a Bachelor of Pharmacy Degree from an accredited university, then complete 2000 intern hours. After that, you must sit and pass the Bahamas Pharmacy Council’s Pharmacist Registration Exam (PRE).

“Pharmacists can specialise in any disease area list in the Price Control list,” Shantia explained.

“We are proud to say that we have pharmacists specialising in Oncology, Nephrology, Compounding, and Infusion/Nutrition. There are also clinical pharmacists that assist physicians on hospital ward rounds for Total Patient Management Therapy.”

That Price Control list of which she speaks, recently became a thorn in the side of pharmacists. The Price Control (Drugs) (Amendment) Regulations 2022, which took effect on Monday, October 17 imposes price-controlled mark-ups ranging from 15 percent to 18 percent on pharmaceutical wholesalers, and 35 to 40 percent for retailers. This will remain in place for at least three months until January 17, 2023, although it could be extended for longer.

Shantia explained the predicament it put members of the BPA in: “Due to inflation in different sectors of doing business, the 50% (price control markup under which we previously operated) only brought us to marginal profit. We were able to sustain ourselves and live comfortably, but it’s not the grand profit margins that people think of when they think of a pharmacy. So, going to 35 or 40 percent would place many of us below operational costs. Bigger pharmacies may have been able to survive the drop, but many smaller pharmacies could not. They cater to smaller communities. They would not have been able to make it through the recommended three months.”

From the government’s standpoint, the changes are necessary to help alleviate the cost of living in several areas, after conducting surveys in order to meet the needs of the public.

But the BPA says it had no forewarning of the price-controlled markup changes, and were blindsided by the government’s decision.

On November 1, 2022, which was the second date of enforcement of price control regulations, most of the privately owned pharmacies in the country closed their doors. Many members of the public were in a panic, and were especially concerned about how long such essential services would be unavailable.

Doctor’s Hospital pharmacies, government facilities, and a few private entities remained open that day.

Shantia explained that in the face of $5,000 fines in violation of the Regulations, and unspecified terms of imprisonment, they were forced to close their doors that day, or face possibly having to close them indefinitely.

Members of the BPA were able to gain an expeditious meeting with government, including Ministers Michael Darville, Michael Halkitis and Attorney General Ryan Pinder.

Together, they strategised a price control amendment that allows for the survival of pharmacy operations, while also providing economic relief to Bahamians. Pharmaceutical wholesalers will operate at a 20 percent markup, and retailers at 40 percent.

“While pharmacists have a mandate to help with the healthcare of our patients, one of our biggest mandates is also education,” Chargrega said.

“We do it on a relatively smaller scale, reaching people one-on-one in our communities. But by partnering with government we can have a broader range and additional capital that makes this education better. One of the things Dr Darville (Minister of Health) said is that the hospital beds are full. In this case, you have patients who either can’t afford the medication, or they are not compliant with taking their medication. So, while the government is trying to get prices down, our mandate has always been education.

“If we can help to educate people on the importance of taking their medication as prescribed, and stay compliant with their medication, then we can help people get better. We can be more proactive instead of reactive, help to reduce hospital admission and keep the numbers down.”

Chargrega’s passion for pharmacy is not only clinical. It extends to the education and regulation areas, leading to her previous posts as Education Chair and Council Member of The Caribbean Pharmacy Association. She is also the immediate past Deputy Chair of The Bahamas Pharmacy Council.

She is currently completing her research thesis paper entitled “Knowledge, Attitude and Practices of Pharmacists in The Bahamas towards Adverse Drug Reaction Reporting”. This will allow her to successfully complete the requirements to be awarded her Doctorate of Pharmacy degree. She is doing all this while being a dedicated mother to her daughter Canaan.

Shantia is also a regional trailblazer. She serves as a Council member on the Caribbean Association of Pharmacists Board. She won the Caribbean Community Pharmacist of the Year Award, 2018 and she was also bestowed the Caribbean Pharmacist of The Year, 2021. When asked about her biggest accomplishment to date, she says that being the best wife and mother she could be is paramount, while giving as much as she could to expand the pharmacy industry in the Caribbean, especially the Bahamas.

When she became BPA president, Shantia and her team swiftly started a movement to ensure that pharmacy remains an active stakeholder in health discussions, initiatives, and unforeseen national disasters. She represented pharmacy owners in the NHI negotiations.

She helped to organise a team of pharmacy volunteers to be ready on day one at the medical triage, Odyssey Suite, during Hurricane Dorian. She also assisted in hosting vaccinator training on the initial vaccination health team of COVID-19 vaccinators.

“If we could educate Bahamians about the importance of going to their doctor every three months, sticking to their medication - every single problem I can think about boils down to education, and so we want to partner with the government on that.”

She believes that pharmacy stakeholders like herself and Chargega stand on great shoulders and have a lot to live up to, for the industry and for the Commonwealth of The Bahamas.

The first BPA president was the father of pharmacy in The Bahamas, E Pedro Roberts. He was succeeded by Viviene Lockhart, Dencil Major, and Clinton McCartney. Successive BPA presidents included: Carrol Sands; Vanria Rolle; Laura Pratt Charlton; Philip Gray; Jeff Lowe; Marvin Smith; Stephon Flowers; Renee Reines; Michelle Finlayson and now, Shantia Hield-McBride.

“As I perused the myriad of experiences that we have had, it is undeniably colourful and heartwarming to see the strides made and templates set for us to follow,” Shantia said.

“We have had some troubling low moments but those have been nullified by the many success stories and the varied hurdles we have overcome.”

There are several types of pharmacies operating in The Bahamas, including: a hospital pharmacy; clinical pharmacy; community/retail pharmacy; wholesale distribution warehouse; and manufacturing facility.

In a letter to the government, the BPA offered several recommendations, including: eliminate Vat and duty on medicines and ensure that Price Control Officers enforce that savings are passed on to customers; and that price control for wholesale and retail operations be revised after 90 days.

They still hope to return to the 50 percent mark-up on prescription medicines for retail pharmacy operations, and 25 percent mark-up on prescription medications for wholesale operations.