Princess Margaret Hospital (2/1/13)

Today we split into two groups to visit Princess Margaret Hospital and Jolly's pharmacy in Roseau. At the hospital we
learned about the inpatient and outpatient pharmacy. The outpatient pharmacy was accessible by the public while the inpatient pharmacy was connected to the outpatient but hidden from view. This allowed the pharmacies to remain connected but handle separate duties. The medications available varied between the two just like they would in the US. The inpatient pharmacy had IV and injectable medications available to treat patients with more serious conditions. The outpatient pharmacy did not handle injectable medications. If prescribed, the patient would need to obtain these medications from a private pharmacy. The doctor could also prescribe oral medications that the outpatient pharmacy didn't stock. The patient would buy these from a private pharmacy as well. The hospital had significantly less medications than an independent pharmacy such as Jolly's. All of the outpatient medications could easily fit in two (possible one) double door cabinet roughly 5 feet by 8 feet which would be unheard of in the US. The medication availability was extremely limited, which makes sense when you think about how the government basically gives them away free and the government has limited resources.

Unlike community or outpatient hospital pharmacies at home, the pharmacists at Princess Margaret Hospital helped the person in front of them from the point of handing over their prescription (or medical book) straight through giving them the medications. This wasn't a 'ready in 15 minutes or less' situation.  The pharmacist only worked with one patient at a time which seemed to help get the patients in and out of the hospital much faster. Since the population is smaller than the States, this system works out well because the hospital seems to fill roughly the amount of one community pharmacy in the States or less. The lines would be miles long if the community pharmacies in the US followed this system.

The technology usage was very different from the United States. Almost everything was done manually at Princess Margaret Hospital using paper and pens. There was no robot to fill the prescriptions. Like the rural clinics, the hospital did not have vials. Pills were placed in plastic zip-lock bags that were labeled with patient name, directions and the name of the medication. There was no sterile compounding area with a hood. Nurses mixed the IVs at the patients bedside. There was a simple computer system that used Miscrosoft Access to keep track of inventory but this was not comparable to the US where the computer system stores every detail about the patient and their medications. The computers system store a patient's electronic medical record in the States and the patients in Dominica still use their medical notebooks/journals for their medical records. While the journals are a great record keeping system since they follow the patient everywhere, they lack details that electronic medical records could have.

In regards to payment for prescriptions, ages 16 and under receive prescriptions free of charge along with those 60 and older. Everyone else between those age groups must pay a flat fee of $5 (EC). The $5 fee is the same for patients picking up one script or multiplication scripts. For inpatient, the patient was suppose to pay for 3 days worth of the prescription but if they couldn't afford it that didn't seem to be a problem. 


The differences between Dominica and the United States hospital pharmacies are substantial. While the US is more advanced, especially technology wise, the Dominican way with the medical notebooks is beneficial. The notebook basically tells the medical timeline of each person and they can bring it anywhere they travel in Dominica. This would be valuable in the States since patients see numerous doctors and don't always know their past medical history or want to share it. Patient care in the United States could be optimized with medical histories that travel with the patient. Overall, both countries can learn from each other. It was a great experience to be tour the hospital, observe their practices, and learn more about Dominica healthcare.