Jamaica

Original Editor -Laurel Walters

Top Contributors - Didzis Rozenbergs, Laurel Walters and Elaine Lonnemann    
Jm-lgflag.gif


Patient Access to Physiotherapy or Physical Therapy Services / Entry Point

The Health Service Delivery in the public sector is provided through a network of Secondary/Tertiary Care facilities consisting of 24 hospitals including 5 specialist institutions and Primary Care facilities comprising 348 health centers, managed by the four Regional Health Authorities.[1]

Patients are referred by their physicians  in hospital settings and private clinics. PT's do not have direct access at this time however they are part of an interdisciplinary team providing care to the patient.

Therapist Preparation

      Degree/Credentialing

EDUCATION/TRAINING

Today, ‘Physio School’, as it is commonly referred to by its students, is administered by the Faculty of Basic Medical Science at the University of the West Indies Mona Campus and offers a three-year Bachelor of Science Degree in Physical Therapy.

At present the minimum entry requirements are five (5) CSEC/GCE subjects including two (2) science subjects, 2 CAPE or Advanced Level science subjects, sixty (60) volunteer hours and an interview. Upon successful completion of the programme, graduation and registration with the Council of Professions Supplementary to Medicine (CPSM) that individual is considered a Registered Physical Therapist and can practice legally in Jamaica.[2][3]

Training requires the completion of a Bachelor of Science (BSc) degree which consists of a three year program which covers the Physiotherapy coursework followed by a 12 months internship [4]

     SPECIALIZATION

The University of the West Indies began offering the Master of Sports and Exercise Medicine to Physical Therapists in September 2010. Physical  Therapy disciplines practiced in Jamaica include:

Orthopedics,Pediatrics, Neurology, Geriatric, Sports Medicine, Women's Health, Ergonomics, Hydrotherapy, Cardiopulmonary, Manual Therapy[4]

POST GRADUATE STUDIES

Physical therapists may choose to do post graduate studies in their area of choice. Some Physical Therapists in Jamaica are enrolled in, or have completed the Doctor of Physical Therapy program offered at Nova Southeastern University. The option for an academic doctorate (PhD) is also available both locally and overseas[4]

Professional Associations

Ms. Phyllis Wilson, the first Jamaican trained in Physical Therapy, recognized the need to have a local association of physical therapists to:

  • give recognition to, promote and protect the profession of Physical Therapy in Jamaica;
  • standardize clinical techniques and practices so as to maintain quality control;
  • achieve bargaining status.

Thus in May 1964 the JPA was formed, with an executive comprising Ms. Wilson, chairman, Ms. J. Erwin, secretary and Ms. W. Magnus, treasurer. In April 1970, the association with a local membership of nine persons was granted membership in the World Confederation for Physical Therapists (WCPT) at the international congress held in Amsterdam. The association today has a membership of 41 therapists both locally and overseas. The committees within the association such as education, fundraising, ethics and public relations work assiduously to attain a high standard of performance and representation for the profession. The JPA has furthermore been instrumental in facilitating the upgrading of the knowledge base of local therapists through organizing educational seminars relevant to physiotherapy.[5]

Upon completion of the 12 month intership program, Physical Therapists are eligible for registration with the Council for Professions Supplementary to Medicine (CPSM). This was replaced by the Health Professions Council on April 1, 2002 At the national level, Physical Therapists are represented by the Physiotherapy Association of Jamaica.[4]

Jamaica Physiotherapy Association

Information about the Patient Community

Physiotherapists treat and prevent many problems caused by pain, illness, disability and disease, sport and work related injuries, ageing and long periods of inactivity. They work in a variety of settings, including hospitals, health centres, schools, sports centres, education and research centres, hospices and nursing homes, rural and community settings.[6]

Proportional mortality (% of total deaths, all ages) - Cardio vascular diseases (32%), Communicable, maternal, perinatal and nutritional conditions (21%), Cancers (15%), Injuries (11%), Respiratory diseases (7%), Diabetes (4%), Other noncumunicable diseases (10%). NCDs are estimated to account for 68% of all deaths.

Behavioral risk factors: 2008 estimated prevalence (%); Current daily tobacco smoking (12.3%), Physical inactivity (47.7%).

Metabolic risk factors: 2008 estimated prevalence (%); Raised blood pressure (39.9%), Raised blood glucose (11.4%), Overweight (55.3%), Obesity (24.1%), Raised cholesterol (30.4%).[7]

Social/Cultural Influences

Cultural/individual views of disability

Cultural concepts that influence views of disability and illness originate in religious beliefs related to Christianity and Afro–Christian sects such as Pocomania and Kumina. There are major beliefs that may have an influence on the way Jamaicans view disability: for example, disability is a punishment for wrongdoing, obeah or guzu, evil spirits, ghosts or duppies, and natural causes. These belief systems are entrenched in Jamaican society.

Jamaicans are firm believers in the power of God as a mediator between good and evil in their daily lives. God is seen as a force operating from a position of duality, at the same time forgiving and punishing. The nature of God is perceived to include a great capacity for a long–term vindictive memory. Those who sin or commit wrongful acts will always be punished. If the perpetrator escapes punishment, their offspring are certain to reap the negative effects of past wrongs. Thus the cause of accidents or congenital deformities may be attributed to punishment deserved. This punishment can be the responsibility of past generations as well as the victim.

The belief that disability is a result of punishment for past wrongs or sins is associated with tremendous shame and guilt. In an effort to minimize public shame, families often conceal the fact that a member of the family has a disability. Hiding a disability is particularly true when it is congenital. A child who has a birth defect may be hidden from public view for life.

In general, Jamaicans tend to self–medicate and exhaust every possible home remedy before seeking professional medical assistance. Elders within the family are generally the repositories of herbal wisdom and they often insist on the practice of self–medication. It is even combined with traditional medicine. Herbs are also used for health maintenance.

Acceptance of certain types of disabilities are affected by the views held about these disabilities. Physical disabilities are more readily accepted than mental or cognitive ones. Of all disabilities, mental illness is most stigmatizing and very little is expected from persons living with mental illness.

Among Jamaicans, causative factors are important not only for the individual with the disability, but for family and community as well. There is diminished compassion as well as anger directed at those who receive injuries or disabilities because of personal negligence. Although care is provided by the family, the person with the disability is reminded that he/she was responsible for the disability.
With regard to adjustment, parents may find it easier to adjust to the fact that their child was born with a disability rather than one acquired during childhood. Grief over the loss of a child's potential is paramount.

It is necessary for rehabilitation service providers to recognize that the desire for personal independence and an active role in decision making is essential for many Jamaicans with disabilities. The high regard for independence and self–reliance might affect consumer's views on independent living or institutionalization of family members. There is a strong sense of self–reliance as it relates to the use of public assistance. The Jamaican consumer might resist the concept of independent living because he believes that a family member with a disability is the responsibility of the family and that he should be cared for and not be forced to work. There is also a belief that a family member should not be placed in a facility outside of the home, unless it is a hospital or similar setting. Placing a family member in a group home would be considered an abdication of family obligations. Because of the belief that a disabled relative should not have to work, job placement might also be met with opposition.[8]

Role of the Community

Community involvement in rehabilitation is limited, but increasing public awareness through media promotion is helping to educate the community about issues faced by people who are physically or mentally challenged. The limited input from the community is particularly poignant as it relates to employment of people with disabilities. Most people with disabilities who are employed are in the governmental work force. The private sector has not yet become a major partner in providing employment.[8]

Interaction between consumers and service providers

Interaction between consumers and service providers may be influenced by the source of referral. Consumers who are referred by the medical profession will be apt to use the resources because physicians are among the authority figures of the society. Rapport–building with physician–referred consumers will also be easier because of their desire to comply with the doctor's instruction.

The use of home remedies is a major health practice among Jamaicans. Traditional medical treatment is generally sought after home treatments have been exhausted. By the time medical intervention takes place, irreparable damage has often occurred. Even when medical care is employed, there is a practice of blending prescriptions with home remedies. It is very difficult for health professionals to convince consumers to rely solely on modern medicine. Cost is a factor. People may have to choose between going to the doctor and buying food. Second, there is a historical tradition of using home remedies that have successfully eliminated health problems. Elders, who are authority figures in the family, are more inclined to use home remedies before seeking medical attention.[8]

Delivery of Care

Jamaican rehabilitation efforts are limited and emphasis on comprehensive and long–term services is virtually non–existent. In 1994, grassroots efforts of the Committee of the National Advisory Council on Disability (CNACD) submitted a draft of a national policy to the Ministry of Labor Welfare and Sports, the governmental body with portfolio responsibilities. In 2000, the national policy was enacted into law. The national policy will focus on ameliorative strategies in eleven key areas of rehabilitation: health, education, vocational training, employment, accommodation, communications, housing, accessibility, political and civil rights (National Advisory Council on Disability, 2000). Rehabilitation service delivery in Jamaica is very limited. In addition to scarce resources, access to programs are most often, if not always, located in the corporate area. Persons residing in outlying or rural areas cannot avail themselves of rehabilitation services. [8]


Inpatient and outpatien rehabilitation programmes are provided by hospitals and rehabilitation centers. [9][10][1] Comunity based rehabilitation programmes are aviable in Jamaica. [2]

Type of Health System

The central government has traditionally provided most medical services in Jamaica through the Ministry of Health. The National Health Services Act of 1997 authorized the decentralization of the health care system through the creation of regional health authorities and the restructuring of the national Ministry of Health.[3]

Priorities for health include the need to reduce/control the spread of HIV/AIDS, focus on Maternal and Child Health, for example, reducing maternal mortality; and implementing the Healthy Lifestyle Policy, promulgated in 2004, to control the incidences of Chronic Non-Communicable Diseases (CNCDs) that are lifestyle related.
The strategies dictate increased attention to health education and promotion to reorient our people towards health seeking behaviours. This is based on a recognition of the cause and effect principles of engaging in risky behaviour related to lifestyles and facilitating individuals taking responsibility for their own health status and making informed decisions and choices.
“User Fees” were introduced recently and persons are asked to make a contribution for health care services, this represents only a fraction of the real costs to the system. The MOH has therefore developed partnerships with local, regional and international organizations to facilitate meeting the challenges, achieving the objectives and maintaining standards, in keeping with the expectations and our aim to deliver a high quality health service to ensure the health and wellbeing of our population.[4]

Jamaica is committed to universal access at the primary health care level.[5]

Payment System

Total health expenditure of Jamaica year 2010:

General government expenditure on health (GGHE) as % of THE - 53,5
Private expenditure on health (PvtHE) as % of THE - 46,5
GGHE as % of General government expenditure - 6,3
Social security funds as % of GGHE - 0,0
Private insurance as % of PvtHE - 25,6
Out of pocket expenditure as % of PvtHE - 71,0 [6]

Resources

WCPT Country profile for Jamaica


References

  1. 1.0 1.1 http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_jam_en.pdf
  2. 2.0 2.1 http://www.jpa.org.jm/pages/about-us
  3. 3.0 3.1 www.mona.uwi.edu/admissions/programmes
  4. 4.0 4.1 4.2 4.3 4.4 www.healthaccessja.com
  5. 5.0 5.1 http://www.jpa.org.jm/pages/about-us
  6. 6.0 6.1 http://www.moh.gov.jm/links/functions/182-role-and-functions-of-physiotherapistsphysical-therapists
  7. http://www.who.int/nmh/countries/jam_en.pdf
  8. 8.0 8.1 8.2 8.3 http://cirrie.buffalo.edu/culture/monographs/jamaica.php
  9. http://chancejamaica.weebly.com/index.html
  10. http://jamaicahospital.org/pages/clinical_services/rehab/rehab.html