Bermuda short: my role as a pharmacist in an overseas territory

John Bentley is a pharmacist at People’s Pharmacy, Hamilton, Bermuda.

What is your career background?

I undertook my preregistration training in 2009 at East Kent Hospitals University NHS Foundation Trust and had the opportunity to rotate through a number of different pharmacy services. One of the things I liked about hospital pharmacy was the potential to work in many different pharmacy roles. I went on to undertake a junior rotational pharmacist role, while commencing a postgraduate diploma in clinical pharmacy. After a couple of years, I moved to Chelsea and Westminster Hospital — a London teaching hospital — as a specialist surgical pharmacist. Working in a large pharmacy department in a dynamic hospital where I had the opportunity to contribute towards the management of specialist surgical patients (such as those with burns or have undergone bariatric procedures) was a valuable experience.

What is your current role and how did you end up in Bermuda practising pharmacy?

I work as a community pharmacist across two pharmacy sites for People’s Pharmacy. One is a busy community pharmacy in the heart of Hamilton, the capital of Bermuda, and the second is in the outpatient pharmacy in the island’s only general hospital. I work as part of a team of pharmacists from many countries, including Cuba, Jamaica, Barbados, Canada, the United States and Ireland.

Much of the legislation that affects pharmacy here has been created using aspects taken from other countries

I had been working as a surgical pharmacist for a few years and was considering my next career step when I came across an advert in The 
Pharmaceutical Journal calling for pharmacists to work in Bermuda. I applied out of interest without knowing much about the country, other than it was famous for its shorts and that planes frequently go missing in its vicinity. After living in the fast-paced city of London and commuting to and from work for three hours a day, a move to a sub-tropical island sounded appealing.

How does your role differ from other pharmacy roles because of its location?

Bermuda is a British overseas territory located in the Atlantic, around 600 miles off the east coast of the United States. Because of the island’s location and history, there are strong British, American and Caribbean influences, although the country does have a very proud and distinctive identity of its own.

Much of the legislation that affects pharmacy here has been created using aspects taken from other countries such as the UK, the United States and Canada. As in all these countries, drugs here are separated into different schedules. Some of the classifications of prescription and over-the-counter medicines in Bermuda lag behind these countries. For example, steroid nasal sprays and emergency contraception are currently only available on prescription here. This can be frustrating and limits treatment options in the pharmacy.

Physicians working in Bermuda have all trained overseas and in many different countries, therefore, prescribing practices between doctors are diverse. When I first moved to the island, I encountered lots of prescriptions for drugs and doses that I had never seen before and had to quickly become accustomed to looking at different reference sources to check prescriptions and not just the British National Formulary.

Pharmacists on Bermuda are expected to dispense and hand out every prescription

Almost everything in Bermuda has to be imported. This can often result in supply issues and delays in getting drugs ordered into pharmacies, which can be for any number of different factors, including the occasional hurricane. As a pharmacist here, you often have to liaise with physicians directly to discuss solutions and suggest suitable alternatives at short notice.

What does a typical day look like, in terms of your tasks and responsibilities?

Pharmacists on the island are expected to dispense and hand out every prescription. This provides the opportunity to spend a lot more time counselling patients, something I often didn’t have the time for, but would have liked to do back in the UK. Bermuda has some of the highest rates of diabetes and asthma in the world and pharmacists here play an important role in trying to tackle this endemic. I spend a lot of time counselling patients about their medicines and providing them with advice on how to best manage these conditions.

As patients often come to the pharmacy first, we are required to diagnose and manage many minor ailments. When I first arrived, I was already familiar with most of the presenting conditions, although there are some local conditions that are more common to Bermuda. The warm, humid climate here is ideal for fungal growth, so we see lots of fungal infections. One fungal infection in particular, pityriasis versicolor, is so common here that it’s been given its own name, ‘Bermuda rot’.

Other conditions you frequently encounter include: Portuguese man-of-war stings; seabather’s eruption (a rash that affects areas of the skin covered by a bathing suit, rather than exposed areas, after swimming in the sea); and ‘road rash’ from accidents on scooters. With the high number of tourists visiting the island, many by cruise ship, I frequently have to treat and provide advice on common holiday ailments such as travel sickness, sunburn and indigestion.

What are the most enjoyable and challenging aspects of your role?

Bermuda, although a British overseas territory, does not have a national healthcare system like the UK and patients here have to pay for private healthcare cover. It can be tough seeing patients sometimes forgo drugs and medical treatments because they are not able to afford them, although the government does provide some basic cover for older people, people with disabilities and the unemployed. This certainly gives you a newfound appreciation for the NHS.

The Bermudian people are renowned for being friendly and coupled with it being such a small island with a population of just over 60,000, you soon get to know many of your patients on an individual basis. I have found that patients here appreciate any healthcare advice that is given and will often come to the pharmacy as their first port of call. It’s rewarding to be able to have such a big impact on patient care.

What might other pharmacists find surprising about working abroad or in an overseas territory?

The vast majority of pharmacists working in Bermuda are from overseas, this is in part because there are no pharmacy schools on the island. Pharmacists applying to work here can be registered in any country, but they must satisfy the Bermuda Pharmacy Council as to their ability and suitability to practise pharmacy. The island might be small but there are pharmacists here from all over the world, which is one of the reasons that makes working in Bermuda so interesting and enjoyable.

Rent here is comparable to central London and it’s not unusual to pay up to the equivalent of £10 for a pint of beer

To register and work as a pharmacist here, you must undertake a one-month preregistration period under the supervision of a Bermudian registered pharmacist. Towards the end of this supervised period you sit a three-hour pharmacy exam.

Working in Bermuda with its sub-tropical climate, world-renowned beaches, outdoor activities, friendly locals and great ex-pat community makes for a good work-life balance. Living in paradise, however, doesn’t come cheap as the island is often listed as one of the most expensive places in the world to live. Rent here is comparable to central London and it’s not unusual to pay up to the equivalent of £10 for a pint of beer.

What should someone who wishes to work abroad or in an overseas territory consider before they do so?

To work in Bermuda, all overseas employees including British citizens must have a work permit. This is applied for on your behalf by your employer and usually runs for a period of two years before you then have to re-apply. Having to continually re-apply for a permit that could be rejected means you can never be guaranteed job security and it may also limit your career prospects.

It is difficult to become a permanent resident of Bermuda and so for many ex-pats, working here is only ever temporary. It can be tough making friends here to then see them leave the island all of a sudden.