Eyes at risk
Under Jamaican law a general practitioner can perform brain surgery and a gynaecologist can practise ophthalmology.
But as bad as that sounds, it isn't half as dangerous as practising without having legal medical qualification whatsoever, and it's one of the problems currently plaguing the fields of optometry and ophthalmology.
Representatives in both fields told the Sunday Observer that they are aware of untrained and unqualified persons practising in each of their areas but say there is not much they can do, given the laws of the country.
The Sunday Observer found eight such individuals whose names do not appear on the most recent (2006) Gazetted list of persons licensed to practise medicine and surgery in Jamaica (which includes ophthalmology), nor do they appear on the register of optometrists held by the local board of optometrists.
Four of the lot work with one particular establishment which has offices in Kingston, Trelawny, Montego Bay and Westmoreland. The others, two of whom are based in Montego Bay with the other two split between Kingston and Spanish Town, seem to work for themselves.
"I am aware that there are people out there who are not registered and who are unqualified to practise optometry," president of the Jamaica Optometric Association and member of the Optometry Board, Dr Dawn Woo-Lawson, told the Sunday Observer.
"I know of a medical doctor who's doing it, but once you're a medical doctor you can do anything. You can take up brain surgery if you want; there's no law against it," she added.
"It demeans the profession because persons put you in the same light as another doctor who is incapable. In terms of the patients, they are in danger because they may think that their eyes are ok when they are not. I know of a case where someone had a foreign body in their eye, went to the doctor and got a prescription for glasses. The person was not qualified," Woo-Lawson said.
"We're not just here to prescribe glasses, in fact, we should be looking at other health problems. It makes the profession look like we don't know what we're doing," she said.
To practise in Jamaica, an optometrist - who is different from an optician in that the latter generally dispenses eyeglasses - needs to have a degree of optometry and must register with the Jamaica Optometric Association.
Practising without having met the criteria is punishable under the Opticians Act (1926) but the penalties, according to Woo-Lawson, are only equivalent to a slap on the wrist.
Section 15 of the Act states: "Any person who, not being registered under this Act, shall hold himself out or pretend to be, or use or take the name or title of optometrist, optician, or doctor or professor of optometry or any name, title or addition implying such qualification or that he is a person specially qualified to practise optometry; shall be guilty of an offence under this Act, and shall on summary conviction before a Resident Magistrate be liable to a penalty not exceeding forty dollars, or to be imprisoned, with or without hard labour, for a term not exceeding six months."
"Do you really think the DPP is going to go after people for that kind of fine?" asked Woo-Lawson, who was trained in the United States.
On the side of ophthalmology, there is no requirement specific to the field, and so there is no punishment that speaks to practising without ophthalmologic certification.
In accordance with the Medical Act (1976), all an individual needs to practise in the field, which deals primarily with correcting disorders of the eye by surgical means, is to be registered as a medical doctor with the Medical Council of Jamaica.
"Once you're a medical doctor you can practise in practically any field of specalisation. It is archaic, but it's legal," said a member of the Ophthalmologist Association of Jamaica who asked that his name not be used because of a 1993 case involving the murder of an ophthalmologist who spoke out against another man whose credentials were in question.
"In Jamaica, we do have a problem with people practising ophthalmology without being trained to do it, but as I said, it is not illegal. There are other guidelines though that say that one should only practise according to the level of skill and training they've had. It's a moral issue," the ophthalomologist said.
In the absence of more definitive laws, he advised that patients be more actively involved in their own health care by ensuring that whoever treats them is qualified so to do.
"It's up to the patient to find out whether the individual from whom you are seeking medical care is qualified, capable and has a good track record to offer good medical care.
Under the Medical Act, anyone who practises without being registered with the Medical Council, practises while his registration is suspended for whatever reason, leads anyone to believe that he is registered or uses any occupational designation relating to the practice of medicine without being registered shall be guilty of an offence and shall be liable to a fine not exceeding $40,000 or to imprisonment for a term not exceeding 12 months or both.
Compared with those under the Opticians Act, these measures are more reflective of a modern Jamaica and the optometrists are seeking to have the law that governs their profession revised to incorporate the changing face of medicine, as well as the changing value of the Jamaican currency.
"Optometry has evolved in such a way that [depending on your jurisdiction], you can treat certain eye diseases right now, not just to test your eyes for glasses and contact lenses," said Woo-Lawson. "We don't do any surgery, but we can prescribe certain drops for certain diseases. They have also started the process of treatment in the UK too, so the whole education of optometry has changed and evolved.
"For example, I was trained in the United States and can treat certain eye conditions, but I'm not allowed to do that here and what has happened is that if doctors aren't able to practise to the fullness of their ability and training you don't find a lot of doctors returning to Jamaica," added Woo-Lawson.
However, it seems the pattern is slowly changing, according to the Optometric Association head who said that in the last year or two, there have been five persons who registered. "That's a lot, because for a long time we didn't have anybody coming back."
There are currently 16 registered optometrists practising in Jamaica.
"I think we are meeting the needs of the population [to some extent]. We could get more, but what is holding us back is a law that is from 1926," said Woo-Lawson.
"We're trying to change the law to incorporate our doctors doing continuing education, because once you're registered you don't need to register again and we need to change all of that so that on an annual basis or every two years you register and you need to show proof of your continuing education," added Woo-Lawson. "We're trying to regularise our profession, but we've been at the legal department for the past two years."