I swallowed the pill and headed for my car, confident I’d completed the course as instructed. I usually left home on Saturdays well over an hour earlier to join the Saturday Morning Walkers before dawn.

As I was driving along the Ridge Road, lines by the English poet Richard Lovelace ran through my head: “I could not love thee, dear, so much,/Loved I not honour more,” from “To Lucasta, Going to the Warres” (1649).

The poet was speaking as a cavalryman who had rejected his wife’s pleas for him to get someone else to fight for King Charles against the rebel Parliamentary army. I did not have that option as I’d promised the race organisers before my illness that I would participate even if no other male “power walker” turned up at the A.O. Shirley Recreation Grounds.

After a prompt 7 a.m. start, the runners soon left behind a handful of female walkers and me. Four of us gradually pulled away from the rest after we crossed over at Port Purcell and began overtaking entrants who had ignored the “walk only” rules, but were already fading away.

I exchanged waves with some Saturday Morning Walkers opposite Treasure Isle, but blamed my slowing down by the time I’d reached the ferry dock on the soft sports shoes I was wearing out of concern that my walking boots might have damaged the running track.

My erstwhile female companions were already returning on the other side before I reached the mini-roundabout after the dolphins, sadly aware that I couldn’t catch them up. A race official near Peebles Hospital drove off after I’d assured her that I was okay.

Leg injury

I sought refuge from a heavy rain shower in an open yard behind a building that fronted on Main Street. As I stepped over a block of wood, however, I heard something snap low down in the back of my right leg and felt such an intense pain in it that I had to balance on my left one.

Having got so far, I was determined to finish the course and needed to get back to my car anyway. I hobbled up to the top of Main Street with my injured leg supported by a blue piece of wood and turned into Lower Estate.

The drivers who offered me a ride looked nonplussed when I declined their offers by explaining, “I’m in a walking race.” However, a walking companion drove back to reassure the organiser that I was on my way.

She met me near the 1780 Lower Estate Sugar Works Museum, where my car was parked, although the finishing line was back at the Recreation Grounds, as everybody else had left. After feeling a gap above my right ankle, she opined that my Achilles heel had probably snapped.

My walking companion kindly took me home and promised to bring my car back the next day.

Pill’s effects

Remembering the organiser’s explanation of my pain, I googled “snapped Achilles heel” and was shocked to see several reports of some successful class actions in the United States which blamed the drug I’d taken for injuring patients’ tendons.

The cases led to drugmakers having to settle for millions of dollars and the US Food and Drug Administration decreeing that warnings of the possible damage to tendons from the use of the drug should be “black-boxed” (prominently displayed) on the patient information leaflets (PILs) distributed with every medication dispensed.

As an inveterate reader of small print, I recalled some warnings about the possible side effects in a small number of patients from use of the same antibiotic, but not that they were particularly prominent. It seemed to have quickly cured a urinary infection six months earlier.

I had enjoyed generally good health until then, but occasionally emerged from my general practitioner’s clinic reassured that I should continue to do so as long as I walked regularly. However, he and two colleagues had repeatedly prescribed a drug that had now deprived me of that ability. I felt confused and a bit angry.

My right leg was encased in a cast for a couple of months, ample time to do a lot of research and reflect on what had brought me to that situation.

I had been prescribed the same drug after a recent recurrence of that urinary infection, but it had not been so effective the second time. Moreover, I had noted on the PIN a warning about possible damage to tendons if the drug was taken by “over 60s” who exercised regularly.

‘Exceedingly disappointed’

A visiting Virgin Islander who practises medicine in the US wrote that he was “exceedingly disappointed that a doctor had recommended that drug without drawing my attention to all the well-known and well-documented warnings on the package insert about the risks to tendons if using this family of antibiotics.”

After my leg had recovered I consulted a urologist from St. Thomas who took appointments on Tortola. Tests and scans revealed no trace of any infection, but he advised me to take two bladder operations in his clinic on St. Thomas (which would be done back-to-back in a younger patient).

What followed revealed the benefits of having FDA-regulated health care in our neighbouring territory. While signing the preoperative permissions in a Tortola clinic, I noticed that one document confirmed that I’d read a “privacy statement.” When I asked to see it, the nurse told me that she’d not brought a copy from St. Thomas because “it’s not needed over here.”

Each medication dispensed by a pharmacy in St. Thomas had an individual new printout in English of the latest version of its PIN attached, with significant warnings as to its use displayed in prominent black boxes.

I do not want to name any particular clinic or pharmacy, but there’s a common tendency here not to encourage a patient’s participation in their own health care. Examples include the following practices:

  • dividing the contents of producers’ packets and dispensing them in clear plastic bags without PINs; and
  • dispensing drugs with PINs that are outdated or printed in a foreign language (commonly Turkish).

Other procedures

Following my urinary treatments, I had minor surgery on Tortola on two other parts of my body that resulted in one case having to rush to Puerto Rico for an emergency operation to cure an infection and in the other to continue to suffer from an imperfect procedure until a St. Thomas specialist clinic is given permission to work on Tortola and correct it.

Other issues that have come to my attention include:

  • male misdiagnosis of female complaints (and vice versa);
  • lack of interest in the condition and pleasantness of waiting rooms (one clinic, little changed over 30 years, would be made more welcoming by re-decoration and oiling the door hinges);
  • the need for a blood bank (presently preoperative patients have to find their own blood-matching donors, although Peebles holds a small store from which blood may be “borrowed” in emergencies); and
  • lack of clarity provided as to National Health Insurance coverage of overnight expenses.

Tougher regulations

The government should support Caribbean health care bodies and Pan-American Health Organisation recommendations, recognising that challenging major pharmaceutical companies requires greater clout than we could possibly have and work towards adopting model health care laws and UK legislation where appropriate, releasing the Attorney General’s Chambers to customise rather than invent the wheel — and give regulators teeth!

This is the first time I’ve shared these issues with anyone except medical professionals, but I’ve been generally very disappointed by their responses. One GP said that although my concerns were important to me, they didn’t have time to keep up with every drug’s side-effects.

Medical tourism is a possible money-earner for the territory, but the first consideration for any new specialist treatment to be offered should be its potential for improving health care in the territory and reducing the need for residents to travel abroad to receive it. The recent operation to insert a pacemaker should fall into that category.