When tallying disease risk factors, normal arithmetic rules do not apply.

Prepared by: Dr. C. V. Alert, MB BS, DM, FCCFP.  

Disease risk factors are characteristics or behaviors that increase a person’s chance of developing a particular disease. Not everyone that has a disease risk factor will develop the disease, and there are some persons who develop a specific disease without having a disease risk factor.

 That said, in our population, the main diseases are the non-communicable diseases (ncds), like heart diseases and strokes, and cancers. Indeed, in Barbados over the last decade, we average just over a heart attack a day and two strokes every three days.  Not everyone dies after having their first heart attack or stroke, but each month at least 20 persons die after having a heart attack and another 20 die after having a stroke.

 The main disease risk factors for the ncds include a family history, getting older, being overweight or obese, being inactive, unhealthy eating habits, drinking alcohol and cigarette smoking. Some of these cannot be modified or changed, such as getting older or changing your family, but, for the most part, the other disease risk factors can be modified or changed. If you have hypertension, diabetes or high cholesterol, you are perhaps many steps closer to having a full blown heart attack or stroke, or (heaven forbid) even sudden death. Reaching this point depends largely on your eating, drinking and exercise habits.

 So, for example, drinking alcohol increases your risk of having a heart attack.  Similarly, being overweight or obese increases your change of having a heart attack: in fact, the bigger; you are, the greater is the risk. But if you have two risk factors such as being an alcohol drinker as well as being overweight or obese, the risk of a heart attack just doesn’t double, but jumps up significantly. Thus one risk factor + one risk factor do not just double the risk for a heart attack or stroke, but may increase this risk five - fold.  While normal arithmetic suggest that one plus one equals two, this does not hold for disease risk factors.  One disease risk factor plus another disease risk factor may increase the risk of a disease much more than two times, for example.

 Someone with three risk factors, for example, may have a ten-fold (or higher) risk of developing a particular disease.

Learning about your risk factors can help you make informed decisions about your health and lifestyle. It allows you to take steps to reduce your risk, such as making changes to your diet or quitting smoking.  Knowing your risk factors can also help you and your family doctor monitor your health more closely and potentially prevent a disease, or catch a disease early, when it may be reversed or easily treated and controlled. 

 We now know that some of the ‘modifiable’ risk factors for cardiovascular disease, such as smoking, drinking alcohol, poor diet, inactivity and overweight/obesity, are also the risk factors for many (but not all) cancers. Thus if we wish to lower our rates of cardiovascular and cancers, we must address the risk factor stage of many conditions, before they become full blown diseases that are often difficult to reverse.

 As far as cardiovascular diseases are concerned, over the last decade scientists have developed “Cardiovascular Risk Tables”, which allow doctors to ‘tally’ the cardiovascular risk of individuals, and calculate the chance of that individual having a major cardiovascular event (like a heart attack or stroke) in the next ten years, for example. This then allows the doctor-patient to identify specific targets, e.g. lose 10 lbs, and lower your systolic blood pressure by 10 mmHG, to lower the chance that you would develop the major cardiovascular event.

 The Pan American Health Organization, PAHO, has introduced a cardiovascular risk calculator called Cardiocal, for specific countries in Latin America and the Caribbean, including Barbados. This was part of the “Hearts in the Americas” program, aiming to promote the adoption of best practices in the prevention and control of cardiovascular diseases (CVD). Use of this calculator should give doctors and their patients targets than can eventually reduce the risk of a major cardiovascular event, lower the overload at the Accident and Emergency Department, and lower the suffering and deaths associated with these major cardiovascular events.

 The latest hypertension guidelines, the first ‘upgrade’ since 2017 endorsed by the American Heart Association (AHA)  and the American College of Cardiology (ACC), releases a few days ago, suggest individual treatment guidelines based on an individual’s cardiovascular risk calculated in a table called PREVENT. PREVENT, unlike Cardiocal, is not calibrated for Latin America and Caribbean use. These 2025 updates represent a more aggressive approach towards managing high blood pressure, based on the latest research. But in the Caribbean we should still be using Cardiocal.

 These are also risk factor calculators for kidney (renal) disease and a few other conditions, but at this time these do not seem to be in widespread use, perhaps until they are calibrated for specific populations.

 Thus, a ‘touch of sugar’, plus a ’touch of pressure’ and only ‘one or two drinks’ can send you on a one way trip to the local cemetery. A little bit of laziness plus a little bit of likerishness add up to big trouble, as far as ‘life and death’ are concerned.  Beware disease risk factors.

 

CCFP Continuing Medical Education (CME) Activities - JANUARY 2025 - AUGUST 2025

 Continuing Medical Education (CME) Activities

CME activities have been crucial in ensuring that our members remain current with the latest developments in family medicine. We have developed an array of online workshops, webinars, and discussion forums, all geared toward enhancing the skills and knowledge of our family physicians. Additionally, the chapters have hosted specialized CME sessions tailored to unique regional needs. Since January 2025,  there have been over 19 conferences/webinars/seminars/forums and workshops hosted across CCFP island states, namely:

1. Nephrology: Approach to Proteinuria
2. Approach To The Complete Blood Count, What Should Trigger A Haematology Referral?
3. Pneumococcal Vaccines
4. Contraception, Iucd's, Mirena, Pap Smears, Hpv Testing And Vaccine
5. Building Mental Resilience in a Changing World
6. Long acting reversible contraception and common clinical scenarios and Mirena insertion workshop
7. Dermatology
8. Triple therapy in the treatment and management of COPD
9. Mental Health & Wellness
10.  Ethics
11. NCD's in the Caribbean
12. Annual One Health Conference (Animal & Human Health)
13. Ophthalmology
14. Women's Health  - Sleep Apnea and Mental Health
15. The impact of the Aging Population on Primary Healthcare
16.  Beyond the White Coat: Mastering Soft-Skills for Better Patient Care
17. 'Sepsis in the GP Setting'
18. A Climate Change Curriculum: Moving from the Classroom to the Clinic
19. ONE WORLD, ONE CORE: SHARED VALUES IN FAMILY MEDICINE Theme: Uniting Diverse Cultural Perspectives around Universal Values in Healthcare

 

Honoring Dr. Alverston Bailey: Commander of the Order of Distinction

The Caribbean College of Family Physicians (CCFP) proudly celebrates Dr. Alverston Bailey, who has been conferred with the Order of Distinction, Commander Class (CD) by the Government of Jamaica. He will receive this national honor on Jamaica’s National Heroes Day, Monday, October 20, 2025, during the official public awards ceremony.

This recognition underscores Dr. Bailey’s distinguished service to Occupational and Family Medicine and his transformative contributions to public health advocacy, medical education, and community development in Jamaica and across the Caribbean.

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A Legacy of Excellence in Medicine and Public Health

Dr. Bailey embodies the ideals of distinguished service, transformative leadership, and unwavering commitment to the advancement of health and society. With a career spanning more than four decades, his impact has been felt in diverse but interconnected fields:

• Occupational Health: As Chief Medical Officer at Kaiser Jamaica Bauxite Company, Dr. Bailey pioneered industrial health programs that reshaped workplace safety and wellbeing. His certification by the American College of Occupational Medicine cemented his standing as a global leader in occupational health.

• Family Medicine: During his tenure as Regional President of the CCFP, he championed regional collaboration, fostered evidence-based practice, and successfully integrated the College into the World Organization of Family Doctors (WONCA). His leadership extended further as President of the Medical Association of Jamaica, where he championed professional standards, community outreach, and policy advocacy, including the landmark Patient Charter of Rights.

• Public Service: As Chairman of the Pesticides Control Authority (2006–2015), Dr. Bailey oversaw vital reforms in pesticide regulation, food safety, and environmental stewardship. His vision elevated Jamaica’s pesticide management framework and advanced national food security.

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Commitment to Service and Education

Dr. Bailey has devoted himself to service far beyond his professional roles:

• Volunteerism: His leadership extended to the Diabetes Association of Jamaica, St. Ann Red Cross Society, and several national boards and health initiatives.

• Education: As an academic mentor and lecturer, he shaped the careers of future medical leaders through his teaching at the University of Technology and his leadership roles in medical schools.

• Public Advocacy: Through syndicated columns, radio programs such as On Call with Dr. Al and Sexwise, and his landmark book Sexplanation: A Guide to Discussing Sex and Sexuality in the Caribbean, he brought vital health knowledge to the public.

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Awards and Recognition

Dr. Bailey has received numerous distinctions throughout his career, including:

• The Medical Association of Jamaica President’s Award (2003)

• The Caribbean College of Family Physicians Chairperson’s Award (2005)

• Fellowship in the Caribbean College of Family Physicians (2006)

• The Sir Alister McIntyre Distinguished Award (2022) for diabetes advocacy

• The World Family Doctor Day Signature Award (2024)

These accolades culminate in the honor of Commander of the Order of Distinction, recognizing his national and regional legacy.

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A Life of Integrity and Inspiration

Dr. Bailey is not only a physician and advocate but also a man of deep integrity, family devotion, and community spirit. A native of Tom Bell, Rio Bueno, Trelawny, his journey from “Kangaroo Kid” scholar to medical leader exemplifies the power of discipline, wisdom, and service.

Married to Clarissa for thirty-eight years, and a proud father and grandfather, Dr. Bailey balances his professional life with personal passions, including photography, poetry, and mentoring.

His personal philosophy is a guiding light:

“Let your life be so well lived that it stands as a beacon for all to emulate.”

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CCFP Regional Tribute

The Caribbean College of Family Physicians extends heartfelt congratulations to Dr. Alverston Bailey, CD. His career represents the highest standards of medicine, ethics, and public service, and his achievements will continue to inspire physicians, communities, and future generations across the Caribbean.

ANNOUNCEMENT - MCCFP Certification 2023–2025

 

Caribbean College of Family Physicians (CCFP)

MCCFP Certification 2023–2025

The Caribbean College of Family Physicians (CCFP) will confer MCCFP Certification on physicians who meet the College’s standards for the period 2023 to 2025.

Who can apply

Members of the Caribbean College of Family Physicians. If you are a physician, and not yet a member of CCFP and would like to apply for MCCFP Certification/Accreditation, you can JOIN the CCFP now and submit you application along with your CME certificates and other qualifying activities, by February 28, 2026.

Application Guidelines:

Full details are available here:
Guidelines for Accreditation for Doctors: Guidelines for MCCPF Accreditation for doctors

Application Portal:

Submit applications online here:
Member Accreditation Form: Application for Accreditation

Important Requirement:

CME certificates and activity records must cover each calendar year from January 1, 2023 through December 31, 2025 in order to qualify.

Application deadline and submission of CME and Activity records - 28 February 2026.

Stay committed, stay accredited!

Clinical Reflections on Patient Non-Adherence & Health System Strain.

 

Dr. C.V. Alert, MB BS, DM, FCCFP.
Family Physician.

A claim from a senior hospital official in Barbados that non-compliance with medication(s) is overwhelming our emergency services deserves further scrutiny. Despite limited national data—exacerbated by the absence of the Chief Medical Officer’s report since 2012—frontline clinical experience corroborates a concerning rise in emergency visits connected to chronic disease mis-management.

 Clinical Consequences of Non-Adherence.

Adherence encompasses more than medication—it includes lifestyle guidance, dietary protocols, exercise, and therapy compliance. Failure in these areas contributes to:

• Escalation of chronic conditions like diabetes and hypertension
• Increased incidence of strokes, cardiovascular events, chronic renal disease and dementia, among others
• Avoidable emergency department admissions and costly interventions. In Barbados there has been an exponential rise in the number of “Emergency Clinics” over the last two decades.

Clinicians witness the shift from “prevention” to “patchwork”—an unsustainable model.

The Silent Phase: Lost Opportunity for Early Intervention.

Chronic illnesses and cancers often progress undetected. Symptomatic presentation typically coincides with advanced disease, limiting reversal potential. Without proactive screening and engagement, clinicians are left addressing damage rather than preventing it.

The costliest phase is not when disease begins—but when it is finally recognized.

 Cultural & Systemic Barriers to Compliance.

Key factors hampering public health efforts include:

• Perception of health care as “sick care” rather than preventive health
• Cultural normalizations of unhealthy behaviors, such as alcohol promotion, cannabis acceptance without comprehensive safeguards
• Limited access to timely medical advice due to system strain or personal aversion

 Clinical Imperatives: What We Can Do.

Let’s reorient our approach:

1. Promote Regular Evaluations

Many persons ‘boast’ that they have not seen a physician in years. Encourage routine check-ups as standard, not exceptional. Use every interaction to reinforce preventive thinking.

2. Champion Lifestyle Counseling.

Move beyond prescriptions—engage patients in meaningful discussions about nutrition, physical activity, and mental wellness.

3. Educate on Risk Factors, Not Just Conditions.

Use tools like the American Heart Association’s Life’s Essential 8 as a framework, to encourage:

• Healthy eating and hydration habits
• Sleep hygiene, stress management
• Avoidance of smoking and alcohol misuse
• Weight, blood pressure, cholesterol, and glycemic control. These all require primary care physician involvement.

4. Advocate for Public Health Infrastructure.

Push for return of national health reports, investment in wellness outreach, and rebuilding bodies like the National Physical Activity Commission and the National Chronic Disease Commission. The public primary health care clinics (polyclinics) need to be upgraded, and the meaning of primary care needs to be revisited.

Conclusion: From Reaction to Prevention.

We must collectively redefine success in healthcare—not just in treating disease, but in preventing its onset. Non-adherence isn’t just a patient issue; it’s a reflection of how we as clinicians communicate, empower, and systematize health.

 

Hypertension: Prevention and Building Resilience.

 

Hypertension: Prevention and Building Resilience.
Dr. C.V. Alert, MB BS, DM, FCCFP.
Family Physician.

Non-communicable diseases (NCDs) are the world’s leading cause of death and disability. They include cancer, cardiovascular disease, diabetes, and chronic lung disease, many of which can be prevented by reducing risk factors such as tobacco and alcohol consumption, physical inactivity, and unhealthy eating. Hypertension affects approximately 25% of the global population and is one of the most prevalent medical non-communicable diseases (ncds). It is closely linked to increased cardiovascular morbidity and high all-cause mortality, the leading cause of death and suffering worldwide. Because hypertension is often "silent"—meaning it may present no obvious symptoms—many people ignore it, despite its potential to cause severe cardiovascular complications such as dementia, heart failure, and kidney failure. Hypertension may be silent, but it is always dangerous.

The Importance of Early Detection.

The only way to know if you have hypertension is to measure your blood pressure—you cannot determine it by symptoms alone. If diagnosed, it is crucial to follow medical advice, which includes:
✔ Self-monitoring blood pressure (SMBP)
✔ Regular doctor visits to track progress and cardiovascular risk factors
✔ Healthy lifestyle choices, such as:

• Avoiding alcohol and smoking
• Reducing salt intake
• Eating more fruits and vegetables, including ‘ground provisions’
• Cutting back on sugary drinks
• Drinking more water
• Getting quality sleep
• Exercising regularly
• Maintaining a healthy weight (or as close as possible to it)
• Managing stress effectively

If medication is prescribed, it is essential to take it daily as directed by your doctor. Hypertension cannot be cured, but it can be controlled.

Hypertension in the Caribbean.

Hypertension is particularly prevalent in the Caribbean, with its frequency increasing with age. Many individuals, active in their youth, find it challenging to maintain physical activity upon entering adulthood due to work and family commitments. This lack of adequate physical activity contributes significantly to the rise in hypertension cases.

What we have learnt, over the years, is that when hurricanes visit our islands, many of the persons whose health is most severely affected are those with hypertension and/or another ncds. Hurricanes disrupt daily life routines. Hurricanes disrupt food and medicine supplies. Hurricanes disrupt medical services. When persons are struggling to survive, regular physical activity gets put on the back burner. So many of the healthy lifestyle options are not possible, and this increases suffering. Doing as much as you can to optimize your health ‘in the good times’, puts you in a better position to deal with many challenges when they arise. Hurricane season preparedness must include making sure you are in the best of health before the hurricane arises, and having a plan to survive after the hurricane strikes.

Covid-19, when it visited Caribbean shores, created the same disruption that the hurricanes do. It sought out individuals in our society whose health was compromised by hypertension and the other ncds, while at the same time vastly overstretching our medical services. [I specifically remember our Minister of Health and Wellness, in the middle of the covid-19 pandemic, commenting on how many obese persons had to be hospitalized with severe covid-19 infections. Apart for obese persons being more likely to have one or more of these silent illnesses, even without a diagnosed ncd obese persons are likely to be in ‘less powerful’ health than their slim counterparts.] “Only the strong survive, the weak fall by the wayside” should be a wakeup call for those who may have ‘a silent disease’, but choose to ignore it because they don’t feel sick. Some others falsely boast’ that they have not visited a doctor in decades, they don’t ever get sick. Silent diseases thrive in these individuals. Unfortunately, scientists predict that other pandemics of severe viral illness (“communicable diseases’) are in our not too distant future, so we should be prepared.  Optimize your health now.

 

The Role of Exercise.

Despite potential risks, the benefits of exercise far outweigh the dangers, making physical activity a key component of hypertension prevention and treatment. The American College of Sports Medicine (ACSM) recommends, as a minimum:
✔ 150–300 minutes of moderate aerobic exercise per week (30 minutes per day 5 days per week)
✔ Muscle-strengthening activities at least twice weekly.

Exceeding these minimum guidelines may reduce hypertension risks more effectively than merely meeting them. Consistency is key; sustained physical activity promotes long-term cardiovascular health.

So don’t wait until a hurricane is imminent. Don’t wait for the next viral pandemic.  Build up your body’s resilience by practicing a healthy lifestyle, and visiting your family physician to ensure that one or more of these silent diseases is not ‘killing you softly’.

 

Pan Caribbean Conferences: The Triennial That Tells Our Story: How CCFP’s Awards and the MCCFP Credential Reinforce Each Other

 

The Triennial That Tells Our Story: How CCFP’s Awards and the MCCFP Credential Reinforce Each Other

Every three years, the Caribbean College of Family Physicians (CCFP) pauses the hustle of clinics and CME calendars to do something quietly powerful: we take stock of who we are becoming. The Triennial Awards are not only a celebration of standout service and leadership; they are a mirror held up to our region’s evolving standard of family medicine—standards the College has shaped as a full member of WONCA, the World Organization of Family Doctors. caribgp.org

What the Triennial Awards Mean

The Triennial tradition grew alongside the College’s Pan-Caribbean conferences, moments when our community gathers to share science, swap pragmatics, and recognise exemplary practice across islands. These gatherings have a long history in the College’s life and culture, with past Triennials anchoring milestones in regional family medicine. Recognition at these events is less about spotlight and more about signal: “this is what good looks like in Caribbean primary care.” globalfamilydoctor.com

Where MCCFP Fits

Running in parallel, the MCCFP (Membership in the Caribbean College of Family Physicians) is the College’s professional credential—grounded in a structured, multi-year educational pathway adapted to the realities of Caribbean practice. It recognizes doctors who have met a benchmark of knowledge, reflection, and ongoing development aligned with CCFP’s mission. In short: Triennial Awards honour exemplary contribution; MCCFP certification affirms enduring competence. Together they create a coherent arc from learning to leadership. caribgp.org+1

Two Lanes, One Highway

Linking the Triennial Awards and the MCCFP credential is strategic, not cosmetic. The Awards elevate role models who embody the habits the MCCFP demands—curiosity, community, quality. And the MCCFP creates a growing cohort of physicians who are ready to rise into the very excellence the Triennial celebrates. This feedback loop—credential → contribution → recognition—raises the floor and the ceiling of family medicine across the region. It tells trainees what to aim for, reassures patients about what to expect, and signals to policymakers the caliber of general practice we are building together. caribgp.org

Why This Matters Now

Post-pandemic Caribbean primary care has been asked to do more with less: chronic disease surges, mental-health aftershocks, climate-related health stressors. In that pressure, standards can drift or harden. The MCCFP gives us a common grammar for learning; the Triennial Awards keep our moral imagination alive. One says “be qualified;” the other says “be outstanding.” We need both.

MCCFP Certification Honourees (2020–2022)

The following physicians were awarded MCCFP certification for the period 2020–2022:

1. Dr. Arna Brown Morgan

2. Dr. Aldyth Buckland

3. Dr. Andrea Purai

4. Dr. Ann Moo Choy

5. Dr. Arlene Henry Dawkins

6. Dr. Bernard Maragh

7. Dr. Charlotte Bedasse

8. Dr. Dane Levy

9. Dr. Donald Chen

10. Dr. Garth Rattray

11. Dr. Garalo Graham

12. Dr. Jennifer Bent

13. Dr. Kathlene Sangster Singh

14. Dr. Lloyd Quarrie

15. Dr. Ravi Avvaru

16. Dr. Seni Ononuju

17. Dr. Tameka Seales-Murray

18. Dr. William Brown

19. Dr. Zahra Mendoza

20. Dr. Jose Humphreys

21. Dr. Eileen Lopez Gordon

22. Dr. Maxine Cargill

23. Dr. Peter Figueroa

24. Dr. Shastri Motilal

Looking Toward 2023–2025

As we look to the next Triennial, the Caribbean College of Family Physicians will proudly confer MCCFP certification on physicians who meet the College’s standards for the period 2023 to 2025. This recognition continues our commitment to strengthening professional standards and celebrating the dedication of Caribbean family doctors.

Application Guidelines

Full details on requirements for accreditation and certification are available here:
👉 Guidelines for Accreditation for Doctors

Application Process

Applications are now being accepted via the official online portal:
👉 Member Accreditation Form

Applicants are required to submit their applications with supporting documentation online for the 2023–2025 certification period. Importantly, CME certificates and activity records must cover each full calendar year from January 1, 2023 through December 31, 2025 in order to qualify. This ensures that applicants demonstrate consistent participation and professional development across the entire three-year cycle.

Closing Thought

A healthy profession needs both rails: rigorous, region-appropriate credentialing and a culture that publicly honours service, innovation, and integrity. The MCCFP and the Triennial Awards—working in tandem—give Caribbean family medicine precisely that. They don’t just hand out certificates or plaques; they chart a path and invite us to walk it, together.

Stay committed, stay accredited!