ASJ Anniversary

12 THE GLEANER | SUNDAY, MARCH 3, 2019 T HE RURAL-BASED surgeon has a spe- cial place in the history of Jamaican medicine, and the present set of such individuals stand on the shoulders of giants who were willing to leave the bright lights of the capital to bringmuch-needed exper- tise to the rural parishes. Such giants of Jamaican rural surgery included Dr R.G. Lampart in St Thomas, Dr Alfred Carnegie in Sav-la-Mar, Dr Antonio in Port Antonio, Dr ArthurWint in Linstead, Dr Francis in Black River, Dr ‘Buddy’Wilson in St Ann’s Bay; and Dr Freeman in Spanish Town, to name those who came readily to mind from the era of the 1950s. These were the first set of trained surgeons, most of whom had fellowships in the English or Scottish colleges of surgeons. The second wave would include emi- nent surgeons such as Peter Wellington in Mandeville, Williams in Spanish Town, Winston Dawes inMay Pen, and Ken Baugh in Montego Bay, to name a few. These men, and others not mentioned, were appointed to these hospitals with di- rectives from theMinistry of Health to bring ethical medical care to the rural population. Their practice guideline and protocols were not distinctly written and promulgated by the Ministry of Health. They were expected to practise to the level of their competence, consistent with their training and experi- ence which, by and large, would have been gained from British hospitals and further burnished by stints at the Kingston Public Hospital before being assigned to a rural hospital. In those days, there were no manuals produced locally. DAUNTING JOB In 1958, the establishment of the Association of Surgeons of Jamaica would help to foment and focus discussions on local issues and diseases. It would also focus discussions on the peculiarities of Jamaican disease patterns and assist these surgeons in continuing medical/surgical education. What made the job evenmore daunting is that inmany cases, and for many decades, these persons were the de facto leaders of the hospital management team. They were administrators and technocrats at the same time. They were always senior medical officers whose presence was mandatory at hospital management meetings, and no significant hospital decision was taken without them. They were almost always the only spe- cialist in any rural hospital, so they had to be broad in clinical outlook – treating not only surgical patients, but also medical, obstetric, gynaecological and paediatric patients. Most had to be fairly proficient at performing common urological and otho- paedic procedures, and these were those who even did burn holes for haematomas – at a time when neurosurgeons were not a part of the landscape. It goes without saying that these in- dividuals had to be resourceful and very good clinical practitioners, as they were faced with limited laboratory and imag- ing services. These are true stories about patients being treated for a puenothorax or haenothorax without even having an xray; of patients being taken to elective and emergency surgery without appropriate laboratory investigations. It is instructive that many rural hospi- tals up to the 1980s had no consistent clinical chemistry services and even now, many have no in-house fluoroscopic or ultrasound. Pathology services up to the 1980s were Kingston-based, and so the rural surgeons had to decide on which specimens had to be sent to the lone pathologist at the then Government Medical Laboratory. Networking with one’s colleagues in the metropole of Kingston was very important, as complex and unusual cases could be discussed and referred, especially surgical cases requiring sophisticated anaesthetic skills or large quantities of blood products. In the last three decades, the landscape has been changing. In many respects, the rural general surgeon has been joined by gynaecologists, starting first in Montego Bay, Mandeville, then Spanish Town, and now in most rural hospitals. My hospital, the Princess Margaret Hospital, received its first trained obestetrician/gynaecologist in 2009. As the University of the West Indies has graduated more specialists, the rural surgeon is now able to refer more patients to clinics in urology, orthopaedics, plastic surgery, paediatric surgery, etc. It is hoped that with more special- ist services moving into rural hospitals, there will be a commensurate increase in sophisticated laboratory and imaging services and, to some extent, the private sector is leading the way. In order to attract young specialist staff, hospitals such as Mandeville, Annotto Bay, Princess Margaret and Spanish town have found novel ways to bring in laparoscopic and endoscopic services, thus decreasing the need for patients to travel for complex procedures and investigations. The rural surgeon is now able to concen- trate on advancing his own specialty of gen- eral surgery and trauma, and no longer has to seehimself or herself as a jack of all trades. DR CECIL BATCHELOR Former Senior Medical Officer Princess Margaret Hospital, Morant Bay The rural surgeon FOR CENTURIES, women have been involved in surgery, albeit not at the forefront until recently. In the last few centuries, there have been reports of women who sought to dis- guise their identity to enable themselves to practise the craft of surgery. Surgery has largely been a specialty pursued by males. This may be so because of the lifestyle, which may not be attractive to women, or the pau- city of female mentors in the field. In the early years of the Faculty of Medical Sciences, University of the West Indies (UWI), females comprised a small proportion of medical students. Despite the fact that majority of the current graduates of the faculty are females, male applicants still outnumber females who seek to pursue postgraduate training in surgery. Many surgical specialties have been ste- reotyped as ‘old boys’ clubs’ and this has been a discouragement to several females. In addition, gender-based stereotypes of what women can and cannot do serve as a deterrent for prospective female surgeons. Surgical training programes across the world are generally competitive and demanding, with surgical residents having long and grue- ling working hours, many sleepless nights, and starting a family under these conditions may be considered an obstacle. It is no secret that many persons in our culture are uncom- fortable with the idea of a female doctor or surgeon. Many female surgeons have grown accustomed to being referred to as ‘nurse’, despite efforts to introduce themselves as the ‘doctor.’ One of the female pioneers in surgery in Jamaica is Dr Mavis Gilmore. Dr Gilmore, the first female fellow of the Royal College of Surgeons of Edinburgh to practise in the Caribbean, served at the Kingston Public Hospital from as early as 1960. Sheer intel- lect and adept surgical skill rubbished any suggestion at the time of lack of compe- tence for the job solely because of gender. Dr Gilmore proved herself as a well-trained surgeon and obtained the respect of many of her colleagues. Even then, there were very few female surgeons. With the emergence of the doctor of med- icine postgraduate training programme at the UWI, Mona, in 1981, the opportunity for local training in general surgery and the subspecialties became more readily availa- ble. In 1986, Dr Barbara Salmon-Grandison became the first female graduate of the postgraduate surgical training programme in Otorhinolaryngology (ENT) at UWI, Mona. Dr Carolyn Pinnock later graduated from the paediatric surgery programme in 2002. However, it was not until 2003 that the first female graduated from the general surgery training programme. Dr Lisa Johnson, a native of Belize, completed the doctor of medicine degree in general surgery, and later served in rural Jamaica. There has been a steady increase in the number of female graduates from the doctor of medicine train- ing programme, at the UWI, Mona, with 36 female graduates since its inception (22 per cent of total graduates). Of these, there are currently five general surgeons, one subspe- cialising in thoracic surgery, two neurosur- geons, four urologists, five ENT surgeons, seven ophthalmologists and four paediatric surgeons working in Jamaica. The postgraduate training programme at UWI, Mona, currently has 37 per cent female surgical residents in training. This may be partially attributed to female surgeons ex- celling in their field and serving as mentors to prospective female surgical residents. For example, Dr Tanya Hamilton, a general surgeon currently serves as senior medical officer, St Ann’s Bay Hospital, and Dr Natalie Whylie serves as senior medical officer at the Kingston Public Hospital. These females and others have helped to eliminate gender-stereotyping in surgery in Jamaica. A career in surgery is filled with the satis- faction of changing human lives, while visibly seeing an effect on patient health. It allows for continuous growth and development of mental fortitude. Apart from clinical practice, it allows for focus on specific areas, such as research or teaching. The wide array of surgical subspecialties allows prospective females surgeons to choose appropriate fields according to their skills and future desires. I have found my career in surgery very rewarding and enjoy it immensely. DR BELINDA MORRISON-BLIDGEN Consultant Urologist, University Hospital of theWest Indies Senior Lecturer and Head, Division of Urology, University of theWest Indies Women in surgery Dr Belinda Morrison-Blidgen, consultant urologist, University Hospital of the West Indies. ASSOCIATION OF SURGEONS IN JAMAICA 60TH ANNIV SARY FEATURE: THE SUNDAY GLEANER MAGAZINE | MARCH 3, 2019