Medical Corner

image-thumb.pngWe have accepted the suggestion from a BU family member to facilitate discussion on medical matters which is a topic area that should interest us all. Based on exchanges with and between BU family members posted over time, many of you work in the medical field or possess information on various medical issues acquired based on personal circumstance or otherwise. Medical Corner seeks to encourage ANYONE to submit views on medical experiences, new developments in the industry or any related matter which readers feel can serve to educate the BU family.

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  • Kidney disease warning for Bajans

    by TONY BEST

    AS THE UNITED STATES’ best known infectious disease expert, Dr Anthony Fauci, warned Americans they may soon have to “hunker down” in the face of a second wave of COVID-19 in the fall and winter seasons, a top transplant surgeon is urging Bajans to beware the highly infectious virus and its potentially deadly complications.
    Dr Velma Scantlebury, a Barbadian and the world’s first black female transplant surgeon, said people in her birthplace should remember some key things about the coronavirus and its dangers to people everywhere, especially the elderly and those with underlying conditions such as diabetes and hypertension.
    Key organs
    At the top of the list is that COVID-19, the disease which has led to the global pandemic, can affect key organs such as the heart, lung, liver and kidneys. “It can cause lasting kidney damage,” the award-winning surgeon told the DAILY NATION. “And Barbadians, like people everywhere, should get tested and be careful.”
    Next, COVID-19 is not like the flu, explained the surgeon who grew up in Goodland in St Michael and came to the US from Barbados as a teenager.
    It is a novel virus that can cause severe complications which can end in death, added Dr Scantlebury, who attended Columbia University in New York and was selected by a top transplant surgeon in the US to be trained in that field.
    Third, young Bajans, as in the case of youthful Americans, Canadians, Europeans, Asians and others, can “end up with severe consequences” if they become infected with the virus.
    Kidney damage
    “You should get checked (medically) for kidney damage,” said Dr Scantlebury. “If you have underlying kidney disease – high blood pressure or diabetes – and your kidney function is okay – not great but not a problem – it can certainly worsen your underlying kidney issue and it becomes important to follow it up if you have a COVID infection. “You should ensure that you get your kidney function monitored. You should have someone check the protein in your urine and check your creatinine to make sure it is not higher.
    “Patients can resolve most of their injuries but if they have an underlying injury to their kidneys despite having what appears to be a normal creatinine, they can still end up with a worsening kidney function.”
    The Barbadian gave her birthplace good marks for its management of the virus when the outbreak occurred several months ago.
    Barbados was able to keep a lid on the spread of the virus, which has taken almost a million lives globally – more than 198 000 of them in the US – since March. She agreed with the decision to reopen schools, saying it would have been difficult to keep the thousands of students out of the classrooms.
    “Barbados has done a good job controlling the spread of the virus,” said Dr Scantlebury, who has chronicled her rise to the highest rungs of the medical ladder in the US in her well written 240page autobiography, Beyond Every Wall, Becoming the First Black Female Transplant Surgeon.
    “The Government was right to shut down the country when it did. That helped to curb any spread of the virus.
    Barbados managed the situation very well and I am sure it will continue to do so in the months and years ahead,” she said.
    “It is very difficult to keep young children in schools from interacting with each other, but it is important to ensure that they wear their masks and that social distancing and contact tracing are carried out.
    “As a surgeon, I have grown accustomed to wearing masks all day and I am sure people in Barbados would get accustomed to it because it protects you.”
    Guidance
    Like Rihanna, the Grammy- award winning music icon whose roots are in Barbados and who praised her mother for her success in business, especially her concepts of beauty, Dr Scantlebury also paid tribute to her mother, Kathleen Scantlebury, for the guidance and commitment to education which the surgeon traced to Barbados and Christian beliefs. “My mother made sure we were always at school,” she wrote in her autobiography. “Excellence was demanded. As part of a new generation (in Barbados) we had better options for further education.”
    “The opportunities for advancement, for accumulating wealth, for snaring the future she knew we all deserved were all tied to excellence in educational pursuits.”

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  • Ethical side of medicine
    By Gercine Carter
    gercinecarter@nationnews.com
    Throughout a 55-year career, Sir Errol Walrond promoted the practice of high ethical standards in the medical profession, while serving as a clinician, surgeon, educator, and as administrator and policy driver for surgical and medical education throughout the West Indies.
    For over 20 years, his knowledge and wisdom about the many ethical issues that undoubtedly arise in the practice of medicine have been informing his contribution as main discussant at the case conferences he was instrumental in convening for this very purpose.
    Today, at 84, the Professor Emeritus of Surgery and former dean of the Faculty of Medicine at the University of the West Indies (UWI), retains a storehouse of information collected in these monthly conferences in which he continues to participate. He has now chronicled those cases, the ethical issues and the discussion surrounding them in his latest book, A Question Of Ethics: Case Conferences In Everyday Ethical And Legal Issues.
    In a review of the just-released 339-page book, Professor Emeritus of Psychiatry and African- American Studies at Yale University, Dr Ezra Griffith, wrote: “All caregivers must understand the familiarity with the professional ethics that undergird our work [and] is a foundation that supports high quality in our caregiving. It is also the best sign that we believe in the inherent dignity of our patients.”
    Explaining his motivation for writing the book, Sir Errol harked back to 30 years ago when he was dean of the Faculty of Medicine at UWI, Cave Hill, and was moved to organise his first case conference for clinicians.
    Did not like behaviour
    “I kept getting people saying to me, mainly people from outside the profession – friends, sometimes patients – that they did not like the behaviour of the young doctors who were coming out, and that they did not seem to have the ethical principles of the older doctors.
    “I felt it was a general problem with how people were seeing the ethics of the profession . . . . I think that meant generally that people were getting more information about their conditions and they were beginning to question the ethics about how some of their illnesses were being handled,” he told the Sunday Sun in an interview. “I thought that we needed to look at the question more generally. I organised a conference which brought together some of the professionals and it came to us that while they were teaching the technical business of looking after patients, we were not teaching how they deal when they met a problem that was not technical.”
    Those case conferences have continued for the last 20 years, with the latest held as recently as last week. Sir Errol records complex cases presented by many clinicians over the years, discusses the associated ethical issues and gives insight into the challenges for both doctor and patient,
    Continued on next page.
    Sir Errol writes about ethics and legal issues facing medical practitioners as well as suggestions offered for possible courses of action. In the placid setting of a shaded patio overlooking the lush gardens of his St James home, as he thumbed through the pages of the book, Sir Errol said it discussed “some very thorny issues”.
    “There are situations where care is futile and sometimes it is the patient, sometimes it is the family, sometimes it is the doctors who are pushing for every minute of life when they know that they are not going to succeed. Those are complex situations.
    One thing I learnt in listening over the years and seeing the advances in medicine over the years is that sometimes what appears futile now is an advance in care in a few years’ time. So you need to have a mental framework of how you are going to handle it and what will be the limits, and those limits have to be individualised.”
    Rules of conduct
    Referring to the section “Professional Conduct And Risk”, aimed at the doctors and medical students, Sir Errol said: “There are a number of things in there where I would want the public and the profession to understand what are the rules of conduct. For instance, there is a proper way of doing a consultation or getting a second opinion . . . . The fact that doctors and sometimes nurses are sometimes ill themselves and they are still working – who bells that cat? Who is going to say you are too ill to work?
    “That is very important and it includes the areas where the practitioner may get into trouble in terms of medical malpractice and negligence, and they need to understand what are the parameters.”
    He related a story about a doctor in a London hospital where he was working as a medical student.
    “This is a case that I always tell them [participants in case conferences] about, that illustrates when you think you are doing good but you are doing it without consent, how you are liable for battery.”
    Acute appendicitis
    He outlined how a male patient was brought into the hospital for an operation for acute appendicitis and said during the operation the anaesthetist drew the surgeon’s attention to a large lump on the patient’s head which was making it very difficult for the anaesthesia to be administered. Identifying the lump as a lipoma, the doctor removed it after having performed the appendectomy for which the patient had originally been admitted to hospital.
    However, soon after the patient’s discharge, the hospital received a suit from the patient’s lawyer claiming substantial damages for loss of income. Only then did the doctor discover the patient worked in a circus as a two-headed man.
    The collection of cases also highlights issues such as whether an unborn child has rights; weighs decisions related to religious beliefs against life-saving medical decisions; explores the legal role of alternative practitioners in medical practice; the doctor’s role in cases of child abuse; and matters of patient consent and confidentiality. Sir Errol also gives the public access to medical insights which would not ordinarily be available to them.
    This is his second book on ethical issues, following the first, Ethical Practice In Everyday Health Care,
    released in 2005.
    Sir Errol qualified as a doctor in 1960, became a Fellow of the Royal College of Surgeons in Britain in 1964 and was the founding president of the Caribbean College of Surgeons, which seeks to set standards for surgeons in the practice of surgery and surgical education. He retired from UWI as a professor in 2001 and was honoured with the title of Professor Emeritus in 2001. He retired from the practice of medicine completely in 2015.
    “Everything I did, I tried to make it a teaching moment and sometimes that teaching moment was the patients,” he said.

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