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.”
    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.”


  • Ethical side of medicine
    By Gercine Carter
    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.


  • Another hospital definitely not needed
    THE RECENT MENTION of “bed-blocking” at the Queen Elizabeth Hospital (QEH) by elderly incapacitated patients has led to the media highlighting a view that “Another hospital is way overdue” (DAILY NATION, Tuesday, November 3) Nothing could be further from the truth.
    Barbados has a larger proportion of elderly citizens than most CARICOM countries. There are several reasons for this: 1. the largely physically active lifestyle before Independence promoted longevity, 2. we probably have a healthier gene pool, for historical reasons linked to the slave trade, and 3. continuing emigration of younger people to North America.
    Unfortunately, the epidemiological transition, with a largely inactive lifestyle since Independence, has produced an epidemic of chronic diseases, which greatly increase the morbidity of the elderly – a high prevalence of high blood pressure, heart disease, diabetes and their consequences such as strokes and amputations, and hence significant disability and dependence.
    But this does not mean that hugely expensive tertiary care beds in a second or expanded hospital are needed. Our beds to population ratio is as good as most Western countries. Incapacitated elderly-forcare do not need intensive and costly tertiary care. As the Prime Minister has pointed out, the QEH beds cost five times as much as Geriatric Hospital beds. What is needed is a multifaceted approach, with several key programmes, to prevent the “bed-blocking” the minister commented on, which has in fact been going on for decades and fluctuates with fluctuations in staffing, operation of equipment such as X-ray and lab services, morale and other causes of variable efficiency of overall care.
    The first need to deal with the current problem is adequate residential accommodation – the Geriatric Hospital, infirmary and elderly care-home beds. The latter is a programme of private care that has been operating for some years. Infirmary beds were seriously reduced with the demolition of the Christ Church Infirmary at Oistins and, more recently, closure of that in St Lucy. The Geriatric Hospital has accommodated more than 500 patients for much of the past. Is it being efficiently utilised today, to accommodate those described as “left” at the QEH and said to be “blocking beds”?
    Day-care centres
    The medium-term solution is the provision of day-care centres. I have written and spoken repeatedly – in conferences, columns and in the Senate – for 40 years about the obvious benefits of such facilities. The example of the St Barnabas Church Day Care Centre is a role model that can easily be followed both by many of our churches which have church halls and similar outbuildings, and by government and the private sector.
    Such a centre not only maintains activity into old age for a longer period, delaying dependence, but solves the problem of day care for many elderly subjects and families.
    The long-term solutions, of course, include both the broad public health and educational approaches advocated by the Chronic Non-Communicable Disease Commission led by Sir Trevor Hassell, and the expansion of the support health care services of rehabilitation therapy (occupational therapy and physical therapy), which help to delay invalidity, accelerate recovery from illness and hospitalisation, and help the disabled to function in their own homes.
    We certainly do not need another hospital or a new hospital in order to improve our health services and the care of the elderly. In fact, some 14 years ago the then Minister of Health commissioned an extensive study by the leading hospital consulting team, Capita, Norman and Dawbarn. The better of their two options proposed, that of a complete rehab and improvement job and a state-of-the-art new multi-storey wing to the north, was estimated to cost just under $600 million. They also suggested a new hospital, with fewer beds, at an estimated cost of just under $900 million – 50 per cent more.
    I am relieved that this Government is not being misled into proposing a new hospital, as we do simply do not need one and would not be able to afford it anyway.
    What we do need, as shown in the study of health care human resources commissioned by the Faculty of Medical Sciences in 2007, are increases in several categories of health professionals. Our problems are all soluble by an evidence-based, multifaceted approach and improved efficiency at all levels – not by more bricks and mortar.
    Professor Emeritus Sir Henry Fraser is a professor of medicine and clinical pharmacology.
    What is needed is a multifaceted approach, with several key programmes, to prevent
    the ‘bed-blocking’ the minister commented on, which has in fact been going on for decades . . .



  • Mobilise against diabetes
    The diabetes epidemic is not an overnight problem, but part of a wider failure at the national level to tackle preventable diseases
    BARBADOS IS TAKEN up with the fight against the COVID-19 pandemic and rightly so, given the health and economic threat it poses. There is, however, another major disease which is impacting a significant number of individuals and by extension their relatives and the nation.
    The devastation diabetes is causing should have a similar kind of national coordinated effort to that which is being placed on containing the coronavirus pandemic and which was done in the fight against HIV/AIDS. It requires a united effort across the public and private sectors, ranging from funding studies at the George Alleyne Chronic Disease Research Centre to placing more emphasis on healthy lifestyles in the workplace.
    Diabetes is inflicting significant financial and medical stress on our health system and national budget and threatens the livelihoods of too many people in a nation whose majority black population appears genetically predisposed to the disease.
    More than 425 million people worldwide live with diabetes, according to the International Diabetes Federation study of 2017, with many going undetected. One in every five Barbadians is believed to be affected by the disease, which is a major cause of death.
    The non-communicable disease specialists have for some years been raising the alarm about the spread of diabetes and there has been some positive response to their appeals for Barbadians to change their lifestyles. The importance of early detection of diabetes so it can be managed through diet, exercise and medication cannot be overemphasised.
    There is an evident increase in physical activity and a greater consciousness of trying to eat the right foods.
    Unfortunately, we are a copycat society and have adopted North American fast food culture by eating and drinking too much of the wrong things. This lifestyle is killing too many Barbadians quickly and quietly.
    The Queen Elizabeth Hospital is consistently full of diabetic cases while surgical wards deal with a high percentage of diabetes-related causes.
    Barbados has gained notoriety for the number of amputations carried out because of diabetes-related problems.
    Healthy foods
    The diabetes epidemic is not an overnight problem, but part of a wider failure at the national level to tackle preventable diseases which exposes the vulnerability of many Barbadians, not only to the COVID-19 virus but a wide range of other health issues. There are too many people predisposed to heart and kidney diseases, strokes, circulation problems and even sexual dysfunction.
    The society faces some pervasive inequalities as a result of the severe economic fallout created by COVID-19 which has put 40 000 people out of work.
    Making healthy foods affordable must be a national priority in the effort to control diabetes. The “No-sugar November” initiative trending online is a welcome effort which should be expanded.
    The country needs a clearly enunciated long-term strategy to reduce the prevalence of diabetes.


  • BAMP warns against dengue delay
    Bajans ‘waiting too late to get checks’
    TOO MANY PEOPLE are waiting too late to go to the doctor to check if they have dengue fever.
    This is according to president of the Barbados Association of Medical Practitioners (BAMP), Dr Lynda Williams, who said while some deem having a fever as symptomatic of COVID-19, that might not be the case.
    “Once we feel someone is coming down with dengue fever, we treat and act and encourage people to present. What has been happening is that I find people have been presenting late and have been symptomatic for days. I don’t know if that is because they are afraid they have something else, but people have been presenting quite late and with advanced stages of dehydration,” she told the DAILY NATION.
    Williams urged anyone feeling lethargic; experiencing pain behind the eyes, headaches, back and joint aches; and/or a rash or generalised itching all over the body, to consult their medical practitioner, particularly if they also had a fever.
    Always vigilant
    “We are always vigilant for dengue. It is an unusual time to be having a dengue outbreak of this magnitude at this time of year, but we are always watchful for the signs of dengue.
    “Of course, people presenting with fever must be interviewed before they even come in the office to find out if there were any respiratory symptoms or other symptoms, so we can differentiate between dengue and possible COVID,” she said.
    Williams, who was recently named as part of Government’s new COVID-19 communications team, said while she could not speak to the number of confirmed dengue cases as that data was collected at the Ministry of Health, there had been more deaths than usual related to the virus.
    Suspect cases
    “When we have suspect cases of dengue, we report them. [The ministry] also does . . . surveillance where they look at certain sites to see how many dengue cases are presenting and see whether there is a rise in cases or not. That’s how we know we are having an increased outbreak,” she said.
    When contacted, Acting Chief Medical Officer Dr Kenneth George said he did not have the statistics to hand, but would be in a better position later this week to provide them.
    Describing dengue as an endemic disease, the BAMP president said it was always around and could flare up at certain times.
    “The thing with dengue is it can develop a very low platelet count and people can develop haemorrhagic fever where they start to bleed suddenly. If you think you have dengue, even if you remain well hydrated, you should still get checked by your doctor to make sure that you’re not having a low platelet count,” Williams said.
    “We encourage everybody who is not feeling well, if you’re having fever, call your doctor’s office. If you’re not having fever, still call and find out and go and be seen and diagnosed. Self-diagnosis and treatment is not always beneficial, so we want to encourage people if they’re not feeling well to be checked,” she said.
    During a media conference at Ilaro Court last December 28, Minister of Health Jeffrey Bostic said the authorities were taking dengue as seriously as COVID-19.
    Mosquito breeding sites
    “We have contracted about 40 additional persons to assist the Environmental Unit to locate mosquito breeding sites. We have spent a considerable amount of money in terms of purchasing both hand-held foggers as well as truck-mounted foggers and we are awaiting the arrival of the foggers.
    “As soon as those machines are here, then we are going to be able to employ four fogging teams – two in the northern half of the country and two in the southern,” he added.
    Over the weekend, Chief Environmental Health Officer Francina Bascombe confirmed that from this week, the Vector Control Unit would restart its fogging programme. (RA)

    Source: Nation


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