The UWI – Architect of Caribbean health care

The University of the West Indies (UWI) opened its doors in 1948, in the simple wooden huts of the Gibraltar Refugee Camp on the Mona Sugar Estate in Jamaica. A handful of staff welcomed 33 young first year medical students and history was made. This year the UWI celebrates its 70th anniversary or Platinum Jubilee, and what remarkable achievements have followed that modest beginning.

It began with the Medical Faculty, because of the desperate health conditions in the Caribbean in the 1940s. We were plagued with typhoid, tuberculosis,
malnutrition, and disastrous infant mortality rates. Hospitals were regarded as places where people went to die. There was merely token health care for the vast majority of the population. Today, although there is room for improvement, health care for all is a reality. And the vision of the university’s founding fathers has paid off a hundred-fold, in every aspect of medical training, research, planning and health care. There are, unfortunately, still problems, but opportunities too, which should be grasped by visionary governments and university leaders.

Two weeks ago I wrote about the Medical Alumni Conference in St. Lucia, and the goals and achievements of alumni in giving back. Today I want to
talk about the amazing achievements of the University’s Medical Faculties, which have gone way beyond the original mission statement of the founding fathers – to train family practitioners – starting with classes of around 30 per year, and to do research. Not only has the University staffed the Caribbean health care system, but its research has had global impact, and it has transformed health care and the health status of our populations.

First, the product: the University has trained some 5 000 doctors graduating from the Mona Campus in Jamaica, some 3 000 from the St. Augustine Campus in Trinidad, and a more modest 800 from Cave Hill and the Queen Elizabeth Hospital. With increasing emphasis on postgraduate and specialty training there are some 1 000 postgraduates – specialist physicians and surgeons, psychiatrists and others, public health doctors, PhDs and Masters in multiple disciplines. And now dentists, nurses, pharmacists, physio-therapists and radiographers.

Some 50% of medical graduates have emigrated, especially from Jamaica, to North America, with many making a mark and enhancing the reputation of the UWI and the region, while the Jamaican government recognises the considerable remissions made, which contribute to their foreign income. But from the earliest days graduates have played key roles as leaders in medicine, transforming our teaching and health care.

Our own Sir Ken Standard of the first (1948) class, became the first West Indian Professor in Medicine, and transformed public health training and public health in Jamaica, and ultimately the Caribbean, with the support of other UWI faculty like Sir Maurice Byer, and in later years Dr. Peter Figueroa, HIV/ AIDS guru and vaccination consultant with the World Health Organisation. Sir Ken Stuart became the first West Indian Professor of Internal Medicine, put the UWI on the global research map and became a leading international figure across the Commonwealth.

Professor David Picou, the first medical graduate and PhD scientist, became Director of the Tropical Metabolism Research Unit and their work not only transformed the treatment of infant malnutrition, but virtually eliminated it in Jamaica, while their methods were adopted globally. Here in Barbados Dr. (later Sir) Frank Ramsey’s work at his National Nutrition Centre eliminated the endemic infant malnutrition in a few short years. And most Barbadians are aware of the work of Sir George Alleyne, who after a major contribution to the Faculty of Medicine’s research and teaching became Director of the Pan American Health Organisation.

Similarly in Barbados UWI graduates and personnel have been chief medical officers and leaders in specialty medical care that we can be so proud of, and one only has to mention names like Professor Sir Trevor Hassell, Dr. Charles Edwards, Professor Anne St. John, most of the consultants at the QEH, and Dr. Michael Hoyos, whose leadership has transformed family medicine in Barbados. But what is distinctive about the teaching of UWI doctors is the tailoring of local training to local priorities and the emphasis on the clinical assessment and examination, which takes time, as opposed to the emphasis in some other countries on costly investigations, to the neglect of the clinical assessment. This has been a much discussed source of concern in the medical literature.

Research from the UWI has been game changing. I particularly like the story of the early discovery of the often fatal Veno-Occlusive Disease (VOD) of the liver in Jamaican children caused by popular bush teas and of poisoning by ingestion of the unripe Jamaican ackee, because it illustrates magnificent examples of partnership with government agencies. A health education programme mounted by the Ministry of Health there not only eradicated the problems with great and rapid success, but it reached the rest of the Caribbean. There is a huge lesson to learn there.

Other areas where UWI research has had global impact include not only the afore-mentioned infant malnutrition treatment but the work of Sally MacGregor, Susan Walker et al on nutrition intervention in young children to improve mental development, comprehensive research and new understanding on the challenge of sickle cell disease, and many other conditions including neurological and dermatological diseases, and current work on chronic diseases and HIV / AIDS. The Barbados Eye Studies and the huge body of work on diabetes and diabetes reversal, hypertension, stroke, cancer, centenarians, ageing, systemic lupus, wound healing, disease surveillance, et cetera, done at our own Chronic Disease Research Centre are far reaching.

But a major problem in relation to medical training and research is the translation of best practice and new research into the health care system. All research and new knowledge does not get known, does not get accepted and often does not get applied. The Medical Faculties of the UWI have been leaders in Continuing Education programmes, which are finally mandatory for re-registration of doctors. But the gap between research, policy and programming is difficult to overcome. It requires constant dialogue and committed partnership between university and government.

Often that dialogue and that kind of partnership has been lacking in the Caribbean, and health planning has often been left to chance or political perceptions. Where it has occurred, outcomes have been impressive. Three outstanding examples of successful partnership between university and government here in Barbados have been: (1) The discussions that led to the development of postgraduate training in Family Practice, with the Family practice Unit at Wildey; (2): The discussions and collaboration that led to the establishment of the Chronic Disease Research Centre, and (3) The agreement for the establishment of a full Faculty of Medical Sciences at the Cave Hill Campus, which has strengthened many aspects of both teaching and health care delivery, particularly in public health and family medicine.

Opportunities for further collaboration are obviously great. An obvious one is the opening of our doors to international students, with our accreditation and our reputation as a leading medical school for CLINICAL SKILLS training. It should be noted that the UWI has recently broken into the Times Higher Education world ranking for the first time – a considerable achievement and a sign of global recognition. I have had a dream for forty years – often expressed - that collaboration between university and government, along with private investment, could create a true Medical Centre of Excellence for the Caribbean. But the message, based on our experience is “collaboration, collaboration, collaboration.”

Professor Fraser is Past Dean of Medical Sciences, UWI and Professor Emeritus of Medicine and Clinical

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