THINGS THAT MATTER
Today’s column continues the theme of my 70th Anniversary lecture on October 10th. Part 1, last Sunday, provided the historical context for the
establishment of the UWI in 1948, describing the dearth of health care and the appalling health status of the West Indian colonies at that time. Today’s column outlines some of the successes of the UWI in these 70 years, while next Sunday’s column tackles some of the challenges and opportunities.
After the riots, the Deane Commission was set up in Barbados (at Queen’s Park House) and among the many people whose opinions were sought was Dr. Harry Bayley. He decried the appalling social conditions and lack of health care and recommended a National Health Service, with all tax payers contributing one pound a month to cover the costs of care for the poor – ten years ahead of the British National Health Service! Then, as a result of the Moyne Commission, the British Government set up the Asquith Commission in 1943 to plan tertiary education in the colonies. A sub-committee, the Irvine Committee, was established for the Caribbean, chaired by Sir James Irvine, Vice Chancellor of the University of St. Andrews in Scotland. It included Mr. (later Sir) Hugh Springer, who became the first registrar, and Dr. (later Sir) Philip Sherlock, who became our second Vice Chancellor (1963–69). The committee’s major recommendations were for:
A single, centralised residential university, capitalised and endowed by Britain,
It must give women access to higher education,
Training of doctors was an urgent priority, and
It should be a centre for research as well as teaching.
It thus made very clear the broad functions of a university. Unlike a trade school, it must provide for research and scholarship at the highest levels, and relate to the wider community’s development in every way. It was indeed to become “A place of light and learning – a light rising in the West that would forever change the hopes and lives of these long wronged, tragic islands that would, that could be Paradise.” We can ask if the University has succeeded in relation to the development of Caribbean health care and national development, bearing in mind the mantra of Sir George Alleyne, “The health of the nation is the wealth of the nation”.
Its initial major impact was on Jamaica, where the mother campus was established at Mona, the World War II refugee camp site. Steady expansion, beyond the vision of the founding fathers, was to Trinidad in 1960, Barbados in 1963 and extra-mural departments, later forming a fourth campus across the region.
Its many major successes included both teaching and research. Early successes included the work of brilliant, dedicated early staff – Professors Dave Stewart, Eric Cruickshank, Gerrit Bras and our own Sir Ken Stuart and Dr. Harold Forde – setting a gold standard for medical education. Earliest graduates included Professor David Picou, Professor Sir Ken Standard and Dr. Knox Hagley, known across the region, and Sir George Alleyne, Director Emeritus of PAHO and Chancellor Emeritus of UWI. The University Hospital of the West Indies, with its first matron, Dame Nita Barrow, transformed specialist medical care in Jamaica and accepted referrals from across the Caribbean. It set standards for satellite teaching and practice at Port of Spain and the Queen Elizabeth Hospital, where teaching started in 1967. And finally, in 2008, the Cave Hill Campus established its own Faculty of Medical Sciences.
Some 8,800 doctors have graduated since 1954 – about 5,000 at Mona, 3,000 at St. Augustine and 800 at Cave Hill, supplying our needs but resulting in more than 50 % emigrating to North America, usually for postgraduate training in the era before our own postgraduate specialty training began. Jamaica has benefited the most from foreign remittances. About 1,000 have received postgraduate diplomas, Masters degrees, Doctors of Medicine in major specialties and PhDs, while a Masters degree in Nursing Education has just begun at Cave Hill. Our teaching is tailored to our needs, emphasising clinical skills, because of the limited technology in much of the region and the high cost, and for this and other reasons the Cave Hill / QEH programme restricts numbers to 70 students per year, in contrast with Mona and St. Augustine, which have 230 - 250 per year. Most of our medical courses are self-sustaining and / or income generating.
Recent recognition of quality came from a report on emergency care by a British firm, Clinic Compare, ranking Barbados at Number 7 globally for emergency Health Care, and rating us first for quality of emergency medical staff.
Important cutting-edge medical research findings have come out of the UWI from inception. Classic early studies reported on the toxicity of bush teas in Jamaica, that were causing an often fatal Veno-Occlusive Disease of the liver (VOD); vomiting sickness from unripe Jamaican ackee poisoning; and the so-called Jamaican neuropathy. The Tropical Metabolism Research Unit (TMRU) carried out major research on the severe problem of infant malnutrition, which has informed World Health Organisation protocols for managing this global scourge. The effect of infant malnutrition on mental development has been extensively studied and the impact of feeding programmes demonstrated. The Sickle Cell Laboratories’ work transformed the understanding and management of sickle cell disease, which is so common in our Afro-Caribbean populations. And Jamaica’s Epidemiology Research Unit and the more recent Chronic Disease Research Centre in Barbados (established 1992, and now the George Alleyne Chronic Disease Research Centre – GA-CDRC) have provided critical data on the chronic lifestyle related chronic diseases – obesity, hypertension, diabetes and their complications – informing national health planning and programmes.
The GA-CDRC is, of course, of special interest to us in Barbados, as it’s an outstanding example of a successful public private partnership. My inspiration for developing the centre was three-fold – inspiration from working with Sir George Alleyne and Professor Picou at the TRMU, the obvious need to address our increasing chronic disease epidemic, and the historical context of early medical heroes in Barbados – Dr. William Hillary of the 18th century and Dr. Harry Bayley of the 1930s to 1959 – founder of the Diagnostic Clinic and who reputedly saved my life from paratyphoid fever in 1953. Thanks to the support of the Dean of Medicine, Professor Walrond, the Ministry of Health and a successful fund-raising effort we were able to be established. We were provided with a base – a condemned 200-years-old residence by the Ena Walters Roundabout, restored at modest cost. And the combination of Ministry partnership, international funding and philanthropy has produced 25 years of continuing research findings, informing and improving health care.
The Centre has had the benefit of outstanding staff, including subsequent directors Professor Anselm Hennis, Professor Clive Landis and now Dr. Alafia Samuels, and dedicated teams. Professors Hennis, Landis and Hambleton were named among the 60 UWI Stars at the 60th anniversary … many times the number of stars we might have expected for our small numbers.
The list of studies, papers and impact on health care has been legion: Diabetes Care – a Caribbean case study, The Diabetes Foot Study, Centenarians in Barbados, Health Well-being and Ageing, the Barbados Register of Strokes, Systemic Lupus, Studies on HIV / AIDS and Inflammation, The Barbados Registry for NCDs, The Cancer study, The Health of the Nation Study, Barbados Diabetes Reversal Study, Wound Healing Study (WHY), Evaluation of Tax on Sugar-sweetened beverages and many more. Meanwhile another major research project is being led by Dr. Adams, Dean of the Faculty of Medical Sciences – ECHORN, the Eastern Caribbean Health Outcomes Research Network. This examines the health behaviours associated with cancer, diabetes and heart disease in the Eastern Caribbean.
Next week’s column looks at some of the challenges and opportunities.
Postscript: do come out and join the 5K Run / Walk organised by the George Alleyne Chronic Disease Research Centre, next Sunday, November 11th, at 3:00 pm. It’s bringing further awareness to NCDs and proceeds from attractive T Shirt sales ($30 each) are in aid of the Research Fund. It starts and finishes at the GA-CDRC at the corner of Jemmott’s Lane.
Professor Fraser is Past Dean of Medical Sciences, UWI, Professor Emeritus of Medicine and Clinical Pharmacology and President Emeritus of the Barbados National Trust. Website: profhenryfraser.com