THINGS THAT MATTER: The George Alleyne Chronic Disease Research Centre – Celebrating 25 years

How time flies. We opened the Chronic Disease Research Centre (CDRC) 25 years ago, in 1992, in the apartment at the back of ‘Avalon’ – a condemned Ministry of Health residence used for junior doctors’ flats, overlooking the Ena Walters Roundabout. It was the brainchild of Professor Sir Trevor Hassell, at a meeting of consultants in the Department of Medicine, and it was a challenge I couldn’t refuse! We started with a mission statement, three projects and three staff – me as part time director, Dr. Colin Alert and a part time secretary. When I demitted office in 2005, thirteen years later, I left a lively, rapidly maturing adolescent in the capable hands of Professor Anselm Hennis.

Our mission statement was “To improve the health of the population and promote human development through research into the prevention and management of the lifestyle related chronic diseases, so as to inform national and regional health policies and programmes (governmental and non-governmental).” Specific objectives defined in the new century were: “to create a world class research unit with epidemiological and molecular biological expertise in specific areas of cardiovascular and diabetes research, of particular relevance to the Caribbean region, but with global applications.”

Our first three projects were: a collaboration with Loyola University on the International Collaboration in the Comparative Study of Hypertension in Blacks (ICSHIB); a collaboration with Guy’s and St. Thomas’s Medical School in London on an ODA funded study: Diabetes Care – a Caribbean Case Study; and a locally funded study: Lifestyle Intervention in Subjects with Glucose Intolerance. The term chronic non-communicable diseases had only just begun to be used to describe the cluster of obesity, hypertension and diabetes, and these early studies addressed all three.

The work of the centre expanded dramatically with the return of Professor Hennis with his PhD in epidemiology from the London School of Hygiene and Tropical Medicine in 1994. First he took on leadership of the National Institute of Health funded Barbados Eye Studies, begun by Dr. Anthea Connell, and these studies provide the most comprehensive information on the major eye diseases in African origin populations in the world. He was principal investigator on a Wellcome Trust-funded Diabetes Foot Study in collaboration with Imperial College; on the Hyperglycemia & Pregnancy Outcome (HAPO) Study; and the PAHO-funded study: Health, Wellbeing and Ageing (SABE). The lessons of the Diabetes Foot Study are clear: daily foot exam and avoidance of high risk footwear. Bare feet, rubber ‘flip flops” and fashionable shoes, e.g. for church, all contribute to amputations.

The Centre was funded for eight years by a mix of overseas grants and 1.3 million dollars I raised locally, from SAGICOR, Cave Shepherd, banks and other insurance companies, and philanthropists such as Richard Brown and Oscar and Rosa Davis, until formally established as a University Centre in 2000, linked with the three research centres in Jamaica, as The Tropical Medicine Research Institute – now the Caribbean Institute for Health Research.

Other productive partnerships were with United Medical and Dental Schools of Guys & St. Thomas’ on the Barbados Register of Strokes, which helped to inform development of the Stroke Unit at the Queen Elizabeth Hospital, led by Dr. David Corbin; and with Johns Hopkins University on the Barbados Asthma Genetics Study. Dr. Hennis made history becoming overseas (non-USA citizen) Principal Investigator for the Fourth NIH Eye Study, which demonstrated the genetic basis of glaucoma in our population, explaining its high prevalence. The next major NIH study was the Barbados National Cancer Study, on prostate and breast cancer. This in turn led to the Barbados National Registries, informing our health care needs and health planning – and then the Health of the Nation (HoTN) Study.

Other important studies include The Wound Healing Study in Diabetes (WHY) led by Professor Clive Landis, whose cutting edge molecular biology lab was a unique development – the Edmund Cohen Laboratory for Vascular Research. Later studies include the HAPO II Study, the Port of Spain Declaration Evaluation led by Dr. Alafia Samuels, the new Director; the MRC / Wellcome Health Systems Development study; and others too numerous to mention. But one of my own pet projects was Centenarians in Barbados (CIB), carried out by Dr. Susan Archer, which found that strong social networks, physical activity and strong religious convictions were key to longevity. Another exciting recent study was the Barbados Diabetes Reversal Study, funded by Virgin Unite - a more formal approach to intervention in diabetes than our early study. This demonstrated reversal of blood sugars to normal after eight weeks on a very low-calorie diet. It heralds great promise for diabetes reversal, control and treatment.

Current projects include: Environmental determinants of lupus; Integrating places of worship (PoWs) into the primary care pathway to prevent and control non-communicable diseases (NCDs) in the Caribbean; and one that’s even more dear to my heart: An assessment of walkability in the UN World Heritage site of Bridgetown and the Historic Garrison.

The total amount of grant money raised by the CDRC, funding so much research, is US$20 million, or about US$1 million per year. The research team has grown dramatically. The CDRC currently holds three grant awards from the National Institute of Health. And assessment in the Accreditation Report on the UWI Faculty of Medical Sciences by the Caribbean Accreditation Authority for Education in Medicine and other Health Professions (CAAM-HP) in February 2016 was glowing: “Much of the research being carried out, particularly that by the Chronic Disease Research Centre, is of world class standard and brings international credit to UWI.”

The CDRC’s success has been due to outstanding leadership by my successors Professor Hennis, Professor Landis and Dr. Alafia Samuels, who have guided it from strength to strength, and to great teams, with a team spirit inspired by the importance of these projects that can make a difference to the health of our nation. A measure of the quality of work is the recognition of three senior staff, Professors Hennis, Landis and Hambleton among the 60 under 60 stars of the University at the 60th Anniversary celebrations – many more than statistically likely for a tiny unit of five academics out of more than a thousand across the campuses! Furthermore, all directors and professors have received Vice Chancellor’s Awards of Excellence, with biostatistician Professor Ian Hambleton and The Port of Spain Declaration Evaluation (POSDEVAL) led by Dr. Samuels, being the two latest awardees. The Centre has also benefited by the University’s emphasis on relevant research, by sagacious advisory committees, led by Sir Keith Hunte and by Sir Trevor Hassell, and partnership with the Ministry of Health.

But the challenge for all researchers is to see results translated into policy, programmes and practice. With this in mind, a functional merger has taken place between the CDRC and the Public Health Group of the Faculty of Medical Sciences. This will strengthen the process of translation and application of research findings, with a holistic approach to Population Health, and will strengthen training programmes – new thrusts led by Dr. Samuels, who brings broad public health and academic experience to the role. The description of the CDRC as “A training powerhouse” is highly applicable, with Masters in Public Health, Doctorates in Public Health (DrPH) and PhDs all linked with research and translation of quality research into practice.

The dramatic growth of the Centre, recognition of need and ability to “provide the goods” has led to further plans for achieving the national goals. These include proposals for a new building – The Population Health Sciences Building – on the old tennis court. Thus a restored historic building, already matched with a state-of-the-art laboratory in a forty foot container, will be joined by a cutting edge modern research block. It provides a major naming opportunity for a generous philanthropist, whose legacy will be assured by sustained high-quality research at the Centre.

Meanwhile there are other opportunities for funding crucial, priority research, such as expanding the National Registry, extending the diabetes reversal studies, studying behaviour change methods and developing monitored public health approaches to address these issues. Barbados can turn around the health of the nation, while contributing ever more significant research findings to the rest of the world. Its mission and goals are being achieved. The success of the vision of the CDRC has been recognised in the renaming of the Centre as the George Alleyne Chronic Disease Research Centre, for Sir George Alleyne, Director Emeritus of the Pan American Health Organisation and retiring Chancellor, and research mentor to many in the Caribbean, including yours truly the founding director.

(Professor Fraser is Past Dean of Medical Sciences, UWI and Professor Emeritus of Medicine and Clinical Pharmacology. Website: profhenryfraser.com)

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