THE SUNDAY GLEANER MAGAZINE | MARCH 3, 2019 I MESSAGES Pre-eminent surgical association IXTY YEARS in the life of an organisation scientific conference and banquet, as well as is a significant milestone. It engenders having a yearly luncheon meeting and week- S reflection on where the organisation end retreat. These all provide opportunities is coming from. It provides an opportunity for networking, camaraderie and continuing to celebrate its past achievements and op- surgical education. Under the auspices of portunities to hopefully learn from its past the ASJ, laparoscopic surgery was introduced failures, with an attitude of gratitude for both. into Jamaica through the efforts of Dr Clive At the same time, we must be looking ahead Thomas. Other initiatives of the ASJ over the and charting a course forward for growth, ex- years have included surgical outreach to rural panded impact and even greater achievement hospitals, fact-finding missions to Cuba, and in the future in an atmosphere of expectancy and hopeful anticipation. meetings held in other territories such as The Association of Surgeons in Jamaica Grenada. Our members have also provided (ASJ) is the pre-eminent surgical association surgical care to other territories, in times of Dr Christopher Tufton that serves as an umbrella organisation for disaster and to provide relief. all the surgical subspecialties represented in As we look ahead, we are grateful for our Jamaica. It was founded in 1958 by a group of founders and past leaders and we commit to visionary surgeons, led by the late Professor Dr William Aiken continuing their legacy of engendering com- A worthy Sir John Golding. The ASJ fosters continuing petent, compassionate and ethical, surgical surgical education and serves as a vehicle for and in the political arena. care of Jamaican patients through creating the ready exchange of ideas, camaraderie The ASJ has been fortunate to have been opportunities for continuing surgical educa- and networking among local, regional and led over the years by many exemplary sur- tion in an environment of mutual respect. We celebration geons who have served as presidents and international surgeons that redounds to the commit to continue to expand the role of the CONGRATULATE the Association of members of the ASJ Council. They have not benefit of our patients. ASJ and its positive impact on Jamaica and Surgeons in Jamaica (ASJ) on its 60th only provided sterling leadership, but have The ASJ has grown numerically in terms of the region by lobbying and advocating for anniversary. It is a significant milestone membership to its current level of 160 mem- expanded the role of the ASJ over the years. I resources/facilities that allow for an accept- worthy of celebration, especially as one bers, but of equal importance, it has grown in More recently, the ASJ, as part of its corporate able standard of surgical care in our nation’s considers the association’s achievements, social responsibility has launched an annual its positive impact on the local and regional including your annual clinical meetings, fundraising event called ‘Scrubs’ which has so hospitals, on behalf of our members and for surgical landscape. Members of the ASJ pro- which allow for research and exchange of far raised J$3 million which has been donated the benefit of our patients. We also commit vide competent and compassionate surgical information and experiences between sur- care every day to people of Jamaica and the to the Jamaica Cancer Society. to work more closely with The University of the West Indies to formulate local guidelines geons from across the region. Additionally, region. Many of our members are medical The primary focus of the ASJ is to engender the Association’s annual conference, which for the surgical care of a number of diseases, chiefs of staff and senior medical officers lead- excellent surgical care of Jamaican patients assembles physicians, surgeons and medi- a process that has already begun. ing many of our nation’s hospitals islandwide. by being a vehicle through which there are cal professionals from across the island, has DR WILLIAM D. AIKEN Additionally, many of our members provide opportunities for networking, knowledge served as a high point to further establish leadership at universities in the region, in transfer, skills acquisition and camaraderie. President the association’s mission of improving med- sports administration, public administration This is achieved by the ASJ hosting an annual Association of Surgeons in Jamaica ical care in the Caribbean. Our clinicians are the backbone of our health system, and it is the associations Recognition of its outstanding contribution like yours that give rise to the social and professional intercourse between sur- HE MINISTRY of Health salutes the seen several great physicians, such as John geons in Jamaica and the region. As you Association of Surgeons Jamaica Golding and Sir Harry Annamunthodo, who continue to develop analysis on health T(ASJ) in recognition of its outstand- have dedicated their time and energy into research management in Jamaica, with a ing contribution to the medical fraternity building a fraternity that has stood the test of view to giving health professionals working over the last 60 years. The association has time. It is hoped that this group will continue to knowledge of issues that affect patients, the promoted among its members the mainte- Ministry of Health will continue to provide nurture young and aspiring doctors into skilled nance of high standards of practice and the the policy framework that creates an even continuous quest for knowledge through its and dedicated surgeons and responsible more enabling environment. Together we clinical meetings. It provides opportunities citizens who will make a difference not only can offer superior clinical and customer for the sharing of ideas among its members in Jamaica, but across the world. service to Jamaicans and all who use our and opportunities for the advancing of all As the association embarks on a next health system. branches of surgery. Again, I commend the efforts of the ASJ The association, over the years, has decade of achievement, I encourage your and wish you all the very best in your 60th supported the continued medical educa- members to be steadfast in the practice of anniversary celebrations and beyond. I look tion of all doctors. The sustained success of our noble profession, to continue to heal forward to working with the members of the ASJ annual clinical conference, that sees our nation, and to ensure that the practice between 600-700 attendees each year, is a the association as we continue to make the of medicine is faithfully passed on to the testament to the high regard and respect health sector a valuable contributor to our that is attributed to the association. The med- Jacqueline Bisasor-McKenzie next generations. nation’s development. ical fraternity and, by extension, the people learnt and shared in these conferences. JACQUELINE BISASOR-MCKENZIE CHRISTOPHER TUFTON, MP of Jamaica have benefited from the lessons The community of surgeons in Jamaica has Chief Medical Officer Minister of Health 2 ASSOCIATION OF SURGEONS IN JAMAICA 60TH THE ANNIVERSARY GLEANER | FEATURE: SUNDAY, MARCH THE SUNDAY 3, 2019 GLEANER MAGAZINE | SUNDAY, MARCH 3, 2019 MESSAGES Honoured to be the We salute founding president the ASJ T IS a great privilege to note the 60th HE MEDICAL Association of Jamaica anniversary of the Association of Surgeons (MAJ) congratulates the Association Iin Jamaica, especially as I have the honour to Tof Surgeons of Jamaica (ASJ) for be the founding president of the Association achieving its diamond jubilee milestone. of Consultant Physicians in Jamaica. Langston A jubilee for any association gives an Hughes, the American poet, maintained that opportunity to look back on the distance if we don’t celebrate ourselves, who else travelled, and to look forward to the journey will? The Jamaican father of modern surgery that is ahead. in our country, George Baxter, of blessed 1958 was the year that Pele became a foot- ball star, scoring in the finals for the world memory, would be a happy and proud man champions Brazil. It was the same year that Clive Lai today to note that his vision and aspirations NASA was created and the first transatlantic presented and there is exchange of informa- for his beloved specialty was not lost with passenger jetliner flight made. But it was the tion and experience between the surgeons the passage of time since he graduated from year that the late Professor Sir John Golding from different centres so as to improve effi- King’s College London in the 1930s. History was instrumental in the formation of the ASJ. ciency, promote high quality healthcare and will also record the sterling contributions Since its inception, the ASJ has grown in to depreciate litigation claims from patients. of Sam Street and Henry Uriah Shaw, who stature in advancing surgery in Jamaica, enthusiastically opened the doors to a flood and has certainly made an impact on We are therefore proud to salute the ASJ of talent during the decades of the ’60s and Dr John Hall the society with its many achievements. on this monumental occasion, and we wish ’70s at the Kingston Public Hospital. The result century with unswerving integrity and Surgery has been taken to newer heights, for them all that is best for the future as they was a spate of fellows of the Royal College of unquestioned skill. with many patients benefiting from cutting take on the challenges of the next 60 years. Surgeons, including several female doctors. DR JOHN A. S. HALL edge technology and the expertise of the DR CIVE LAI President The association has a duty to our country Chairman of the Medical Council of surgeons. At the ASJ scientific meetings, MAJ to continue this journey during the 21st Jamaica. papers of the highest standards are

ASSOCIATION OF SURGEONS IN JAMAICA 60THTHE GLEANER ANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, SUNDAY2019 GLEANER MAGAZINE | MARCH 3, 2019 3 MESSAGES A strong and vibrant organisation HE FACULTY of Medical Sciences at competing with surgical care for other con- expertise to our training programmes and the University of the West Indies (UWI), ditions ranging from the management of an are key in building a partnership of quality in TMona, congratulates the Association of inflamed appendix to removal of dreaded training. We are indeed very grateful. Surgeons of Jamaica (ASJ) on the achieve- cancerous tumours. The reality is that we must The Faculty along with the University, cel- ment of its 60th anniversary. This outstanding be very grateful for the 60 years of service ebrated 70 years of service in education in lifespan is testimony to a strong and vibrant given by the ASJ to the country. 2018. However, there can be no celebration The Faculty is particularly proud of the organisation that has been making a signif- without partners and so, we join with the Association, whose many members were icant contribution to improving health and Association in celebrating now and in antic- trained through postgraduate Doctor of well-being in Jamaica and the Caribbean. Medicine programmes in surgery developed ipating the future. We welcome the crafting Our surgeons are at the forefront of saving and delivered by the UWI. In the past decades, of an era of further strengthening of collab- lives in the context of Jamaican society. The we have seen growth and development of oration in training, research and service in epidemic of injuries facing our population training to include a wide range of surgical the coming decades to benefit Jamaica and with violence and road traffic accidents as specialties and increased use of technology the region. the main perpetrators, calls for skilled sur- in surgical care and treatment such as laparo- Tomlin Paul gical intervention and care in our hospitals scopic surgery. Additionally, the membership Dean, Faculty of Medical Sciences, UWI, Tomlin Paul across the country. These demands are always of the Association has given of their time and Mona We thank you and the ASJ for this contribution URSES ASSOCIATION of Your aims and objectives have hysterectomies, Caesarian Sections 60 years ago. This did not happen Jamaica (NAJ) is delighted nurtured, educated and impacted and Orthopaedic surgeries, but now by chance but through the commit- Nto offer sincere congratula- not only members of your profes- we are blessed with the various spe- ment of your members to ensure tions to the President and members sion, but also nursing and other cialties in most of our institutions greater improvements in health of the Association of Surgeons in health groups through your annual where your members perform de- care and sometimes with very little Jamaica (ASJ) on this your 60th conferences and grand rounds in liberate and targeted specialised or at your own expense. The NAJ anniversary celebrations. You have rural hospitals, and we thank you interventions to improve the health thank your members on behalf of done well to maintain the vision and the ASJ for this contribution. of the populace. You are also now the populace, because we believe and foresight of your fore-runners The ASJ has achieved much; moving ahead to be on par with the Jamaican population should and I make special mention of John you have come a long way and other first world countries, as we have access to the best available Golding who conceived the thought your members have ensured that have seen a tremendous increase in treatment to present and respond but did not allow it to fall on stony the goal of ‘Health for All’ will be the use of cutting edge technology to their health care needs. ground, however, ensured that achieved. Much has changed over such as the use of laparascopy and A milestone of 60 years provides the idea germinated into a legacy, 60 years. We recall that in most rural laser treatment that aid in earlier the ideal opportunity to reflect on that still lives on and remains very hospitals, the General Surgeon recovery period for our patients, Carmen Johnson relevant after 60 years. was the one who performed which was unimaginable in Jamaica PLEASE SEE ASJ, 5

4 ASSOCIATION OF SURGEONS IN JAMAICA THE60TH GLEANER ANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, 2019SUNDAY GLEANER MAGAZINE | MARCH 3, 2019 MESSAGES

accomplishment is the result of ASJ hard work, courage and strong 60 years of existence determination. Continue to push CONTINUED FROM 4 THE ASSOCIATION of Anaesthetists quest to restore health to patients. your limitations, you have already in Jamaica (AAJ) joins the rest of the The role of the anaesthetist as the made the unthinkable possible, medical fraternity in paying hom- protector and preserver of the the history and achievements of so continue to serve with pride. age to the Association of Surgeons patient while the surgical process the ASJ and your tremendous The NAJ would like to once in Jamaica (ASJ) on the occasion is being undertaken, literally makes impact. It creates the context again commend all mem- of achieving the milestone of 60 the process possible. Needless to within which to chart the course bers, including past executive years of existence. Congratulations say, if the surgeon had no knife, to achieve your ultimate mission to the ASJ and its membership for the anaesthetic professional would members who have built the ASJ to improve surgical care in the the leadership role it has played have no raison d’etre. Caribbean; with present and new into one of the most prestigious in the development of medicine It is therefore from a proximate technologies, the possibilities are associations. You can be proud in Jamaica since its inception in vantage point that the AAJ salutes endless. The NAJ thereof wishes that your efforts have made a 1958. It is noteworthy that this or- the ASJ on the achievement of this for the present and future exec- lasting, positive contribution to ganisation pre-dated the birth of detailed analysis of health research important landmark. Six decades utive abundant success in this the well-being of the populace, the Jamaican nation, and there is management in Jamaica, with the of contribution and leadership of regard. aim to provide doctors and other and not only in Jamaica, but no doubt that the ASJ has made an important sector of national de- As you look to the future, our a seminal contribution to national healthcare professionals with an velopment is worthy of note and from the Caribbean and other members will continue to work progress and development. administrative overview of health we are proud to have stood with with your members to ensure territories. You have made many From its position at the van- issues that affect patients within you during this time. It is our hope Jamaicans live longer, healthier, families happier and hopeful. guard of the health education hospitals in the Caribbean and other that the ASJ continues its sterling happier and fruitful lives. A big congratulation from the and healthcare delivery efforts in parts of the world. work in the Jamaican healthcare As you move forward into NAJ, and please accept our best Jamaica and the Caribbean, this The symbiosis between surgeons landscape, and we pledge our the next decade, we trust that wishes for continued success in august body of some of the coun- and anaesthetic professionals is one steadfast support of your quest to you will become stronger, be- try’s brightest and best has worked of the most celebrated in medicine. lead Jamaica along the cutting edge the years to come! cause of the respect the ASJ has with purpose to actualise its pri- Each profession literally owes its of global healthcare development. earned for striving to improve CARMEN JOHNSON mary mission of improving medical existence and development to the DR BRIAN JAMES your profession and the health President of the Nurses care in the Caribbean. They have presence of the other. The surgeon’s President of the Jamaican people. Your Association of Jamaica focused on the development of a scalpel is the symbol of his or her AAJ

ASSOCIATION OF SURGEONS IN JAMAICA 60THTHE GLEANER ANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, SUNDAY2019 GLEANER MAGAZINE | MARCH 3, 2019 5 The birth of the ASJ and when the association almost died N MY opinion, the most impor- tant aspect of the ASJ was the fact Ithat, of the four major clinical de- partments at the University College Hospital of the West Indies, medi- cine, obstetrics and gynaecology, and pathology were represented by local branches of overseas or- ganisations, while surgery was the first to be represented by a local professional association. John Golding, who arrived in 1954 as senior lecturer in orthopaedics, be- lieved that a local association was not only possible, but essential. He entered into discussions with the Prof Carpenter looks on at Honourable Mavis Gilmore and her husband, Dr established surgeons in discussions Gilmore. with the established surgeons in Professor John Golding mingles with the crowd. the government medical service on an all-expenses paid visit to see and the result was the formation for himself, most of the cancelled of the Association of Surgeons in level of crime, there was a feeling Bustamante Hospital for Children bookings were restored. The col- Jamaica (ASJ), based on a similar of being in a ‘civil war’, and the re- being a terrifying experience be- lege group was booked on British body in Great Britain. This was a big sulting marked public anxiety led to cause of the deathly quiet road- Airways and Air Jamaica. The day deal because it brought together a state of panic. No one wanted to ways, with the reports of hold-ups before the start of the conference, the government and university sur- travel from or to areas around the by criminals in just such a circum- while the college group was at the geons as a united body. island for scientific meetings. stance. This was the decade the airport, Air Jamaica cancelled its During the latter part of the A state of emergency was declared ASJ nearly died! Meetings were flight, but chaos was averted as 1970s, because of the political (1976-1977). Carpenter recalls a 2 a.m. difficult to organise and it seemed the two airlines were persuaded to tensions at the time and the high journey from Half-Way Tree to the that that the organisation was cooperate in making sure that the programmes and first-day present- ers were all on British Airways. In the end, the meeting was a resounding success! Everyone celebrated! Carpenter has fond memories of the last night of the meeting. During the closing banquet, there was torrential rain and the flooded roads made driving hazardous, but Carpenter and wife managed until Harry Annamunthodo and Prof near home when the car stalled Michael Woo Ming. on a side road near their home at Half-Way Tree. Carpenter stripped about to collapse. One Saturday, Sir to his underwear, pushed the car Harry Annamunthudo volunteered into the heavy waters pouring Carpenter to give the president of down Hope Road, which would the Royal College of Surgeons of carry it down to the gate of their Edinburgh, here on WHO business, home, his wife at the wheel while a guided tour of the University Carpenter, in underwear only, ran Hospital. During the tour asked, he after it. A passing police car paused, spoke about their first attempt at an presumably intrigued by the sight, overseas meeting which had been shook their heads and drove on. held in Egypt, but this had not gone Fortunately, or the ASJ president well. Carpenter, with hope rather may have had some explaining than expectation, asked whether to do! Next morning, after all our there would be the possibility of guests had departed, we found that holding a second one in Jamaica. He one of our lecture rooms was under seemed open to the possibility, and, water. This meeting turned out to in due course, arrangements were be the stimulus that was needed. set up between the college and the The ASJ was alive again. ASJ for a meeting at the end of 1978. (Memories of Professor Carpenter The programmes were printed by as told by Dr Mark Newnham) the college and brought by their PROFESSOR REGINALD attendees. A few weeks before the CARPENTER due date, a political statement from Former Head Jamaica caused a significant num- The Department of Surgery ber of cancellations, but by having University Hospital of the West their travel agent come to Jamaica Indies

6 ASSOCIATION OF SURGEONS IN JAMAICA THE60TH GLEANER ANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, 2019SUNDAY GLEANER MAGAZINE | MARCH 3, 2019 The role of surgery and surgeons in public health The evolution of a significant threat to population receives only 3.5 per cent of the surgical disease health. Surgical diseases, which surgical operations undertaken are diseases completely or partially worldwide. as a public health treatable by surgery and excluding So, what do we know about the problem obstetric emergencies for the pur- current ranking of surgical disease poses of this discussion, include 60 as a cause of morbidity in the UBLIC HEALTH may be con- per cent of cancers, orthopaedic and Jamaican population? There are no cisely defined as the societal other injuries, diabetic foot compli- statistics available which specifically Ppractices geared towards the cations, blindness from cataracts, maintenance and improvement of congenital abnormalities, and other separate ‘surgical disease’ from other the health of the population as a miscellaneous conditions. PLEASE SEE SURGERY, 8 whole. These practices involve not But because of local societal only the systems specifically dedi- changes – such as almost complete cated to healthcare, but also social reliance on motor vehicles for trans- services, such as provision of safe portation, the ready availability of water supply, sanitation, food-safety guns, which are more destructive controls, food security, and even implements of interpersonal vio- poverty alleviation. lence than the population hitherto In traditional public health prac- had access, the ageing of our pop- tice, there has been greater empha- ulation and the success of public sis on disease prevention rather than health strategies in controlling on treatment – for the simple reason communicable diseases – surgical that prevention strategies achieve and other non-communicable dis- proportionally much greater gains ease now constitutes a much larger in population health than cura- proportion of illnesses in general. tive services. This was particularly This transition from predominantly true in the era in Jamaica when communicable to non-communi- communicable and nutritional cable disease as the major threats illnesses posed the predominant to population health, referred to threat to population health. in public health jargon as the ep- Prevention strategies, including idemiological transition, occurred immunisation programmes and the in Jamaica towards the end of the social services mentioned above, 1970s into the 1980s. Except for the have been phenomenally successful threat of reversal of this trend from in improving population health in HIV at the height of the epidemic, Jamaica, enabling us to achieve life now reasonably well controlled, the expectancy approaching that in de- transition is essentially complete. veloped countries. This success story ‘NEGLECTED STEPCHILD’ should not be taken for granted; Internationally, this trend to- our successive governments, over wards an increasing threat to pop- the past 60 years, have served us ulation health from surgical disease well in this regard, as they remained has been recognised by the World steadfast in support of progressive Health Organization (WHO) and public health policy, ideological dif- World Bank for at least a decade. ferences in approach to governance In 2008, Jim Kim, current president notwithstanding. of the World Bank, along with Paul In this scenario, surgery, being Farmer, a co-founder along with a curative discipline involving sec- Kim and others of the organisation ondary care or treatment after the Partners in Health, made the mo- occurrence of illness, did not play mentous declaration that “surgery a proportionally major role in im- may be thought of as the neglected proving overall population health. stepchild of global public health”. Surgery improves the quality of life The trend is occurring even in pop- of individuals afflicted by surgically ulations that have yet to experience treatable illness, and, of course, indi- the epidemiological transition, ag- viduals make up a population. But gravated in these poor countries by in the era of high infectious dis- woefully inadequate surgical ser- ease prevalence, surgical disease vices; a study by Weiser and others constituted a relatively small pro- published in the journal Lancet portion of illnesses in general and, in 2008 estimated that the poor- therefore, could not be considered est third of the world’s population ASSOCIATION OF SURGEONS IN JAMAICA 60THTHE GLEANER ANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, SUNDAY2019 GLEANER MAGAZINE | MARCH 3, 2019 7 has an adequate complement of SURGERY surgeons capable of offering the full spectrum of surgical specialties; CONTINUED FROM 7 most if not all of these surgeons, non-communicable disease, but across the specialties, are members some inferences may be drawn of the ASJ. All Jamaicans now have from statistics on other measures access to advanced surgical services of disease effect. at or through all public hospitals, For example, according to the private hospitals and the University WHO, the leading causes of death Hospital of the West Indies, as ASJ (mortality) in Jamaica in 2016 were members are distributed through- as follows: out the country. n 30% - Cardiovascular diseases Research into the local clinical n 20% - Cancers epidemiology of surgical disease is n 15% - Other NCDs critical if we are to design effective n 12% - Diabetes public health interventions n 11% - Communicable, maternal, targeted specifically at our pop- perinatal and nutritional conditions ulation. ASJ members have been n 9% - Injuries acquiring the necessary skills and n 3% - Chronic respiratory illnesses have been conducting advanced Mortality tables reflect the clinical research; this is a new prevalence of disease in a trend, as surgeons now recognise population only to the extent that and embrace our emerging role as the disease is ultimately lethal. clinical epidemiologists and public Disability-adjusted life-years health advocates. (DALYS) present a more accurate Under a collaboration between picture of the burden of disease in the ASJ and the Department of a population, since this measure takes into account years of life lost Surgery, Radiology, Anesthesia and both to premature mortality and Intensive Care at the UWI, soon- disability occurring in people liv- to-be published guidelines for ing with disease. However, given management of the most common that a large percentage of surgi- surgical diseases in Jamaica have cal diseases are cured by surgery, been crafted. These guidelines will thereby curtailing any deleterious be distributed to all our members effect the disease might have on and hospitals, and are expected to life expectancy, this statistic also standardise management of these presents only an indirect and partial conditions across the island. picture. Finally, as emphasised in According to the WHO, the top traditional public health practice, 10 causes of DALYS in Jamaica in the ASJ acknowledges that disease 2004 were: prevention, where this is possi- n 21.3% - Neuropsychiatric ble, is more impactful on overall conditions population health than treatment. n 12.3% - Infectious and parasitic The National Road Safety Council, diseases with its mandate to promote safe n 10.7% - Cardiovascular diseases driving practices and advocate for n 8.4% - Intentional injuries legislation aimed at reducing motor n 6.4% - Malignant neoplasms vehicle accidents, was convened on (cancer) the basis of a paper written by one n 5.8% - Respiratory diseases of the founding fathers of the ASJ, n 5.3% - Sense organ diseases Professor Sir John Golding. Also, n 5% - Unintentional injuries several ASJ members partner with n 4.9% - Perinatal conditions n 2.9% - Musculoskeletal diseases the Jamaica Cancer Society in its Thanks to general and special- drive to promote screening for ist postgraduate surgical training breast, prostate and colon cancers, programmes at The University three of the most common cancers of The West Indies and prior in the Jamaican population. to that, the Royal Colleges of DR JEFFREY EAST Surgeons in the UK, particularly Consultant General Surgeon the colleges in Edinburgh and and Former Deputy Dean Glasgow, and fellowship training Faculty of Medical Sciences in North America, Jamaica now University of the West Indies 8 ASSOCIATION OF SURGEONS IN JAMAICA 60THTHE GLEANERANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, SUNDAY2019 GLEANER MAGAZINE | MARCH 3, 2019 ASSOCIATION OF SURGEONS IN JAMAICA 60TH THE ANNIVERSARY GLEANER | FEATURE:SUNDAY, MARCH THE SUNDAY 3, 2019 GLEANER MAGAZINE | SUNDAY, MARCH 3, 2019 9 The role of the surgeon as an administrator EDICAL HISTORY has they are in operative surgery. Whilst become established as an expert in which will ease them seamlessly into attribute of an administrator which shown that surgeons have excelling in this additional role, the their chosen field, which is essential the administrative position. stand out above anything else, and Malways been given the task value of surgeons as administrators in gaining the respect of both the It is important that as an admin- that is the ability to have open and of administrators, this is not only has been commensurate with the academic community and the wider istrator, you have a clear vision effective communication skills. Clear a local phenomenon, but reflects advances in technology and admin- health team. Your colleagues will of the direction your institution communication avoids misunder- the trend in the International health istrative processes. Formal training in need to have that confidence in you should take and adopt a strategic standing and miscon ception of the community. There is the expecta- hospital or business administration and your abilities before following plan, which clearly outlines the roles and responsibility of your staff; tion that surgeons will not only is absolutely necessary. The timing your lead in the management and methodology of effecting change however, do not ignore the need to excel as clinicians, educators and of the entry of the surgeon into the development of the health services. and the means of achieving these listen. Listening to all staff and col- researchers, but also as leaders of administrative role is very important A young surgeon, yet to be estab- ends. Initially, it is useful to select leagues you represent is vital to your the health team and, ultimately, in an effort to achieve a successful lished, may find that this new role ‘low-hanging fruits’ (easily achieved success as an administrator. administrators. Global changes in outcome. may adversely affect their academic objectives), as the successes The years of surgical training, with the delivery of healthcare demand The surgeon should first focus on and clinical growth, and later lead achieved will build confidence in an emphasis on detail, continued that some academic surgeons be- developing and excelling in his/her to disillusionment and frustration. your team and ensure continued monitoring of activities, precise come as skilled in administration as clinical practice and research, and Alternatively, embarking on an ad- interest in the long-term objectives. decision-making and the willing- ministrative role later in one’s career The buy-in by your staff and recog- ness to take on full responsibility may be problematic, as the advances nition of their successes is essential for projects and outcomes, makes in technology and administrative to a successful outcome and ensures the surgeon an exceptional can- systems may become too onerous the maintenance of enthusiasm in didate for the role of an adminis- to effect a satisfactory outcome. It meeting all the stated targets in the trator. However, it is important to is therefore important that a struc- expected time frames. bridle enthusiasm with reality when tured, careful selection of persons An administrator must be careful seeking positions of authority, in an to adopt a career in administration not to appear to do everything alone; effort to ensure a successful career is pursued, rather than selecting delegation of responsibility to care- as an administrator. young,enthusiastic candidates, who fully selected persons is oftentimes TREVOR McCARTNEY may be better advised to develop the key to the overall success of pro- Former Senior Medical Officer a track record of clinical successes jects and programmes. There is one Kingston Public Hospital

10 ASSOCIATION OF SURGEONS IN JAMAICA THE60TH GLEANER ANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, 2019SUNDAY GLEANER MAGAZINE | MARCH 3, 2019 ASSOCIATION OF SURGEONS IN JAMAICA 60TH THE ANNIVERSARY GLEANER | FEATURE:SUNDAY, MARCH THE SUNDAY 3, 2019 GLEANER MAGAZINE | SUNDAY, MARCH 3, 2019 11 The rural surgeon Women in surgery HE RURAL-BASED surgeon has a spe- who even did burn holes for haematomas FOR CENTURIES, women have been involved cial place in the history of Jamaican – at a time when neurosurgeons were not in surgery, albeit not at the forefront until medicine, and the present set of such a part of the landscape. T recently. In the last few centuries, there have individuals stand on the shoulders of giants It goes without saying that these in- been reports of women who sought to dis- who were willing to leave the bright lights dividuals had to be resourceful and very guise their identity to enable themselves of the capital to bring much-needed exper- good clinical practitioners, as they were to practise the craft of surgery. Surgery has tise to the rural parishes. faced with limited laboratory and imag- largely been a specialty pursued by males. Such giants of Jamaican rural surgery ing services. These are true stories about This may be so because of the lifestyle, which included Dr R.G. Lampart in St Thomas, Dr patients being treated for a puenothorax may not be attractive to women, or the pau- Alfred Carnegie in Sav-la-Mar, Dr Antonio or haenothorax without even having an city of female mentors in the field. In the in Port Antonio, Dr Arthur Wint in Linstead, xray; of patients being taken to elective and early years of the Faculty of Medical Sciences, Dr Francis in Black River, Dr ‘Buddy’ Wilson emergency surgery without appropriate University of the West Indies (UWI), females in St Ann’s Bay; and Dr Freeman in Spanish laboratory investigations. comprised a small proportion of medical Town, to name those who came readily It is instructive that many rural hospi- students. Despite the fact that majority of the to mind from the era of the 1950s. These tals up to the 1980s had no consistent current graduates of the faculty are females, were the first set of trained surgeons, most clinical chemistry services and even now, male applicants still outnumber females of whom had fellowships in the English or many have no in-house fluoroscopic or who seek to pursue postgraduate training Scottish colleges of surgeons. ultrasound. in surgery. Dr Belinda Morrison-Blidgen, consultant The second wave would include emi- Pathology services up to the 1980s were Many surgical specialties have been ste- urologist, University Hospital of the West Indies. nent surgeons such as Peter Wellington Kingston-based, and so the rural surgeons reotyped as ‘old boys’ clubs’ and this has in Mandeville, Williams in Spanish Town, had to decide on which specimens had to been a discouragement to several females. native of Belize, completed the doctor of Winston Dawes in May Pen, and Ken Baugh be sent to the lone pathologist at the then In addition, gender-based stereotypes of medicine degree in general surgery, and in Montego Bay, to name a few. Government Medical Laboratory. what women can and cannot do serve as a later served in rural Jamaica. There has been These men, and others not mentioned, Networking with one’s colleagues in the deterrent for prospective female surgeons. a steady increase in the number of female were appointed to these hospitals with di- metropole of Kingston was very important, Surgical training programes across the world graduates from the doctor of medicine train- rectives from the Ministry of Health to bring as complex and unusual cases could be are generally competitive and demanding, ing programme, at the UWI, Mona, with 36 ethical medical care to the rural population. discussed and referred, especially surgical with surgical residents having long and grue- female graduates since its inception (22 per Their practice guideline and protocols were cases requiring sophisticated anaesthetic ling working hours, many sleepless nights, cent of total graduates). Of these, there are not distinctly written and promulgated by skills or large quantities of blood products. and starting a family under these conditions currently five general surgeons, one subspe- the Ministry of Health. They were expected In the last three decades, the landscape may be considered an obstacle. It is no secret cialising in thoracic surgery, two neurosur- to practise to the level of their competence, has been changing. In many respects, the that many persons in our culture are uncom- geons, four urologists, five ENT surgeons, consistent with their training and experi- rural general surgeon has been joined by fortable with the idea of a female doctor or seven ophthalmologists and four paediatric ence which, by and large, would have been gynaecologists, starting first in Montego surgeon. Many female surgeons have grown surgeons working in Jamaica. gained from British hospitals and further Bay, Mandeville, then Spanish Town, and accustomed to being referred to as ‘nurse’, The postgraduate training programme at burnished by stints at the Kingston Public now in most rural hospitals. My hospital, despite efforts to introduce themselves as UWI, Mona, currently has 37 per cent female Hospital before being assigned to a rural the Princess Margaret Hospital, received the ‘doctor.’ surgical residents in training. This may be hospital. In those days, there were no its first trained obestetrician/gynaecologist One of the female pioneers in surgery in partially attributed to female surgeons ex- manuals produced locally. in 2009. Jamaica is Dr Mavis Gilmore. Dr Gilmore, celling in their field and serving as mentors As the University of the West Indies DAUNTING JOB the first female fellow of the Royal College to prospective female surgical residents. has graduated more specialists, the rural In 1958, the establishment of the of Surgeons of Edinburgh to practise in the For example, Dr Tanya Hamilton, a general surgeo n is now able to refer more patients Association of Surgeons of Jamaica would Caribbean, served at the Kingston Public surgeon currently serves as senior medical to clinics in urology, orthopaedics, plastic help to foment and focus discussions on Hospital from as early as 1960. Sheer intel- officer, St Ann’s Bay Hospital, and Dr Natalie surgery, paediatric surgery, etc. local issues and diseases. It would also focus lect and adept surgical skill rubbished any Whylie serves as senior medical officer at It is hoped that with more special- discussions on the peculiarities of Jamaican suggestion at the time of lack of compe- the Kingston Public Hospital. These females ist services moving into rural hospitals, disease patterns and assist these surgeons tence for the job solely because of gender. and others have helped to eliminate gender- there will be a commensurate increase in continuing medical/surgical education. Dr Gilmore proved herself as a well-trained stereotyping in surgery in Jamaica. in sophisticated laboratory and imaging What made the job even more daunting surgeon and obtained the respect of many A career in surgery is filled with the satis- services and, to some extent, the private is that in many cases, and for many decades, of her colleagues. Even then, there were very faction of changing human lives, while visibly sector is leading the way. these persons were the de facto leaders few female surgeons. seeing an effect on patient health. It allows In order to attract young specialist staff, of the hospital management team. They With the emergence of the doctor of med- for continuous growth and development of hospitals such as Mandeville, Annotto Bay, were administrators and technocrats at the icine postgraduate training programme at mental fortitude. Apart from clinical practice, Princess Margaret and Spanish town have same time. They were always senior medical the UWI, Mona, in 1981, the opportunity it allows for focus on specific areas, such officers whose presence was mandatory found novel ways to bring in laparoscopic for local training in general surgery and the as research or teaching. The wide array of at hospital management meetings, and and endoscopic services, thus decreasing subspecialties became more readily availa- surgical subspecialties allows prospective no significant hospital decision was taken the need for patients to travel for complex ble. In 1986, Dr Barbara Salmon-Grandison females surgeons to choose appropriate without them. procedures and investigations. became the first female graduate of the fields according to their skills and future They were almost always the only spe- The rural surgeon is now able to concen- postgraduate surgical training programme desires. I have found my career in surgery cialist in any rural hospital, so they had to trate on advancing his own specialty of gen- in Otorhinolaryngology (ENT) at UWI, Mona. very rewarding and enjoy it immensely. be broad in clinical outlook – treating not eral surgery and trauma, and no longer has Dr Carolyn Pinnock later graduated from DR BELINDA MORRISON-BLIDGEN only surgical patients, but also medical, to see himself or herself as a jack of all trades. the paediatric surgery programme in 2002. Consultant Urologist, University obstetric, gynaecological and paediatric DR CECIL BATCHELOR However, it was not until 2003 that the first Hospital of the West Indies patients. Most had to be fairly proficient at Former Senior Medical Officer female graduated from the general surgery Senior Lecturer and Head, Division of performing common urological and otho- Princess Margaret Hospital, training programme. Dr Lisa Johnson, a Urology, University of the West Indies paedic procedures, and these were those Morant Bay 12 ASSOCIATION OF SURGEONS IN JAMAICA THE60TH GLEANER ANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, 2019SUNDAY GLEANER MAGAZINE | MARCH 3, 2019 Relevance of the doctorate of medicine programme The contribution of the University of West Indies postgraduate training programmes to the Association of Surgeons in Jamaica (ASJ)

WHY A DOCTORATE OF MEDICINE (DM)? The establishment of the medical school in 1948 and its first gradu- ating class in 1954 established a steady and dependable stream of adequately trained doctors to meet the needs of Jamaica and Commonwealth Caribbean nations. Once this need was met, the next step was to address the acute short- age of general and specialist-trained surgeons. The opportunity to do so came in 1972 when a DM programme in surgery was established by The University of the West Indies (UWI) with funding from the Government of Jamaica. Critical expertise was provided by the Hope Foundation (Project HOPE). The first graduates Surgeons Keith Wedderburn, Trevor McCartney and Delroy Fray being honoured by the Medical Association of Jamaica in 2016. were Ronald DuQuesnay in general ORL was confirmed and accepted the islands in between. Additionally, This is despite the fact that in ad- of elective abdominal operations surgery and, soon after, Charles Lyn throughout the region, the period you will find graduates of the DM dition to the University Hospital compared to the conventional, and Halda Shaw in otorhinolaryn- of the 1980s and ’90s saw the es- in surgery in established practice in of the West Indies, Kingston Public open-surgical approaches, there gology (ORL). These three pioneers tablishment of additional training the USA, Canada, United Kingdom, Hospital and Cornwall Regional is still a lot to be said for a well- ushered in a new category, the aca- programmes in orthopaedics, urol- as well as several currently doing fel- Hospital as accredited training in- performed open-surgical procedure demic surgeon, whose responsibilities ogy, cardiothoracic surgery, neu- lowship training in Australia. stitutions, aspects of training are done in a compassionate and caring included their development as aca- rosurgery, and paediatric surgery. CHALLENGES & also now provided at Mandeville environment. demic teachers at the Mona campus. More recently, DM programmes in CONCLUSION Regional Hospital and Spanish Town For continued success in meet- Now in the retirement phase of their ophthalmology and plastic surgery Today, through globalisation and Hospital. We will have to engage ing the needs of Jamaica and the careers, they have become household have been established to provide easy access to information through international partners, such as the region, the Association of Surgeons names in surgical practice in Jamaica the necessary trained specialists to Google, our specialist surgeons University of Toronto, to facilitate of Jamaica (ASJ), the UWI and other meet the needs of the region. Our through their significant influence aim for, and are held to, the high- fellowship training for our super professional bodies, such as the DM in the various subspecialties on the development of surgery in est level by a discerning public. The subspecialist-trained surgeons, Caribbean College of Surgeons, Jamaica. of surgery is recognised by the expectations of patients are not but we must also regionalise care must continue to work together, In general surgery, Ronald accreditation bodies of the United surprisingly real and they do not to areas of expertise and develop combining resources, forming part- DuQuesnay was a master surgeon, Kingdom, Canada and Australia, want a ‘trainee doctor’ to do their centres of excellence with restrict- nerships, so that a fully equipped a surgeon’s surgeon, especially well which has allowed our graduates operation. Whereas with the right ing and matching surgical proce- surgical skills laboratory is available known for his no-nonsense opinions the opportunity to complete fellow- supervision and assistance, most dures to institutions and skill sets. for the professional development of in situations where the decision to ships in these countries. As a result, residents in the later stages of their Centres of excellence for cancer care the members and residents, offering operate or not was being discussed. there are now super-specialists in training can effectively perform He also provided a critical overhaul laparoscopic surgery, hepatobil- many operations with similar out- and trauma care are areas that come workshops, short courses and struc- of the surgical programme when iary surgery and colorectal surgery, comes as the consultant, this fact readily to mind. tured training sessions as we strive this was needed and for well over among other areas. is sometimes unknown or lost to Whether it is minimal invasive to provide excellence in surgical a decade, he was in charge of post- CONSOLIDATION the public. No surgical procedure surgery, endoscopic surgery or care, training and research. graduate surgical training at the The DM programmes attract is without the possibility that even other means of reducing the trauma Evidence of partnership is provided UWI, Mona campus. Drs Lyn and some of the brightest and best of the appropriate direct actions may usually associated with accessing by the ‘2018 Guidelines Initiative’ Shaw similarly contributed to the the graduating class and over a pe- be associated with complications, the disease or damaged body and supported by the Stewart’s development of teaching, to both riod of at least five years, they are some with harmful consequences. It part, the majority of surgery per- Automotive Group, which saw the undergraduates and graduates in trained in the scientific and clinical is often said that a surgeon without formed nowadays is dependent on ASJ and the Department of Surgery, their specialty. As the programmes methods of surgical diseases, as well complications is not operating often expensive technology which require UWI, developing practice guidelines developed, graduates had the as the technical skills required for enough. significant capital expenditure and to standardise the quality of surgical opportunity to learn basic man- providing high quality surgical care. It would be remiss of me to con- will need replacement over time. care being delivered across the island. agement techniques, which were Today it is fair to say that the ma- clude without some comments There may be enthusiasm for the Such initiatives augur well for the especially useful for those subse- jority of the surgical consultant staff about the future of surgical train- latest robotic intervention, but future of surgery in Jamaica. quently appointed senior medical at our hospitals were trained in this ing, given of the significant costs careful cost analysis shows that PROFESSOR JOSEPH PLUMMER officers in charge of government programme in Jamaica. Currently, in involved and the trend towards even in the best hands, the robot General and Colorectal Surgeon hospitals. addition to Jamaica, our graduates subspecialisation. The immediate may not yet be fully beneficial to Head of the Department THE EARLY YEARS are active throughout the region – challenge is to address the cur- the average patient. While there is of Surgery, Once the quality of the DM as far south as Trinidad and Tobago, rent shortage of specialist-trained good evidence of the superiority of University Hospital of the West graduate in general surgery and and north as The Bahamas, and all surgeons throughout the island. laparoscopic surgery in the majority Indies

ASSOCIATION OF SURGEONS IN JAMAICA 60THTHE GLEANER ANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, SUNDAY2019 GLEANER MAGAZINE | MARCH 3, 2019 13 Health and the KPH, with me as a collaborator from the UWI. The JISS Trauma care in Jamaica since the 1980s collects data on all injuries present- RAUMA IS a major cause of Presently, injuries account for one in in Jamaica for a very long time. The line, I went about suturing his wounds. ing to the Accident and Emergency morbidity and mortality in seven healthy life years lost worldwide, main trauma hospital in Jamaica is However, after some time, I noticed Departments at the government Tboth the developed and and the World Health Organization the Kingston Regional Hospital (KPH). that he was no longer restless but had hospitals across the island and is ad- developing world. It is perhaps the predicts that this will increase to one It should not be a surprise then that become quite still. The nurse and I ministered by the Ministry of Health. disease which has the most negative in five by 2020, with low- and mid- on the first day of my internship, two attempted to check his blood pres- Information is collected on demo- impact on healthcare systems and so- dle-income countries accounting for injured patients were brought to the sure, and then we realised that he was graphics, mechanism of injury, loca- cieties today. Injuries are the leading the majority of the increase. ward, one with a gunshot wound and pulseless. Attempts at resuscitation tion and circumstances which caused cause of death under the age of 40 in Jamaica, with a murder rate of 36 the other was a young man found in failed. That incident was to have a pro- the injury, victim-perpetrator relation- the USA and the fourth-leading cause per 100,000, is one of the highest in a ditch with multiple stab wounds. I found influence on my career and led ship, and disposition of the patient. of death for all Americans. It results the world, while the death rate from started with the gunshot wound, as to my interest in trauma and injuries. These two databases enabled us to in greater loss of potential years of motor vehicle accidents (MVA) is 18 I thought that was the more serious It is because of this interest in trauma fairly define the epidemiology of in- life than cancer and cardiovascular per 100,000, compared to 10 and 10.2 injury. A nurse, however, pointed out that I accepted the academic post at juries in Jamaica. diseases combined. In the develop- for the Caribbean region and Britain, to me that the young patient with the the University of the West Indies (UWI) For the period 2000-2009, infor- ing world, injuries in males in the age respectively. Trauma and injuries, stab wounds was bleeding profusely when this was offered to me. My man- mation from JISS revealed that 11 group 15-44 years resulted in 55 mil- therefore, have held the attention of from his wounds and was quite rest- date was to transform the Casualty per cent of all accident and emer- lion disability-adjusted life years lost. surgeons and public health workers less. After setting up an intravenous Department into a modern Accident gency visits were due to injuries. and Emergency Department. I Road traffic accidents account for accepted because of my interest in 17 per cent, unintentional injuries trauma and injuries, which I still regard account for 45 per cent, and inten- as a surgical disease. In the early years, tional injuries account for 38 per the first Accident and Emergency cent of injuries. Patients less than 19 Department in Jamaica was estab- years old accounted for 57 per cent lished at the University Hospital of of unintentional injuries, while 62 the West Indies (commissioned in per cent of these injuries took place 1993) and later, the DM in Emergency in the home. Relationship between Medicine Residency Programme and the victim and the perpetrator in training in emergency nursing were intentional injuries found 47 per established. cent being injured by an acquaint- The need to define the epidemiol- ance. Thirty per cent of injuries in ogy of injuries in Jamaica was clear. This women were inflicted by an inti- was necessary for the development of mate partner. preventative measures to control this The Trauma Registry at the epidemic. In the late 1980s and 1990s, UHWI was started in 1998 and it I attempted to gather this information documents detailed information on injured patients. With no research on all trauma admissions using the assistants, no access to electronic data- software programme Trauma! devel- bases, I attempted to collect this infor- oped by Cales and Associates and mation from the dockets of admitted now managed by Digital Innovation patients and visits to the Emergency Inc. Analysis of data from 11,733 Department. After collecting a lot of trauma admissions during the 10- information, my first attempt at data year period, January 1, 2001 to analysis revealed to me the folly of December 31, 2010, revealed that 20 my actions, as it was impossible to per cent of all admissions to the sur- retrieve and analyse the data with- gical wards were injury-related. The out coding. I therefore explored the epidemiological data is similar to possibility of establishing a Trauma that of the JISS. The peak incidence Registry. My research led me to was in the second and third decades Professor Lenworth Jacobs, a UWI with a male to female ratio of 2.5:1. alumnus, who was one of the lead- Unintentional injuries accounted ing trauma specialists in the USA. He for 57 per cent of injury-related was significantly in the development admissions, of which falls and MVA and international promulgation of were the major contributors in this the Advanced Trauma Life Support category. The majority of intentional Programme in the USA. Professor injuries were as a result of penetrat- Jacobs assisted with the acquisi- ing trauma occurring in the home or tion of the software for the Trauma on a nearby street. Knives, machetes Registry at no cost to the UWI and and firearms were the weapons of the Department of Surgery. choice. Overall, the mortality for The importance of trauma and the period was five per cent and, its impact on the health dollar led as expected, MVA and assaults by to the development of two projects, firearms accounted for the majority the Jamaica Injury Surveillance Survey of deaths. (JISS) and the Trauma Registry at the The estimated cost of hospital University Hospital of the West Indies care for the treatment of injuries in (UHWI). The JISS was developed by colleagues from the Ministry of PLEASE SEE TRAUMA, 16 14 ASSOCIATION OF SURGEONS IN JAMAICA 60THTHE GLEANERANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, SUNDAY2019 GLEANER MAGAZINE | MARCH 3, 2019 ASSOCIATION OF SURGEONS IN JAMAICA 60TH THE ANNIVERSARY GLEANER | FEATURE:SUNDAY, MARCH THE SUNDAY 3, 2019 GLEANER MAGAZINE | SUNDAY, MARCH 3, 2019 15 from the University of Toronto, in this improved quality of care is TRAUMA Canada, who successfully lobbied better pre-hospital care and speedy CONTINUED FROM 14 the American College of Surgeons transfer of the injured to the nearest to introduce the programme in appropriate facility where timely 1998 was US$33.4 million, or 20 Jamaica at a much-reduced cost. ASJ Presidents’ list interventions can be effected, given per cent of the health budget. The He agreed to train the instruc- total cost of injuries to the Jamaican tors and still provides support to that the greatest number of deaths – 1958 to present society has been put at US$1billion. the programme. The role of Sister occurs in the pre-hospital phase of This is approximately 7.2 per cent of Juliet Buchanan from the Accident care. This service is currently of- the Jamaica’s gross domestic prod- and Emergency Department, fered in Jamaica only privately. In 1. DR L. McFarlane 1958 – 1959 21. Dr W. W. Wilson 1981 – 1983 uct. Thus, a 50 per cent reduction in as the nurse coordinator for the addition a multifunctional rehabil- 2. Dr J. S. R. Golding 1959 – 1960 22. Dr J. A. McHardy 1983 – 1985 the incidence of injuries will save programme since its inception, itation centre, though in theory is 3. Dr S. P. W Street 1960 - 1961 23. Dr L. Douglas 1985 – 1988 the country seven times the total should be noted. 4. Dr J. Gilmour 1961 – 1962 present in Jamaica, is grossly inad- 24. Dr F. Roper 1988 – 1990 health budget. This is especially An efficient system of trauma 5. Dr C.V. Harry 1962 – 1963 equate. For these essential services 25. Dr P. Fletcher 1990 – 1992 important, given that for the 2010 care involves intervention at least 6. Dr P. Wiles 1963 – 1964 to be more accessible and effective, 26. Dr B. Lyle-Harper 1992 – 1994 national Budget, four per cent was three levels. Primary prevention 7. Dr I. S. Parboosingh 1964 – 1965 projected to be spent on health – they need to be deemed a public 27. Dr H. Spencer 1994 – 1996 focuses on pre-event action and 8. Dr D. B. Stewart 1965 – 1966 a fall from seven per cent in 1998 is fa cilitated by legislation and good. The urgency in changing 9. Dr H. Annamunthodo 28. Dr W. Dennis 1996 – 1998 and 4.7 per cent in 2006. These education. Secondary prevention the current status quo cannot be 1966 – 1967 29. Dr P. Wellington 1998 – 2000 data show that injuries are a major aims to minimise injuries sustained overstated. This is highlighted in a 30. Dr R. D. DuQuesnay 2000 – 2002 public health problem and place in the event and include the use of 10. Dr K. L. Hart 1967 – 1968 study using data from the Trauma a heavy burden on the health ser- helmets and seat belts, for example. 11. Dr J. D. McNeil-Smith 31. Dr T. McCartney 2002 – 2004 vices, as well as the Jamaican econ- Tertiary prevention focuses on care Registry, which showed a prevent- 1968 – 1969 32. Dr G. Williams 2004 – 2006 omy. There has been no significant and rehabilitation of the affected able death rate of 22 per cent. This 12. Dr G. W. Milner 1969 – 1970 33. Dr A. McDonald 2006 – 2008 higher-than-expected death rate 13. Dr H. U. Shaw 1970 – 1971 change in the data over the years. individuals for the optimisation 34. Dr P. Bhoorasingh 2008 – 2010 There is therefore a need for a coor- of outcome. As members of the among our trauma patients would 14. Dr A. F. Mason 1971 – 1972 35. Dr L. Francis 2010 – 2011 dinated multidisciplinary approach healthcare team, there are some suggest that we need to act now. 15. Dr V. E. Brooks 1972 – 1973 36. Dr M. McFarlane 2011 – 2012 to effect a significant decrease in the factors beyond our control; for When it comes to trauma, time is 16. Dr R. G. Lampart 1973 – 1974 incidence of injuries. example, getting each occupant of a 37. Dr C. Batchelor 2012 – 2014 truly a life-and-death matter. 17. Dr D. O. Gore 1974 – 1975 A significant initiative in the motor vehicle to use seat belts. Our 18. Dr J. L. Williams 1975 – 1976 38. Dr C. Thomas 2014 – 2016 1990s was the introduction of Professor Archibald McDonald emphasis is usually placed at the 19. Dr A. H. Cotterell 1976 – 1978 39. Dr M. Newnham 2016 – 2018 the advanced Trauma Life sup- tertiary level, where an improved Former Principal 20. Dr R. A. Carpenter 1978 – 1981 40. Dr W. Aiken 2018 to Present port course to Jamaica. This was quality of care will decrease the University of the West Indies facilitated by Professor Jameel Ali overall cost to society. Inclusive Mona Campus

16 ASSOCIATION OF SURGEONS IN JAMAICA 60THTHE GLEANERANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, SUNDAY2019 GLEANER MAGAZINE | MARCH 3, 2019 ASSOCIATION OF SURGEONS IN JAMAICA 60TH THE ANNIVERSARY GLEANER | FEATURE:SUNDAY, MARCH THE SUNDAY 3, 2019 GLEANER MAGAZINE | SUNDAY, MARCH 3, 2019 17 HE SURGICAL technique em- sessions, nursing help became ployed in kidney transplanta- available. Ttion is an example of this. In The Genesis of Haemodialysis DC did well on her dialysis, and 1913, a German doctor-researcher, in September, a motor vehicle acci- Dr Carel, remembered surgically dent left a young man seriously in- for his development of the Carel jured with no brain function. He was suture, after many long-term fail- and Renal Transplantation not only a perfect ABO blood-group ures at transplanting kidneys in match, but fitted all the criteria for animals, documented the surgical organ donation. Preparations for technique, which has remained transplantation were set in motion. basically unchanged until this day. The operation went off without a He recognised that failure was due hitch. First, the donor was taken off not to the surgery, but to some the ventilator, and after the heart other factor now recognised as the had stopped beating, the left kid- immune response. Thus, the success ney was removed, sparing the blood of modern kidney transplanta- supply to the upper ureter. tion is not a surgical triumph, but The kidney was flushed with cold rather, due to the many research- normal saline until the effluent was ers who recognised the immune clear then taken across to the room, response and developed various where the recipient had been pre- Immunosuppressive agents to help pared by the team led by Dr Henry control this. Shaw, and transplanted. The first successful kidney trans- Urine was produced almost im- plant for management of end-stage mediately, which is the most joyous renal disease (ESRD) was performed sight for any transplant surgeon. in the mid-1950s by Murray et al In the surgeons’ room, Dr Ali, Dr in Boston. No immunosuppression McHardy’s Nigerian resident, de- was required in that instance as the clared it a significant occasion and other surgical teams began trans- came a young British-trained sur- the expertise and knowledge with donor and recipient were identical that he was honoured to have been planting, with the Ottawa team geon from Jamaica, who took a keen him when he returned home to twins. However, with the develop- in on the first kidney transplant in ment of basic immunosuppression, starting in 1966. On to that scene interest in the proceedings, taking Jamaica in December 1969. Kidney transplantation goes hand the Caribbean and possibly the in glove with haemodialysis, which, ‘Third World’ (the accuracy of that in those days, not only confirmed has never been verified). that the patient had ESRD, but Our longest-surviving transplant allowed time for a matching kidney is MP, a retired nursing supervisor in to be found. Enter Dr Samuel Street, Baltimore whose original transplant a Jamaica scholar and brilliant was done in 1971. This eventually Association of surgeon, who, as the senior med- failed about eight years ago and ical officer (SMO) of the Kingston she had a second cadaver kidney Surgeons in Jamaica Public Hospital (KPH), decided that placed by another Jamaican sur- technological advances should not geon working in Maryland. She leave the island behind and in 1966 continues to do well. purchased a dialysis machine for The following were members the hospital! of our transplant teams over the Thus it was in January, 1970, years without whose expertise the young surgeon from Ottawa, and skills this programme would now consultant urologist to the not have succeeded. Henry Uriah Government, based at the KPH, Shaw (my original surgical men- wandering through the instrument tor), John McHardy, Micky Roper, storeroom at the hospital, came Dr Ali (neurosurgical resident from across this almost new Kolf dialysis Nigeria), Lawson Douglas (original machine. It was the identical model transplant team), Guiermo Fraser, on which he had done his training at Peter Fletcher, ‘Bangie’ Samuels, the Civic Hospital in Ottawa. Cecil Aird, Trevor McCartney, Patrick In March of 1970, DC, aged 13- Bhoorasingh, Hope Russell, Robert OPENING HOURS years was admitted with ESRD, and Wan, and Mark Cadogan. Apologies Mondays to Thursdays 9:00am to 5:00pm after consultation with her parents, to any significant player whose name I have erroneously omitted. Fridays 9:00am to 4:00pm it was decided to dialyse her. A Brachio-Cephalic arterio-venous Professor Lawson Douglas Saturdays 10:00am - 2:00pm fistula was done to provide vascu- Consultant Urologist 72B Hope Road, Kingston 6 lar access, and a month later, when Former Head of Department Tel: 618-3674, 618-3680, and 978-4242 it had matured, haemodialysis was of Urology at the Kingston Fax: 978-4272 started. This was done twice weekly. Public Hospital and University At first, there was quite an audi- Hospital of The West Indies. Email: [email protected] ence to observe the new, strange Professor, the Hon. L. Lawson treatment but soon things became Douglas was recently named a mundane, and we were left on our living legend in urology by the own. After the first two or three Canadian Journal of Urology. 18 ASSOCIATION OF SURGEONS IN JAMAICA 60THTHE GLEANERANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, SUNDAY2019 GLEANER MAGAZINE | MARCH 3, 2019 Development of specialised surgery Laparoscopic surgery in Jamaica IN SAN Diego, California, in the summer of The animal laboratory was set up after N INNOVATIVE method of treating infected many of them being left with deformed, short, 1992, August to be exact, Dr Clive Thomas, consultation with the Veterinary Unit of the non-unions of bones was born in the and chronically infected limbs. In some patients, a consultant general surgeon practising Ministry of Health. The pigs were procured ASiberian town of Kurgan, USSR in early amputations were performed because of inability at the Kingston Public Hospital (KPH) met by the surgeons that were being trained. 1950s by Professor GavriilIlizarov. The principle to control the infection as well as in those with up with Dr James ‘Butch’ Rosser, and dis- The course was a huge success, and this of the Ilizarov Method to treat large bone defects significant limb-length discrepancies. cussions were first held regarding lapa- signified the start of a new era. without bone grafts, utilised the bone’s ability to These extremely challenging cases are always roscopic surgery and the need for these Prior to James departure from Jamaica, form new bone (regenerate bone) during gradual managed by the Orthopaedic and Plastic and procedures to be introduced to Jamaica. laparoscopic operations were commenced distraction using wires, rings and rods, a process Reconstructive Services at the UHWI. Non-union, Rosser agreed with Thomas that Jamaica at both The University Hospital and the known as Distraction Osteogenesis. This unique infection, shortening and deformity are all addressed should not be left behind, and from that KPH. The equipment used to conduct the method is used to treat congenital, developmental simultaneously by the Ilizarov Technique. moment, the seed was planted. course was donated to both hospitals as and acquired deformities, along with reconstruc- The limbs of a large number of patients have The seed, however, needed nutrition to a gesture of goodwill in order to enhance tion of large bone and soft tissue defects and been saved by this unique method of treatment grow, and on his return to the island Dr the surgical development of this new skill complex fractures. combined with usually extensive soft tissue Thomas approached Dr Trevor McCartney, across the country. The Ilizarov Technique was introduced into coverage. who, at the time, was not only the head of As we look back over the 25 years since Jamaica in 1998. The greatest challenge was RESTORATION OF EQUAL surgery, but also the senior medical officer the introduction of laparoscopic chole- that of obtaining funding for the equipment. LIMB LENGTH and chief executive officer of the KPH. A cystectomies to Jamaica, it is so apparent proposal was hatched to introduce lapa- that thousands of patients have benefitted, Ninety-nine percent of patients who required Limb length discrepancies in children are roscopic surgery into Jamaica with Rosser and the private hospitals have embarked this specialised treatment are public patients, secondary to congenital and developmental ab- being the tutor to spearhead the initiative. on providing this method of surgeryfor and many have difficulties obtaining funds normalities as well as growth plate injuries. The Thomas made contact with Ethicon Latin their patients. to pay for their surgeries at the University discrepancies can be as great as 8cm to 10cm. America and the Caribbean in order to We now have advanced laparoscopic Hospital of the West Indies (UHWI). The finan- Limb inequalities in excess of 3cm can only be cial constraints of the UHWI over the past years source equipment for the inaugural train- surgery available. Nissen’s Fundoplication satisfactorily addressed by lengthening of the ing session as well as start-up equipment and repair of hiatus (diaphragmatic) resulted, understandably, in the funding of more limb. Similarly, adults with large bone defects urgently needed equipment. Financial assistance to get laparoscopy off the ground across hernia, bariatric surgery, colectomies, secondary to trauma or tumour have had their the island, and they obliged. They donated appendectomies, splenectomies, pros- was therefore sought from the private sector. This limbs restored by the same method. annual financial assistance began in 2003 and has equipment, which included disposables tatectomies, nephrectomies, and hepatic and three laparoscopic towers. (liver) resections are now being performed continued until 2017. All public patients received CORRECTION OF LIMB DEFORMITY At the same time, Dr Ronald DuQuesnay, laparoscopically in many hospitals across the use of the Ilizarov Circular Fixator free of cost. Lower limb deformities when present in programme director of the DM Post- Jamaica. The impact of this unique method of treatment children and adults require correction (straight- Graduate General Surgery Programme and We are eternally grateful for the unselfish can be measured in the following ways: ening of the limbs). Failure to correct the deformity will result in damage to part of the collectively, along with McCartney and philanthropic efforts and gesture of Dr SALVAGE OF LIMBS joint, usually the knee joint. These deformities Thomas, believed that The University of the James Rosser Jr. He has made such an Trauma from gunshot wounds, motorbike such as Blount’s in children are best corrected West Indies might be the most appropriate impact on the practice of medicine in and vehicle accidents continue to be prevalent using the Ilizarov technique with a circular location to have the teaching course. It was Jamaica. Our residents in training have in Jamaica, and often results in extensive open frame. At the UHWI, over the past 17 years, organised to be held at the Old Library, benefited tremendously, and several of wounds with complex fractures. Some of these approximately 700 patients have been suc- and all qualified surgeons across the island our DM (Doctor of Medicine) graduates wounds become infected and fail to heal. Young cessfully treated. The most dramatic progress were invited to participate free of cost. have done fellowships abroad to improve The programme was developed by their skills and have returned to give the males from the lower socio- economic communi- in orthopaedic surgery in the last two decades Thomas and Rosser and comprised a dex- knowledge and expertise to our people. ties are usually the victims of this type of trauma. has been in the field of deformity correction and terity course, which involved the use of Contributions from: The problems in infected non-unions include: patients in Jamaica and other Caribbean islands laparoscopic instruments to remove the Dr Clive Thomas multiple draining sinuses, infected bone, have benefitted greatly from this revolutionary bone and soft tissue loss, joint stiffness, com- skin off of chicken breasts (provided by Consultant Surgeon method of treatment. Jamaica Broilers). Past President plex deformities, limb-length inequalities and Dr R E C Rose multiresistant infection. Prior to the introduction This was then followed by actual lap- Association of Surgeons in Jamaica Consultant and Former Head aroscopic cholecystectomies (removal Dr Trevor McCartney of the specialised surgery in Jamaica, patients with Orthopaedic Surgery the above problems were poorly treated, with of the gallbladder) performed on actual Former Senior Medical Officer University Hospital of the West Indies (anaesthesised) pigs. Kingston Public Hospital

ASSOCIATION OF SURGEONS IN JAMAICA 60THTHE GLEANER ANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, SUNDAY2019 GLEANER MAGAZINE | MARCH 3, 2019 19 IS A MASTECTOMY THE ONLY OPTION? Let’s talk about breast cancer The earlier that one detects breast SK ANY woman what con- DO I REALLY HAVE TO DO with your physician, a mammo- cancer, the more options are cerns her about breast cancer A MAMMOGRAM? gram and ultrasound examination available for treatment. Many Aand the questions are fairly It was recently reported by the done and examined by a quali- women with early breast cancer are candidates for breast consistent. American Cancer Society in early fied radiologist is the best way to conservation rather than a 2019 that it was estimated that detect early breast lesions including WHAT IS MY RISK AND mastectomy. Breast-conservation early detection using mammog- microcalcifications. HOW CAN I PREVENT surgery involves removal of a raphy, coupled with advances in We currently recommend that BREAST CANCER? portion of the breast that contains treatment, has saved over 500,000 Jamaican women over 40 start Contrary to popular belief, a the cancer and is usually lives in the United States since 1989. screening mammography, and at negative family history does not combined with an assessment of The earlier that breast cancer is de- an earlier age, should there be any protect against breast cancer as the the possibility of spread by tected also means that there are family history or proven genetic minority of cases, perhaps five-10 sampling the lymph nodes under more options of treatment, and the risk. It is not unreasonable either the arm using a minimally invasive per cent, are hereditary. It is esti- overall prognosis is better. to start thinking about screen- mated that the lifetime risk for the sentinel lymph node biopsy Mammography can detect ing mammography between technique. Typically, the whole development of breast cancer in a breast lesions long before they are 35-39 years, and this should be breast is irradiated to lower the risk 2000. Immediate reconstruction at Jamaican woman is one in 21. There palpable. For women with dense discussed with your physician. If an of a recurrence. the time of mastectomy allows the is nothing that one can do about breasts, a combined ultrasound is abnormality is discovered on mam- The traditional mastectomy is oncological (cancer treatment) as- age, genetics, or the presence of recommended. Apart from learn- mography, the abnormality may being replaced by newer techniques pects of the surgery to be combined dense breasts on a mammogram ing how to perform a breast self- need to be biopsied, and there are such as nipple and areolar sparing with an acceptable aesthetic and (that makes detection harder), but in examination and having frequent several minimally invasive methods mastectomies, techniques that have cosmetic result. general, a healthy lifestyle is helpful. visits and clinical examinations to do this. been practised in Jamaica since Not every woman diagnosed with breast cancer needs chemotherapy, particularly in early stages. Certain tests will be done on the cancer, including standard pathological examination, additional receptor studies, and/or tumour genetics, and the medical oncologist will tailor the medications, including hormonal treatment, to the individual. IF I NEED SURGERY, SHOULD I REMOVE BOTH BREASTS? Since the advent of the newer more cosmetically acceptable techniques of mastectomies, and with some celebrities sharing their experiences with double mastec- tomies, more and more women are asking about this method. With proper treatment of the initial cancer, the risk of a second breast cancer is very low once there is no genetic risk. For some women, even this low risk is too much. The addi- tion of a second procedure to the in- itial curative surgery, however, does increase the risks of the surgery and may delay treatment. It is also obvi- ously an irreversible step. As such, Discussions have to be had where all the pros and cons are explored at length to arrive at the best decision for the individual patient. The dis- cussions are best held over several visits with an experienced breast surgeon and medical oncologist. Dr Mark S. Newnham, Senior Lecturer and Consultant General Surgeon, University Hospital of The West Indies 20 ASSOCIATION OF SURGEONS IN JAMAICA 60THTHE GLEANERANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, SUNDAY2019 GLEANER MAGAZINE | MARCH 3, 2019 ASSOCIATION OF SURGEONS IN JAMAICA 60TH THE ANNIVERSARY GLEANER | FEATURE:SUNDAY, MARCH THE SUNDAY 3, 2019 GLEANER MAGAZINE | SUNDAY, MARCH 3, 2019 21 View from the other side of the table EAR AND apprehension are in the hands of the skilled Dr Johnson, common experiences of the so I decided to await the completion Finteraction between doctors of this procedure. There must have and their patients. In fact, it is not an been some difficulty as he did not overstatement to mention that an seem to finish fast enough to avoid elevation of one’s blood pressure is an the onset of stridor. expectation of a patient when facing The emergency room, fortunately, his/her doctor. was adjacent to the operating suite. Apprehension, yes, as one can The initial blood investigation was ex- never correctly predict the out- cellent, and a thought of a supraten- come of what might appear to be torial diagnosis must have been the most basic medical examina- entertained. However, the struggles tion, as it ranges from the ‘all is well’, during hypoxia were followed by a much to the patient’s content, to wave of tiredness and then panic something far more complex with for my surrounding friends as the the need for further intervention. cyanosis now became evident in my And such was my experi- peripheries. Next was the slowing of ence when I first sought to self- my heart rate; which I was not aware medicate on a September morning of as I was a distant spectator to the before panic and later, what can commotion around me. be described as a real crisis was My good friend whispered to me experienced. that he was going to administer It started with what first appeared adrenaline and that “I would feel as the common cold, accompanied bad”. The possibility of death had by stuffiness in the ears. This was not entered my mind as I was in a similar to the symptoms I expe- hospital surrounded by competent rienced when I was assessed as medical staff, all of whom were my having a middle-ear infection. The friends. He did not lie! The adrena- ailment was treated with a course line went straight to my heart and of Cephalosporin, which was effec- ripped it out or at least, that was tive after two days, so the remaining how I felt. I was sure I had died, and course was stored just in case it was I felt that I sat up and shouted the needed again. same, but no one can remember Remembering this, I carefully this event! researched the tablets in order to The next words I heard were, “I deal with this new problem. need more retractors”, as the stab The next morning, I became con- into my windpipe. The surgical cerned as I experienced a change in clamps could be felt hanging off my voice, which was accompanied the neck, but there was no pain! by a strange feeling of the tongue. The The completion of the tracheostomy beginnings of the allergic reaction was done in the operating theatre. were self-assessed as the possibility I truly recognised the fortune that of pharyngitis! Thankfully, the pres- I had, being close to the hospital, ence of the antihistamines taken for and the fact that it happened during the runny nose slowed the onset of the early morning, when everyone shortness of breath of the self-treating was present. The lines were slowly physician. being placed, but I grabbed the But greater panic was left to be hand which seemed to be heading experienced. The dyspnea created to insert the urinary catheter. Our another level of alarm that required eyes met, and I pleaded and hand the need for urgent second opinion. -signalled that I could use a urinal. One cannot go to the doctor untidy, Being on the other side has so it was imperative that a shower taught me what it is like to be a be had before the journey to the patient, experiencing anxiety, real hospital, which was, fortunately, fear, and eventual panic. Thankfully, on the same compound. Knowing many doctors may never experience that my problems were in the upper ill health until well on into their airway, I thought best to find the careers. Entertainment Service whose sched- This also illustrates the need for ule I knew well as that was the last members of the medical team to rotation, I had been placed on. Tonsillectomy is a quick operation PLEASE SEE VIEW, 23

22 ASSOCIATION OF SURGEONS IN JAMAICA 60THTHE GLEANERANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, SUNDAY2019 GLEANER MAGAZINE | MARCH 3, 2019 to an unexpected crisis. VIEW A truly traumatic and unforgetta- CONTINUED FROM 22 ble experience has taught me many life lessons as a surgeon sitting, even members of the medical team to momentarily on the other side of exercise patience, compassion and the table. real understanding, especially when Dr Rajeev Venugopal a patient panics, not being quite Lecturer and Consultant Plastic certain of the eventual results of Surgeon what might first appear a simple University Hospital of the West intervention but which might lead Indies Where are we going?

Y NOW, if you are reading no longer be free, but would be held this, it means you have read as an all-inclusive charity event, with Ba lot about the Association of all of the proceeds being donated Surgery in Jamaica (ASJ) and should towards a surgical cause. To add a be versed on its birth and history, further twist to differentiate it from but the question must always be the previously held surgical parties asked, you know where we came and many other all-inclusive parties from but where are we heading? held across the island, live entertain- Over the past two decades, the ment was included as well. number of surgeons in the associ- Some members, of course, ation has tripled, for reasons men- objected. “What do surgeons know tioned earlier in this supplement, about throwing parties?” some said. and this has resulted in an increase, Well, based on the success so far, the in the number of female surgeons, council replied, “A lot!” In February more specialists in all surgical fields of 2017, the inaugural staging of and an increase in the number of SCRUBS, ‘SCRUBS 1/0’, was held young surgeons. All of the above at the Senior Common Room’s are illustrated in the executive grounds on the university campus, council of the association, which with live entertainment provided has a good mix of young and older by one of Jamaica’s greats, Freddie surgeons; female council members, McGregor. That year approximately with one holding the post of secre- $500,000 was raised for the Jamaica tary; and many different specialties Cancer Society to aid in their fight being represented over the last 10 against breast cancer. The following to 15 years. While the association year, the event was held at the same continues its role, administration venue with a crowd that doubled and surgical education, its role in in size, and with increased corpo- outreach had fallen behind. From rate sponsorship, $2,000,000 was time to time the association would handed over to the cancer society, visit rural hospitals to aid those thanks to Agent Sasco, who pro- surgeons remotely placed another vided the live entertainment last view in the management of surgi- year. cal patients. This programme has This year, the event promise to become regularised. Another mile- be even larger, and the hope is to stone of the association was the res- surpass last year’s donation to the urrection of the annual surgeon’s cancer society. So far, the prognosis party. This event used to be hosted for SCRUBS appears to be positive, by The University Hospital of the and this year’s charity is still the West Indies Department of Surgery Jamaica Cancer Society, in aid of and was held annually around the their fight against prostate cancer. Christmas season. It was funded by Hopefully, Tarrus Riley and friends surgeons, along with the depart- can help us reach that goal. ment. However, its time came to an Dr Hugh A Roberts end in the early part of the 2000s. In Consultant General Surgeon 2017, the ASJ decided to resurrect and Associate Lecturer (UWI) the event, but with a twist. It would Kingston Public Hospital

Articles on ‘Sinus Surgery’ and ‘Updates on Prostate Cancer’ can be viewed on our new website: www.surgeonsja.org

ASSOCIATION OF SURGEONS IN JAMAICA 60THTHE GLEANER ANNIVERSARY | SUNDAY, FEATURE: MARCH THE 3, SUNDAY2019 GLEANER MAGAZINE | MARCH 3, 2019 23 24 PRINTED BY THE GLEANER COMPANY (MEDIA) LIMITED • 7 NORTH STREET • KINGSTON • JAMAICA