Careers & Education

Women's health, their specialty

Petre Williams-Raynor

Sunday, August 05, 2012    

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THEY are the professionals on whose skills and experience a woman relies when she is experiencing disorders, such as pre-eclampsia — a potentially lethal illness that affects some pregnant women.

But obstetricians/gynaecologists will tell you that they are about more than that; they seek to safeguard the overall health of women and, when they are pregnant, also that of their babies.

For insight into their work, Career & Education talks this week with Dr Leslie Samuels, a consultant obstetrician/gynaecologist (ObGyn) at the University Hospital of the West Indies (UHWI) and associate lecturer in the Department of Obstetrics and Gynaecology at the University of the West Indies (UWI).

A graduate of Campion College, where he went to sixth form, Samuels later attended the UWI where he undertook both undergraduate and graduate studies in medicine.

During the course of his training, he worked at both the Victoria Jubilee Hospital and the Mandeville Regional Hospital before securing his current position at the UHWI.

According to the married father of one child, his work as an ObGyn "represents the perfect blend of the best areas in the practice of medicine".

"I got the best of all worlds," he tells Career & Education. "We see a lot of the chronic illnesses that internal medicine specialists see, such as hypertension and diabetes; we do several types of surgery, like the general surgeons; and we get our fair share of sudden emergencies like the emergency room physicians do. But, probably most important to me, we generally have 'happy endings' in obstetrics. What's more joyful than having a baby, right? It's great!"

At the same time, Samuels said there is no underestimating the value of the work of the ObGyn.

"On an individual basis, we try to promote attaining and maintaining good health for women through all stages of life by helping to monitor them and by providing the advice and support necessary to prevent problems where that is possible, and to diagnose and definitively treat them in a timely fashion, when prevention isn't possible," he said.

"Jamaica is a largely matriarchal society, so I think that if the women are well, it fosters the ability for families and communities to be well. In turn, strong families and communities form the basis of the progressive growth of the nation," Samuels added.

"On a different perspective, pregnancy is stressful in many ways — physically and emotionally. The woman's body is changing on a weekly, if not daily, basis; there is often the discomfort of nausea and vomiting in the beginning, and awkwardness, pain and anxiety towards the end. In addition to the purely medical aspects of the job, we provide reassurance and symptomatic relief where possible to as many of the minor maladies associated with pregnancy as possible," he said further.

Who is an obstetrician gynaecologist?

An obstetrician gynaecologist is basically a doctor specialising in providing medical care for issues unique to women. An obstetrician takes care of women while they are pregnant; a gynaecologist takes care of them when they are not.

What are some of the 'tough' conditions that you treat?

Some of the more challenging conditions that we see in pregnancy, which are caused by the pregnancy itself, are those involving hypertensive diseases, and bleeding (haemorrhage). In addition, there are lots of illnesses, like diabetes, heart disease, and sickle cell disease, which exist prior to, but are made more complicated by pregnancy. In the realm of gynaecology, I would say that infectious diseases, particularly sexually transmitted infections such as HIV and HPV (human papilloma virus), and malignancies, such as cancer of the cervix or ovaries, constitute some of our greatest challenges. Then there are the more common ailments, such as fibroids and endometriosis, which are generally more benign, but which can still significantly affect the patients' well-being on a day-to-day basis, for years of their life.

What are the academic requirements for entry into the field?

To be accepted into the O&G (obstetrics and gynaecology) training programme, you must have completed basic undergraduate medical training, that is, you would have already been a registered medical doctor. The university (UWI) requires you to have finished internship and to have then done additional work in a surgical area, and an internal medicine area for six months each. This ensures that a solid foundation of medical knowledge and experience exists, prior to commencing specialist training. So once one completes the programme, he or she may work in any situation that a general practitioner does, in addition to managing specialist obstetric and/or gynaecology patients.

What does it take to become a consultant ObGyn at the UHWI?

The term consultant is the title of a post or job given at the hospitals here in Jamaica, for specialists who lead a team of doctors and nurses in their area of expertise; persons in the same posts in the United States are also called attendings or attending physicians. For UHWI, and for most Government hospitals, there is a defined number of these posts for all levels of staff members, so a 'new' post doesn't usually open up unless someone is promoted or is transferred or retires.

What are the challenges that you face on the job?

There are lots of those. Time management is one, as the nature of obstetrics, in particular, is very dynamic. The labour ward can be relatively quiet one minute, and then be filled to capacity within an hour or less. Or you can have a patient who seems to be low-risk and progressing normally, and her condition (and/or that of the baby) can change in a heartbeat. Obstetrics, by definition, presents a continuing challenge as we are the only group of doctors who routinely manage two patients simultaneously, on a regular basis. Then, the changes associated with a pregnancy persist even after the infant has been born, and many mothers and babies may still develop difficulties after delivery, so continued vigilance is mandatory. Needless to say, this can wreak havoc with trying to develop any type of efficient schedule, as the work situation changes on an almost daily basis. Another major challenge that any physician faces is losing a patient. This is a crippling blow to the family, but can also often affect the staff members who managed the patient quite severely. It is particularly devastating in our field (obstetrics) because people do not expect women to do badly, or worse to die during an everyday event like the delivery of a baby; but it happens. There is no country in the world that has zero women in their population who die during pregnancy, or even afterwards. We do our best on a daily basis, but when these events occur, it really takes a toll on everyone involved.

What do you most enjoy about the work that you do?

Obstetrics in particular tends to have good outcomes: woman becomes pregnant, woman has baby, and everyone lives happily ever after. In gynaecology, our patients also tend to be younger and generally well, so when they do present with problems, they are the ideal patients in whom definitive and often curative management can be carried out. So, overall, it is very satisfying to be able to positively influence the lives of the patients who come to you for care.

Having been trained as an ObGyn, what sort of employment options are open to you?

There are actually quite a few options which can branch out from our field. One can practise the specialty from a hospital, clinic or private practice, and there are also opportunities for teaching, at many levels, in the medical fraternity and within the wider community. Research always provides ongoing areas of interest, as we seek to understand the details regarding conception, pregnancy, and birth, and a variety of medical problems, such as abnormal periods, infertility, contraceptive use or the lack thereof. In addition, our field is also quite closely aligned with public health, with issues like vaccinations and preventative medicine, so additional options branch off from there.

Why would you advise anyone to get into obstetrics/gynaecology?

The field of obstetrics and gynaecology is a versatile and dynamic one. Once training is complete, one can choose the aspects of the practice that one may prefer, and focus more on those. For instance, I love high-risk obstetrics, but I have colleagues who are equally enthusiastic about laparoscopy/minimally invasive surgery, and gynaecological oncology (cancer prevention, detection and treatment). I think the most important factor in entering this, or any field of medicine, is a real love for what you do, so if a medical student or junior doctor expresses an interest, and shows a love and a talent in obstetrics and gynaecology, I try to encourage them in that direction.

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