Surgeons advocating more public awareness of services here

BY ALPHEA SAUNDERS
Senior staff reporter
saundersa@jamaicaobserver.com

Wednesday, August 21, 2019

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Surgeons are pushing for the ramping up of public awareness of the treatment options in plastic and bariatric surgeries that are available in the public sector, and for more emphasis to be placed on the expansion of training and development in these specialised areas of medicine.

Senior plastic surgeon at the University Hospital of the West Indies (UHWI), Dr Guyan Arscott says with more knowledge, candidates for elective surgery will be able to make better decisions, and reduce the risks of complications for botched procedures.

He said Jamaica has been making strides in the treatment of breast cancer, inclusive of reconstructive surgery, with survival rates over the past 10 years being comparable with those in first world countries.

“It seems to me that there is some disconnection in how we are developing personnel to allow the public to access cutting edge skills that we are training young doctors for at the Type A hospitals — the University Hospital, Cornwall Regional, and Bustamante Hospital for Children. There is information that the public is lacking in what is possible and what they can access in the public sector,” Dr Arscott said.

“We do have a formal training programme at the University Hospital for plastic surgery involving reconstruction and cosmetic surgery,” he added at this week's Jamaica Observer Monday Exchange.

Dr Arscott noted that one of the major advantages of the Type A hospitals is that the public can access a suite of collaborative services at one facility. He said that in the case of breast cancer patients there is access to the oncologist, oncological surgeon, and reconstructive surgeon, among other specialists, to provide “immediate breast reconstruction”.

He also pointed to the treatment of gynaecomastia — or male breast enlargement — which has recently received media attention.

“That condition has been managed and treated at the University Hospital and general Type A hospitals for decades; it is not new. We do large numbers of them. We have particular interest in it because it affects the paediatric age group, [and] the men, and sometimes we have to bring in the reconstructive side of plastic surgery and liposuction. Where the need exists at the public hospital, we provide that kind of surgery for this condition,” he said.

Colleague plastic surgeon Dr Rajeev Venugopal said 56 patients have been treated at the UHWI for gynaecomastia in the past two years. “So this is something that the university has been providing for many years. There are times where patients come to see us and they say they did not know that these services were available in Jamaica,” he said.

Dr Arscott stressed that, “We have never before had so many medical students being trained in the Caribbean; and it's at this time that we have this paradox where the health service seems to be not working...the personnel is here, and instead of attracting doctors to fly in and fly out and leave us with some of the problems they create, we need to develop some of our services here. We have bright young doctors who pass through medical school every year, and there needs to be a conversation between the authorities and the doctors.”

He said cosmetic plastic surgery, as part of the broad area of plastic surgery, is often misunderstood, and there is a danger of the practice becoming a “free for all” if there is a lack of proper training and exposure of residents.

Dr Arscott emphasised that it is time for cosmetic plastic surgery to be incorporated into the public health system. “We think it should be done — all aspects wherever possible should be brought into the public service,” he said, stressing that some areas of plastic surgery, such as breast reduction and abdominal wall repair, have significant health benefits.

The surgeons are also concerned about the low uptake of patients for bariatric surgery, against the background of 54 per cent of the population being overweight or obese, according to 2017 government statistics.

Laparoscopic and weight loss surgeon Dr Pierre Leake, who also practises at the UHWI, said surgery can help people who have been unsuccessful with multiple weight loss methods.

“It's a jump-start; it's a means to try to help to start a lifestyle that can improve their health overall — it isn't just appearance, it is health and co-morbidities. A lot of research has shown that co-morbidities such as hypertension and diabetes can be improved or cured with control of weight,” he stated. However, ideal candidates have to be morbidly obese.

“The expertise is there, but the main (issues) are the uptake, the knowledge, as well as some resource challenges that we have to look at,” he said, pointing out that a World Health Organization study shows that Jamaica will spend over $77 billion between 2017 and 2032 on the management of co-morbidities. “Therefore if there is a means to eliminate or reduce that, then that should be considered,” he stressed.


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