It was with poignant reflections that I read recently of the sudden death of Saymar Ramsay from Spot Valley High School. I did not want to comment on the recent sudden death of another youngster from St George’s College because of the sheer grief I saw etched on his parents’ faces.

Ramsay’s death brought me back to 2008 when Matthew Hylton, a young swimmer, collapsed in the pool at the YMCA and died at the Andrews Memorial Hospital. Matthew was like a son. He would never pass me by without saying hello. As a parent, I watched as he swam with my daughter. They were both elite members of the Jamaica National Swim Team and swam for the country at the Carifta and Junior Olympics levels. I would usually sit on the deck with his mom, Angella, and sometimes when Matthew slowed down in his specialised stroke, the breaststroke, we would egg him on to speed up. The breaststroke involves pushing the chest forward. Little did we know that Matthew had a congenital cardiomyopathy (heart condition). After Matthew died, I visited with his mother and wept bitterly. I am absolutely sure Matthew did a medical as part of Jamaica’s National Swim Team requirements, but it was not robust enough, I later learnt. Children or people involved in sports have to do more than an ordinary medical and echocardiogram. They need to do at minimal an exercise echocardiogram or stress test, and a complete blood count which includes Haemoglobin.

Years ago as a young medical technologist, I was preparing to migrate and was required to do a medical. The late eminent cardiologist Professor Charles Denbow did my medical, which included an echocardiogram. Everything was normal, but out of concern that I was to face the health rigours of living in a foreign country, he did a stress test. He found a minute flap on the left side of my heart. This necessitated that I take antibiotics before any dental procedure to ensure that only sterile drainage touches that flap. This was one of the reasons why I later embarked on medical research. Teaching and researching in the Faculty of Medical Sciences at The University of the West Indies (UWI) have brought to front the stark reality of how much is required to preserve the health of our young athletes.

It is imperative that our cardiologists and sport practitioners come together to design a screening programme for school athletes. Most recently Dr Paula Dawson, Jamaica’s only physiatrist, and I were involved in a study funded by UWI’s Principal Professor Archibald McDonald. The study sought to look for early indications of inflammatory markers that may cause muscle damage in athletes. The study was to be a random double-blinded study. That is, Dr Dawson was to examine the patients as a rehabilitation specialist, and I was to analyse their blood results. Each of us would not know the results of the other’s work during the study, but was to compare results at the end to see where the results coincide; that is, if the biochemical work up matched the medical/clinical diagnosis of the athletes.

Ironically, a day after sending the first set of samples to the lab for complete blood counts, the research technologist called to say the haemoglobin value of a female athlete was below 7g/dL. The normal value for haemoglobin for females is 11-13g/dL. A blood transfusion is usually required for a person with hemoglobin below 7g/dL.

Dr Dawson being the clinician had to refer the athlete for treatment. The female student was on scholarship and had done a routine medical before the start of school. The student could have gone into cardiac arrest while training because of low haemoglobin, and therefore lack of oxygen or hypoxia in the heart. In the study we had included an athletic club and some high school athletes, and found that more than 40 per cent of that cohort had inflammatory markers and injuries and had to be recused from the study prematurely, because no valid results could be obtained because of these injuries.

Often, before I called Dr Dawson about abnormally elevated inflammatory enzymes levels, she would be calling me to indicate premature recusing of athletes based on their medical examinations. Some of the athletes were so severely injured that they needed more intervention than could be added from the resources provided. The inflammatory muscle enzymes creatinine kinase and lactate dehydrogenase were often quadrupled fold above normal. What was really frightening was that one of the athletes had major cardiac problems with diabetes and hypertension, and was actively training for about 10 years without any intervention and had represented his school at Champs for years. He was a Class One and Two champion in the 100m and 200m.

Another was pre-diabetic and in his mid-20s and never regained the former glory of being a youth champion. Why write about this at this time? I strongly believe the Government, through the ministries of education, sports and health, should come together to design an intervention study/programme that can be used as a screening tool for our young athletes. When concussion was a major problem in the USA, the Government with some doctors and scientists came up with a plan of action to reduce morbidity and mortality rates in young footballers and those who play tackle sports.

Based on our study at The University of the West Indies, it seems that hypertension is very high in young Jamaican males. Cardiac issues might be prevalent based on the yearly sudden deaths in young males who play sports. Our cardiologists should be more involved in sport medicine. I know they are burdened, especially with the rise in chronic diseases in our older population. There are, however, stress echocardiogram machines in the Faculty of Medical Sciences. These machines are used to teach medical students how the heart responds under stress and extreme exercise. Some abnormalities show up only when the heart is under stress. There is at least one machine at the Heart Foundation of Jamaica, and numerous in private practice. A stress heart test costs upward of $50,000. I, however, think we can utilise the machines in the Faculty of Medical Sciences and the Heart Foundation of Jamaica when these places are closed on a Saturday and Sunday to provide some sort of service to our young athletes. I am sure one or two of our cardiologists would volunteer on a Saturday/Sunday to read the graphs after the technicians run the tests. Each school should also have some basic equipment, such as a simple blood pressure machine or an oximeter, to indicate when an athlete is becoming too stressed.

If the pulse rate and blood pressure are too high and oxygen saturation level is too low repeatedly, that student must be pulled and be seen by an experienced nurse or doctor. I know we have recently got some defibrillators for schools; whilst these are useful, we need a more coordinated medical plan for our young athletes that takes into consideration preventative and rescue medicine. Cuba does not regularly buy new equipment for emerging crisis, but use what they have to cauterise the problem. The holistic approach to care for athletes is remarkable in Cuba.

Over to you ISSA and Dr Walton Small; talk and visits to schools after athletes’ deaths are not enough. An immediate plan of action is required.

Editor’s note: Dr Rachael Irving is the Senior Research Fellow in the Faculty of Medical Sciences at The University of the West Indies, Mona.