JULY 2012. Doctorate in Obstetrics & Gynaecology complete. Residency is over and my journey is complete! No more long working hours and studying! Time to finally settle into practice and ride off into the sunset with my wife and kids. Well, that fairy-tale idea lasted maybe three months.

Fast-forward almost 15 years and the long hours continue. This time though, I’m good with it, because those long hours have helped restart minimally invasive gynaecology surgery at May Pen Hospital.

The start-up

We initially started back around 2015, with organised staff training, pushing through the usual start-up resistance and at times hauling in my own equipment just to get things moving. Along the way the Government stepped up and provided a high-definition camera system and some sustainable instruments, allowing the service to slowly grow.

Even then, progress was never going to happen overnight. Building a minimally invasive gynaecologic surgery (MIGS) programme in the public sector takes more than just equipment. It takes trained nurses, motivated residents, supportive anaesthesia teams and theatre staff willing to learn a different way of operating.

The resurgence

Then came 2020 and COVID. Like many health-care services, progress stalled for years. That, coupled with the usual staff migration and the loss of trained personnel that comes with it, delayed our restart once again.

In 2024 our team decided that minimally invasive gynaecology surgery was not going to be a side show anymore. We wanted better outcomes for our patients. Less downtime after surgery for working class women who cannot afford to be out of work for weeks after an operation. Less pain. Smaller incisions. Faster recovery.

The hospital ward was also not getting bigger anytime soon, so the benefit of same day surgery and shorter hospital stays became even more important. Every patient discharged safely and earlier meant another bed potentially available for someone else in need. We dedicated an entire theatre list every week to advancing minimally invasive surgery, and with support from all relevant departments, today I’m happy to say it has become a reality.

What can we offer?

The MIGS programme restarted with simple hysteroscopy. This is where we insert a thin camera via the vagina to evaluate the inside of the womb and diagnose causes of abnormal bleeding, infertility and even endometrial cancer.

DR RYAN HALSALL.

We now offer operative hysteroscopy as well, allowing for some of those same problems to be treated with the aid of the camera. For many women this avoids more painful procedures and improves treatment success, reducing the need for repeat surgeries.

We also perform diagnostic and operative laparoscopy. Diagnostic laparoscopy is often used to help provide answers to women suffering with chronic pelvic pain and infertility, especially when imaging such as ultrasound and MRI scans are inconclusive. Operative laparoscopy allows us to treat some of the conditions causing chronic pain, and also more common gynaecological conditions such as ovarian cysts and fibroids. Most importantly, these procedures often allow patients to return home the same day or after just one night in hospital instead of spending several days admitted recovering from a large abdominal incision.

More recently, we have also started performing laparoscopic hysterectomies at May Pen Hospital, something many people would never imagine being routinely offered within the public healthcare system.

What’s the cost to the average patient?

In the private setting these surgeries can cost anywhere from $300,000 to over $2 million and are often simply out of reach for many Jamaicans without strong health insurance coverage.

Through the MIGS programme, patients can access all hysteroscopy surgeries free of cost. Zero dollars and zero cents. Some laparoscopic procedures can also be done free of cost, while more advanced laparoscopic surgeries may still require patients to source a few disposable items. Even then, the out of pocket cost for advanced MIGS rarely exceeds $100,000, which is still a far cry from what many patients would face privately.

What’s next?

We are still not where we need to be. More staff training is needed, and greater investment from the Government would help reduce the need for patients to purchase certain essential surgical items themselves.

But despite the limitations, the outlook is promising. The goal is not simply to perform a few advanced surgeries here and there. The goal is to make minimally invasive gynaecological surgery a routine and sustainable part of public health care in Jamaica.

There is still a long way to go, but progress is finally being made, and for many Jamaican women that progress already means less pain, less time away from family and work, and a faster return to normal life.