Women’s Health Heroes – Pt 4
Professor (Emeritus) The Hon Joseph Frederick OJ, CDTITLE: Specialist in Reproductive Medicine, Consultant Obstetrician & GynaecologistTraining, practice:
My undergraduate and postgraduate training were done at The University of the West Indies.
In 1984 I became a member of the Royal College of Obstetricians & Gynaecologists in the United Kingdom and in 1985 got a doctorate in Obstetrics & Gynaecology.
I was employed as a temporary lecturer in 1985 and moved up the ranks to Professor of Reproductive Medicine in 2004.
My main interest was women in the reproductive age group who presented with chronic pelvic pain, heavy menstrual periods and infertility in the Emergency Unit and in the Gynaecology clinic. Those with enlarged uteri and bleeding were easily diagnosed as having symptomatic uterine fibroids. The dilemma was with the patients who had chronic, incapacitating pelvic pain and infertility who were simply diagnosed as having pelvic inflammatory disease (PID) and often, the diagnosis of endometriosis was missed.
We were taught ‘that fibroids have a greater incidence in women of African descent and endometriosis was more common in the affluent women who postponed motherhood’.
With the advent of imaging which provided minimal access to the abdominal cavity, minimally invasive surgery took its roots.
In capable hands, operative laparoscopy provides a panoramic view of the intra-abdominal organs, and with the introduction of accessory ports, instruments can be inserted to perform 90 per cent of traditionally open surgical procedures.
Chronic pelvic pain, infertility, tubal disease and endometriosis can now be easily diagnosed, but not easily treated. How to relieve the symptoms and allow them to get pregnant is a nightmare to many gynaecologists.
My interest in increasing my skillset came from the 10 per cent of couples who, despite surgical treatment, remained childless. Professor (Emeritus) the Hon Hugh Wynter OJ, CD encouraged me to pursue further training in assisted reproduction and provided the necessary funding, and this technique has helped many women in Jamaica and the wider Caribbean.
My interest in infertility grew as time went by, and was largely influenced by the late Dr Joseph St Elmo Hall, OD who sent all his infertile patients to me.
On my way back from the United Kingdom, where I was trained in all aspects of in vitro fertilisation (assisted reproduction and embryo transfer) I met a patient of mine. She asked me quite informally, ‘What are you up to these days?’ After much prompting I told her. She replied, ‘I know a couple who had two ectopic pregnancies and no children. I will tell them about you’.
As destiny would have it, that couple became my first IVF patient and became the so-called first home-grown test-tube babies in Jamaica in 2001.What made you fall in love with the job?What would you say is your field’s most valuable contribution to Jamaican women?What makes focusing on women’s health important to you?What makes your field particularly dynamic and interesting?If you had one bit of advice for Jamaican women, what would it be?What’s one interesting thing that your patients probably don’t know about you?If you could trade this job for anything, would you?
•When you treat a couple who has been trying to get pregnant for 10 years and it finally happens, the joy that is evoked from that gift of life is priceless.
• The fact that we can now offer our patients first-world treatment and produce high quality success rate on par with the rest of the world.
• IVF is an ever-changing technique and it ushers in new technology to produce greater success rates in infertile couples.
Symptomatic uterine fibroids affect a large number of women in both reproductive and post-reproductive age groups. Whilst in the menopausal age group a definitive surgical procedure can be a simple hysterectomy, the removal of uterine fibroids (myomectomy) can be a big challenge with blood loss during and post surgically.
We have many publications about the use of two old drugs called Vasopressin and Misoprostol reducing blood loss considerably, making the surgical procedure much safer, with less scar tissue.
Focusing on women’s health is important because of their role in reproduction, nurturing their children, and now playing the role of matriarch and patriarch, and still forming part of the productive national work force.
Infertility could be due to a male or female factor. Assisted reproduction is an emerging discipline which can bring joy to many hopeless couples. It is a highly specialised and expensive area. Among its exploits, even a woman in her fifties can use donor eggs with her spouse’s sperms and can carry a foetus and give birth successfully.
Men who have no sperms in their semen upon ejaculation, if its due to blockage of or absence of vas deferens, spermatozoa can still be harvested from the testicles directly. Then one sperm is injected in each egg through a process called Intracytoplasmic Sperm Injection (ICSI). The fertilised egg (pre-embryo) is inseminated into the uterine cavity for implantation.
In Jamaica, matriarchy prevails, so I would encourage every woman to develop her skillset to take advantage of opportunities before getting pregnant in her teens and early twenties. At the moment, you can freeze your eggs for later use after completing your studies.
I am a very impatient surgeon and have acquired the name Speedy Gonzales, a trait that probably serves me well and saved many, many lives.
I have an unshakeable belief in destiny that all of us were created to play a certain role in life. I have brought happiness to many couples in Jamaica and the region. I have published articles in the British medical journals, American medical journals in OBGYN, and the highly rated Journal of Human Reproduction which have now become the gold standard in the management of uterine fibroids.
Never, I wouldn’t trade this job for anything.
Dr Sean A Parkinson
TITLE: Consultant Obstetrician and Gynecologist, Co- Academic Programme Coordinator, Victoria Jubilee Hospital, Associate Lecturer, Dept of Obstetrics and Gynaecology, UWIWhat he does:
I am presently the co-academic programme coordinator and a consultant in Obstetrics and Gynaecology at Victoria Jubilee Hospital. I am also an associate lecturer in the Department of Obstetrics and Gynaecology in the Faculty of Medical Sciences at The University of the West Indies. I am charged with leading a team of doctors at Victoria Jubilee Hospital with the mandate of delivering effective, evidence-based, compassionate health care to all of the patients under our care. On a daily basis we see medical and surgical emergencies, direct the management of patients admitted to the various wards, including pregnant patients in labour, perform elective surgeries in pregnant patients, eg caesarean sections, perform elective surgeries for common gynaecologic complaints such as removing fibroids (myomectomy) and removing the womb/uterus (hysterectomy). I also coordinate my team to manage patients in the once-weekly outpatient antenatal clinic where we see high-risk pregnancies, and the gynaecology clinic where we see patients who need specialist care by a gynaecologist. This is accomplished by teaching and mentoring the medical students, interns and the residents (doctors training to become obstetricians and gynaecologists). I am therefore required to immerse myself in teaching as well as providing guidance to my assigned staff to appropriately manage the patients under our care.
Women are an integral component of the family structure in our society. Optimising the overall health of a woman will confer a better outcome during pregnancy. This is essential in enhancing the likelihood of a successful pregnancy, and bringing the joy of a healthy newborn into the world. I also consider it a privilege to have the requisite training to address women’s physical, emotional and psychological health. Their most sensitive and personal information is being shared as they seek to have their health issues rectified. I am therefore extremely sensitive to this and act accordingly to consolidate and validate the trust they have placed in me. Cite come of the achievements in your speciality:What makes your field particularly dynamic and interesting?If you had one bit of advice for Jamaican women, what would it be?What made you fall in love with the job?
I would cite two novel accomplishments by my colleagues in our specialty.
1. A team of Jamaican gynaecologists pioneered the successful and safe use of an injection administered during surgery to remove fibroids, which significantly reduced bleeding during this procedure. This was a landmark achievement which continues to have a substantive impact worldwide. This study was published in a peer reviewed journal.
2 . The establishment of the Hugh Wynter Fertility management Unit at the University Hospital of the West Indies. This is an important milestone, as couples with infertility who previously had to travel overseas to get treatment are able to get similar treatment at this facility by the team of reproductive endocrinologists and infertility specialists at this state-of-the-art facility. The ‘test tube baby ‘ (IVF) among other types of assisted reproductive technology are offered here and it boasts success rates similar to that of first world countries.
The mammoth responsibility of addressing the sensitive and profoundly personal complaints of women as well as fluctuating emotions often conferred by pregnancy including the tragedy of adverse outcomes such as miscarriages and stillbirth and the tremendous happiness and joy after successful childbirth, make my field very interesting and dynamic. Women will disclose more information to you during consultations once they discern that you are sincerely empathetic, sensitive and trustworthy. As their physician you therefore need to genuinely have these attributes to facilitate a more productive consultation. I am confident I possess these attributes.
My main advice for women is not to settle for mediocrity during consultations with their doctors; they should instead consistently receive compassionate and holistic care. They should receive counselling regarding healthy lifestyle modifications, eg a healthy, balanced diet, regular exercise, avoiding smoking and other high risk behaviours, etc, as well as conforming to the recommended age related cancer screening modalities and recommended vaccines. This will effect prevention of devastating and detrimental communicable and non-communicable diseases, including cancers.
I had an aptitude and undying love for chemistry and math in high school. I would have therefore pursued a career as an actuary or a chemical engineer.
My fascination and interest in becoming a doctor piqued during my teenage years when my mother took me to the doctor for check-ups, etc. There was an overwhelming but unexplainable intrigue in the field of medicine and specifically obstetrics and gynaecology. This was enhanced further by my aptitude for female reproductive biology during high school. I was also motivated by the fact that the obstetrician and gynecologist from my birthplace of Savanna-La-Mar was highly revered, especially by my mother.What’s one interesting thing that your patients probably don’t know about you?
My patients see the white coat and glasses and listen to me translate esoteric medical verbiage. So they wouldn’t know that I was athletic during high school and university years, where I played numerous sports, but I especially excelled at basketball and that I am still very fit and stay in shape. I am also an avid basketball (NBA) and American football fan (NFL). Also, I attended high schools in the country (Manning’s School and Munro College).
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