Courting death
With prostate cancer claiming hundreds of lives each year, medical professionals are calling on the Government to urgently employ more urologists in the public health system and provide patients with greater access to basic care and treatment.
Dr Gillian Wharfe, consultant haematologist/oncologist; Dr William Aiken, consultant urologist; and Dr Belinda Morrison-Blidgen, consultant urologist — all of the University Hospital of the West Indies (UHWI) — say although there are plenty of trained urologists they are not being offered jobs in the public health system, despite the urgent need for these specialists to meet patient demand and ease the pressure on the few who are in the system.
In addition, diagnostic and other critical resources available for men with prostate cancer are woefully inadequate.
The specialists pointed out the gaps at this week’s Jamaica Observer Monday Exchange with the Jamaica Cancer Society in observance of Prostate Cancer Awareness Month.
“We need to increase the number of specialists. We are training specialists but they have no jobs. They want to hire them at levels below consultant level and that’s unsatisfactory,” Dr Wharfe said.
“I don’t know what happens at KPH [Kingston Public Hospital] or Spanish Town, but just to give you an example, Spanish Town has only just hired a urologist, and it’s a one-man service,” Dr Wharfe said.
“There’s a consultant, and then there are medical services. That urologist is operating at seven o’clock in the night, so it’s a burden on the physician [and] it’s a burden on the patient who has come there from morning and has to spend the entire day waiting for treatment.”
The medical specialist said while the turnaround time for a prostate-specific antigen (PSA) test is usually under a week at UHWI, getting patients through follow-up clinics is a challenge.
“The clinics that have to see these patients are rammed, so there will be delays in terms of patients getting appointments to see the urologist, because there are just so many patients,” she said.
Dr Aiken pointed to a study done some years ago which found that the entire south-western section of the island, with a population of close to 800,000 people, had the benefit of only one urologist operating out of Mandeville Regional Hospital.
“And that has not changed,” he said. “The university has been training urologists, turning out urologists. St Ann’s Bay just got a urologist and that was after prodding and letters in the newspapers. We have to do better than this. The university is training urologists, but the Government of Jamaica is not putting the urologists in the hospitals to serve the population. How can it be that the entire south-western part of the island only has one urologist?”
Responding to the concerns, Health and Wellness Minister Dr Christopher Tufton told the Observer on Tuesday that the ministry is currently undergoing a significant programme of review and restructuring in public health, including expansion of infrastructure, compensation review, and increase in staffing.
“This I think will address some of the anomalies that currently exist,” he said.
Data from the World Health Organization’s International Agency for Research on Cancer show that in 2020, of the 7,197 new cancer cases reported in Jamaica, prostate cancer ranked at number one with 1,561 cases and 844 deaths.
On Monday, Dr Morrison-Blidgen said that while there are other countries in the region which have similar high risk for prostate cancer, their outcomes are not as dire, because the critical services are better resourced.
“The outcome of a disease is dependent on a number of variables. Some diseases are biologically aggressive, so the outcomes may be poorer, but the outcome may be affected by the intervention and the lack thereof and the determinants of health. We have been training urologists over the years [and] there are many pathologists who are being trained, there are many medical oncologists,” she stated.
The urologist noted that diagnostic tests such as multi-parametric MRIs, which have revolutionised imaging for prostate cancer, are not available in the public sector. She said a positron emission tomography (PET) scan, which is frequently requested, is also only available privately at a very high cost.
Noting the heavy costs facing men who are stricken by prostate cancer, Dr Morrison-Blidgen pointed to the plight of at least one patient who spends $14,000 in travelling costs to Kingston for follow-up care.
“When I ask him to do a bone scan and an MRI, which in total will cost him $100,000, he has to think whether he has to pay for the bone scan and MRI, or not, and that’s a reality,” she said.
She stressed that most people do not have health insurance, and that even for those who have private insurance, the Government should provide basic minimum services to assist prostate cancer patients.
“So it seems a little contradictory — we are saying, we want you to come in [because] the disease is a killer, but there are challenges,” she said.
The Jamaica Cancer Society screened 312 men for prostate cancer last year, and 308 in 2020.