International Café: Jamaica Chapter of the ACS

Jamaica is the largest country of the English-speaking Caribbean, with a size of 4,181 square miles and a population of 2.9 million. Ranked 53 in overall health care performance by the World Health Organization (WHO), life expectancy is 74 years for men and 78 years for women. The total health care expenditure is 5.4 percent of Gross Domestic Product (GDP), which is approximately $476 USD per capita.

Jamaica’s relative success in health care delivery is a result of its strong primary health care system, which focuses on prevention services such as immunization and the care of chronic health issues. At the other end of the health care delivery system are 23 governmental and 10 private hospitals. Three of these are Type A hospitals (tertiary referral hospitals with access to subspecialty care and advanced investigational facilities): the University Hospital of the West Indies (UHWI) and the Kingston Public Hospital (KPH), which are both in Kingston, and the Cornwall Regional Hospital (CRH), which is in Montego Bay, at the western end of the island.

The UHWI, an internationally recognized academic institution with 579 beds, continues to facilitate the clinical training of health care professionals and has expanded to meet the needs of Jamaica and the region by offering the most surgical procedures representing all surgical specialties. Partnering with the KPH (505 beds) and the CRH (400 beds), undergraduates and postgraduates are trained across Jamaica, with the UHWI serving as the main center of training. Formal undergraduate training began there in 1948, whereas postgraduate training began in 1972. Degrees offered include the general undergraduate degree of MBBS and the postgraduate degree of Doctor of Medicine (DM).

Surgery in Jamaica

A DM graduate in any of the surgical specialties of general surgery, pediatric surgery, orthopaedics, otolaryngology, neurosurgery, cardiothoracic surgery, urology, ophthalmology, and plastic surgery is expected to be able to practice independently at the completion of his or her training. According to the WHO, Jamaica’s physician density is 0.472/1,000 population, as compared with the U.S., which has a density of 2.5/1,000. This figure drives Jamaica’s undergraduate program—more than 250 doctors will graduate in 2018.

The majority of Jamaica’s surgical leaders and attendings throughout the country have received undergraduate and postgraduate training in Jamaica, with some having acquired advanced skills such as in minimally invasive surgery and robotics from either formal programs or fellowships in North America and the United Kingdom.

Apart from the usual spectrum of surgical conditions, including cancers and non-communicable diseases, trauma accounts for more than 20 percent of surgical admissions at the UHWI, with even greater numbers at the KPH and CRH. In 2017, there were approximately 4,500 elective surgical admissions at the UHWI. Of these, 1,155 were trauma admissions and almost 50 percent were intentional. A true public health crisis has resulted, creating a significant burden on resources, especially as most of these injuries were preventable.

Strategies are currently being developed to address this crisis at the governmental level. The Jamaica Chapter believes that the introduction of the Advanced Trauma Life Support^® (ATLS^®) program has had a positive impact on the care of trauma patients.

ACS in Jamaica

Founded in collaboration with one of Jamaica’s surgical giants, the late Peter Raymond Fletcher, the Jamaica Chapter of the American College of Surgeons has since grown to include 45 active members. The chapter has been able to modestly achieve some of its core goals over the years in the advancement and improvement of surgical care. Since its inception, the chapter has been partnering with the main local surgical society, the Association of Surgeons in Jamaica (established in 1958), at its annual scientific meeting to sponsor and host the ACS guest lecturer—a highlight of the scientific program.

This year, the chapter had the privilege and honor of having one of Jamaica’s own, Lenworth M. Jacobs, MD, FACS, as the guest lecturer. On May 19, Dr. Jacobs, a current member of the ACS Board of Regents, delivered a lecture on “Increased Survival from Active Shooter and All Causes of Severe Hemorrhage,” which was well received by the audience of surgeons and health care workers. The Stop the Bleed^® campaign is of particular interest to Jamaica because of the country’s high incidence of interpersonal violence in addition to the usual traumatic causes of bleeding. The chapter is committed to promoting and developing the Stop the Bleed program in Jamaica.

University examinations for the undergraduate and postgraduates are held twice per year, and the Chapter’s connections with the College have afforded the opportunity to have ACS faculty assist local faculty as external examiners to help maintain and improve standards of the examination process. To this end, these established connections have been of tremendous value.

With help from colleagues in Trinidad and Tobago, the chapter started conducting ATLS courses in 2001. The chapter has since transitioned from the use of animals in skills stations to the use of Trauma Man mannequins. Typically, the chapter conducts three courses per year, with the ability to conduct many more. ATLS Jamaica is excited about the new developments of the global transition from the 9th to the 10th edition of ATLS. With the 20th anniversary of ATLS Jamaica fast approaching, there is an opportunity to expand this level of training to even more physicians.

Annually, the chapter sponsors deserving residents, mainly in the general surgery postgraduate program, to attend the Clinical Congress. In 1998, I benefitted from this experience and since then have only missed a handful of meetings. Certainly, as a young surgeon being trained outside of the U.S. system, attendance at Clinical Congress helped validate my own experience and afforded me the opportunity to hear from surgical giants. Meeting and establishing connections with peers from around the world has been invaluable. Visiting and experiencing all that the host cities have to offer makes it the complete package. I look forward to attending the Clinical Congress 2018 in Boston, MA, this October.