A Trip to Trinidad

[Arnon Krongrad, MD]

The Krongrad Institute for Minimally Invasive Prostate Surgery is joining with HCA's Aventura Hospital and Medical Center, at which our patients have LRP, in developing a series of peer-to-peer workshops in the Caribbean. It's been exciting to meet old friends and make new ones, including Risa Birbal, a 4th year medical student and now the Social Network's newest member.

We presented the history, technique, and clinical outcomes associated with laparoscopic radical prostatectomy. There was a bit of a buzz created by the story of Gene and Milton Creque, two brothers from the British Virgin Islands who had LRP the same day. Amazingly, one of the audience members had been their consulting oncologist. It's a small world.

The trip was also a chance to share details of the Krongrad Institute's newly launched clinical trial for chronic prostatitis and Prostate Cancer International's quickly evolving Prostate Cancer Caribbean web portal.

Discussion focused primarily on the Trinidad and Tobago sub-page with some specific review of the Tobago Prostate Survey; none of the members in attendance had been involved but they were quite aware of it.

Some photographic highlights from our trip including from the Oncology Conference at San Fernando, the TT Surgeons Society in Couva, and the Port of Spain meetings, including the Internist meeting happily convened by Dr. Tony Strisiver and the payer conference organized by CMN and ATTIC and cheerfully hosted by Gerard Scott of Sagicor.

Overall, we reached out to 100 doctors, students, and residents and 40 administrators of the members of the Association of the Trinidad and Tobago Insurance Companies. And I still have a wedding to get to (how did this happen?).

It's hard to believe that we found a Caribbean nation that Shai has not been to. He's all excited by his first trip to Trinidad.

It turned out that "check your PSA" is not what Customs had in mind when they posted the "Something to Declare" sign. Oops!

Senior urologist Lall Sawh, MD, organized a lot of the activity and was a most gracious host. Here he reviews the presentations.

On the panel with radiation oncology and medical oncology.

Addressing the Southern Medical Clinical oncology conference.

So why would two Miami boys get all excited by a coconut?

With senior surgeon Dilip Dan, who has strong interest in laparoscopic surgery, and Lall Saw, plus Trinidad Surgeon Society dinner sponsorts Lisa and Darron, who represent Bayer and the makers of Levitra.

There were many students and residents at the events, including from left Danilo Malubag, Daniel Otajele, and George Udekwa. Group leader Risa Birbal promised to energize her peers and involve them with online health communication. Thank you, Risa!

And what would a prostate conference be without Dr. Persad, a pathologist?

Dr. Tony Strisiver gets ready for the event at the Kapok Hotel

Aventura Hospital's Andres Prieto joins CMN's Alex Kroon, yours truly, and CMN's Woody Berzen for a shot before dinner.

The professionals: Shai Gold and Andres Prieto get ready to present.

Trinidad resident and my patient Winston Millett, who had LRP in 2003, makes a surprise visit and makes an impromptu speech to share his experience with prostate cancer. Winston won everyone's heart.

They should just implant the microphone into my hand: 4th talk in 4 days. And still chipper and ready to go! Here presenting The New Prostate Cancer InfoLink!

Discussing prostate cancer and case management with health insurance managers. Here showing off The New Prostate Cancer InfoLink and Social Network. The audience reacted very enthusiastically and it seemed many questions were motivated by personal as well as professional interest.

The room was packed!

On the left is Paula Araujo-Wilson of Sagicor; on the right is Tahjaa Knuckle of CMN. There were lots of questions about public awareness, the costs of early vs. late diagnosis, and cost containment generally.

As I told the audiences, there may be a growing awareness in the Caribbean. As one example, my patient Wilmoth Daniel, Deputy Prime Minister of Antigua, openly disclosed to Parliament that he had been diagnosed and treated for prostate cancer. But I am not sure. I know of at least one other Caribbean president who absolutely refuses to use his own case as a lesson to others.

What do you think? Is there a growing awareness of prostate cancer in the Caribbean? Will internet based resources be useful?

[Angela Jenkins]

Excellent post and great pictures!!! It's cool for the rest of us to see how the network is expanding both nationally and internationally, and see the positive reception you're getting!!
As to your question, I'll defer to others in the Caribbean group for specifics, but in today's world with technology becoming the primary resource of life in general, I would be extremely inclined to believe that internet based information will become very useful in the Caribbean in time. And with access to information, I think we'll see a growing awareness of PCa as well.

[Dr Brent Wilson]

Thank goodness Trinidad has somebody as enthusiastic as Dr Sawh. Did he tell youi he has had a species of microscopic organism named after him? http://www.ville-ge.ch/mhng/paleo/paleo-pdf/25-2/pal-25-2-04.pdf

[Arnon Krongrad, MD]

I had absolutely no idea! No, he didn't say a thing. I will see him later today and will surprise him with this knowledge. I am sure he'll be pleased. Thank you for bringing it to my attention.

Yes, his enthusiasm is infectious. No pun intended.

[Arnon Krongrad, MD]

What a day! First the CMN conference. Then a wedding that I missed. Then the opening of the Southern Medical Clinic oncology center's Millenium Wing, then a site visit of the West Shore Medical Center, then room service and a delightful documentary on the Battle of Trafalgar. I am ready to return to the peace and quiet of surgery.

With "the genius" neurosurgeon Dr. Krishna Maharaj, on my left, who regaled us with stories of cerebral angiograms and old fashioned myelograms -- "the doctors today have no idea how to do them" -- and with His Worship the Mayor of San Fernando Alderman Kenneth E Ferguson, and anesthesiologist Dr. Venu Potluri.

PS: Brent, I told Lall what you revealed and he was stunned, as predicted. Actually before that I told the entire CMN conference membership that a disease had been named for Dr. Lall, which caused them and him great joy. "How did you know?" he asked. I told him that the Network knows all, that if he really wants to be in the know he needs to be a member. He was delighted by the revelation and was duly impressed. So ... thanks for this. It was priceless.

[Nathan Consedine]

Arnon,

This looks fantastic and is a great advertisement for the network - it's a shame I didn't know about it as I would love to get to know a few people in PC in the Caribbean so I can broaden my knowledge beyond Brooklyn-based Caribbean groups. And yes, I think awareness is increasing. For example, I suspect other members will have told you about the Afro-Caribbean Cancer Consortium (AC3) originally developed by people at the University of Pittsburgh which has members throughout the Caribbean and Africa (including some on the forums). People can find out a bit more about it here:

http://www.upci.upmc.edu/ac3/index.html

The key of course is an issue of practicality. I am unsure how widespread efficient internet access is in the Caribbean and/or whether the "culture" of self-education regarding health has germinated yet. That noted, dissemination via electronic media would seem to be a great first step towards increasing awareness and reducing all the negative outcome stats that seem to dominate the PC headlines in the region.

[Arnon Krongrad, MD]

Thanks for the note, Nathan. I'll keep your interests in mind on the next go.

Today I met with the former Health Minister of the Cayman Islands and will meet with him (and Angela and Mike ) again on Wesdnesday, along with Deputy PM of Antigua, Wilmoth Daniel. The agenda item is to explore mechanisms by which awareness can be increased, including consideration of the logistical issues: fragmentation (many countries, many bureaucracies), "macho" culture, and need for off-line supplementation.

To be continued ...

[E. Michael D. ("Mike") Scott]

Nathan: Your assessment of our intent in building the Caribbean site is spot on. We aren't expecting a vast upsurge in the use of this site overnight. Rather, we were trying to develop a simple, reliable set of information that can at least theoretically be accessible to anyone in the Caribbean (journalist, patient, health worker, you name it), complete with easily printable (and photocopyable) PDF files that could be printed out and distributed at churches, social centers you name it. The next step is to grow awareness of the resource. All ideas welcome!

We are doing the same thing for Africa (see Prostate Cancer Africa).

Mike

[Arnon Krongrad, MD]

Incidentally, Nathan, I am not sure if you noticed but a number of Trinidadian students took interest in all this. One of them, Risa Birbal, is what they call their "group leader." Her twin, Ria, and their classmate, Maria Clapperton, are also here.

I am not sure if you have specific immediate needs but if you have projects/surveys suitable to eager, thoughtful students, I would strongly consider discussing this with Risa and her network. Trinidad, by the way, seems culturally unusual to me in being half African and half Indian in descent (I never felt that in places like Antigua, for instance). Anyway ... if you need specific contacts we may be able to help so don't be bashful. Arnon

[Dr Brent Wilson]

Dear Dr Krongrad

I am pleased to hear that the bug that I named after Dr Sawh caused some merriment. (It was not a disease, but a form of shelled, amoeba-like critter that lived in the sea about 16 million years ago.) It also caused some amusement earlier this week when, after presenting a research seminar on my work at the Smithsonian Institution, I confided in another cancer survivor that I have named a species after my doctor. Other than the traditional box of choccies or bunch of flowers, I could think of no other way to express my appreciation.

I can appreciate why Dr Sawh might not wish to join the network. Are there not ethical issues in patients and doctors communicating in this way? Also, doctors do deserve a private life, don't they?

Once again, many thanks for highlighting my gift to Dr Sawh.