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Graham Serjeant, Sickle Cell, Jamaica and Beyond: A Life, Ian Randle Publishers (Kingston and Miami), 2021

Year: 2021
Type: book-review
Abstract: Graham Serjeant’s remarkable memoir of his distinguished career studying and taking care of sickle cell disease patients in Jamaica is a very unusual combination: a recounting of a half-century of progress in understanding and treating this disease and also a fascinating travelogue. Serjeant begins the tale of his professional career with his journeys, first as a London medical student in east Africa and then his choice of Jamaica’s sickle cell programme in 1966 for his first major position, shortly after his marriage to Beryl, his companion in clinical care, science and all other aspects of their very active lives. (The Carribean climate was a major factor in this decision.) The early chapters of the book recount their stepwise development of a robust sickle cell clinic using newly developed laboratory methods – Beryl’s field of expertise – especially after realising that, to the surprise of almost all the leaders in the field, that many sickle cell patients could live reasonably well for many decades. By 1974 they were able to organise universal testing in Jamaica of all newborns for sickle cell anaemia, the first in the world. This was followed by the development of a comprehensive sickle cell clinic programme – including a day care center – to enable them to follow all the cohorts (and their controls) from the screening program as well as their current sickle cell patients. The clinics included explicit education of the patients and their mothers in their programme. Serjeant also began pioneering clinical studies, many of which established collaborations with subspecialists from the UK and the US. Important and novel therapy studies, such as penicillin prophylaxis, were also soon developed. The resulting information about the course that sickle cell disease takes, including in those with the various genotypes, led to many publications, including several editions of a definitive monograph. I believe that it was this work that was most responsible for initiating the ‘modern era’ of understanding the clinical presentation of this disease, including its complex genotypes. For many readers, these chapters will be an important education on the evolution of our understanding of the manifestations of sickle cell disease in the last half-century. Serjeant’s studies of the entire sickle cell population in Jamaica – rather than concentrating on those patients presenting to medical care with serious complications – made physicians in the US and Europe rethink many aspects that had been assumed from the earlier literature. Reading about Serjeant’s equally important role in outreach to many regions of the world, reminded me of a discussion about ‘scientific exchange’ which I attended long ago. In the 1970s, in recognition of the new exchange of scientific delegations between the USSR and China with the United States, as well as the robust rebirth of international meetings, the National Institutes of Health (NIH) organised a symposium to ponder how to maximise international medical and scientific exchange. The one vital idea I recall from that event was the brief talk by my mentor, Dr. Christian B. Anfinsen, to the effect that ‘scientific exchange requires exchanges of scientists’. He was referring to the long periods he had spent abroad throughout his career and its relevance compared to mechanisms, such as meetings and the then fashionable official delegations. The second half of Graham Serjeant’s book is a tribute to his energy and determination in making such visits and strongly contributing to the care of sickle cell patients in many of the locales of the world in which this disease is endemic but lacking the resources found in the ‘west’ to care for these patients and their families. In this way, more than anyone else, he has been the expert in sickle cell disease whose presence has allowed the advances of the last half century in the diagnosis and care of these patients to be widely shared. His tales of his international outreach include summaries of his 27 visits to India, as well as to many of the countries of the middle East and of Brazil during the last few decades. These visits were primarily to bring his knowledge of effective clinical methods and treatments for this disease to areas with minimal resources. However, even in this jet-set age, the ongoing difficulties in making these journeys and establishing field facilities in areas with large sickle cell disease populations will be very evident to most readers. Ironically, very recent developments – including political changes and the near universal Covid-19 pandemic – would make many of these ventures near impossible now. In this they remind me of David Attenborough’s recent autobiographical books and films in which, despite his deep concerns about how the world is changing, he also celebrates the period of his ‘youth’ when such incredible journeys were possible for the first time for a small number of academics – many originally from the UK – who began the world-wide dissemination of scientific advances. World-wide health statistics show the continued spread of modern medicine is indeed already having a huge beneficial effect on morbidity and mortality, but is also contributing greatly to the continued increase in the world’s population. In 1999 Graham had to pass on his Medical Research Council funding because of arbitrary age limits on its international funding programmes, but he and Beryl have elected to remain in Jamaica and work with the Sickle Cell Trust (Jamaica) – which they had helped to establish – to continue to contribute to the study of this disease on that island. All in all, the sickle cell ‘community’ – especially patients and their families in the many parts of the world with very limited resources – will be reminded in this fascinating book of how a single, intrepid investigator can contribute in so many ways to medical care for very large numbers of patients, and provide important new clinical information for even the resource-rich areas like the United Kingdom and the United States.
DOI: 10.1111/bjh.17686
Language: English
Field: Medicine
Open Access status: bronze
OpenAlex ID: W3211001338
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