Consultant surgeon passes baton as Annotto Bay's Senior Medical Officer; will serve as head of surgery

BY H G HELPS

Dr Fraser shows one of the books he consults frequently — History of Kingston College, written by Ambassador Anthony Johnson (Photo: Joseph Wellington)

DR Ray Anthony Fraser has shut the door labelled 'Senior Medical Officer' and opened a new one marked 'Head of Surgery'.

The name most synonymous with the Annotto Bay Hospital for more than two and a half decades has shifted his deck of medical cards, but remains in the game of improving medical care to St Mary and its environs.

Dr Fraser, who has held the job of SMO at the hospital for 24 years and who significantly changed the fortunes of the institution from one with only one functioning doctor and an assistant to over 56 full-time and a handful of part-time practitioners, retired from his substantive post last week. But the Ministry of Health, through its regional arm, the North East Regional Health Authority (NERHA), recognising the tremendous contribution that the surgeon has made at the institution, has persuaded him to stay on as head of the department of surgery.

He is to be replaced as SMO by another member of staff, Lt Col Dr Sydney Powell.

In a wide-ranging interview with the Jamaica Observer last week, Dr Fraser retraced his years at the facility.

The medic, who was born and raised in the tough South St Andrew community of Jones Town, and who spent some of his toddler years in coffee-less Blue Mountain in Manchester, excelled in academic work at Kingston College before reading for a degree in chemistry and biochemistry at the University of the West Indies.

But greater things beckoned, and soon the ambitious doctor-to-be was included in the first group of Jamaican medical students to set foot in socialist Cuba, following the guinea pig experiment of the first Jamaican duo to study in that north Caribbean island — Dr Wykeham McNeill and Joseph Manley a year earlier.

Having graduated from the University of Havana Medical School, Dr Fraser returned to Jamaica in 1984 and was placed at the Mandeville Regional Hospital where he spent three years. The Kingston Public Hospital (KPH) then, was the next stop on the trail and he leapt at the opportunity. Seven years at the KPH, during which time he completed his specialisation in surgery at the Royal College of Surgeons Edinburgh, Scotland led to an unexpected call one day that would change his direction in life forever.

“I was still at KPH and covering for Dr Cecil Batchelor (SMO) at Princess Margaret Hospital early in 1994 when I got a call from Dr Goffe, one of the directors in the Ministry of Health at the time, saying that she was going to send me to Annotto Bay to see what I could do because it was in a very bad state.

“I had never heard of Annotto Bay before and it took me six months to reach there because of doubts I had. I got there in July 1994 in the Ministry of Health's vehicle and Dr Goffe herself who came with me. It was the first time I had gone to Annotto Bay. When I got there I was in a state of shock because the place was so dilapidated, most of the damage of Hurricane Gilbert (hit Jamaica in 1988) was still there. At that time there was a discussion about which hospital should be closed — Port Maria or Annotto Bay, and the greater feeling was to close Annotto Bay, but Harry Douglas (Member of Parliament) stepped in and the Prime Minister (P J Patterson) said no.”

The physical state of the hospital left Fraser in shock and left him depressed for several weeks, but then he, expressing himself as a Fortis who would never fall down, showed his tougher side by accepting that he would be in it for the long haul and proceeded to list his priorities.

“There was no lab. All investigations were sent into Kingston. But one day we had a visiting team from California in the United States and among them was an army doctor and he said to me, 'Dr Fraser, what do you want' and I told him a lab and lab technicians. A couple nights after I got a call around midnight from him and he said, 'Dr Fraser, I've got two medical technologists here who are willing to work with you for a period of time, will you accept them?' and I said yes. It was when I woke up in the morning that I realised that I told the man yes and did not have a lab.

“The technicians paid their fare and arrived two weeks later. We got bits and pieces of equipment, found a room and some of the technicians from KPH with whom I had maintained contact came and set it up and we started a lab,” continued Dr Fraser, the holder of national honour Order of Distinction, Commander Class, for services to medicine.

Days later, Dr Fraser got a call from the Ministry of Health's Dr Fay Whitbourne who told him that she had heard that he had started a lab and offered her help. He told her that he had to take the bull by the horn. Organisations such as the National Commercial Bank, the Oracabessa Foundation, St Mary Banana Estates and others were approached, with positive results.

The old tuberculosis ward, which had been destroyed by Hurricane Gilbert and taken over by cows, goats and overgrown trees was the target of renovation — a project spearheaded by Patsy Kelly of St Mary Banana Estates' parent company, the Jamaica Producers Group. That donation at the time totalled $1.5 million — a huge sum then that was not only used to fix the old ward, but set up a lab, a conference room and accommodate an office for Dr Fraser.

Dr Whitbourne had even before that assigned a consultant to design the lab, which upon completion, received budgetary support from the Government, and the task of taking samples into Kingston and other places to be tested was almost over.

“We had other challenges with supplies and the operating theatre, Accident & Emergency, the wards were all in a deplorable condition. We made contact with the Deaconess Group in Indiana, USA and they came and visited with us.

“I was very moved by the laundry staff at Annotto Bay, because at the time they used to hand wash and put the linen on the grass to dry. When there was no water at the hospital the staff used to pack the dirty clothes in the ambulance and go to the river and wash them. I was so motivated by that. So when the Deaconess Group came they invited me to Indiana to give a presentation at a 2,000-bed hospital. Our then administrator Ms Dorothy Cousins and I went to Indiana and I did the presentation with pictures and other material to the board and they were convinced.

“We were warmly received by the group and soon after they brought in an industrial dryer, industrial washer and equipped the laundry — they are the ones largely responsible for the renovation of the other sections of the hospital,” Dr Fraser said.

After setting up the laundry, the Indiana Group renovated the A&E Department, wards, operating theatre, brought operating theatre lights and medical supplies and equipment for about 12 years. At one time, the Indiana Group used to send supplies twice a year for 12 years to the point where the hospital did not depend on Government for supplies. The hospital too, had found itself so self-sufficient, that it began to assist other institutions in need.

Dr Fraser estimated the group's contribution to the Annotto Bay Hospital over a 15-year period at more than $450 million.

Entertainer Capleton, also from St Mary, has also earned the veteran medical practitioner's plaudits. Capleton, with his regular show St Mary Mi Come From,donates a major share of the proceeds to the hospital. “Capleton and his manager, Mrs Kemp, are giants in the effort,” Dr Fraser said. “Proceeds from the show have helped us and we have close relationship with the organisation as we also provide medical support for the show. The ISSA Trust has also assisted us and we have received generous donations from Australian group Air Supply, spearheaded by the ISSA Trust.”

Other initiatives, including an Adopt-a-Ward project led by John and Jenny Greaves of Tankweld helped in the turnaround and convinced Dr Fraser even further that Annotto Bay was the place to be.

Further support from NCB; and a special effort by international artiste Beres Hammond, a St Mary man, continued to lift the institution's fortunes. Hammond tiled the female ward with his own money.

“Another group that assisted us was the Jamaica Association of California, through their medical mission. They came in, provided surgical equipment, laparoscopic equipment, general hospital supplies, they brought in experts, trained our local surgeons in laparoscopy, they held annual laparoscopy conferences, attracted surgeons and nurses from across Jamaica. Some of our leading surgeons would have passed through Annotto Bay for laparoscopy. Our group would have done outreach to other hospitals like Princess Margaret, May Pen and Savanna-la-Mar, our team was taken to California every two years for training. Annotto Bay Hospital has one of the best trained laparoscopic nursing staff in Jamaica. We are one of the leading laparoscopic centres in Jamaica right now, in terms of the number of surgeries done.

“When I started, it was myself and one other doctor doing everything. At the time, I used to do general surgery, Caesarian section, hysterectomy, all gynae surgeries, orthopaedics and paediatric surgery, tendon repair, fractured feet, etc.

“Since I was the only doctor on staff there, I used to do ward rounds on the medical ward, the paediatric ward. I used to bring some doctors over, like Dr Natalie Whylie, the now SMO at KPH, she used to assist me, among others, who would come down willingly.

“A group of medical doctors based in New York called Doctors on Call, headed by Dr Orville Palmer, used to do ENT surgery, plastic surgery, vascular surgery, with this group for a number of years. When I went there, a significant number of patients were referred for specialist treatment, so I wanted to reduce that. I brought in an internist, obstetrician, gynaecologist, consultant anaesthesiologist, consultant paediatrician, psychiatrists, A&E specialists, to the point now where we have departments of medicine, surgery, paediatrics, anaesthesiology, psychiatry and child guidance.

“We have forged some important alliances,” Dr Fraser emphasised. We have signed an MoU with Campbell Medical School in South Carolina where their students rotate in surgery in particular as part of their experience. That group has been assisting us with supplies for the past 15 years. Two years ago the UHWI sent their accreditation committee down. They were quite impressed with Annotto Bay. They have accredited Annotto Bay for rotation of interns for the UHWI and they are looking at the possibility of other rotations.

“After Hurricane Sandy, I reached out to the different corporate groups and RJR with Gary Allen came on board and mobilised a number of companies and individuals locally and abroad that made significant contributions that assisted us with the renovation, about five years ago. Half of the hospital was de-roofed.

“One of my greatest contributions was to assist a number of Cuban-trained graduates prepare for their Cam C Exam (Caribbean Association of Medical Council Exam for those who studied outside of the University of the West Indies or medical schools that do not have automatic accreditation) as they had challenges to pass their exams elsewhere. Over the past 15 years we have had 95 per cent success rate. There were even some from The Bahamas and Cayman who also came and passed. I'm glad I was able to guide them.

“We have forged a close relationship with the Annotto Bay community. They respond, support, defend the hospital. One of the most touching things to me was a time when there was an accident, and an elderly gentleman fell from a tree — an ordinary Joe — and he fractured his spine. I went and assessed him and said he needs to be transferred to Kingston, I called the JDF air ambulance, and the little barefoot man said 'Imagine, simple people like we can go pon helicopter'. It impacted on me. He said: 'Jesus God, me caa believe a countryman like me a go pon helicopter'. He couldn't believe it. That convinced me that we had to do everything to ensure that the hospital provided good service to the population,” Dr Fraser said.

Annotto Bay Hospital is now at a stage by which it serves as the referral hospital for Port Maria and Port Antonio hospitals in obstetrics and gynaecology.

The hospital is the largest employer of labour in eastern St Mary with over 280 people on the payroll, far exceeding the number employed by St Mary Banana Estates which once ruled the working roost in the parish.

Patients too, are coming from all over Jamaica for surgery, as near as Portland, St Ann, St Andrew, and Kingston, and as far as Montego Bay — mainly to do laparoscopic interventions.

The first chairman of the Annotto Bay High School and former president of Axum Football Club in Annotto Bay, Dr Fraser also recounted briefly several satisfying moments during his time as SMO, one of which still stands out.

“There was a 12-year-old boy who came in with acute abdomen (belly pain). We had to rush him to theatre, when we went in we found that he had a severe pancreatitis (necrotic) and I had to do a partial pancreatectomy (surgical removal of the pancreas) on him. That's the risk I took. We had to transfer him immediately to the Intensive Care Unit at KPH. When he got there the doctors said how Fraser so brave to do such a surgery out there. The child came back a few years later with his mother, he is diabetic but that's the risk I took at the time. He was exceedingly sick and would have died had I not done that,” Dr Fraser recollected among the thousands of surgeries that he has taken on over the 34 years that he has been practising.

In another incident, one of his juniors was doing a case and complications arose. “They found a massive cyst from the liver that was bleeding. To control the bleeding we had to do a thoraco abdominal incision — we had to open his chest, mobilise the liver and pack it to stop the bleeding, leaving a chest tube and then pack the abdomen with gauze and go back and remove the pack a couple of days after.

“A medical student came to me last year to say her mother sends hello, she said he was the one who did the C section and delivered her, and she came back as a young doctor. Those things are very fulfilling. A number of patients have come back,” Dr Fraser remembered.

He is too, one of the leading laparoscopic surgeons in Jamaica, and the Annotto Bay Hospital leads the way with the number of laparoscopic surgeries done in Jamaica, ahead of healthcare giants the KPH, University Hospital of the West Indies, and Cornwall Regional Hospital.

Dr Fraser admitted, firmly and with glee, that among the procedures that he relishes doing most, is attending to fractured penises.

“I enjoy repairing them,” he said of the sex organs, grinning with satisfaction. “When an erect penis suffers from trauma you have to move fast and be precise. I've done a few, which usually happens when a patient, while in a sexual act, misses the target and hits … say something like a bed post for example. The penis in that state is like a cane, and it will just snap, so you have go in and get to work, which involves a circumcision and other things,” he said.

“Upon reflection too, the other day I was going through the number of hysterectomies and I realised that I did nearly 400 in the early days. That's just gynae work. Not many gynaecologists in their career would have done that,” said the man who might not be the owner of a national brand name in medicine, but who has few rivals to his accomplishments.

Now, he has a different focus as head of surgery.

“I want to focus more on teaching now. I have been teaching all these years but I want to step it up and guide the younger staff in surgery and see how much I can impart to them, especially on laparoscopy.

“I have thoroughly enjoyed my time in Annotto Bay,” said Dr Fraser, who over the years had turned down many job offers from as near as the Caribbean to as far as Scotland, out of a high level of commitment to the town.

“I have no personal regrets working in Annotto Bay. I would have loved to have seen more infrastructural development in my time but I had no control over that. I have brought the hospital to a level where those who come behind me can build on.

“I am happy that there are projects in the pipeline like the building of the new lab, renovating and expanding of the A&E department and the expansion of the children's ward.

“One of my greatest satisfaction is I am seeing where Annotto Bay Hospital is now being transitioned from a Type C to a Type B hospital. I have accomplished a significant amount and I am happy reflecting that I would have made my contribution and for those who come after me they have something to work with. There is a legacy.

“I really enjoy working with the staff. I relate to everybody at all levels. Of all the hospitals I have been to, the Annotto Bay staff are the most committed, hard-working and love their hospital. There is the Annotto Bay culture which is a family affair. Those people would do anything to defend their hospital,” stated the former president of the Kingston College Old Boys' Association.

Dr Fraser, a director of Winchester Surgical and Medical Institute, Winchester MRI, former head of the North East branch of the Medical Association of Jamaica and still a member of the Medical Council of Jamaica, is from a family of medical blood. His older brother, Wayne “Chicken”, runs a large medical practice in Florida. A younger brother, Ricardo — a dentist — was murdered in Clarendon and his car stolen, a case that remains unsolved after eight years.

His family members — wife Angella 'Angie', sons Rouel and Antoine, who is following in his footsteps, and daughter Raychelle — have been his guiding influence and “rock of support”. Mom Ivy Ducille is also very much in the picture at age 93, cooking sumptuous meals when she is in the mood, and giving away scholarships in Blue Mountain, Manchester in aid of her slain son.

NERHA, led by its chairman Tyrone Robinson, and regional director Fabia Lamm also came in for praise, likewise the hospital's matron Claudette McLennon and her nursing staff.

“It's unbelievable how strong the support from NERHA has been,” Dr Fraser revealed. “Ms Lamm and Mr Robinson have given the hospital strong support. Whenever we need staff they are very supportive and in terms of the infrastructure they are equally supportive.

“I enjoy working with the matron Claudette McLennon and her staff, although they say I am miserable because I tell them what I feel but the next day we are best friends. The administrative staff is also a great group. New CEO Delroy Morgan means well, is very professional and is doing his best. So when you have that kind of chemistry in place, you are bound to have a successful operation.

“As staff, we used to have frequent outings to places like Boscobel and Jamaica Grande hotels; trips to Manchester and St Elizabeth, and boat rides in Clarendon which we should again start doing more frequently,” Dr Fraser stated.