As a young doctor in internal medicine Kamela Bemaul-Sukhu was troubled by the many patients with blood disorders who at times lay in hospital beds for long periods with no real help given to them; this drove her to become specialised and today she is the only hematologist in the country.
“The suffering and pain of patients is always a big motivation…, especially with hemophilia patients…,” the mother of two told the Stabroek Weekend in a recent interview.
Dr Bemaul-Sukhu graduated in 2003 and worked as a general practitioner in internal medicine for a number of years at the Georgetown Public Hospital (GPH) as there was no residency programme at the time specialising in internal medicine.
Seven years ago, the first residency programme was initiated in internal medicine and infectious disease and all of those on staff for a while entered. After three years of training, she became specialised. A year later she went on to the fellowship in hematology at the McMaster University in Canada.
Going back to her journey of becoming a hematologist, Dr Bemaul-Sukhu named hemophiliac patient Looknauth Mohamed as one of her biggest motivations to take the path that she took. Over the years, Mohamed spent extended periods in the hospital because of uncontrollable bleeding. It was only after he started accessing the Factor VIII (eight) injection that he now has some relief.
“When I was here, Looknauth was in the hospital. He was hospitalised for a couple of months, in a bed, couldn’t move and everyone thought he would have died because his hemoglobin was really low, maybe two or something. And he was just helpless there bleeding away; you can’t do anything for him,” she said.
At that time, she said, they made desperate contact with Laurence Baksh, who is a founding member of the Guyana Hemophilia Society (GHS) and who at the time was accessing the Factor VIII injection through a relative.
“Laurence came in, none of us knew how to give it [the injection] and all of that so as a patient he came in, went to the HDU [High Dependency Unit] and he showed the nurses what they had to do and they did it. We got two vials from Laurence and that really helped a lot,” she shared.
While only those with severe hemophilia need the injection and Mohammed’s is a mild case, he had an adnominal problem which may have resulted from the number of years he bled from various injuries. Therefore, he had to get a lot of the Factor VIII to stop the bleeding.
“That is one of the big things that pushed me, Looknauth’s case… Laurence, I knew him since I was an intern and for his cousin to send in the Factor VIII we would have to sign up the form saying that a doctor would receive it… So I knew him for a long time,” she said.
Hemophilia is an inherited bleeding disorder in which the blood does not clot properly. This causes spontaneous and/or prolonged bleeding after an injury or surgery. People with hemophilia have low levels of specific clotting factors, which are proteins in the blood that help it to clot. People with low levels of Factor V111 have Hemophilia A, and those with low levels of Factor 1X have Hemophilia B.
Today, both Mohamed and Baksh, along with other hemophilia patients, access the injection free of cost from the World Federation of Hemophilia (WFH), through an arrangement by the GHS. The injection comes through the GPH. Dr Bemaul-Sukhu said she understands the fear in patients that the injection donation might end, but she does not foresee this and even if it did then the Government of Guyana would have to step in to fill the gap. The powers that be at GPH and the Ministry of Health have been engaged on the issue in the past and they are aware. The injection is expensive and since it is being accessed free there is no rush to purchase it; that money can be spent somewhere else.
“But it would be reassuring to know that they said okay we would purchase it because that is what we want to know, that they commit to it and let’s say the WFH stopped sending the Factor VIII, the government has already committed to it,” she said.
Apart from hemophilia, Dr Bemaul-Sukhu said, there were other general hematology patients like those with sickle cell who would just attend a clinic where their hemoglobin was monitored and then they were sent home.
“No one was specialised then, so it was just a regular follow up,” she said, adding thalassemia as another such disease.
According to the Mayo Clinic, thalassemia pronounced (thal-uh-SEE-me-uh), is an inherited blood disorder that causes your body to have less hemoglobin than normal. Hemoglobin enables red blood cells to carry oxygen. Thalassemia can cause anaemia, leaving you fatigued and severe forms might require blood transfusions. Those affected can take steps to cope with fatigue, such as choosing a healthy diet and exercising regularly.
Sickle cell anaemia was described as one of a group of disorders known as sickle cell disease. It is an inherited red blood cell disorder in which there are not enough healthy red blood cells to carry oxygen throughout your body. There is no cure for most people but treatments can relieve pain and help prevent complications associated with the disease.
“Those are big ones for hematology and then there are bleeding disorders,” Bemaul-Sukhu said. “There are so many stories you would have heard about bleeding disorders and I know people have been blamed for the deaths of patients but you wonder, did the patient actually have a bleeding disorder and it was not recognised?”
She referred to reports in the past about patients having teeth extracted and then bleeding continuously and the dentist being blamed.
“But who knows, maybe those patients had bleeding disorders that were not diagnosed,” she said. She recalled that when she was an intern there was a patient who had an extraction and was later admitted, given several transfusions but died.
“Reflecting, I am sure he had some kind of bleeding disorder that was not recognised… You would hear of cases and procedures that have gone wrong and patients just bleed out and die and nothing is really definitive about what happened…,” she pointed out.
Taking all of the above into consideration Dr Bemual-Sukhu said she felt there was a need for hematology patients to be referred so at least they could be diagnosed and even if the treatment was not readily available, they could work to have it in the future.
Talking about hemophilia, the doctor said from birth the patients can present issues and she pointed to prolonged bleeding when the umbilical cord is cut and also if they have to have a hemoglobin and sugar count they can also bleed for prolonged periods. Vaccines can also see prolonged bleeding and she said all of those are signs not just of hemophilia but bleeding disorders.
“So when parents see these things or any medical personnel see them then they should start to think that something is not right…,” she stated.
When the child starts to move and has swelling of the joints and is falling, that is not normal and this should alert parents that all is not well. Also, when the child bleeds a lot after suffering a minor cut or after an extraction or has black and blue marks, parents should seek medical attention.
Severe cases
In the severe cases of hemophilia, the patients can just bleed spontaneously and Bemaul-Sukhu noted that it mostly manifests in male children who are usually more active than their female counterparts. And it is usually the mother who is the carrier of the condition.
“So they would have bleeding continuously in the joints and things like that. So over a period of years they develop deformities. Presently we have one of our hemophilia patients, he is in a wheelchair, his joints and limbs are so frozen that he can’t bend them,” she said.
The boy is a teenager who did well at his CSEC examination and his parents have to carry him to do everything and “the impact it has on the quality of life is so terrible,” she added.
At present, they are on a drive to prevent the bleeding by giving the children the factor infusion twice a week prophylactically, along with the adults who have severe hemophilia. Children who exhibit such bleeding problems are referred to GPH and the requisite test is done. There is awareness and medical personnel will refer both children and adults to internal medicine at the GPH, where they are then sent to the hematology department headed by her.
Mostly Dr Bemaul-Sukhu’s service is outpatient and she has a clinic from Monday to Wednesday where patients with bleeding disorders are sent. She also sees patients who are hospitalised if the need arises and she works along with others in managing them.
“I feel more complete in terms of something that was lacking usually in Guyana, that we can address these cases and know specifically what to do instead of guessing… Like for example sickle cell patients… my goal is if I can see all the sickle cell patients at least one or two times will be good,” she said.
She wants to see those patients and set out a plan and once this is activated she can refer them back to the health centres where they were before. According to Bemaul-Sukhu there is medication for the condition but patients need a lot of monitoring and that is a big part of what the clinic does. Once the patients are stable they can be referred out as there are a lot of patients.
On record, there are 22 patients with hemophilia A. Three adults and two children are the most severely affected and they have been getting the Factor VIII injection twice a week, along with two who have hemophilia B.
She pointed out that in the past if medical personnel knew patients had hemophilia they would not touch them, even to do dental work but now through the clinic contact is made with the dental school and the patients will go via appointment to access the service.
She works along with the dental school and they are accommodated but they are pre-medicated before being sent.
“The whole idea is to have awareness so persons can start to recognize that maybe something is not right and it doesn’t mean it is hemophilia alone, but like I said it could be some bleeding disorder,” the doctor said.
The hematology department also takes care of patients with blood clots and also monitors cells that can abnormally increase or decrease in number. There are also bleeding disorders caused by other illnesses such as kidney and liver conditions.
If patients need surgeries the department works along with the teams conducting the surgery so that it is done, which, according to the doctor, “is a real big step because in the past nobody would touch a hemophiliac”.
Always liked medicine
Bemaul-Sukhu was always on the path to becoming a medical practitioner, as even in secondary school she knew she liked medicine. But it was cemented when her mother- Bibi Monzealeen Razack and who has been her rock throughout-for whom she is the only child, expressed the wish for her to do so, as it was a career path she herself had wanted but did not get the opportunity to pursue. Her grandfather also expressed the same wish and for her the decision was already made.
For her, most doctors must have that feeling of compassion and care for patients and that must be one of the reasons they become doctors.
“Quite frankly, it can’t be because of the money from the start because the money you make from the start you will be amazed how little it is. So for me from the start it could have never been the money because there wasn’t any big money…,” she said.
It is only after a doctor has chosen to specialise and work privately (she has a private clinic) that they can do better financially.
“Compassion is a big thing and I like to see when you can do stuff for people and they can get better. For example, the joy is having a patient come in as sick as ever and have the patient walk out and say you know what thank you. For me that is the biggest, biggest reward that you can have,” she said. “It is a very fulfilling profession.”
Bemaul-Sukhu is married with two sons, Timothy and Nicholas, and she said she has been able to do what she does because of her supportive family, especially her husband, Davindra Sukhu, and mother.
She is the founder of the Save a Life Charity, which is involved in charitable work and medical outreaches to various communities and orphanages among others.
