The Hugh Wynter Fertility Management Unit

Dr. Vernon DaCosta

Director

The Hugh Wynter Fertility Management Unit (HWFMU) under the direction of Dr. Vernon DaCosta continues to make strides to improve Clinical Services, Training, Research and Outreach, its four, interconnected areas of focus. The HWFMU has aligned its activities with The UWI’s Triple A Strategy to achieve greater access, alignment and agility in advancing the sexual and reproductive well-being of the Caribbean and the diaspora. Special attention is continuously paid to developing a caring team of experts to serve Jamaica and the wider region.

ACCESS

Clinical Services

The retooling of the clinical infrastructure together with staff training has contributed to effective delivery of the clinical services, namely; family planning, minimally invasive gynaecological surgeries and assisted reproductive technology. During the review period, the HWFMU registered 278 new patients for family planning.

Clinical services delivered during the reporting period included:

  • 954 contraceptive services to the University Hospital of the West Indies outpatients (Table 1)
  • 1919 contraceptive services to HWFMU patients (Table 2)
  • 426 surgical services to HWFMU patients (Table 3)

Table 1. Family Planning Methods provided by the University Hospital of the West Indies (UHWI)

Table 2. Family Planning Methods and Procedures provided to HWFMU Clients

Table 3. Surgeries and other Procedures Performed at the HWFMU Clinic

Assisted Reproductive Health Services

Access to in vitro fertilisation (IVF) services continue to expand with the HWFMU offering care in line with international standards. The preimplantation genetics testing (PGT) programme was established in February 2019. Prior to embryo transfer, IVF patients now have the option to test for genetic disorders such as sickle cell. Additionally, the laboratory embryo culture systems have been optimised and the ongoing pregnancy rates have improved significantly. During the review period HWFMU performed 722 assisted conception procedures (Table 4).

Table 4: Assisted Conception Procedures Performed at the HWFMU Clinic

Student Development

Final year MBBS students on obstetrics and gynaecology rotations were facilitated by the HWFMU’s IVF team for clerkships in Minimally Invasive Surgery and Assisted Conception. The clerkships were conducted in ten-week rotations and allowed for teaching and learning around IVF lab operations.

Dr. Kamali Carroll currently supervises Lance Sterling, candidate for the Master of Philosophy in Applied Physics, Faculty of Science and Technology, UWI Mona.

Training

The MSc Counselling programme: continued to be suspended during 2018/2019. The programme is under review with the aim of restructuring including modifying the curriculum to a two-year programme; offering primarily online delivery and facilitating annual student intake.

Thus far, key strategic actions have included the establishment of a Curriculum Working Group (CWG). The CWG, together with other professionals and interim staff have reviewed the programme to optimise for online delivery, and developed and assessed new programme and course outlines. A proposal and project budget have also been completed.

During the review period, twenty students were enrolled in the programme. Four students have withdrawn, eleven are completing research projects while two returned from leaves of absence. Seven re-sit courses were also offered between the first and second semesters with a 100% success rate. Seven students from Dominica, Jamaica, St. Lucia and Trinidad and Tobago successfully completed the programme and were recommended for graduation in October/November 2018.

The Training section has been under the leadership of Programme Officer, Miss Elaine Jackson since the Training Coordinator retired in 2018.

Intensive training in MIGS: The HWFMU partnered with ISGE and the Caribbean Association of Gynaecological Endoscopic Surgeons (CAGES) to host an intensive week of training from September 24-28, 2018. Presentations were delivered by ISGE faculty members and HWFMU Consultants. Fifty-seven participants from Jamaica and the Caribbean were trained in laparoscopic suturing techniques, hysteroscopic techniques and other areas of minimally invasive gynaecologic surgery.

Post-training, 15 doctors completed the Bachelor of Science (BSc) in Minimally Invasive Gynaecological Surgeries (MIGS) and three qualified for Masters degrees.

ALIGNMENT

In 2018/2019 the HWFMU formed strategic partnerships to better serve the needs of its target communities. The Outreach Section specifically engaged in public education, social outreach and promoted the work of the Unit through various activities.

Partnerships

CAGES and ISGE: The HWFMU has forged strategic and mutually beneficial partnerships for training in minimally invasive gynaecologic surgeries and assisted reproductive technology. Sponsors and partners in this initiative included:

  • The Caribbean Association of Gynaecologic Endoscopic Surgeons (CAGES)
  • International Society for Gynaecologic Endoscopy (ISGE)
  • Ferring Pharmaceuticals
  • Roche Diagnostics - Central America and the Caribbean

Further, the provision of pharmaceuticals has been extended, and additional service delivery points established for assisted reproductive services in Jamaica and the wider Caribbean. These partnerships have made significant contributions in upgrading the skills and knowledge of obstetricians/gynaecologists across the Caribbean in hysteroscopic, laparoscopic and assisted reproductive technology.

JMMB Bank Financing for Fertility Treatments: Addressing the growing levels of infertility in Jamaica, the HWFMU signed an agreement with JMMB Bank in April 2019 to provide up to J$ 5 million in loan financing to patients accessing the Unit’s ¬infertility treatments and related services. The agreement led to the offering of an unsecured maternity loan, the first of its kind in the Jamaican financial sector.

Health Advocacy

HWFMU’s health advocacy activities during the review period included:

  • Ongoing laparoscopic training by HWFMU Consultant, Dr. John Harriott, with doctors from across hospitals in Jamaica, including Cornwall Regional Hospital (Montego Bay), Mandeville Regional Hospital (Manchester), Falmouth Public General Hospital (Trelawny) and Noel Holmes Hospital (Montego Bay).
  • Laparoscopic training with Doctors in the Turks and Caicos Islands conducted by Dr. Vernon DaCosta, HWFMU Director.
  • Participation in Mona Campus annual Research days.
  • A field visit by MSc Nursing Administration students from The UWI School of Nursing.
  • A presentation on ‘Endometriosis and Fertility’ to the Rotary Club of New Kingston by Dr. Michelle Bailey, HWFMU Consultant during Endometriosis Awareness Month.
  • Media interviews by HWFMU Consultants Drs. Loxley Christie, John Harriott and Shaun Wynter during Endometriosis Awareness Month.
  • Participation in The UWI Western Campus, Montego Bay Medical Symposium including presentations on Assisted Reproductive Technology (ART) by the HWFMU Director and Consultants and an information booth.

Outreach

HWFMU’s outreach activities during the review period included:

  • The hosting of three representatives from the international Council to World Mission - Young Women Enabling Transformation Programme. The participants from Nauru, South Africa and Guyana were exposed to teaching, research and services in sexual reproductive health that can be useful in the transformation process.
  • Participation in the Tarrant Baptist Church Health Fair, with Nurse Yvonne Walters offering screenings and health education.
  • A presentation at the Immaculate Conception High School Medical Fair, on nursing and counselling as career paths, by Nurse Yvonne Walters.
  • Partnering with the Anne Dawson Home for Children, St. Andrew to host their Children’s Christmas Treat.

AGILITY

Digitisation of HWFMU

The HWFMU’s investment in social media advertising has helped the Unit capitalise on its growing target market. The acquisition of the Baby Sentry Database Management System has also helped the Unit to improve the management of patient information as well as staff’s ability to conduct research. Members of the HWFMS participated in a web-based training series with Baby Sentry Ltd introducing them to the application components of the fertility database management system.

Staff Accomplishments

During the review period, HWMFU’s staff published four research papers, presented another four papers and participated in 14 major international conferences/seminars.

Employee Engagement and Development

Programmes to improve professional efficiency and service delivery included training for the Unit’s Nurses, Scrub Technicians and Operating Theatre Technicians in partnership with Johnson and Johnson. Additionally, two of the HWFMU’s nurses received sponsorship to attend the Western Gynaecology Association’s one-day educational conference on the ‘Ethics of IVF, Oncofertility, Endometriosis and Infertility.’

Members of staff also completed courses in ‘Computer Literacy’ and ‘Computer Application’ and a workshop on the ‘High Performance Team’.

Finances

2018/2019 income and expenditure at the HWMFU was as follows:

Income J$ 258,198,026.02
Staff Costs J$ 63,478,069.54
Departmental Costs J$ 139,044,234.02
Net Revenue J$ 55,675,722.46
Commitments J$ 452,177.29

Public Service

Staff members at the HWFMU continue to be engaged in public service through their contributions to professional associations and various non-profit/non-governmental organisations in reproductive and mental health, administration, religion and higher education. Director, Dr. Vernon DaCosta serves as the President of the Caribbean Association of Gynaecological Endoscopic Surgeons (CAGES) and is a member of the International Society for Gynaecologic Endoscopy (ISGE).

Staff Movement

In 2018/2019 Mrs. Lilith Williams, Training Co-ordinator retired and Mrs. Neila Ingram, Administrative Assistant resigned.