Letter of the Day | Prof Graham Serjeant transformed the outlook for sickle cell patients

THE EDITOR, Madam:

Graham Serjeant –whose life’s work was in sickle cell research and the care of persons with complications of the disease – passed away recently. This is my letter of appreciation written on behalf of Jamaican beneficiaries, and also for his personal mentorship.

In his autobiography, Sickle Cell, Jamaica and Beyond, Serjeant informs us that his parents, being Quakers, “raised him to believe that there is ‘that of God in everyone’”. He also recalled his high school zoology teacher’s remark, that “the thing [he lacked] most [was] a genuine compelling interest in the work for its own sake”. These experiences, I believe, are clues to his “core motivations”.

I first came across Prof Serjeant when he and a team of health professionals drew blood from students being screened for sickle cell disease at my alma mater, Excelsior High School ( circa 1968). At that time, students and teachers knew next to nothing about sickle cell disease, even though at least 10 per cent carried the gene for sickle cell disease, and could pass it on to their offspring. Serjeant’s work at the Sickle Cell Unit at the University of the West Indies led to Jamaica becoming aware that sickle cell disease, although having a variable course, causes severe complications, including bone pain, pneumonia, blood infections, chronic kidney disease, and strokes. His work in screening and follow-up with newborn children, infection prevention, parental education and proactive outpatient care has transformed hospital management and patient survival.

DISEASE’S FOREMOST AUTHORITY

While research work during his tenure at the Sickle Cell Unit was financially covered by the British Medical Research Council, care for the sick was not. He had to secure financing locally for a functioning clinic, knowing that it could be deemed unethical to conduct research on subjects with a lethal disease and not shoulder some responsibility for their welfare.

He made sure that patients not only got healthcare on the grounds of the research facility, but, exceptionally, took the sickle cell clinic into their villages and homes.

Serjeant first arrived in Jamaica on August 6, 1966. He died on March 25, 2025 after a chronic illness. He obviously was determined to live and die in Jamaica, because he refused offers to finance his return and extend his working life in England at retirement. Harking back to the lesson inherent in his high school teacher’s comment, Serjeant worked assiduously in a manner as if service, in and of itself, was its own reward. Through individualised care, he transformed the outlook for patients with sickle cell disease, and by publishing internationally he became the disease’s foremost authority. He exported universally applicable interventions developed in the Jamaican clinic to Africa, India, Brazil and Saudi Arabia. He hunted down sickle cell disease patients on the hospital wards to ensure that the care they received was of a high standard. He was especially intolerant of practices that strayed from established protocols of care. On the local and international scene there was none like him, which is why I will say without risk of contradiction: Graham Serjeant, he above all, relieved suffering and extended lives in sickle cell disease.

In 1988, I approached Serjeant for assistance in completing a paper titled Cholecystectomy in Sickle Cell Disease, which he corrected, walking me through the script, line by line. The lessons learnt from this early interaction prepared me well for more challenging work in the future. Serjeant’s support could always be counted on later when I applied for the Commonwealth Scholarship in 1989, and the American College of Surgeons International Guest Scholar Award in 1995. Serjeant’s support was fulsome, never half-hearted. My experience was replicated many times over.

When the famous Hungarian tropical surgeon Imrie Loefler needed an essay to be written for the Journal Surgery, Serjeant recommended me and assisted me by providing data. My essay, titled Sickling and the Surgeon, was subsequently printed in a special tropical edition of that journal in 2006.

Serjeant collaborated with the paediatric surgical service at the University Hospital when he set out to discern whether sickle cell disease patients subjected to splenectomy were placed at a disadvantage because their spleens were removed. Through detailed records, meticulous follow-up and expert statistical analysis, he was able to prove in the Journal of Paediatrics in 1999 that these patients were in no way jeopardised by that surgical procedure.

NEWTON DUNCAN

Professor Emeritus of Surgery,

UWI