It was not the best of times to visit London; cost of living crisis, environmental protests, rail strikes, tube strikes, bus strikes, even a nationwide nurses strikes! There were lots of distractions and uncertainties around. Prof Baba had just retired from his clinical role when I arrived at Evelina London Hospital, which is the children’s hospital in Guy’s and St Thomas NHS Trust (GSTT). So I was introduced to the paediatric sickle cell team, led by Dr Samah Babiker who took me in and made me feel a part of the team. There was a good balance of business and humour! We had clinics, ward rounds, multi-disciplinary team meetings, even occasional trips to the haematology lab to view slides under the microscope. The team dynamics and communication was great. Someone was always ordering coffee, even though I found it hard to indulge. Then there were chocolates, biscuits and lots of snacking to douse the atmosphere during meetings. And people hurled banters all over the place at every opportunity. I really felt at home, and it made the London chaos inconsequential.
I observed up close the management of a broad range of sickle cell disease vasculopathy manifestations: patients with abnormal transcranial Doppler (TCD) velocities maintained on red cell exchange programs, the application of the TWiTCH study, neuro-psychological assessment for patients with vasculopathy, and post-stem cell transplant patients who had previous stroke and severe sickle phenotypes. There were also patients who were referred to the school for educational psychology assessments and an education and health care plan (EHCP) in order to provide additional special educational support to meet the needs imposed by their neuro-disabilities.
The other aspect of my secondment experience was to undergo TCD training for which I was mentored and tutored by Dr Soundrie Padayachee, the TCD lead for the UK National Haemoglobinopathy Panel. It was a predominantly one-to-one instruction and interaction. There were lecture sessions and practical sessions, I scanned volunteer subjects and sickle subjects. I came a novice, and left quite proficient in imaging and non-imaging TCD techniques.
To share some of my experience with my hosts, I did a teaching session for the sickle team in which I chose to discuss the relationship and interactions between malaria and the sickle gene. The session highlighted how the scourge of malaria in sub-Saharan Africa and the tropics influenced the development of the sickle gene where the trait protects from severe malaria but the homozygous state becomes lethal giving rise to a balanced polymorphism.
The icing on the cake for my secondment was attending many international conferences and personal development courses. Top on the list was the Academy of Sickle Cell and Thalassemia (ASCAT) conference 2022, the UK Forum for Haemoglobin Disorders academic meeting, and the International Pathology Day of the Royal College of Pathologists.
Coming back home to Zaria, I believe the secondment has empowered me to set up a TCD clinic in ABUTH where hundreds of children afflicted with sickle cell disease will have the opportunity of routine TCD screening to help in the management of their condition and prevent stroke occurrences which hitherto have been unacceptably high.
Dr Jamilu Faruk Abdullahi