Hyperbaric Medicine Selective Students Come to the Rescue of Ill Grenadian Fisherman

Each May and December, immediately following final examinations, first- and second-year students at St. George’s University School of Medicine can participate in a pair of Grenada-based selectives in hyperbaric medicine. In addition to intense study of the theoretical underpinnings of hyperbaric therapeutics, students gain practical experience, with a focus on chronic wounds associated with diabetes.

Late in 2018, however, the participants faced an even more dramatic challenge.

During a routine training session for the hyperbaric students at St. Augustine’s Medical Services (SAMS), a Grenadian fisherman showed hemiparalysis and urinary retention. Confronted with decompression sickness-related dysfunction of the brain and spinal cord, the students confidently and professionally rose to the occasion. Over approximately seven hours of supervised effort, they successfully deployed their fresh knowledge and skills, sparing their patient from a lifetime of profound disability.

When completed in succession, the selectives constitute a course that is approved by the American College of Hyperbaric Medicine (ACHM) for progression toward the professional credential of Certified Hyperbaric Technician (CHT).

“The students did a fantastic job. Enabling achievement is part of what the course was designed to do. So, to see this objective met is extremely gratifying,” said Dr. Duncan Kirkby, the course’s director and professor of neuroscience at SGU. “The students expressed genuine concern for the well-being of the patient. They were respectful, professional and highly motivated to achieve the best possible outcome.”

Dr. Kirkby worked with Lutz “Joe” Amechi, MD ’93, the medical director at SAMS, to bring hyperbaric medicine to Grenada in 2017. Previously, the nearest chamber to treat diving-related injuries resided in Barbados. The installation of the chamber at SAMS facilitated the development of the selectives, which supplement the preclinical education that medical students receive at SGU.

“There are two major expectations of participants in the selectives,” Dr. Kirkby said. “First, they rapidly develop a fledgling body of team-based practical experience that is steeped in the care of Grenadians. Second, because hyperbaric technologies are applicable to a broad and growing array of clinical conditions and disciplines, participants are expected to gain an experiential advantage in the pursuit of residencies.”

Dr. Tyler Sexton, who studied under Dr. Kirkby, supplied Grenada’s hyperbaric chamber and is the primary instructor for the selectives. He is also a visiting professor at SGU and the CEO and medical director of Caribbean Hyperbaric Medicine.

“There are over a dozen varied indications for hyperbaric oxygen therapy. Applicable disciplines include but are not limited to emergency medicine, reconstructive surgery, internal medicine, aerospace medicine, and trauma surgery,” Dr. Sexton said. “It has been my honor to join Drs. Amechi and Kirkby in bringing hyperbaric care to Grenada and promoting the professional, scholarly and personal development of the students of SGU.”

Dr. Lutz “Joe” Amechi, MD ’93, resident physician and managing director of St. Augustine’s Medical Services (SAMS), introduced the nation’s first hyperbaric chamber and a 64 slice CT machine in 2017. St. George’s University is partnering with SAMS to provide medical students with a clinical selective in hyperbaric medicine.

St. George’s University Welcomes New Class of Aspiring Doctors in White Coat Ceremony

Last week, St. George’s University welcomed its newest class of aspiring doctors to campus with the traditional White Coat Ceremony.

“It is a very special day, and the beginning of a new journey,” said Dr. Glen Jacobs, provost at St. George’s University, in his remarks before the new class. “I don’t know what it took you to get here today—each journey is different. But you should be really proud to be here.”

The ceremony signifies the start of medical school for St. George’s January class. Students can begin classes in either January or August.

Other speakers included Dr. Molly Kilpatrick, a 2013 graduate of St. George’s, who congratulated the incoming class and chronicled the history of the White Coat Ceremony. St. George’s University Vice Chancellor Richard Liebowitz offered words of encouragement and emphasized the value of a diverse student body, the importance of shared success, and the school’s extensive support network.

Dr. Daniel Herr, a 1981 graduate of St. George’s and the current chief of surgical critical care services and director of the Cardiac Surgery Unit at the University of Maryland, delivered the keynote address. He urged students to embrace new opportunities and take advantage of the globally focused education St. George’s provides.

“I advise you to really become a part of the culture of Grenada, because it will serve you well when you start going out into the medical school world, or out into the real world,” Dr. Herr said. “The real world isn’t just the United States anymore. The real world is interacting with other countries, other cultures, and learning other medicine.”

Altogether, nearly 100 countries on six continents are represented within the St. George’s student body.

Among the other highlights from the ceremony was the surprise presentation of a white coat to incoming student Aidrian Ranjith by his parents Ranjith Mahadeva and Koshela Ranjith, who are both SGU alumni currently practicing medicine in Ontario.

“I have no doubt that every student in this room is going to be successful,” said Dr. Liebowitz in his remarks. “At SGU, we’re going to do everything we can to ensure that success.”

SGU Medical Students Get Their Start in Keith B. Taylor Global Scholars Program

In January, 34 students from St. George’s University took their first steps into the medical profession at a traditional White Coat Ceremony held at Northumbria University in Newcastle, UK. They joined the prestigious Keith B. Taylor Global Scholars Program (KBTGSP), a longstanding partnership between SGU and Northumbria University that is now in its 12th year. Students in the program are able to take the first year of their Doctor of Medicine degree at NU, before settling in Grenada to continue their studies.

The White Coat Ceremony was emceed by Dr. Derrick Eyong Ebot, MD SGU ’09, who started in the KBTGSP and is now one of the program’s clinical tutors. Dr. Ebot spoke of his time studying at Northumbria before introducing the White Coat Speaker, Dr. G. Richard Olds, president of SGU.

Dr. Olds gave a moving address, drawing heavily on his personal experiences as a doctor of medicine, to impress upon the students that their motivation must always be what is in the best interest of their patients. Enrollees were then invited onto the stage to be robed in their white coats; a symbol of the responsibility society places on those in the medical profession.

“Our relationship with Northumbria University is a vital component in our ability to offer our students a truly international education,” Dr. Olds said. “By training in different countries with international colleagues, SGU graduates will have experienced a diversity of medical and cultural settings—standing them in good stead to be world-leading doctors. This is reflected in the current group of students here in Newcastle, who come from 12 countries on four continents.”

Keith B. Taylor Global Scholars Program Hosts British Association of Clinical Anatomists Winter Meeting at Northumbria University

All elements of anatomy—the backbone of medicine—were on the table for discussion and examination at last month’s British Association of Clinical Anatomists (BACA) Winter Meeting at Northumbria University, UK. Hosted by St. George’s University’s Keith B. Taylor Global Scholars Program, for which SGU’s medical students spend their first preclinical year on the NU campus, the meeting welcomed clinical anatomists, surgeons, and students from the UK and beyond.

Dr. James Coey, Assistant Dean of Basic Sciences at SGU’s Newcastle campus, and Dr. Sara Sulaiman, Teaching Fellow at the University of Bristol, hosted the meeting, which was attended by 80 delegates, primarily from the United Kingdom. It included 16 oral presentations and 29 posters covering gross, microscopic, clinical, applied, translational, surgical, and radiographical anatomy, as well as anatomy education.

The conference included a plenary lecture from Dr. Stephen Clark, a consultant cardiothoracic surgeon at the Freeman Hospital in Newcastle, and professor of cardiothoracic transplantation, presented on the topic “Heart Transplantation: Anatomy and Surgical Techniques.” SGU’s Marios Loukas, dean of basic sciences, professor of anatomical sciences and president of the American Association of Clinical Anatomists (AACA) presented a keynote titled “A Snapshot of Anatomical Translational Research and its Applications.” SGU was further represented through two oral presentations and four poster presentations from clinical faculty (Drs. Al-Jaberi, Bourne, Ebot, Elajnaf and Hilal) and Nosheen Sandhu, a first-year medical student, working in a research group led by Drs. Coey and Hilal with local and international collaborative partners.

“I believe in collaboration as a channel of continuous advancement and progress,” Dr. Sulaiman said. “Hosting a BACA meeting where the best minds of anatomy come together under one roof for an entire day is the perfect opportunity to drive new ideas and foster future partnerships.”

“This conference has clearly demonstrated what can be achieved through reinforcing links between partner associations, establishing new academic and clinical connections, and fostering future collaboration,” added Dr. Coey. “Encouraging students, physicians, and academics alike to engage and participate is paramount to the future of our associations”

Dr. Sulaiman began attending BACA meetings when she was a student at the University of Dundee in Scotland, calling them a “supportive, nurturing environment” that helped her thrive as a researcher. Drs. Sulaiman and Coey went on to design a selective in 2015 for SGU students to introduce the research cycle and further their anatomical knowledge through a self-directing learning exercise. Since its inception, 33 students have presented their work at international conferences leading to publication abstracts in clinical anatomy.

“I’ve had my students attending and presenting across the years and I was so glad to see them benefiting from its encouraging and stimulating atmosphere as I did years ago,” she said. “To me, hosting a BACA meeting was a dream and being involved in organizing a world-class, well-recognized scientific meeting was truly an amazing experience.”

Founded in 1977, BACA aims to advance and publish the study and research of clinical anatomy in the United Kingdom. The organization hosts two scientific meetings each year, providing an opportunity for members and other attendees to network with fellow academics and clinicians who share an interest in anatomy. In addition, the Journal of Clinical Anatomy, a collaboration between BACA, AACA, and international associations from New Zealand, Australia (ANZACA), and South Africa (ASSA), publishes eight times each year, displaying original and review articles of scientific, clinical, and educational interest.

The success of BACA helped spawn the AACA in February 1983. Dr. Ralph Ger, a professor in Albert Einstein College of Medicine’s Department of Anatomy, had attended the BACA meeting in 1982. He recognized the need for a better forum for clinicians, teachers and students to discuss the status and future of anatomy, and later became one of the AACA’s 18 founding members.

From U-2 Pilot to OB/GYN: A Veteran Reflects on Her Career Path

When Cholene Espinoza, MD SGU ’15, looks back on her childhood, she remembers imperfections and failure.

“I was always kind of a screw-up as a kid,” said Espinoza, chief resident in Cedars-Sinai’s Department of Obstetrics and Gynecology. “I started first grade when I was five, so I was always feeling behind and was often put in the corner for being disruptive in class. I was independent and never really fit in to the traditional educational system.”

For years, Espinoza struggled to focus academically and socially, but the summer before seventh grade, she had an epiphany: “I remember telling my mom I didn’t want to be a loser anymore.”

She hasn’t let her mom down. Espinoza’s stellar career and life have played like a Hollywood movie with her roles including—an elite spy plane pilot; a passenger originally scheduled to board one of the ill-fated planes on 9/11; a wartime journalist; a Hurricane Katrina volunteer; a published author and, finally an OB-GYN who has a profound reverence for human life.

As Veterans Day approaches, Espinoza, an Air Force veteran, reflected on the meaning of the day and how her own service changed her life and set her on her path to becoming a physician.

“What is would say to veterans is, ‘thank you. We’ve served together, you kept me safe and there’s not a day that goes by that I don’t appreciate you in every way,” Espinoza said.

Espinoza’s Military Career Takes Flight

At 17, Espinoza enrolled in the United States Air Force Academy in Colorado Springs, Colorado. In the 1980s, when she was a young cadet, the Academy limited female enrollment to just 10 percent of a class. (With those gender restrictions now gone, last year’s freshman class at the Academy was about a quarter female.)

“Like anything in life, there were moments when I struggled, and things or comments happened that shouldn’t have,” she said. “But it taught me to surround myself with supportive, good people and to work through the hardships.”

A Path Discovered

But more hardships were to come. Around Christmas of her sophomore year, Espinoza’s father died. The shock and grief soon led her to an unexpected, but clear path.

“I was taking a course in glider flying and it enabled me to get over my father’s death on some level,” she said. “Flying came natural to me when nothing else in my life had.”

After graduating, Espinoza served as a flying instructor for four years, and later, she was selected as a U-2 spy plane pilot for the 99th Reconnaissance Squadron at Beale Air Force Base, California–the only U-2 squadron in the world.

U-2 spy planes are single-jet engine, ultra-light gliders that maneuver on the edge of the earth’s atmosphere. Designed to avoid enemy detection, the planes are equipped with sophisticated instrumentation that provides vital intelligence, day or night and in all-weather.

In a 12-hour mission, the aircraft can capture extraordinarily detailed imagery of a country the size of Iraq. And while much about the aircraft remains classified, Espinoza points out the planes do far more than reconnaissance—they also aid in peacekeeping and directing humanitarian aid.

Flying solo missions in U-2 plane can be an otherworldly, almost spiritual experience, said Espinoza. Wrapped in the cocoon of her space gear, she can sometimes still feel the stillness of the open sky and the brilliance of the earth.

“I would fly across Europe all night and it felt as though I could just reach out and touch the stars,” she said.

But along with the beauty came harsh reminders of the chaos on the ground.

“I would fly over beautiful civilizations like France and Germany, but when I made it to my target areas, it would be pitch black,” she said. “Then, I would see a flash of light and know it was a blast, and that meant someone is killing or someone is dying. It always gave me reverence for how fragile human life is and how unjust war is.”

Espinoza observed war from the quiet remove of a spy plane, but with each mission she would feel a stronger urge to assist those affected on the ground.

“I couldn’t directly help people from the stratosphere and that propelled me to eventually get out of the Air Force cockpit,” she said.

From Above 70,000 Feet to 30,000 Feet

Espinoza left the Air Force for a career in commercial flying with United Airlines and then Emirates Airlines–allowing her to travel to every continent except Antarctica.

“As a commercial pilot, I had to be broken of my ‘single pilot mindset’ and not disregard input from others,” said Espinoza. “Success was based on the efficacy and quality of the entire crew.”

Espinoza was working for United Airlines on September 11, 2001, when terrorists hijacked four aircrafts and slammed two of them into the World Trade Center, one into the Pentagon and the fourth in a Pennsylvania countryside.

She was not scheduled to fly the fourth plane hijacked that day, but was supposed to be a passenger. The flight boarded in Newark, and was supposed to land in San Francisco. It never made it.

“I was living in New York City at the time and had just accepted a bid to be a captain out of San Francisco,” said Espinoza. “I planned to take the flight as a passenger to find a new home in San Francisco, but the crew desk realized I had gone over my flight limitation hours, so the first leg of my trip was cancelled and I wasn’t on Flight 93.”

Espinoza’s United Airlines colleague and former Academy classmate, Leroy Homer, Jr., was co-piloting the airplane that crashed in Pennsylvania.

“I knew Leroy since I was 17 and had just seen him in London on a layover,” said Espinoza. “He was happier and more content than I’d ever known him to be, showing me pictures of his daughter and wife. I often think of him that day in Hyde Park, with his smile, wishing I’d been there for him on that flight.”

Espinoza’s Service Shifts from Sky to Ground

The events of 9/11 soon led her to take a pair of three-month leave from United Airlines to cover the Iraq war as a civilian radio journalist. Her first tour was with the Marine Corps and the second, and third with the Army. Espinoza worked as an embedded journalist for Talk Radio News Service (now Talk Media News), which gave her an opportunity to come face-to-face with war—both its injustice and its heroism.

“I departed Iraq from mobile hospital in Iraq and there were surgeons trying to save children who had limbs blown off from mines and ammunition,” said Espinoza. “The medical teams were trying to make something right out of something so horribly wrong. When you’re in the middle of a war, you see the destruction and insanity of it, and then you see these beautiful acts.”

Espinoza witnessed how war changes people.

“In order for me to overcome what war had done to me, I needed to engage and fix what was broken,” she said. “That’s what inspired me to leave the cockpit for good and directly take care of people by switching careers from pilot and journalist, to doctor.”

But before taking care of people as a doctor, Espinoza’s desire to serve brought her to Mississippi’s Gulf Coast in 2005 after Hurricane Katrina.

“On our first trip to Mississippi, my spouse and I connected with a small community and fell in love with the people and their struggle,” said Espinoza. “We realized how many people drowned from the storm because they didn’t know how to swim, since there were no community centers or public swimming pools.”

So, the couple made it their mission to change the community’s access to water safety by raising money to build a public swimming pool. Amid rebuilding and spending all of her down time and vacation days on the Gulf Coast, Espinoza penned a novel, Through the Eye of the Storm: A Book Dedicated to Rebuilding What Katrina Washed Away.

“I realized each of us has something to give and that gift is desperately needed in our world,” said Espinoza. “For me, being gay had not stopped me from serving two of my greatest loves in life, God and country. This book is the story of my life, the lives of truly heroic Americans and the transformation of my spirit that took place unexpectedly in this small Mississippi town.”

The proceeds raised from the book, which she wrote and published in less than one year, supported the rebuilding of one of the most hurricane-ravaged communities on the Gulf Coast. The writing process helped Espinoza accept herself completely.

“It wasn’t until I was out of the service that I wrestled with my own identity,” said Espinoza. “In the service, I didn’t have relationships with women, I focused on flying. I had tried to deny that part of who I was but realized through the writing and humanitarian process a stronger desire to live authentically.”

Becoming a Doctor: Her Final Mission

In 2009, after what many would consider an already fulfilling and long career, Espinoza started her journey of becoming a doctor. Then 45 years-old, Espinoza started over with preclinical and then graduated from St. George’s University School of Medicine in Grenada, West Indies at the age of 50.

“I have the distinction of starting menopause and residency at the same time,” Espinoza jokes.

Espinoza started her residency training in Obstetrics and Gynecology at Cedars-Sinai in June 2015 and is scheduled to finish this coming June. She has been accepted to be re-commissioned into the military as a Reserve U.S. Army OB-GYN. She can be deployed to any medical surgical unit, nationally or internationally.

“Military medicine is what first inspired me, but I thought I was too old for the military,” said Espinoza. “But they desperately need doctors.”

While she’s not serving on Reserve duty, Espinoza plans to work in South Sudan, a struggling country where she has been working and traveling for over six years–first being trained by the South Sudanese when she was a medical student–not teaching and practicing as a doctor.

“With each trip, I can do more, because I’ve learned more here at Cedars-Sinai.”

Above all, residency has been the challenge of her lifetime.

“With medicine and obstetrics specifically, there are no permissible errors,” said Espinoza. “It’s the same as flying jets–there is a certain level of intensity and desire to execute perfection, which drives and motivates me to work harder every single day.”

But, as Espinoza knows, whether in war or in medicine, mistakes are inevitable.

“I start each day with a sense of humility and respect for human life and for people across all socioeconomic levels,” she said. “That humility comes from seeing a lot of bad things happen and knowing I, too, have made mistakes. But every day is an opportunity to try to do better, let go and forgive ourselves.”

And at a time in her life when many people would be slowing down, Espinoza is relishing her uncharted journey ahead.

“I have been blessed with a rich life and experiences, but without question–the most magical, beautiful thing I have ever experienced in my life or career is being in the room when a baby is born,” she said. “Any pain, loss, or hurt parents may have previously felt evaporates the split second their baby is born. Witnessing and participating in birth is the privilege of a lifetime.”

This story, video and photos originally appeared on the Cedars-Sinai Medical Center website. They have been published here with permission from Cedars-Sinai.