CDRC
CHRONIC DISEASE RESEARCH CENTRE
TROPICAL MEDICINE RESEARCH INSTITUTE
UNIVERSITY OF THE WEST INDIES (CAVE HILL)
Jemmotts Lane, Bridgetown
BARBADOS
Tel: (246) 426 6416 Fax: (246)
426 8406
Email:
______________________________________________________________________________________________________
Development
The CDRC was conceptualised by the School of Clinical Medicine and
Research, at the Cave Hill Campus of the University of the West Indies (UWI),
in 1990, in response to the
growing epidemic of chronic non-communicable diseases in Barbados and the
Caribbean. High blood pressure,
diabetes,
obesity, heart disease and their
complications now account for the majority of death and disability in most of
the region. The CDRC was
approved by the UWI in 1989 - 90 and incorporated in its successive 5
year strategic plans, with Professor Henry Fraser as Honorary Director.
Development was delayed by the economic crisis of 1991, but two
important projects were carried out between 1991 and ’95, with external grant
funding:
the International Collaborative
Study of Hypertension in Blacks, in collaboration with researchers at the
University of Loyola in Chicago (funded by the
National Institutes of Health);
and Care of Chronic Diseases, in collaboration with the University of London
(funded by the Overseas Development
Agency of the UK). When these funds ended in 1995 a CDRC Appeal was launched to raise funds for 3 core academic posts for three years. This
was successful, with an
enthusiastic response from the private sector of Barbados, particularly the
leading insurance companies.
Researchers, including
a biostatistian, were appointed on a phased basis. This allowed slow but steady growth in the
research work of the centre, its impact through training
and collaboration on other
research efforts in Barbados in particular, and public and government
sensitisation to the need to address the chronic diseases
and HIV / AIDS more
aggressively.
The CDRC was incorporated, in the year 2000, into a new, University -
wide Tropical Medicine Research Institute (TMRI), designed to increase
research on the major
health problems of the region. The other centres linked through this
Institute are, at present, the Tropical Metabolism Research
Unit (TMRU), the Sickle Cell
Unit and the Epidemiology Research Unit on the Mona Campus of the UWI,
Jamaica. The CDRC collaborates
closely with
these other centres as well as
the School of Clinical Medicine and Research (SCMR) at Cave Hill / Queen
Elizabeth Hospital, and other local health care staff,
in its research programmes, in
order to create a critical mass of specific skills, achieve successful
partnerships, and lead in turn to the application of research
findings in health care. It
continues to raise research funds through international medical research
funding agencies as well as local donations.
Current staff
compliment is 15, of which two
thirds are funded through grants and contracts. Some indication of the impact of its work may be given by the
fact that 14
papers from the Centre were
presented at the Caribbean Health Research Council Conference in Nassau in
2003, and several papers at international conferences
in Paris and the USA.
Physical facilities
In 1992 the Ministry of Health agreed to provide a site - an apartment on the ground floor of
Avalon, a historic nineteenth century merchant’s house on the
corner of Jemmott’s Lane,
adjoining the Sir Winston Scott Polyclinic and within “a stone’s throw” of both
the QEH and the Ministry of Health.
First we
worked out of three small rooms,
but in 1998 most of the restoration was completed and the Minister of Health
declared the CDRC at last formally open!
Three rooms upstairs were later
handed over for our rapidly expanding projects, and the Centre’s handsome pink and
white structure is now quite a well
known landmark. The latest addition to the site is a large,
40 foot container, converted into a state of the art laboratory for molecular
and vascular research.
The new lab will be called the Edmund
Cohen Vascular Research Laboratory, or the ECOVAR Lab, in honour of the
generous donor who provided the
funding at a moment of need. A
renewed covenant from SAGICOR Life Insurance Inc. also helped to fund
alteration of the building to provide integration
with the laboratory,
declared open on March 30, 2004.
Equipment, like salaries, has come from many sources, but chiefly from
the generosity of the corporate sector of Bridgetown (see Box), while the Oscar
Davis
Library was established through the Oscar and Rosa
Davis Trust. The new ECOVAR Lab will
be largely equipped by a grant from Bayer.
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Mission Statement
“To improve the health of the
population and promote human development through research into the prevention
and management of the
lifestyle related chronic diseases, so as to inform national and regional
health policies
and programmes (governmental and non-governmental).”
The prime goal of the CDRC is to focus on the major chronic
diseases (high blood pressure, diabetes, obesity and heart disease) which are causing most of
the morbidity and mortality in the Caribbean today, and carry out the appropriate research which
will lead to the best and most
cost-effective prevention and
treatment strategies. It will collaborate both with the Ministry
of Health and with other institutions such as PAHO / WHO and non-governmental
organisations
such as the Heart Foundation of
Barbados, the Diabetes Association of Barbados and the Barbados Cancer
Society. It will place emphasis on research that is
essential for improving health
care, and it will play a key role both in training for research skills, in
education, consultation and advocacy, as required. An add
itional goal, agreed after its inception, has been to carry out the
Essential National Health Research urgently needed for guiding health
policy. It therefore agreed
to carry out under contract for
the Government of Barbados a major HIV / AIDS Situation Analysis and Economic
Impact Study, beginning in 2001 and on-going.
Funding
Funding for the CDRC has come from five sources:
1.
The UWI provided a part
time Honorary Director, a secretary and support funding, until 2000, when the
Centre became a part of the TMRI and
2.
funding from the “University
Centre” was established for core academic posts and two support posts. The Board for Graduate Studies and Research
3.
has also funded research
projects.
4.
The Government of Barbados (Ministry of Health) has provided a
building, its maintenance and some support services. It has also loaned a
5.
senior public health nurse to
work with the Barbados Register of Strokes (BROS), funded by the Wellcome
Trust.
6.
The Corporate Sector of Barbados and several Trusts and
individuals, through the CDRC Appeal, have provided salaries and partial grant
support.
7.
The Caribbean Development Bank.
8.
Several international agencies, notably the Wellcome Trust
of the UK and the ODA of the UK have funded research on diabetes,
hypertension
9.
and the health of the elderly,
as well as the National Institutes of Health (NIH) of the USA,
which is funding our latest major project, The Bar-
10.
bados National Cancer Study.
WHAT WE’VE LEARNT FROM OUR RESEARCH
Collaboration in the International
Collaborative Study of Hypertension in Blacks (ICSHIB), led by Professor
Richard Cooper of Chicago, and funded
by the NIH,
produced comprehensive data on the high levels of obesity, high blood pressure and diabetes. Nearly 30% of our women are obese, 30% of
adults
have high blood pressure and over 10% of all adults have diabetes. Obesity is a major cause of high blood
pressure.
The ODA funded study of the Care of
diabetes and hypertension (in Barbados and Trinidad) showed the areas of
deficiency in primary care. This led
to
the development of Guidelines for the care of
Diabetes and Guidelines for the care of Hypertension in the
Caribbean, through the auspices of the Carib-
bean Health Research Council (CHRC).
The Barbados Diabetes Intervention Study
(BDIS) showed that a lifestyle intervention in adults at high risk of
diabetes could improve glucose tolerance
and
promote weight loss.
The Adolescent Health and Fitness Study
(AHFIT) has evaluated, in 1999, health habits and activity patterns in
secondary school children, and attempted
to
correlate them with levels of fitness. This study was done in collaboration
with Ms. Beverley Griffith, Physical Education
Teacher of Queen’s College,
and Professor Jack Douglass of the University of
California.
A study of the lifestyle, Diabetes and health
indices of Seventh Day Adventists was carried out, in collaboration with
the SDA Churches of Barbados, to
evaluate the well known healthy life style of
Adventists and its impact on diabetes, hypertension, cholesterol etc. It demonstrated that a vegetarian life style
reduced
the risk of obesity
A very large and challenging study was carried
out on the Health and well being of the Elderly, with Dr. Anselm Hennis
as Principal Investigator and
collaboration with Dr. Farley Brathwaite of the Faculty of Social
Sciences. This is the SABE / PAHO seven country study in
Latin America and the Carib
bean.
Barbados is the only English speaking country. Almost 2,000 subjects over 60 years were interviewed. It was funded by the Caribbean Develop-
ment Bank with seed money from PAHO,
and will provide a major input in to the health and social care of this very
rapidly growing segment of our population.
In conjunction with this study is an exciting, UWI
(Cave Hill) funded study of Centenarians in Barbados, in which
factors causing extreme longevity,
health,
anthropometry, nutrition and functional status, and psycho social evaluation of
our large number of living centenarians is being carried out by Mrs.
Susan
Archer.
A Wellcome Trust funded study of Amputations
in diabetics has just been completed.
This is a collaboration with Professor Nishi Chaturvedi of Imperial
College,
London. It will provide a detailed
prospective evaluation, including assessment of peripheral and autonomic
neuropathy, of diabetic amputees, with
an
anticipated 300 patients over two years. It has provided the most accurate
figures in the Caribbean on diabetes amputation, patterns and associated
factors,
and
showed a very strong link between poor footwear and amputations. The Director of this project, Dr. Anselm
Hennis, was also the Local Director of the
very
large Barbados Eye Studies, designed and coordinated by Distinguished Professor
Cristina Leske of the State University of New York at Stonybrook.
This study has made a major contribution to the
understanding of eye diseases in our population, with some 40 international
peer-reviewed publications.
The HIV / AIDS Situation Analysis and Economic
Evaluation Study was initiated by the Ministry of Health, and led by Principal
Investigator Mrs.
Sarah
Adomakoh. It has had many components,
and has been a model of collaboration with other HIV / AIDS sectors,
particularly the HIV / AIDS Ref
erence Laboratory and the National HIV / AIDS
Commission. Among other things the
project has demonstrated the great savings in morbidity and mor
tality, and in hospital admissions and costs,
resulting from introduction of well monitored HAART therapy.
PRESENT
WORK
The Barbados Register of Strokes (BROS) is
a national register of first time strokes, funded by the Wellcome Trust of the
UK, in collaboration with
Professor Charles Wolfe of GKT, University of London and Professor
Rainford Wilks of the ERU / TMRI, UWI, Jamaica, and starting in October 2001.
It is
led by Dr. David Corbin, Consultant Neurologist and Associate Senior Lecturer
with the School of Medicine. The
team networks with the entire
health
care system, public and private, to identify all patients. It has now collected data on more than 600
subjects, evaluating them in the first week,
at 3 months and at one year. Findings are being
compared with blacks and whites in South London. It has found that one first time stroke occurs every
day in
Barbados. Findings are shared as they
emerge with the health sector, and have major implications for health planning
and care.
BROS is now the longest continuously running
national stroke register. It is currently supported by loan of a senior nurse from the Ministry of Health
and by
the CDRC Appeal Fund, but until another international grant is obtained,
local funding is urgently needed.
The Barbados National Cancer Study is a
major study of cancer of prostate and breast, the leading types of cancer in
Barbadian men and women. It
is both
a national incidence study and a genetic and family study. It is funded by the National Institute of
Health and is a collaboration over 4 years with
Professor Cristina Leske of the State University of New York at
Stonybrook and the Department of Biological Sciences of UWI, Cave Hill. Dr.
Anselm
Hennis
is Principal Investigator - we believe this is a first, to have an “overseas” P.I. on an NIH grant!
HIV / AIDS work continues on several
fronts. Support has come for
institutional strengthening from the European Union funded SIRHASC
project.
This
provided two lecturer salaries, Mrs. Sarah Adomakoh and Mrs. Juliette
Sutherland. Mrs. Sutherland has led the
work of UWIHARP at Cave Hill
including curriculum developments to incorporate HIV / AIDS
material in many course, while developing
new curricula and new courses;
and multiple
approaches to training of lecturers and students - e.g. workshops
to prepare students as Peer Educators.
Current work is also focussing on Stigma and
- Discrimination.
The elderly will continue to be a focus of
the CDRC, with the publication of the full report of the SABE Study of the
Elderly. An Alzheimer’s Asso-
ciation grant has been received, to fund work on
Ascertaining Cognitive Function and Dementia in African-Caribbean Populations
by Mrs. Susan Archer.
Mrs.
Archer is also engaged in diabetes management guidelines research, in
collaboration with Dr. Anne Carter at the SCMR.
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THE FUTURE
The Strategic Plan for 2002 - 7 includes
expansion through initial self financing and grants, contract research and
collaborations.
This has been
moderately successful with covenants particularly from Mr.Richard Brown and
from SAGICOR, and international
grants
from the Wellcome Trust and the NIH. Temporary posts in Health Economics,
Biostatistics and Data Management need
to be established.
Plans for a new Vascular Research Laboratory
have been facilitated by a generous
gift from Mr. Edmund Cohen. The ECO-
-VAR Laboratory will be run by our newest
Faculty member, Dr. Clive Landis, formerly of Imperial College (the Royal Post-
graduate Medical School at Hammersmith
Hospital), London, who has been initially appointed to the TMRU and seconded to
the CDRC.
Dr. Landis will be collaborating with Dr. Hennis on the pathogenesis of
“the diabetic foot”, with Professor Forrester
on
sickle cell disease, and Dr. Adomakoh and Dr. Abayomi on HIV / AIDS and Dengue
fever, using common molecular research
approaches.
Other exciting and challenging proposals are
being developed. The CDRC is a part of
the new alliance of UWI’s medical research
units, the Tropical Medicine Research
Institute, bringing an institutional vision and a regional and international
breadth to its activities.
The
CDRC sees its role not just as a research unit initiating and executing
research on its own but as collaborator, catalyst and faci-
litator of research efforts with others both
across campuses, internationally with the best metropolitan centres, and
locally - with the
School
of Clinical Medicine and Research, the
Ministry of Health, QEH and the Sir Arthur Lewis Institute of Social and
Economic
Studies. It provides a
locus for dialogue and for planning, and with the necessary financial support
it hopes to provide a Centre of
Excellence for health research which will not only make a difference to the health of our
people, but will be known internationally
for the
high quality of its work. Such a
reputation will strengthen the Medical School, the reputation of Barbados and
our regional
university, and even our tourism product, all
leading to the optimal development of country and region.
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FINANCIAL NEEDS
The Centre was born at a time of financial crisis. The health consequences of the financial
crisis – both budgetary constraints on health care
and impact on population
choices, earning capacity and well being - have in fact greatly increased the need for the work of the Centre. Bridge-
town businessmen and other charities (See Box), kept the Centre going
for three years and subsequently provided “seed” money for several pro-
jects. Their generosity is
recorded on the walls of the Centre for posterity, through naming of rooms and
on a large mahogany plaque. The Univ-
ersity budget is expected to
establish further key posts in the coming year. In the mean time ongoing research and new needs call for urgent,
short term funding and seed
money which must be found outside of
the usual cycle of
University and Government budgets. The
University
must urgently find alternative sources of financing. In fact more than 70% of the current
salaries and expenditure of the Centre are from “soft”
money, grants and donations! But
new opportunities and challenges call for further capital investment and
sustainable Essential National Health
Research. Priorities (and challenges) include:
Lifestyle intervention for prevention and management of chronic diseases,
including primary prev-
ention of obesity, high blood pressure and diabetes; research on stigma,
prevention and management of HIV / AIDS; better basic understanding
of the causes of diabetes and
its destructive complications such as the diabetic foot; healthy ageing; and
the prevention and management of stroke.
YOUR CHANCE TO MAKE MEDICAL HISTORY!
The Fund Raising Committee seeks contributions
to the work of the Centre, in the form of funded Lectureships or Fellowships,
covenants or donations, and seed
money
for projects, all of which will be acknowledged in University reports and
newsletters of the Centre, through the University’s press and the media, and for
posterity within the building, e.g. through the naming of rooms
after Gold Star donors. The University
is a registered charity and can receive tax deductible cove-
nants over three years or more.
If you would like to play a part in this
exciting work, call us or come and see us at the CDRC, on the corner of
Jemmott’s Lane and Lower Collymore Rock,
246) 426
6416, Fax 426 8406, and e-mail cdrc@uwichill.edu.bb
CDRC DONORS
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GOLD STAR DONORS
Caribbean
Development Bank
Amberstone
Trust
Barbados
Shipping and Trading
The
Oscar & Rosa Davis Charitable Trust
The
Barbados Mutual Life Assurance Society
Mr.
Dick Brown
FOUNDATION DONORS
Barclays
Bank plc
CIBC
Holdings Ltd.
Goddard
Enterprises
Insurance
Corporation of Barbados
Royal
Bank of Canada
Barbados
Olympic Association
A.
S. Brydens
BICO
Ltd
Caribbean
Home Insurance
Collins
Ltd.
T.
Geddes Grant (B’dos) Ltd.
Ernst
& Young
The
Derrick Smith Charitable Fund
Cable
Wireless Information Systems
Dr.
Morton Shuman
Servier
West Indies Ltd.
Carlisle
Laboratories
Mr.
Tony Gill Memorial
Foster
& Ince Cruises Services Inc.
Williams
Industries Inc
Carters
General Stores
Neal
& Massy (B’dos) Ltd.
Mrs.
Elsie Rice
Standard
Distributors
Moore
Paragon (Caribbean) Ltd..
______________________________________________________________________________
Address:
Chronic Disease Research Centre (CDRC)
“Avalon”
Jemmott’s Lane
Bridgetown
Barbados
Director: Professor
Henry Fraser
Admin. Assistant: Mrs.
Kim Johnson-Gibbs
Tel: (246)
426 6416
Fax: (246)
426 8406
Email cdrc@uwichill.edu.bb (CDRC) or