Graham Roger Serjeant

Graham Roger Serjeant CMG (born 1938) is a British medical researcher who studied sickle-cell disease in Jamaica, setting up screening programmes and long-term cohort studies. He was Director of the MRC Epidemiology Research Unit at the University of the West Indies and remains chairman of the Sickle Cell Trust (Jamaica). He is author or co-author of three books and over 140 publications on sickle-cell disease.[1] His work has addressed the variability of sickle-cell disease with special emphasis on developing low-cost models of management suitable to countries with large numbers of patients and limited resources.

Early life and education

Graham Serjeant was born in Bristol on 26 October 1938 to Ewart and Violet Serjeant, the middle of three boys born five years apart.

At about 18 months of age, his family moved to Hove in Sussex and he attended the local primary school between the ages of five and 10, then entered the Quaker boarding school at Sibford Ferris in Oxfordshire. In those days, school ended at the 5th form and after passing 11 subjects at O-level, he moved to another Quaker boarding school, Bootham in York. Here he studied botany, zoology, physics and chemistry at A-level but set his sights on attending Cambridge. He was successful and proceeded to the entrance examinations at Cambridge where, following an interview with Sir Henry Thirkill, master of Clare College, he was offered a place to study the Natural Science Tripos in September 1957. He completed the Natural Science Tripos Part 1 in two years with a 2–1 degree and proceeded to sit for a Part 2 in anatomy under Professor John Dixon Boyd.

He visited East Africa in the summer of 1960, before commencing clinical studies at the London Hospital in Whitechapel in September 1960. He sought an opportunity to return to Uganda for some clinical training in paediatrics for four months under Professor Derrick Jelliffe. He was the only student at that time to request an elective period abroad whereas this has now become a routine part of medical education. This experience proved vital in later decisions to work on sickle-cell disease in Jamaica.

Returning to Cambridge in June 1963 to take the Medical Tripos examinations, he then returned to the London Hospital for house jobs with the Surgical Unit and Paediatrics (1963–64) and then to the Royal United Hospital in Bath (1964–65) where he completed a six-month assignment in General Medicine and one year in Neurology before returning to London as senior house officer to Professor John Goodwin and Dr. Celia Oakley in cardiology at the Royal Postgraduate Medical School, Hammersmith. While in Bath, he met his future wife Beryl Elizabeth King, a medical technologist, and they were married in March 1965. After Hammersmith and passing the Membership of the Royal College of Physicians of London (MRCP), he then looked for work abroad especially Uganda and Nigeria. He applied for a post of senior registrar in the Department of Medicine at the University of the West Indies (UWI), Kingston, Jamaica, and was offered the job by Professor Eric Cruikshank.

Life in Jamaica

In August, he and his wife set sail from Portsmouth on the Golfito for the 12-day journey to Trinidad and then Jamaica. For a year, he worked in the Department of Medicine with wards rounds and busy outpatient clinics but early on was asked to assist in the sickle-cell clinic recently formed by Dr. Paul Milner of the Sub-Department of Haematology. On each Friday morning, this clinic saw 15–25 patients with sickle-cell disease and it became clear that the current textbook descriptions of the disease were at variance with observations in Jamaican patients. Focusing on patients with the generally severe homozygous sickle-cell (SS) disease, the textbooks stated that few survived childhood whereas many of the Jamaican patients were over 30.

The hypothesis that standard medical concepts of the disease were heavily biased towards hospital based patients attracted the interest of Dr. Peter Williams, then secretary of the Wellcome Trust, and a chance meeting resulted in Wellcome Trust support to Dr. Paul Milner, Dr. Graham Serjeant and Beryl over the next four years (1967–71). The grant provided a Volkswagen minibus which functioned as a mobile clinic and extensive travels over Jamaica following up patients long lost to the Clinic and the University Hospital showed that many were well and had actually improved with age. This observation changed the whole concepts of sickle-cell disease, confirmed the role of symptomatic selection and made the case for studies of the true natural history based on newborn detection of the disease.

In September 1971, Dr. Serjeant returned to Cambridge to work with Professor Hermann Lehmann at the Medical Research Council (MRC) Abnormal Haemoglobin Unit. Intending to spend 3 years and complete a PhD on haemoglobin structure, he sat in a laboratory with 10–12 other workers whereas the clinical studies in Jamaica had ceased. The period was a useful time in writing much of Clinical Features of Sickle Cell Disease, published by North Holland in 1974. After three months in Cambridge, it became clear that this was the wrong decision and it was decided to leave Cambridge after one year and return to Jamaica. Now on the staff of the MRC, he transferred to the MRC Epidemiology Research Unit at UWI in November 1971 with the aim of initiating a cohort study of sickle-cell disease from birth. This was made possible by the expertise of Beryl who adapted methods for the diagnosis of the disease on samples taken from the umbilical cord.

The Jamaican cohort study

Once the diagnostic methods were perfected (this at a time when the rest of the world believed that it was not possible to diagnose the disease at birth), screening of births at Victoria Jubilee Hospital, the main Government Maternity Hospital in Kingston, commenced on 25 June 1973 and continued until 28 December 1981 for a total of 100,000 consecutive births.[2] All 550 cases of sickle-cell disease were identified and along with 250 normal matched controls have now been followed for up to 40 years. Thanks to the advantages of an island and an intelligent cooperative population, virtually all surviving case of the disease continue to be monitored and the study has told the world much about sickle-cell disease.

Coincident with these developments, the Director of the MRC Epidemiology Research Unit departed, Professor Serjeant was appointed Director and the unit's name changed to the MRC Laboratories (UWI). The cohort study[3] provided unique opportunities for studying every aspect of the disease and the staff gradually grew to 28 including doctors, medical technologists, nurses, statisticians, computer staff, social workers and counsellors. The Unit was also fortunate in attracting many visiting workers such as Professor Alan Bird from Moorfields Eye Hospital in London, who for 20 years, led a team of ophthalmologists to document the evolution of retinal disease. Support from the National Institutes of Health in the US also allowed three studies on the role of laser treatment in eye complications. The requirements of the staff and the research programmes now outstripped the facilities inherited from the previous MRC Unit and further developments were needed.

Sickle Cell Trust (Jamaica)

The Trust was established in 1986 as a locally registered charity to assist in the development of sickle-cell services. The acquisition of a diagnostic ultrasound instrument was followed by construction of a dedicated Sickle Cell Clinic in 1988 and an Education Centre for Sickle Cell Disease in 1994. As dictated by MRC policy, Professor and Mrs. Serjeant retired from the Sickle Cell Unit in September 1999, but continue to work as Chairman and board member of the Sickle Cell Trust (Jamaica).[2] From 2000, the Trust embarked on an education program delivering illustrated Powerpoint lectures to almost all the island's 160 secondary schools and with the development of electronic media, these lectures were professionally recorded and given to all schools on either tape or DVD. At question and answer sessions following these lectures, the dominant question was where could the students learn their haemoglobin genotype and whether they were at risk of a child with sickle cell disease.  This issue was addressed in the Manchester Project[4] which offered free haemoglobin genotype to senior classes of 14 secondary schools in the parish of Manchester in central Jamaica. Over six years (2007–2013), a total of 16,636 students, mostly aged 15-19 years, were screened, given genotype cards, and the 2,417 carriers of abnormal genes offered counselling. To determine whether this information influenced reproductive decisions, newborn screening was established in 12 hospitals in the south and west Jamaica where mothers were most likely to have their babies.  Subsequent analysis found 2,442 deliveries to mothers screened at school of which 11 babies had forms of sickle cell disease indicating that genotype knowledge in this population had not influenced reproductive decisions.[5]

In 1995 he was awarded the Musgrave Gold Medal by the Institute of Jamaica[6] and in March 2014 received the Humanitarian Award from the Sickle Cell/Thalassemia Patients Network (SCTPN) at the Crowne Plaza Hotel in New York.[7] The work was recognized by the British Government with the award of the CMG (Companion of the Most Distinguished Order of St. Michael and St. George) in 1981 and by the Jamaican Government by the award of the CD (Order of Distinction, Commander Class) in 1995 and of the OJ (Order of Jamaica) in 2015.

Books
  • The Clinical Features of Sickle Cell Disease, North-Holland, 1974, ISBN 0720473047
  • Sickle Cell Disease, Oxford University Press, 1992, ISBN 978-0-19-263036-0
  • A Guide to Sickle Cell Disease, Creative Links, 2001, ISBN 9766103925

References
  1. Graham R Serjeant, BiomedExperts
  2. Stacy-Ann Ashley, "A lasting legacy in Jamaica", MRC Centenary, January 2014.
  3. Serjeant GR, Serjeant BE, "Management of sickle cell disease; lessons from the Jamaican Cohort Study", Blood Rev. 1993 Sep;7(3):137-4.
  4. Nadine Wilson, "The Manchester Project — screening for sickle cell, one baby at a time", Jamaica Observer, 11 February 2013.
  5. Serjeant, G. R.; Serjeant, B. E.; Mason, K. P.; Gibson, F.; Gardner, R.; Warren, L.; Jonker, M. (2017). "Voluntary premarital screening to prevent sickle cell disease in Jamaica: does it work?". Journal of Community Genetics. 8 (2): 133–139. doi:10.1007/s12687-017-0294-8. PMC 5386916. PMID 28251585.
  6. "Musgrave Awardees". Institute of Jamaica. Archived from the original on 18 October 2014. Retrieved 6 February 2015.
  7. "UWI professor to be honoured for sickle cell research", Jamaica Observer, 15 March 2014.
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