The unplanned confluence of idea, intent and community concern between an internationally renowned medical practitioner and a leading Bermudian medical student has led to the creation of the Daily Male Men’s Health Clinic a mobile facility designed to offer free men’s health screening in the critical areas of prostate cancer and cardiovascular disease.
The initial six-month pilot of the mobile, free clinic will commence accepting walk-ins on a first-come-first-serve basis on February 4, within the Bermuda Industrial Union (BIU) building and operate from 9 am until 1 pm, and continue to operate on the first Saturday of each month, from a different venue, including:St George’s Cricket Club (March 4,, 2023), Somerset Cricket Club (April 1, 2023) Warwick Workmen’s Club (May 6, 2023), Bailey’s Bay Cricket Club (June 3, 2023) and Pembroke Hamilton Club (PHC) (July 1, 2023).
Dr Jonathan Makanjuola, a locally based consultant urological surgeon, and Jade Robinson, a third year student at American University of the Caribbean School of Medicine (AUC), with a Master of Public Health, have embarked the project, which targets what the pair view as an under-served, uninsured and under-insured collective of Bermudian men in the over-60 age bracket.
Among the project goals is that of identifying a percentage of high-risk men that will need to be assessed for prostate cancer or poor cardiovascular health and offered early diagnostics and treatment.
Dr Makanjuola and Ms Robinson are acting upon the theory that education combined with testing will lead to early detection and treatment, which would aid in the preservation and enhancement of lives of those among the demographic, as well as stymie spiraling costs of managing metastatic prostate cancer and improve the awareness for prostate and cardiovascular health among men in Bermuda.
“Prostate cancer is the most diagnosed cancer among men in Bermuda, with the rate higher than most comparable countries,” explained Dr Makanjuola, who has a specialist interest in bladder cancer, diseases of the prostate, men’s health, stone disease and upper urinary tract transitional cell carcinoma (TCC). “It’s a good story, how Jade and myself came together and wanted to do something about this.
“Before moving to Bermuda full time I was a visiting specialist and worked at North Shore Medical, whereas my wife is a Bermudian doctor. So, about two years ago I decided to come, but as a visiting specialist every time I would come I would diagnose four or five guys as having prostate cancer.
“I said to myself, ‘This is crazy. We have to do better and improve the standard of care.’ So I’ve made it my mission to try and do that.
“My meeting with Jade was very organic. I decided on doing a daily clinic, moving away from just doing something in November — designated prostate cancer month — and doing this more regularly.
“And I produced a document to detail how we can do this.
“At the same time, Jade reached out to me on social media and told me that she, herself, had an idea for a clinic. So, I sent her my document and she sent me her document and they were almost identical in what we were attempting to achieve, so we just had to work together.”
Ms Robinson’s version of her side of what has shaped as a welcomed collision similarly depicted a innovative, wellness minded individual with a penchant for community service and a longing to have male cancer issues be as equally provided for as their female counterparts.
“During my Master’s course I did a Masters in Public Health,” began Ms Robinson, an Dean’s List student, who recently received the Honour and Service Award at AUC. “I had to create an intervention and do a research paper and I chose my Bermuda.
“In 2020 I produced a paper based on research I did in regards to prostate cancer and breast cancer and noticed there was an inequality in regard to awareness, education and mortality rates.
“This really intrigued me to see how I could create an intervention to increase prostate awareness in Bermuda. So, I did a lot of research and my intervention was more so targeting barbershops, as a means of increasing prostate cancer awareness and having local GPs come in and have all work as a community to address prostate cancer.
“It was a 15 page research paper. And then, just recently at medical school, I was asked to present some of the research that I had done and at the time I didn’t have any recent research. So, I looked at some of the old research that I had done in 2020.
“I decided to talk about the prostate cancer research that I had designed. But before I did my presentation I had reached out to Dr Makajuola to ask if he could proofread my presentation and take a look at my documents, in order to make sure that what I planned to say during this presentation was accurate.
“Because I was to speak in front of all of the deans at the university, where I was the only international medical science student presenting, while all of the others were advanced clinical, ready to commence working in the hospital wards.
“I really wanted to show out and demonstrate that I knew my stuff.”
The intended simple matter of a ‘proofing’ by a superior became an intriguing opportunity to kineticise a dual desire to make a positve difference among the high-risk, older, Black male sub-group.
Relayed Ms Robinson: “When Dr Makanjuola looked at all of my documents, that’s when he realised that our projects were super similar, involving the community, addressing the same disease and just bringing everyone together. And that is when it was like, “Wow”.
“We had references that were the same. Citations and much of the things aligned. So, it was really organic as to how this came about. Two people looking at an issue and actually seeking to address and find solutions for it.
“As a future physician I really believe it is important to give back even before you get there. I think that everyone should look at giving back to the community, because the community is what makes us.”
As part of the mission to bring health interventions to the community, Daily Male has teamed up with various sporting and workmen’s clubs, local barber shops, health agency providers, Government and funding institutions and individuals.
“By targeting traditionally those that have poor engagement/distrust with healthcare services in Bermuda,” reads a company statement. “We aim to train local community leaders/volunteers, with local physician support to assist in the screening programme.”
The targeted screening programme will offer rapid point of care testing, providing results within 15 minutes of testing, that includes the Prostate-Specific Antigen (PSA) test, a blood test used primarily to screen for prostate cancer, blood pressure testing, determining each patient’s body mass index (BMI), which is a measure of body fat based on one’s height and weight, along with urine flow testing and urine dipstick testing, that can help detect diabetes, urine infections and other potential maladies.
Daily Male has also partnered with the Bermuda Hospital Board laboratory to ensure quality and consistency of test results.
“We’ve managed to get a hold of the islands first PSA analyser,” noted Dr Makanjuola. “The PSA is the blood test which can take anywhere from four to 24 hours to get the results, but we can get the results back in 15 minutes, so we want to get the men in, do the consent and get the test done.
“Just so that men understand the text we are going to do, the test involves a finger-prick, rather than a blood draw, which takes 15 minutes and is the longest test we are going to do, so we can also do other tests during the interim.
“Some men will take just the 15 minutes, while some will take a little longer.”
However, the intention is not to simply test, offer numbers and statistics that might be ‘foreign’ to many and dismiss a person demonstrating abnormality back into the state from which they arrived, but to also ensure that requisite treatment needs are also made available.
“If we find that there is a high PSA we are not going to stick them out into the street,” assured Dr Makanjuola, adding that clients will be afforded access to treatment as the relevant operational facilities and services at KEMH and its public and participating affiliates. “We will offer them support and guide them as to what the next steps are.
“I’ve spent a lot of time involved in screening programs in the UK and abroad and one of the things that really worried me was that you can screen 100 men in a quick session, where they all get five minutes and you can pick up things, but then they don’t have any avenue for a follow-up.
“But what’s the point of doing the screening and identifying issues if there’s no ability to do a follow-up?
“It becomes a case where a person would rather just not know if there is not going to be a follow-up.
“I have been in discussions with the hospital and what we are going to do is offer all the men that have high risk issues.
“So, say if you have a high PSA or something that is abnormal, we will get you registered in a free program that is available and you will get to see a urologist in the hospital for no charge. And for that we will do several rounds of testing, including an MRI, a prostate biopsy to diagnose prostate cancer as well as any treatment for the prostate cancer.
“Then we can partner with the Bermuda Cancer and Health to enable men to get the treatment that they require. So we have identified a pathway forward for the in high risk categories to get them from diagnosis to treatment.”
Ms Robinson and Dr Makanjuola are likewise hopeful that their efforts in bringing education, testing and care closer to the community can allay embedded fears among, particularly Black males, regarding cancer and eliminate any negative stigma attached to matters of the male prostate and intimate areas.
As such the Daily Male Clinic stressed their initial use of the PSA test, as opposed to the digital rectal examination, a procedure that has long discouraged many men from getting checked.
“I’ve been doing this for years and I know that, particularly among Black men, there is a big stigma about this examination.” said Dr Makanjuola. “I’m working backwards, so we are doing the PSA examination and if the readings are very high we will tell them that we need to do more tests. Because I know that if we go first with the digital rectal examination it will have a tendency to scare guys off.
“Among the main concerns for, particularly Black men, are the prostate, as well as cardiovascular. So we want to hit both of those areas initially and then go forward.”
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