Dr Sara Watkin
(Paediatrician Cayman)

I have extensive experience as a Consultant Neonatologist in 2 large regional level 3 (tertiary) NICUs. Firstly, I was employed at Nottingham City Hospital from December 1994 until April 2006, some 11½ years including a significant number as Chief of Service). Then, I was then employed at University College London Hospital as a locum from 2009-10 and as a permanent consultant from December 2010 until July 2016 (with 5 years as Chief of Service here too). After that, I took up post as the primary neonatal specialist for the island of Grand Cayman.

Nottingham City Hospital

Nottingham City Hospital had 6,000 births and delivered over 3,000 neonatal intensive care and high dependency care days per year. Out of hours, I was on call for both hospitals in Nottingham (10,000 births and 6,000 IC and HD days) and managed both complex neonatal medical and surgical cases.

University College Hospital

University College London Hospital is one of the UK leading specialist centres. It has 6,400 deliveries per year with over 1,000 admissions to the Neonatal Unit of extremely sick complex babies requiring in total nearly 6,000 neonatal intensive care and high dependency care days. UCLH has the highest inborn admission rate in the UK for babies born at less than 29 weeks gestation. UCLH has a renowned fetal medicine unit and is the delivery unit for babies who will need future care at Great Ormond Street Hospital. This means we took and cared for sick newborns from across the UK with complex problems especially cardiac problems, neurosurgical problems and general surgical problems including diaphragmatic hernias. UCLH is also a designated centre for brain cooling for birth-related newborn brain injury & has a significant number of referral of infants with complex neurological problems.

Neonatal Care in Cayman

That probably all sounds rather over-scientific. Yes, it does mean that I have lots of experience in newborn care, including the most complex forms too. The majority of births here don’t need that depth but when they do demand it, it’s obviously reassuring to have. With over 5 years of practice here in Grand Cayman, I have cared for multiple ELBW (extremely low birth weight) babies, including care here and transfers to the US. However, most weeks I am involved in the care of an infant with complications, either preterm or term. Our biggest challenge is we so frequently don’t know what might happen and that’s when skills count and team matters.

I have a broad education in both general and tertiary paediatrics including training at Great Ormond Street Hospital, as well as Nottingham City Hospital. I covered general paediatrics as registrar in Derby, Nottingham City Hospital and Stoke and as senior registrar in Queen’s Medical Centre in Nottingham. In Stoke I did a general paediatric clinic each week and at QMC I had 2 general paediatric clinics each week, as well as a neonatal follow-up clinic.

In my infant feeding and growth clinic at UCLH, I was referred many patients from the local GPs for advice including children with cow’s milk protein intolerance and food aversion. Following children up for many years until 2 years of age means that I have extensive experience in dealing with problems in this age group, as well as developmental assessment. However, my experience in paediatric care extends right through to adulthood.

Paediatrics on an Island

Good paediatrics in somewhere like Cayman is about being up-to-date and about the right approach when you find yourself sometimes with limited support or back, a challenge facing all smaller islands.

From 2006 onwards, before I moved to Grand Cayman, I undertook frequent paediatric assignments from single weekends to much longer in duration. These were at both Consultant and Registrar level, in a range of paediatric settings but predominantly in 3 hospitals:

• Chesterfield Royal Hospital
• Horton Hospital
• Ysbyty Gwynedd Hospital in Wales

So, I am unusual in having extensive tertiary experience of the sickest children but at the same time lots of experience of smaller hospitals and clinics with limited resources and facilities. These latter experiences are just like practising in Cayman (only colder!)

Paediatrician Cayman Style

In my general paediatric role in Grand Cayman, I see up to 20 children a day in the outpatient setting. These children range from newborn to 16 years and have the full spectrum of childhood complaints from very minor to complex health and developmental problems, including respiratory disease, failure to thrive, short stature, diabetes, duchennes muscular dystrophy, complex cardiac disease and immune deficiency.

I have admitting rights at both of our local hospitals and in George Town Hospital (HSA), that includes both the paediatric wards and the neonatal intensive care unit.