The Editor, Sir:

We were interested to read the recent article by Paul Williams (The Gleaner, September 29, Page C6) titled 'A dream deferred, a life of pain', the latter referring to a patient with sickle cell disease, Coy Hall. We have known Coy for many years and are aware of his problems as he copes with this disease.

This disease is genetic and life-long. It resulted from the inheritance of abnormal genes from both parents and most people only know that they carry these genes when they have an affected child, although it can also be detected by a simple blood test. If young people were empowered with the knowledge that they carried abnormal genes, they could select partners with normal genes and so avoid having a child with sickle cell disease.

Premarital screening

In the Kingdom of Bahrain in the Arabian Gulf, premarital screening has halved the frequency of births with sickle cell disease and laws mandate screening for the sickle cell gene in both Bahrain and Saudi Arabia prior to marriage. These countries have very different societies from Jamaica with traditions of arranged marriages. But even in Jamaica, prevention of the disease would still be possible with screening and counselling.

Free testing for youths

This is the purpose of the Manchester Project. Since early this year, the Sickle Cell Trust, in association with the Ministry of Health, has offered free tests to detect such abnormal genes in the fifth and sixth forms of the 15 Manchester high schools. All students receive laminated cards detailing their results and the 15 per cent carrying abnormal genes are counselled and given additional information. The programme is slated to continue for the next five years and to see whether it works, newborn screening has been set up at Mandeville Regional Hospital and will later be extended to other maternity units in the parish.

This will not only allow the early detection of babies with sickle cell disease, already proven to improve their outcome, but it will also determine whether the intervention of free screening and counselling change people's decisions and reduce the frequency of births with the disease. We hope to empower the students to make informed reproductive decisions which could avoid having an affected child with the emotional and financial consequences described by your correspondent, Paul Williams. If successful, it will begin to reduce the burden of sickle cell disease in Jamaican families and will provide a model for reducing the disease island-wide. It will also provide vital information to the countries of sub-Saharan Africa where 280,000 babies with SS disease are born each year and where the limited resources are unable to prevent much suffering and early death.

Prevention of disease is the way forward not only for problems such as obesity, hypertension and diabetes, but also for genetic conditions. Jamaica has unique opportunities to teach the world about the prevention of sickle cell disease and we hope that the Manchester Project will show the way.

I am, etc.,

GRAHAM R. SERJEANT

Sickle Cell Trust (Jamaica)

14 Milverton Crescent

Kingston 6