For decades, rheumatologist Cindy Flower, MD, accumulated images of systemic lupus erythematosus (SLE) in her patients, as well as clinical vignettes to use in teaching at Queen Elizabeth Hospital in Bridgetown, Barbados. For decades, she has wanted to do something wide-reaching with these materials, sharing information from her practice and her mentor, the late Prof. George D. Nicholson, DM.
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“Prof. Nicholson, an internist and nephrologist, managed hundreds of cases of lupus and developed an expertise in treating all aspects of the disease,” says Dr. Flower. “He inspired and encouraged me to specialize in rheumatology [because] there was no rheumatologist in Barbados.”
Dr. Flower recently used her information and expertise to co-author Lupus Essentials: Lessons Learned About the Diagnosis, Misdiagnosis and Management of Systemic Lupus Erythematosus. The booklet is an effort to help physicians diagnose and treat the disease, particularly as it presents in Black patients in the Caribbean, where patients may not have easy access to a rheumatologist. Lupus is two to three times more prevalent in Black women and women of color than in white women.1 Barbados is predominantly Black.2
Born in Trinidad and Tobago, Dr. Flower moved to Barbados as a teenager. She graduated from the University of the West Indies (UWI) Medical School, Cave Hill campus, Barbados, where she also attended a postgraduate program for internal medicine. With Prof. Nicholson’s encouragement, she completed a rheumatology fellowship at the University of Minnesota, Minneapolis, and returned to Barbados to start the Rheumatology Clinic at Queen Elizabeth Hospital in Bridgetown, the island’s capital city. She is currently an associate consultant in rheumatology and a senior associate lecturer at the Cave Hill campus of UWI, teaching medical students and internal medicine residents.
“The rheumatology clinic was formally established in 1997,” she says. “I saw a broad range of very interesting rheumatologic diseases, and it was always clear that lupus was highly prevalent.”
‘In some parts of the world, you may be forced to treat for a presumptive diagnosis of lupus before you have all the supportive data that would make you comfortable. But you need to do it to save a patient’s life,’ Dr. Flower says.
She worked with Prof. Nicholson during her medical school education, internship and residency, as well as after returning from her fellowship. When he retired in 2002, she inherited his patients with lupus.
The Hope Foundation of Barbados, a nongovernmental organization that helps patients with SLE and other chronic diseases, published Dr. Flower’s booklet, which she co-authored with the foundation’s president, Shelley Weir. Dr. Flower sits on the Hope Foundation’s medical advisory board.
“I wanted to do something special [for the Hope Foundation’s 30th anniversary],” she says.