Out of three rooms off a corridor reaching deep inside Globe City Plaza in Chase Village, a mission is taking shape for the rescue of Trinidad and Tobago men who may not even know they need help. The mission — undertaken by a slightly built man with a vaguely ascetic air, wearing white shirtjac, receding hairline, pigtail, and salt-and-pepper handlebar moustache—has a straightforward aim: "Help a Trini".
Many of the "Trinis" Dennis Webster aims to help are surprised to learn they may need help. His offer is not necessarily of help that heals the sin-sick soul, but certainly the kind that addresses the quality, and even the continuity, of mortal life.
On the wall of the reception room, colour illustrations map a section of the male body showing the rectum, bladder, penis, testicles, and the walnut-size organ connecting the bladder and the urethra—the prostate. This locates ground zero of the threat that Webster has mobilised to combat: cancer in the prostate, the organ that governs how men urinate and how (and if) they ejaculate.
Cancer in the prostate has killed some notable men, and can kill, or is killing, more men who are more or less notable. Over the last four years, Keith Smith, Terry Joseph, and Roy Boyke number among the prostate cancer fatalities known just to the "Trini" media world.
Prostate cancer can degrade the lifestyles and doom the survival prospects of any number of still-unsuspecting men. "It's moving from bad to worse in T&T," says Webster, in a knowledgeable observer's assessment of the prostate cancer danger. In the 60-69 age group, the prostate of one in every 15 T&T men is estimated to have cancer.
"Whatever we're doing right now is not working," he concludes. "Everybody's doing something different."
Webster speaks as a medical first responder to the widening devastation of the lives of men middle-aging and older. Most such men, researchers say, are Afro-T&T, and are predisposed to wander into the prostate cancer zone by family history—through having a close relative who had been there before.
His own approach derives from training as a registered nurse in Canada where, as a teenager from St Joseph, he had migrated, and earned his credentials in 1988. The training early oriented him toward a kind of care in which people are encouraged not to "expect the doctor to solve everything".
By imparting knowledge and an I'm-there-for-you reassurance to those knocking on medical doors, he aims toward building such self-confidence as would make them active partners in their own care. Webster has evolved a language which discards the word "patient" in favour of "client".
The different way of talking and practising comes from someone with a profile less familiar than that of generalist and specialist doctors. The prostate cancer specialty falls within the remit of urologists whose names recognisably precede a string of academic initials.
Webster is positioned in the field in the capacity of a registered nurse with decades of experience in the field of oncology (cancer science). He has worked as a nurse in treatment, teaching and research areas of such world-class Toronto institutions as Princess Margaret Hospital and Sunnybrook Hospital.
"He has in-depth clinical knowledge of oncology disease process and treatments," wrote a Princess Margaret Hospital official in 2011. The reference cited his 20 years' work experience in an "acute care oncology centre treating complex cancer patients."
Inside his three rooms in Chase Village, he easily sets limits on his own claims to expertise. "I don't do treatment," he says. "I only do risk assessment. I don't make medical diagnoses, nor do I advise. I only give information and educate people, depending on what their situation is."
This limited-intervention approach, reaching out to offer an emotionally reassuring helping hand, is spelt out on Webster's helpatrini.com website. To a man in his sixties, say, relatively laid-back of attitude, overtly enjoying reasonable health, the shock discovery of cancer in his prostate can precipitate flash-flooding intimations of mortality, or at least vulnerability.
"You are not alone!" Webster's helpatrini.com website proclaims. That's the heartening consolation he repeats like a mantra to clients of his Global PSA Rising Limited.
As principal of pioneering Global PSA Rising, Webster carries out both prostate risk assessment and a practice of "nurse navigation". The trendily titled "navigation" is described in helpatrini.com as a process "by which a registered nurse trained in cancer care guides and supports you and your family through the challenges of a cancer diagnosis, from diagnosis to recovery." The service includes care toward managing the impact of cancer on men's families and careers.
For the nurse navigator, the journey begins with checking for prostate cancer risk, employing both conventional and newer methods. For Webster, it implies raising consciousness among the outstandingly at-risk category — black men pushing 40 and over — of the need to check their prostates.
"What you don't know can, and will, hurt you," he urges. Many men avoid prostate examination, he says. They can't stand the digital rectal examination, which entails insertion of a doctor's gloved and greased index finger up the anus to probe the prostate of a fella lying helpless in the foetal position.
That remains a standard part of the prostate-cancer check-up, but Webster points to the efficacy of other ways of testing. "I'm not forcing men to have DRE (rectal examination)," he says, referring to his outreach encounters with macho males such as Fire Service officers.
He worries, however, that insistence on the up-yours probe may be turning away homophobic men from the procedures aimed at earliest prostate cancer finding. His own counselling and navigation are aimed at urging men to have the risk assessment, with or without DRE, sooner rather than later.
The anal finger probe, together with the routine blood test for prostate specific antigen, or PSA, belong apparently to old-school testing techniques. In a poll sample of 1,134 men cited on helpatrini.com, 40 per cent opted to skip the digital-rectal, to take the PSA, and to "answer a few questions instead". Another 33 per cent replied, "Maybe".
What's certain is that Webster, as long as he is involved, will stay at the side of men wanting to know, needing to know, or who have got the news about their prostate standing, good, bad or indifferent. "My goal," he says, "is to empower people, tell them the truth, and to prepare and educate them to gather the information their physicians will need."
He is also promoting adoption of a new method of prostate-specific-antigen, or PSA, testing. This entails use of a state-of-the-art analyser, which delivers findings for a "nomogram", a mathematical "prediction tool" developed at Toronto's Sunnybrook Hospital. On a backroom counter of his Globe City offices, the $TT100,000 analyser, about the size and shape of a kitchen microwave oven, delivers in 11 minutes results of a blood sample in the form of a ratio of free to total PSA.
Results from the analyser, which must daily be recalibrated, feed into the nomogram calculations to deliver an International Prostate Symptom Score. Knowing the score, a man can either sigh in relief, or go further with those data, to a urologist, who will likely order an ultrasound test, and then a biopsy.
Laboratory analysis of a prostate tissue sample obtained through biopsy "is the only way of confirming a diagnosis." Nor does the analyser-nomogram finding of ground for suspicion end Webster's role as nurse navigator.
"I can go with you for your specialist appointment," he says. "I teach patients to care for themselves, to go to hospital websites," from which they can learn for themselves. He notes a relative shortage of relevant information in T&T, where, for example, not all institutions trouble to provide information to the Cancer Registry.
His "navigation" services stay in effect throughout the extended medical-care itinerary that, for those diagnosed, ranges from "watchful waiting" through radiation, to surgical removal of the prostate. Information and a comradely presence at one's side ("You are not alone!") describe the promise of Webster's "Help A Trini" brand.
It is a mission; he calls it a "passion" heightened after his stepfather's death seven years ago from prostate cancer, and inspired by his grandmother, a nurse who lived to 94. His Canadian experience, however, informs the criterion by which he proposes to deliver his services and influence others, in T&T: "In top hospitals, what would be the care level?"
It's also a business in which he estimates to have invested some $TT2 million. Since 2001, Webster has been back and forth from Canada but, drawn by the pull of navel string, he is pledged to set up here "a good business giving good health care."
The website of the nurse navigator with a mission to "Help a Trini" thus advertises for his own business his identifiable T&T roots: "At Global PSA Rising Ltd, every creed and race finds an equal place."