SPORT MEDICINE IN TRINIDAD AND TOBAGO AND THE CARIBBEAN
By Ian Hypolite
Doctor and Psychiatrist

The Trinidad and Tobago Sport Medicine Association was formed in 1985 out of the recognition of the need for a body to assist in the development of sport in the country by way of education of athletes, officials and the sporting public with respect to the principles of Sport Medicine. There was also a need to regulate the practice of Sport Medicine, which, hitherto, had been dominated by a few individuals who, though well meaning, functioned independently without peer review and close scrutiny. The Association embraced professionals in several spheres of activity - medicine, physiotherapy and massage therapy in the majority. Among medical practitioners there were internists, orthopaedic surgeons, general surgeons, anaesthetists and psychiatrists. Almost all had a deep interest in sport and had participated in sport at some level.

Since no one was trained specifically in Sport Medicine at the time, a massive educational drive was launched with a proliferation of seminars, symposia and importation of literature to which members were exposed. Affiliation to regional and international bodies followed. International symposia organised under the auspices of the World Body (FIMS) were staged.

This was the catalyst needed. Similar bodies were established throughout the region. Trinidad and Tobago could be described as the birthplace of Sport Medicine in the Caribbean. Now Sport Medicine Associations exist along the entire Caribbean archipelago spanning the Cayman Islands in the north and Guyana in the south.

These individual Associations have found widespread acceptance in their respective countries and it is safe to say that every major sporting event in each territory receives input from the membership of the respective Associations. In addition, representatives of individual Associations are present at every major international multi-disciplinary sporting event so that the Pan American Games, the Central America and Caribbean Games, the Commonwealth Games and the Olympics afford the opportunity for us to get together as a group.

THE LOCAL EXPERIENCE

Education

This can be looked at from two perspectives: education of the public and continuing information upgrade by members. In Trinidad and Tobago, there has been a cooling of the initial ardour associated with education of the general public. Nonetheless, members are constantly involved in lectures to sporting bodies and clubs. The profile of the Sport Medicine professional has been elevated to the extent that at least one such professional is included in the staffing of almost every sporting team and if not, consultation is usually sought. Liaison with colleagues throughout the Caribbean reveals the same picture.

Safety

In Trinidad and Tobago one of the first activities that the association became involved in was the Trinidad and Tobago Marathon. This proved to be germinal since the education process was responsible for the eradication of several myths and practices that were ingrained and that made the marathon experience a dangerous one in our setting. Apart from a relative minority who had prior experience with marathon running abroad, it was generally felt that preparation over a few weeks was adequate for this gruelling event. The significance of hydration before, during and after the event was lost on a majority of participants. The use of proper footwear and clothing that "breathed" was generally ignored. Education in these matters helped to minimise the incidence of heat and overuse injuries making it safer for all. The Association is no longer associated with this event but the initial involvement over the first two to three years has set the pace for further editions as well as other endurance events.

Interestingly, there have been odd attitudes toward the issue of hydration during physical activity in the demanding environment of a tropical country. Many coaches and instructors held the belief that water should be withheld during the exercise process and forbade, in particular, young charges from ingestion as testimony to "toughness". Education has eliminated this taboo.

Warm-up/Cool down

While there has been much success in convincing athletes of the importance of a proper warm-up, there has been much less with respect to cooling down. This is a problem shared throughout the Caribbean. Explanation of the rationale for cooling down has not been enough to ensure a consistent approach to cooling down. The struggle continues.

Recovery

Education has been successful in convincing coaches and athletes alike of the importance of rest and recovery in the training and exercise process. It once was widely held that more was better. This invariably led to a proliferation of overuse injuries as well as poor performances. The ever-increasing success of Caribbean athletes particularly track athletes but including swimmers and soccer teams at the international level is testimony to this process.

Nutrition

This area poses the greatest challenge for Sport Medicine practitioners in the Caribbean. There has been a departure from traditional low-fat, high carbohydrate diet to a predilection for high-fat, fast foods. Our proximity to North America and exposure to mass media that glamourises these foods is largely responsible for this. Again, the problem has been the inability to ensure consistency in behaviour. There tends to be a preference to replace sound nutritional principles with supplement consumption resulting in "faddism". Much more effort is needed in this regard.

Drug Use

While there has been the occasional doping incident, by and large we have managed to spread the message of abstinence from illegal performance enhancing drugs. Generally there is a resistance to the use of injections among Caribbean people. This cultural factor acts as a deterrent to the use of a wide range of performance enhancing drugs particularly anabolic steroids. A silent problem exists in regard to the use of recreational drugs, particularly cannabis, among sportsmen. Again education, in concert with demand reduction methods employed by the State, has assisted greatly in minimising this problem.

Regulation

Individual Associations continue to monitor the Sport Medicine scene in respective territories with a view to ensuring standards of practice and playing a role of watchdog. The small size of individual territories makes this possible. Members are directly involved in the training of personnel in physical therapy and rehabilitation. Programmes sanctioned by Associations are readily accepted and accredited.