Graham Sergeant obituary

The Guardian

21-04-2025

The British doctor Graham Serjeant, who has died aged 86, lived and worked in Jamaica for more than 50 years, researching sickle cell disease and treating patients with the genetic condition. His long-running research study and publications helped transform doctors' understanding of the disease, as demonstrated by two contrasting experiences.
At the beginning of his career in 1968, Serjeant found it difficult to get a medical journal to publish an article about Jamaicans aged 30 with sickle cell. The journal editors were sceptical because the textbooks of the day said few people with the condition survived beyond childhood.
In 2009, Serjeant again had difficulties getting a paper published. This time it was about people with sickle cell aged over 60, a subject the journal editors did not think was newsworthy. Thanks to his 40 years of research, 500 papers and several textbooks, the medical community were now well aware that it was possible to live into middle age with the disease.
Born in Bristol, Graham was the son of Violet (nee Winter) and Ewart Serjeant, an insurance broker. He was the middle child, with two brothers, Michael and Christopher, and was educated at two Quaker schools: Sibford in Oxfordshire and Bootham school in York, before studying natural sciences and medicine at Cambridge University and the London hospital (now the Royal London) in Whitechapel in the East End.
In 1963 Serjeant qualified as a doctor, and inspired by the four months he had spent as a student in Uganda in 1962, he was keen to work in a developing country.
In 1966 he arrived in Kingston, Jamaica to work at the University Hospital of the West Indies, with his wife, Beryl (nee King), a haematology technologist, whom he had married in 1965. Serjeant helped at a weekly clinic for people with sickle cell disease, which affects about one in 150 people in Jamaica.
The haemoglobin in an affected person's red blood cells is chemically different, causing anaemia and changing the cells' shape. They become long and pointed, like a sickle, and can block blood flow in small vessels, causing damage and pain. If they damage blood vessels in the brain, a stroke may result. Because they can clog up the spleen, which acts like a sieve for the blood, they can prevent it from doing its job, meaning blood-borne bacteria can cause life-threatening infections.
Working at the clinic, Serjeant assumed he would be seeing young children and was disconcerted that some of his patients were adults. Was the disease different in Jamaica? Or were the medical textbooks, which classed it as a children's disease, written by hospital doctors who came across only the sickest children and were not aware of others living into adulthood?
In 1967 with a grant from the Wellcome Trust, Serjeant and his wife travelled around the island in a Volkswagen minibus that had been converted into a mobile clinic. They traced a number of adults living with the disease and, as he tested families' blood and worked out family trees, Serjeant was drawn into the intricacies of the condition, discovering variations in how it manifests.
For example, in one affected family he found a young girl who, though definitely carrying the genes, had no symptoms at all. Wanting to understand why, he became passionate about setting up an ambitious long-term study to document sickle cell in all its complexity.
In 1972 Serjeant joined the Medical Research Council research unit in Jamaica and two years later became its director. In 1973 he set up his research project: the Jamaican cohort study of sickle cell disease.
It screened 100,000 newborns on the island between 1973 and 1981. It was thought that you could not accurately diagnose sickle cell disease at birth because a newborn still has foetal haemoglobin which can obscure the sickle cells, but Beryl managed to adapt laboratory techniques to make it possible.
The Serjeants were a close partnership and, with Beryl working in the laboratory, they identified 550 babies with sickle cell disease to follow for the cohort study. For more than 40 years, Serjeant tracked the health of both these children as they grew up and, for comparison's sake, children without sickle cell disease. They all had a range of checks annually, yielding a huge database of information for researchers to explore on everything from genetics to symptoms and treatments.
For Serjeant, though, this was never just a scientific project. Prof Mike Stevens, a paediatrician who worked with him, said: 'Graham never forgot that behind every interesting haemoglobin test, there was a child and a community.'
He worked hard to develop ways to manage sickle cell disease and save lives, immunising children to prevent pneumococcal infections and teaching parents not to let children get cold, which can bring on painful sickle cell crises. He encouraged parents to feel their baby's spleen regularly, explaining that if a baby's spleen was enlarged due to a build up of red blood cells (acute splenic sequestration) they should come to hospital for emergency treatment. As a result, the death rate from that particular complication fell by 90%. Through the Medical Research Council, he arranged visits from specialists, such as ophthalmologists from the Moorfields eye hospital, in north London, who came each year to Jamaica to check the children's vision.
In 1999 Sergeant was over 60 and according to the university's rules had to step down from his post. Something of a workaholic, he was not ready to stop, and carried on following up people in his cohort study and researching sickle cell for a further 25 years. His textbooks revealed there are as many as 15 types of sickle cell disease and there is an overlap with another genetic blood disorder: thalassaemia. Children with sickle cell disease can experience an 'aplastic crisis' in which their red blood cell count suddenly plummets and Serjeant made the connection with a virus, parvovirus 19, which can be treated with transfusions and antibiotics.
Serjeant chaired a local charity: the Sickle Cell Trust Jamaica, which he founded in 1986, and led its Manchester Project, which offered genetic screening and education about sickle cell disease to secondary school students.
As well as his work in Jamaica, Sergeant was interested in the different forms of sickle cell disease that occur in places such as India, Greece, central Africa and Saudi Arabia, and he visited these countries frequently to share his knowledge. Until Covid-19, he also made annual trips back to the UK, partly to visit haematology and genetics colleagues, but also to see relatives and stay in his flat in London, where he sometimes enjoyed watching the tennis at Wimbledon.
In 2015 Serjeant was awarded the Order of Jamaica. He lived with a chronic lung condition and his health began to fail in 2024.
His elder brother Michael predeceased him. He is survived by Beryl, and his younger brother, Christopher.
Graham Roger Serjeant, physician and researcher, born 26 October 1938; died 25 March 2025