Paediatrician Martijn Tilanus
When he was a young boy, Netherlands-born, Caribbean enthusiast, Dr. Martijn Tilanus, would sneak into his grandfather's study and read his medical books. He was glued to the drawings and fascinated by the anatomy. He knew from then that the medical field was his calling. After years of focus, study and dedication, the 37-year-old is now an attending paediatrician caring for St. Maarten's youngest patients – children. Interestingly enough, Tilanus' twin brother is also a medical doctor.
Tilanus gave insight into his practise during a one-on-one with Health and Beauty.
Who is Martijn Tilanus?
I am always an enthusiastic and optimistic person. I am also persistent, especially when it comes to finding the best care for my patients. I try to be helpful and motivating to others. I am curious in scientific developments, especially in the medical field, but also in political issues, such as health care organization and preventive care.
How did you discover your love for medicine?
My grandfather was, before entering politics, a general practitioner... As a young boy, I would sneak into his study and read his medical books. The pictures of all kinds of skin disorders didn't really bother me, but the anatomy drew my attention. The book titled Internal Medicine was interesting and so was the paediatrics book, a relatively new field at that time. During my high school years, the famous series, the Flying Doctors, was broadcast. I wanted to become a real doctor just like them and fly out from Coopers Crossing to those who needed it most in the outback of Australia. I even considered applying for the Royal Flying Doctor Service (Australia) seriously!"
Where did you pursue medical studies?
In September 1998, I started my medical studies at the University of Utrecht. Years later, in 2005, I received my medical degree and decided to continue in the field of paediatrics.
Why paediatrics?
In the first week of medical school, there was one week of so-called "orientation in medicine." One of the speakers was a paediatrician. He presented a young infant who became life-threateningly ill in less than 12 hours after admission and the doctors had no clue about the cause. The paediatrician pointed at me and asked: "Young man, do you have any idea what might be wrong with this child?" My answer was: "I am not really sure, but could it perhaps be something with the food? Or an allergy perhaps?" He smiled at me and said that my suggestion was not bad at all and close to the solution. The diagnosis of celiac-sprue was completely unknown to me at that moment. After revealing the diagnosis and showing pictures of the child rapidly improving after removing all gluten from his feeding, the paediatrician stepped towards me and said: "Interesting field; isn't it? Paediatrics." At that time, I was clearly convinced what my final destination had to become.
Tell me about your earlier years in the field?
After earning my degree in Utrecht, I got an offer for a residency at the children ward of St. Elisabeth Hospital in Curaçao. After that, I returned to the Netherlands and completed my specialisation as a paediatrician in Germany.
How did you end up in St. Maarten?
The two years of working as a resident in St. Elisabeth Hospital was a learning experience. My interest was roused to return to the Caribbean after finishing my paediatric residencies. At the end of my period in Germany, I heard that St. Maarten Medical Center needed an extra paediatrician and so I applied and started working here on July 1, 2013. SMMC is ambitious and preparing for major developments. The Paediatric Department is undergoing changes and so there are lots of exciting, new challenges. Therefore, I currently have no plans to go elsewhere.
What's an average day like?
My typical workday starts in the morning with a clinical round together with the nurses to check those children that are admitted on the children's ward. This round starts as early as 7:30am. After that, I start the outpatient consultations. The number of outpatients I see per day varies.
What's the most common medical issue in children here?
Except for the more common problems as flu and ear troubles, I see many patients with asthma and other respiratory tract diseases. Globally, it is a growing problem, probably caused by the negative effects of air-pollution. The therapeutic options for children are excellent. Most children can live a relatively normal life with asthma. A special one is the sickle cell disease. It is an inherited disorder in which the red blood cells have an abnormal shape which makes them vulnerable. This chronic disorder is characterised by frequent episodes of painful crises and it is highly prevalent among afro-Caribbean people. A curing therapy is not there as yet but the new results coming from gene therapy is promising.
Your top three concerns among children?
One, two and three are obesity. Overweight is a major global concern; but especially here in the Caribbean. On some islands, one out of three or four children is overweight. For decades, the general understanding was that consuming fats (saturated fats) was responsible, but the consumption of high amounts of carbohydrates (sugars) is much more responsible for overweight. It can't be emphasized enough that children nowadays are too exposed to excessive carbohydrate-intake. Soft drinks and juices are often nothing more than just lemonades with a fruit-taste. A can may contain the equivalent of eight to 10 cubes of sugar. The body can't handle that amount of sugar and converts it into fat.
The consequences of overweight are not seen quickly. It may take several years until real problems occur. The most important one to mention is a lack of insulin sensitivity – a slow process that gradually worsens and eventually might lead to diabetes. The latter is eventually responsible for many adverse cardiovascular events.
Advice on preventing common ailments in children?
Artificially sweetened juices should be avoided. If you want to give your child real fruit juices then start by giving real fruits. Also popular soft drinks can be harmful when consumed too frequently. A child cannot be held responsible. Some of them are simply too young to realise what the harmful effects of sugar-enriched drinks might be. So it is the responsibility of the parents to pay attention to this problem. Older children are to be informed by teachers in school: overweight is simply bad for the health. They have to become aware that the consequences of a diabetes and/or obesity will eventually lead to serious cardio-vascular diseases around the age of 50.
Is it generally more difficult to treat a medical issue in children than in adults? Why or why not?
Not necessarily difficult, but different in several aspects. Children are in a continuous process of growing and development and in each phase in their lives, there are specific kinds of disorders that can disturb that process. Also, disorders may present themselves in different ways, depending on the age of the child. As a paediatrician, you have to be aware of that. For example, an infection that occurs in a two-month-old infant needs to be treated differently from that of a 16-year-old. One of the reasons for this is that the immune system is simply not as developed as in the older child or adolescent. The calculation of the medication to be given is based on the weight and sometimes even on the body surface of the child. This is typical for the treatment of children. The younger the child, the less information the patient himself can provide to the doctor, as verbal development is not sufficient yet. You have to rely on what you see and what the parents tell you.
Challenges/benefits of working with children?
Children are the future. It is challenging to provide care that will support them to reach adulthood in the best and healthiest state possible.
Tilanus sees outpatients weekly from 9:00am to 12:00 noon; and by appointment from 1:30 to 3:00pm. Patients need to visit their family doctor and obtain a referral letter before visiting the paediatrician.
