In 2017 Antoinette Dyer had a lot on her plate.

She had a full-time job as an ICU nurse at King Edward VII Memorial Hospital. She was also the dedicated head of Bendigas Rophe Ministry, “an international charitable outreach organisation that provides donations and holistic care to the less fortunate”.

Called to do more, she enrolled in an online programme with Walden University with a view to getting her PhD in public health with a concentration in epidemiology in seven years.

She did it in five.

“If you’re a full-time student you have four years,” said Dr Dyer, who completed all her theory requirements in three years. “What I did, I doubled up on the modules. People tell you that's impossible because we’re talking statistics, economics, at PhD level. It wasn't a walk in the park.

“Five years ago I didn’t know about Covid-19. The end of my programme was so stressful – I couldn't fly over for my residency so it had to be online and I had to balance time in nursing Covid-19 patients because I work in the Intensive Care Unit.”

Her dissertation examined the impact of stroke education on stroke patients in Bermuda.

With the pandemic in the background, she was “a bit disturbed” that it took her two years to complete but she came to realise it was actually “perfect timing”.

“[My findings] contributed to the Primary Stroke Unit that was inaugurated [at BHB] this year in March,” said Dr Dyer, who expressed her gratitude for the assistance she received from Francene Gayle, a consultant neurologist and stroke centre director with Bermuda Hospitals Board. “Dr Gayle was very instrumental in getting data for me, especially for epidemiology. [And that information] added to BHB’s accreditation process from Canada.”

Jamaican-born Dr Dyer moved to the island to work as a nurse 14 years ago. With financial assistance from BHB, she received a bachelor’s and then a master’s degree in nursing before deciding to pursue her PhD.

“We have a lot of nurses who did that because of the new improvements of the academic programme in nursing.”

With a PhD, nurses are allowed to “prescribe drugs and work independently” just as medical doctors are.

Becoming a medical doctor had always been her goal but “the good Lord had a different pathway” for her, Dr Dyer said.

“I went through the humbling path because I think nursing is a humbling and dynamic profession that is so underrated. [Because of my training] I actually know the nuances or the idiosyncrasies and all the ins and outs in the medical field.

“Frankly, I wanted to just do my doctorate in nursing and then just call it but my [pathway was called]. So then I said, ‘What better way to end the whole academic ladder than to become an epidemiologist because with that knowledge you can do so many different things.’”

At the moment, Dr Dyer is the only person with specialist training as an epidemiologist to the PhD level in Bermuda. Apart from her, there is a nurse who is an epidemiologist and Michael Ashton, the Chief of Medicine at BHB, has “some epidemiology training in infection control”.

“Bermuda is an excellent place to do a lot of studies because of the sample size and, unfortunately, the disease processes. There are some unique processes here that would not only be very instrumental to academic research, but also to help others how to manage these different disease processes,” Dr Dyer said.

With her research into stroke patients, she discovered that many did not have great health literacy.

“It's not a lack of information, but it's the understanding of the information and that's where you get health illiteracy. You might have a PhD or you might be CEO of a company – understanding is a different story.

“Because if you knew that if you don't take your medication that in the course of two weeks you would end up in ICU with a stroke, I'm not thinking that you’re going to stop taking it. If you knew that if you walk 30 minutes per day, if you eat right, it would help you stay healthy, you would definitely start looking at some lifestyle changes. If you knew your outcome would be the fact that you end up in ICU, or on a ventilator, or have some disability, you would change. So health literacy cannot be overemphasised enough. That’s what is needed really – understanding it. And I would start it from the high schools.”

Socio-economic factors often play into people’s decision-making, Dr Dyer added.

“Many people probably understand it to a certain level, but I think that they're looking at their handicaps – their financial ability. To eat healthy, it may cost a lot, and I can't afford it. The cheapest way to go is unhealthy but at least I'm having food.

“So we have to educate persons how to live in a country like Bermuda, on a budget that is economical but it is also nutritious. That's another thing that needs to be targeted when we're doing public health campaigning. It's very difficult if you're not earning a certain salary to buy organic.”

She believes she got through her studies with prayer and “a lot of support” from family, friends and colleagues.

“You can't do things alone. It takes a village, not only to raise a kid, but to live. You have to surround yourself with persons who are positive and who actually have your interest [at heart].

“I had an excellent support team both here and back home in Jamaica as well. I don't have kids and I’m not married and I'm not dating anyone because when I started the programme they said, ‘If you're not in a serious relationship, cut it off, because it's not going to work. If you have kids, make sure you have a good nanny or somebody looking after them.’ It’s that intense.”

Dr Dyer believes medicine is in her DNA. Her grandmother was only educated to primary school level and worked as a midwife. Her mother “knows everything about my books” and “guided me straight through from bachelor’s right up to PhD level”.

“So, it is a pleasure for me to work,” she said.