Pishon making breakthrough in women fertility

Paulinus Abu is the Managing Director, Pishon Women Specialist Hospital and Chief Consultant, Federal Medical Centre, all in Makurdi. He spoke with the Press recently in an interview about Pishon’s breakthrough in the Medical profession for Women fertility. Our Correspondent JAMES SHIM participated in the interview. Excerpts:

Who is behind the Pishon Women Specialist Hospital?

I am Dr Paulinus Abu, Chief Consultant Obstetrician and Gynaecologist, with the Federal Medical Centre, Makurdi. Our mission and vision is to become a foremost and leading Clinic in the promotion of effective and efficient healthcare services. It is to prevent mothers from deaths for getting pregnant and children that are born through the provision of quality, accessible and affordable health care services. And our quality of declaration is that, we value the dignity of women in been human. That has been our driving force towards achieving what we feel we have achieved so far in Makurdi. We have gone a step further by doing endoscopic gynaecological treatment. What that entails is that, through some kind of technology we can do surgeries for gynaecological cases without necessarily giving them a big scar. Medically, we call them Pin Hole surgery. They are surgeries you do with minimal scar. We can remove fibroid too with that surgery. We have started this less than a year and I am glad that we have our first IVF baby girl weighing about 4kg. Both mother and the baby are doing well. We have gone further by not just screening for cancer of the Cervix by doing what we call Papsmear but we have a machine that can help us look into it and direct us to have a biopsy that will help in the diagnosis of Cancer of the Cervix. In the next few months we shall have what we call Keroterapy, which is treatment that we do for early cases of Cancer of the Cervix.

How long have these facilities been here?

They have been here for roughly  two years.

 Is the public aware of the availability of these facilities here?

We believe in the principle of what our forefathers set in the medical field, that, we don’t advertise our services but I am sure if you talk to a lot of ladies in Makurdi, they might know Pishon and we believe our services are taking us to far places beyond Makurdi.

What pushed you into this area of intervention in the Medical profession?

It was a childhood dream to become a doctor. My mum was in labour at Federal Medical Center in Gombe for my younger sister and we went to give her delivery items and walking towards the labour room I heard women shouting and screaming, doctor! doctor!! I was 5 or 6 years, and I asked why these women were shouting, was there no doctor? My dad said yes. And I said I am going to become a doctor when I grow up so that these women will stop looking for a doctor. I think I have lived up to that promise and the passion to giving women in despair hope.

What would you say are your main challenges?

The major challenge in health care is finance. If you look at the western world you will find out that health is not their challenge, probably because their governments have a well secured and well monitored insurance scheme. But here you find out that a lot of people pay out of pockets and health is very expensive. I remember Mahatma Ghandi of India that said, “Health is wealth” and not the other way around. So the major challenge is finance to access the state- of-the – art equipments.  Another challenge still boils down to finance, the inability of the patients to pay for services. For example, Benue is a civil service state and majority of the people are peasant farmers. So sometimes they know what their problem is but they are limited because of finance. And very often they stay until when the problem get worse before they start looking for solutions. Illiteracy too is a challenge in health care as it borders on some traditions that are difficult to change. I have tried to take out the political and government will but government can have a lot of contributions in the health sector like the issue of health insurance, if it is well managed it will definitely help in checking a lot of complications and deaths.

Why is the rate of infertility increasing in our society and what remedy can be readily given for women?

When you talk about infertility it looks as if you want to limit it to women. Infertility by the definition is inability of couples to achieve pregnancy after ]one year of sexual activity without any form of family planning method. When you categorise it, you look at the male and female factors and you find out that both contributions are the same. So you find out that the percentage of infertility is the same. Then you have unexplained infertility where both do not have a problem and you wonder why pregnancy is not occurring. As a gynaecologist, let me just dwell on some of the causes on women infetility. In our own part of the country, infection can be the major cause. May be early inflammatory disease from repeated termination of pregnancies that becomes complicated and can lead to blockage of the tubes in the inner side of the uterus, which is the most common one, before you go into whether it could be an ovarian factor. These are the two major ones that we have. For the men, may be low quality sperm, infection, hormonal imbalance, among others. Then you come down to cancer, which is an abnormal growth in any part of the body beyond which the body can control. Most at times, nobody knows the cause of cancer but there can be predisposed factors. For example, cancer of the cervix, the predisposed factor is what they call human papiloma virus infection. Again, there are others that can be caused by exposure to some environmental toxins. An example here is smokers; they may be affected by the cancer of the lungs. So depending on which part of the body you are looking at. Family history too can be there. These are incidences that you can have cancer of the Cervix.

What will it take for an average person to access medical care from the services you are rendering?

Considering the fact that we are dealing with masses of low income, our card and consultation fee are cheap as close as what they pay in government hospitals. The hospital also has indigent committee that looks at cases of those who are financially challenged and they offer free services to them or at a much cheaper rate. There is also an NGO that occasionally comes to find out if we have patients with financial challenges and they assist, not actually in paying all the bills but substantially.

People are skeptical about the life expectancy level of these children been given birth to with the aid of technology, how is the situation?

It is not true. Even the Bible says, “Go ye and subdue the world”. Technology has gone a long way in subduing a lot of things. Even in agriculture you can have food production within a very short period of time and it is of good quality. Even in banking, traveling and whatsoever. So in IVF too, what it does is that it will just pick the most important components of forming a baby which are the sperm and the egg.  Technology has a way of bringing out the main components and then uniting them for fertilization to occur naturally. The growth is not done outside; it is done in the womb just like any other pregnancy. I think more than 10 million babies have been delivered through IVF worldwide. The First delivery is a lady called Lois Brown, delivered in UK in 1978; she is still alive with 3 kids- two boys and a girl. The next fear is, could there be genetic modification in their growth. So far, they have not found out anything different from those who are given birth naturally. That fear doesn’t exist.

How about intelligence?

No, the IQ is the general intelligence of the genetic component of where the egg and the sperm come from. But again, IQ is not only genetic, environmental factors too contribute to it.

Do you have a feeling that government can come in to help in some of your challenges?

Yes.  I have been meeting some high political people in the society, I always tell them that health is quite expensive and some of the few ways that I feel they can contribute to reducing the financial burden on the clients, starting from the government perspective is that, Government can make it like a universal health care, a universal health insurance scheme whereby, everybody is covered in the insurance scheme. Of course, it can come from contributions. Some of these big companies too should be made to pay certain percentage of their profit for that. Then, government too should find a way whereby they can help in paying qualified health care professionals in the private sector certain stipends so that the burden that the practitioners have in paying salaries too will be reduced. Because all those things that make it more expensive have to do with taking care of logistics of the staff. The other one is taxation. The tax they keep asking health facilities to pay is much. For example, you pay to your local government, you pay to state government, apart from that, you are paying to the state Ministry of Health. So it centres on the multiplication of taxation that you definitely have to pay .They can also look at areas of electricity, all of you know that paying electricity bills is quite expensive and medical equipments consume a lot of electricity. In fact, you need to maintain it with electricity and it’s not there so you have to buy diesel. Water too is a challenge in Benue. You find out that some facilities that want to maintain standards have to have a bore hole and I can say that is what I have in this facility. That borehole is part of my corporate social responsibility, I give water to the nearby environment, people come here to fetch water. Some of them we know that they have financial challenges we offer them free medical services that are gynaecologicaly, obstetrics in nature or minor ailments like malaria and typhoid. When we are celebrating yearly, we visit the motherless homes and offer little stipends that we feel the hospital can offer to make them have a sense of belonging in the Society.

What would be your message for those who are facing challenges of stigmatization finance and sometimes spiritual?

Stigmatization is rather unfortunate. It shouldn’t be like that. When we look at natural conception, this is the way God made it. Natural conception is about 20-25 percent. That is, if you have couples that are married without any problem, not every married couple will get pregnant. Naturally about 20-25 percent will have that problem. But there are solutions to it and these solutions shouldn’t be something that we stigmatize despite that it is technology base. Infertility too should be seen as health challenge, not spiritual or a curse or whatsoever because there are various modalities of taking care of it. And when you talk about IVF there are degrees of IVF. There are some you can start with a simple medication as if you are treating malaria. The media should be able to enlighten our society that there should not be any stigma towards that.

Now on deaths following fertility treatment, it goes through a lot of processes. Sometimes when people come for fertility management they come without a problem, so in that situation you give them medication and you see how you can achieve it. We expect that as you are given this medication the gynaecologist  should be monitoring. So you can pick some of those complications that might arise early and treat.

How do you manage the issue of payment and single ladies coming for IVF?

The fertility treatment unfortunately is quite expensive and it’s not covered under health insurance scheme. Even in advanced countries it’s not covered, it is something you pay out of pocket. It is actually expensive because of the drugs and even the technology involved and getting the equipment is quite expensive. To reduce that burden, of course, we wish our government could look into this, unfortunately, government does not see infertility as a problem but having discussions like this can help them see it as a problem and make health insurance to pay, maybe half the money so the person can contribute to all that. Again, we are living in a world that human rights must be respected. We know it’s not our culture but it is now becoming a universal right. A lady can walk into a facility and say for reasons best known to her, I don’t want to marry but I want a child. Of course, you respect that and offer her the service. I’m not sure there is any law in the country that prohibits people from doing that until maybe a legislation comes and prohibits that, if not, most of our laws, we copy the British law. And as long as anyone is concerned a single lady can walk into a facility and decide she wants a child and the service will be offered to her.

The major breakthrough I will mention is IVF. We just had our first baby girl weighing 4kg. We feel it’s a breakthrough for us here. Again, so far we have not had any of those complications and I think that has to do with our diligence of following them up. The other one I want to mention is the lapasosopic surgery that we have started and we have done quite a number of them here, normally it has three levels and as of now, we have gone to the level known as the gynaecological laparoscopic or indoscopic. In the next few months we will step up to the level three of it.  I have been going for a special course and training, hopefully, for the whole of February I will be there to further enhance my skills on the level three training. I think we are the pioneers in Benue State.

What causes failure of the IVF?

The IVF which is infertility fertilization mimics nature and in my description earlier, I mentioned the fact that the conception rate naturally is 20-25 percent. So the IVF too is within that range.  If at all you’re very good, then, you get to 30 percent, even if you go to America, India or whatsoever, that is just the chances. Now the failure rate can be looked at in many ways; it could be inadequate preparation, in terms of the drugs you give to the patient, monitoring the changes and also as you give the injection and then you also plan to retrieve the egg, you must get a good embryologist to get a good egg from the egg cellitory and then look at a quality sperm for production so that once you fertilize them you now transfer. But if you do adequate preparation making sure that the womb is adequately prepared for it to receive the embryo, the other ones nature takes over. So it all goes down to adequate preparation and adequate counselling, you can have a good and successful reproduction rate.

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