In recent times, there have been some misconceptions about Assisted Reproductive Technique (ART), especially In Vitro Fertilisation (IVF).
A school of thought says it is fraught with risks due to multiple births and caesarean births. Another is worried about the high cost, lack of regulation and guidelines; and indiscriminate springing up of fertility clinics. There are also fears that IVF babies cannot compete favourably with those born through natural means.
Director, Nordica Fertility Center, Victoria Island, Lagos, Dr. Abayomi Ajayi, in this interview with CHUKWUMA MUANYA throws more light on these misgivings on IVF, why Nordica is offering free IVF treatment to Nigerians, plans by the clinic to offer free treatment and screening services to more Nigerians; among other things.
There are heightened fears on the perceived risks associated with Assisted Reproductive Technique (ART), especially In Vitro Fertilisation (IVF). A school of taught says that it's association with multiple pregnancies and Caesarean section increases the chances of mother and child mortality. How true is this?
Yes! Multiple pregnancies, we know that about 25 or 30 per cent of babies born from assisted conception, especially IVF will be more than one. Therefore the more the number of babies the higher the risk of operative deliveries to start with. That is one way of looking at it. Of course we know the procedure that assisted conception involves. It involves multiple ovulation sometimes even multiple transfer of embryos and therefore sensible success rate. And one of the problems of this is multiple pregnancies and multiple births. They are the attendant risk of this multiple transfer. You remember the one that happened recently in the United States which was overblown. But in this environment we tend to tolerate multiple pregnancies better than Caucasians for whatever reasons. Naturally, Nigeria and the Republic of Ireland have the highest twinning rates in the world. So, there is something in us that carries at least two better than the Caucasians. But when it gets beyond three now it becomes something.
But unfortunately the procedure of IVF also involves transferring more than one except now in Europe where they are doing what is called single embryo transfer.
We have not started doing that here in Nigeria and I am not sure whether we are looking forward to doing single embryo transfer, except in very selected patients. Because like I said we tend to accept multiple births.
It is has also been said that IVF is bedevilled with multiple births because the practitioners are trying to increase the chances of conception?
Yes! That is the thing, because here everybody pays out of pocket. Government does not pay for anybody and therefore you want to maximise the chances without causing any harm to the patient and that is why we do not transfer more than three. The worse case scenario we have triplets, which even without IVF in this environment almost every obstetrician would have had to deliver one or two triplets in his career.
So triplet is still not being frowned at but higher order of multiples above triplets is what people are not comfortable with.
Considering what happened in the United States where assisted conception led to sextuplets, what are the chances on the procedure we practise in Nigeria on your patients having such?
in Nigeria it is better we confine it to not more than three because there is no support system here, unlike in the United States. You remember when the woman even had the babies there was a Nigerian that had sextuplets before who came to visit, and all the children survived. That is of course because services are well advanced, if they have to take over the ventilation of the babies, they have the facilities. But here it is not readily available.
Another issue is that of cost. It has been suggested that it costs between N600 and N1.5 million to procure one cycle of treatment, making it out of reach of the ordinary Nigerian. And in that cycle, the chances of the woman getting pregnant is not more than 30 per cent. How true is this?
That is true! The success rate of IVF is about 25 to 30 percent and that is any where in the world. What IVF tries to do is what happens in a woman in a natural cycle. And the success rate of nature is about 18 to 20 per cent every month. So if IVF can give you 25 per cent, it is a little bit more than what nature can do. And therefore the success rate is like that and people are still working to see how we can improve the success rate. But as of now that is it. One thing we cannot afford to do is compromise standards. IVF babies are normal babies and that is because the quality control system in the body are not tempered with in IVF.
So, that is why we have normal babies. So people want to increase success rate without decreasing the quality of the baby. So that is usually the balancing act that is being carried out in researches.
On the issue of cost I can only talk about my own centre, I do not know how much other people charge. I know that there is no treatment that is up to N1.2 million for a cycle in my centre.
But people are crying that they cannot afford this. How much do you charge for an average cycle here?
We charge between N600 to N800, very maximum N900. You always take things out of context not comparing it what happens in other parts of the world. For instance in the United Kingdom, a cycle costs about $4000, that is without the air fares and other logistics. We have to bring in all the materials we are using even our consumables from there. And they do not have the problem of electricity supply. I have three electricity generating sets here now, and if I tell you how much I spend on diesel every month.
There are costs for us that we need to meet, but we are also mindful of the environment in which we practise that it might get to a point and people will not be able to afford it. But is not as bad as it sounds most of the time.
Do you have plans for the ordinary Nigerian to be able to access this assisted fertility technique considering the cost and the economic realities. Practically a couple that earns an average of N100,000 month cannot afford it. How can it happen?
The bad thing about our environment is that you have to pay for everything out of pocket. There is nobody helping you, no government to help, whatever. Whether it is possible for government to help, I am not very sure. You know that the government is saddled with so many responsibilities now. But the good thing here is that we have the extended family network. Infertility is always a challenge not only to the couple but to the whole family. So even if you are earning a N100,000 you will see the rate that family members are ready to help because they know that if you do not have this, you will continue to look for it and it is unsettling.
Even the World Health Organisation (WHO) defines health as not only physical but also emotional. Therefore if someone has something troubling him or her, is not likely to be at his or her best and people are aware of that. So, it is like people rally round. I am sure that is not everyone that comes around here is paying out of their own pocket; this like most of the time a joint effort. We are mindful of that in this environment, and that is why we want to give the patient the best value for their money.
Do you have a program to help those who cannot afford it?
Yes! We did this EART (Expanding Access to Reproductive Treatment), which has crystalised now to Fertility Treatment Support Group (FTSG). There is now a support group that is incharge of that program. We are still running it this year.
The programme is offering free IVF treatment to patients. It was so rewarding to us that really encourage us. We tried to get sponsors last year but we did not succeed. Well, we got some sponsors; some of the media houses came to our rescue. But we did not really get anybody to bring out the money, so it was like we sponsored almost the whole thing and that limited the number of women we could give access to. But we are still working on it, to see how we can increase the number.
How many women or families have benefited from this programme?
What we have in mind is that we are going to give free treatment to 16 women; we are going to be giving two women every quarter. But we are going to be giving free screening to 10 women every quarter.
And out of these ten women, we choose two people. The first set that we gave was so revealing. There were some things that we found out, that out of these 10 people- some that were not even part of the two that finally had IVF- there was a life saving situation in one of the women. I am not sure whether the woman would not have dropped dead one day if the condition was not diagnosed. She had what was called a polyp in the uterus and she was bleeding every month, and they were not doing anything about it. It was during our screening that we saw that, and what we now did was to use what we call hysteroscope to bring out the polyp. She is alright now, she does not have a child yet but she is alive and well. And that made us to see that it is beyond even having children, that this programme can also help in sustaining health in this environment.
Another issue is the fear that people born through IVF cannot compare favourably with people born through natural means. Some suggest that IVF babies are not normal or not perfectly normal. Can you compare children born through IVF with those born through natural means?
The answer is yes! As I told you earlier on, all the quality control system in the body are reclaimed in IVF and so babies born through IVF are normal babies. We have had over three million babies born all over the world by IVF and they are perfectly normal babies from what statistics have shown us. You can talk to even some of our own babies. One just came on Saturday.
How many babies have been born in this facility through IVF?
We presented our figures a few weeks ago, over 268. We still have about 60 women on the waiting list, and two of them have delivered.
What is the age of the first IVF baby?
The first will be five in September
Boy or Girl?
A boy, Julian.
What is the next thing for Nordica? What are your plans for the future?
Well! Two things we did. We had a dinner where we invited all stakeholders, including the press to see what we have done so far in our last six years of establishment of Nordica. We also wanted to work with the media in raising the awareness on endometriosis. So these were two things we wanted to do together. It is very important for the public to be aware of things concerning assisted reproduction, for it to always be in their consciousness that it is necessary for some people to have assisted conception and they should not leave it as the last resort; that when you need it, you need it and you should go for it soon enough because we know that success decreases with age especially of the woman. Also for us to raise the awareness of this condition called endometriosis, which is not given its proper place in media practise in Nigeria.
What is endometriosis? And what is its impact on fertility rate in Nigeria?
Well endometriosis is the occurrence of endometrial tissue in any other place apart from in the endometrium (the inner lining of the uterus). And what happens is that this endometrial tissue reacts to the hormone that the woman secrets every month, just like the endometrium does. You see what happens it that the women sheds her endometrium when she sees her menstrual cycle. The same thing she now sheds the endometrium in order places apart from inside the uterus. So you can imagine if it is on top of the ovary, she is now shedding her endmetrium inside the abdomen. So with time there is a collection of blood, which contains some unwanted substances and it starts to form what we call additions or scarring inside the woman. So, definitely because of this, it disturbs the anatomy of the reproductive organ leading to infertility.
The other way is that because of these chemicals that are contained, which is not normally in the abdomen, these chemicals are released which kill eggs and ill sperms. So two ways that endometriosis can affect fertility is either chemical or mechanical.
What the percentage of the infertility caused by endometriosis?
It would be around 20 to 40 per cent.
You said its being neglected?
When we were in medical school we were told 15 years ago that endometriosis was not common in this environment. Now, whether it was not common then or we were just simply missing it, I do not know. But I know now that it is common. Maybe because we now have better facilities to diagnose and we are better skilled at doing some of things. But it is not a peculiar thing to Nigeria, because in the United Kingdom, between the unset of symptoms and diagnosis takes about eight years in which she must have seen about five doctors who will not have made the diagnosis. And that is where records are kept. So in Nigeria, where records are not kept, many women go through out their life time without a diagnosis.
At what stage will a couple need assisted reproduction and how should they go about?
I think the question to ask is at what stage will they need intervention, evaluation of a doctor. This depends on the age of the woman to start with because there is no particular age at which women get married.
It is when the man comes along. So if the woman is above 35, then after six months of trying she should see the doctor who should do some investigation. But if she is less than 35 years she can wait for one year and then see the doctor. But if there are obvious things in the offing then she does not need to wait this long. For example if her menses are irregular; if the man has some history of trauma to the testes while he was younger, undescended testes. Those are things that are obvious and they are pointer to the fact that you do not need to wait, you need to quickly see the doctor. When these things are not present, we allow six months for women who are above 35 and above, and we allow one year for a woman who is less than 35 to be properly evaluated
Are you concerned about late marriage especially by women, and its impact on childlessness?
I think that is a fact all over the world. Women are going to school more than they used to do before and that also is taking a toll on fertility, because we know that a woman is most fertile in those years that they go to school. And by the time they finished school they want a career and may be Mr. Right might not come on time. All these are things that might hinder reproduction when they finally decide to do that. So what we try to let people know is that no matter what you do, nobody is against a woman having a career or whatever, do not forget to have children at the right age.
Another issue is that of quackery. Some clinics are making audacious claims on IVF. Do you have an association? How is the regulation of the practice in Nigeria?
Regulation. None for now and that is one of the things that we are clamouring to have in our industry.
So for now what the IVF clinics do is just to register with the Medical and Dental Council of Nigeria (MDCN) and the Nigeria Medical Association (NMA)?
You are just a doctor and that is it. If you are a gynaecologist, you belong to the society of Gynaecologists of Nigeria (SOGON).
Do you not think this is a dangerous trend, and you are allowing cracks in the practice?
Obviously, it is not a very healthy development. If you trace the history of IVF all over the world, it is just the same thing that happened even in UK that is happening here. We need to form a strong body that will see to it. But of course we cannot do anything without the government, because no matter how we need policing and the only person that provides policing in Nigeria is still the government. So it is for us to have a body and then align with the government in order to give teeth to whatever regulation that we want to be in place.
More studies are implicating petrochemical products and paints as major causes of infertility. How strong is this link?
Well! The environment has always played a factor in fertility especially with industrialisation. We know there are so many hydrocarbons in the atmosphere that can be converted into oestrogen (female sex hormone) and when a male is exposed to a particular level of oestrogen it affects spermatozoa formation. Everywhere in the world the environment's an issue. In Denmark, it has been shown that in mothers who smoke their boys usually have lower sperm counts.
What is your advice to Nigerians to things they should do to ensure that they stay fertile? Or have maximal fertility rate?
I think the most important thing is that you live a healthy life. And living a healthy life involves what you do, what you eat and what you drink. And probably even what you wear. It is better to maintain a healthy Body Mass Index (BMI) and that might involve exercises. BMI is a measure of weight in kilograms over height in metres square (kg/m2). BMI between 20 and 25 is normal/healthy, 25 to 30 is overweight, and above 30 is obesity. And then you must watch what you eat also to ensure that you are eating balance diet. Not too much alcohol, if possible none at all. Sometimes we talk about this cotton underwear. Some people who are on the borderline, this might be helpful for them. Limit the exposure of the testes to hot temperature. Avoid hard drugs, avoid if possible smoking, it has been known to affect both the man and woman. No obesity, and if you can be in control, choose the job you do.
What is your parting remark?
Infertility will always be with us and therefore it is important for people to know what to do when they face the challenge of infertility. It is important for us to give the right knowledge to people, so that they will do the important thing when they are faced with the challenge of infertility. I am not saying that you should not go to any religious setting, but they should do the right thing go to the proper places where they can be helped. The most important thing is for you to know where you can be helped; you need knowledge. The Internet is there. I keep saying that to my patients.
Wednesday, May 27, 2009
Tuesday, May 19, 2009
Like a million stars, she is illuminating the lives of couples having infertility problems, turning their anguish to joy. Indeed, her heart bleeds for couples who have difficulties in having children of their own as and when required; hence, she feels duty-bound to give them succour even when their cases have been written off.Undoubtedly, Mrs Bobo Kayode, Nigeria’s first female embryologist, has been able to stand out as nature’s assistant in the laboratory of procreation. Her organization, Omni Medical Centre (OMC) and Advanced Fertility Clinic (AFC), Lagos, has, over the years, recorded remarkable feats in assisted conception and reproduction techniques. These include assisting a woman suffering from Turner’s Syndrome (absence of ovaries) to achieve pregnancy and deliver safely, multiple births through IVF.Equally remarkable, her clinic has pioneered low-cost In-Vitro Fertilization (IVF) in Nigeria. The effort, she says, is aimed at helping those who cannot afford the full course treatment.In this encounter, the executive director of OMC and AFC explains why she is assisting men to impregnate their wives, recent developments in her special field among other issues.
Why I assist couples have children?
I am directly in charge of the fertilization laboratory. Basically, we do much work with couples that have fertility problems. I have chosen to tread this path because I know what people who do not have children of their own go through. Over the years, especially in the African society, we get to see thatmany people usually look down or heap scorn on childless women. What most people do not actually know is that child bearing is a two-way thing involving a male (husband) and a female (wife). And over the years, there has been many myths and beliefs that anytime there is a problem with child bearing, the problem is from the woman in a relationship.But it is not always so. We are in this business to get people to be aware of how to get pregnant when they are married or decide to raise a family. If there is a problem when you do not get pregnant as at when you want it, what do you do? When you have actually taken a decision, what kind of decision do you take? What kind of factors do you look at before reaching a decision? And when you’ve actually taken a decision, what do you do if one treatment or another fails?
There are various factors to be considered to be able to treat or accept people having infertility problems. In a nutshell, we assist people achieve pregnancy if they are having problems doing that on their own.Causes of infertilityThere are various causes of infertility. It could be male-factor problem or it could be female. It could also be genetic. If it is a male factor problem, we are talking about the male having problem to produce sperm or the male having problem to release sperm. For the female, it could be tubal blockage; it could be endometriosis. It could be absence of a womb. One of our major breakthroughs a couple of years ago was when we had a woman who had a residual uterus. She was treated and she gave birth to a baby boy. That woman was practically a male, but we thank God we were able to take her through the proper treatment and today she has a baby boy.
There could be various physiological things wrong in the uterus that would prevent a woman from actually getting pregnant. Indeed, there are various factors that could cause infertility to the male and female.
I would say that there has been an upsurge in infertility because of various factors: the kind of food we eat, stress, the environment we live in, lack of adequate medical care at the appropriate time. These and more have caused an upsurge in infertility in both male and female. And there has been a rise in male infertility recently because of many factors. Males are now smoking more, they are now drinking more, they are now wearing more tight fitting clothes. These are some of the things that affect men not to produce enough sperms.
Talking about stress, because of the genetic makeup of men, they are more prone to stress because of the responsibilities that a lot of them bear. This has contributed to the increase in male infertility problems.
When to seek treatment
We always advise couples that come to us to complain of their inability to achieve pregnancy that they must have been having unprotected sex for at least 12 months before they can begin to think that they may or may not have fertility problems. If a woman has been meeting regularly with her husband unprotected and she does not get pregnant in 12 months, she should please go and see a qualified gynaecologist.Assisted Reproduction Techniques (ART)In Omni Medical Centre and Advanced Fertility Clinic, we take in a patient that comes with her husband because we must meet the couple. They see the medical doctor and they are also counselled. Then we take them on various tests. Immediately after they have seen the gynaecologist, we do what we call investigative surgery, a situation whereby we look at the female internally to determine if the patient has a clear uterus, clear tubes and visible ovaries. From there, we go to hormonal treatments.
We assess and do various tests to find out the semen analysis, then to inseminations. From inseminations we go on to either In-Vitro Fertilisation. If there is a problem with the male regarding sperm production, we actually go into the testes and have his sperm extracted. If there is need for ESCI, we do it. We can go to IVF or other techniques that would result in embryos being fertilized, cultured and put back into the female uterus.
At our own clinic, we have pioneered what we call the low-cost IVF in Nigeria. It is a course of treatment whereby those who cannot afford the full course treatment are taken through the minimal drug stimulatory regime that would at least encourage their follicles to be developed and produce ocytes that would enable us to proceed with the treatment. The minimum cost of that procedure is about N280,000. I am happy to say that we’ve had pregnancies from low-cost IVF. The other day, a woman came in and she was taken through the minimal dosage required.
I think the whole thing cost N320,000 and she has a baby boy. There are several others that we have put through that regime that have actually gone home smiling with their babies.Now depending on the patient’s response to the drugs, she might have to go the full IVF treatment. That could run from about N650,000 to N750,000 per cycle. If we are going to do an ESCI cycle, we will be talking about N750,000 to N1 million
depending on the patient’s response to the drugs and the entire procedure.
However, not all patients require IVF or ESCI. Insemination costs between N20,000 and N60,000 depending on the cycles and number of procedures required per cycle.ChallengesFirst of all, you must be a patient individual to engage in Assisted Reproduction Technique (ART). You must be ready to endure and keep at what you are doing diligently. You must be able to stick to your lab protocols, stick to your drug regimes and alter when necessary for various patients depending on their responses. You must remain focused to achieve results. It is good to interact with other people in your field of specialization, but don’t be carried away by the results he claims to be getting because that could be a great deterrent. It could disturb or discourage you if you believe or concentrate on what people say they are doing. Just do what you are doing diligently and properly. The end will always lead to success.
There is the problem of lack of infrastructure in Nigeria. We all know about the epileptic power supply in the country. I don’t think there is a cycle we have run without having to use own our generators and inverters. All these increase the financial burden to make sure the procedure is done properly and all the regimes are administered properly and that you meet the actual conditions that would give you optimal embryo growth and development. Of course, the staff must be trained and retrained to keep abreast of modern techniques. Unfortunately, after training the staff, they run away to another clinic before you know it. So, high staff migration is a big problem and it is quite difficult to get staff that are trustworthy that will stay with you and carry on with your standard of treatment and procedure to ensure that you actually get your desired results at all times.Advancement in assisted conception and reproduction techniquesMy best moment was the first delivery through IVF we had at the then Osagie Medical Centre, Surulere before we changed to Advance Fertility Clinic (AFC). It was around 1988 or 89. Another major breakthrough was helping the woman who has residual ovary to have a baby boy about four years ago. Indeed, we have recorded several landmark situations including having twins through IVF.Only recently, we did a batch of ovary donation cycle for five women whose average age was 56, and four of them got pregnant. It was wonderful, amazing. Indeed, one of them was about 61 years old and got pregnant. The procedure entailed stimulating a young ovary donor, collects ocytes from her and fertilize them with the older patients’ husbands’ semen and the resulting embryos were then transferred to this group of five women. The youngest was 55 and the oldest was 61. We were all very thrilled.
Talking about sperm and/or eggs being donated for couples, some issues bothering on ethics come up, such as right of child, confidentialities of the transaction and ownership of the child, among others. A counsellor plays a very important role in counseling the sperms and ocytes donors as well as the carriers of such garment. The person who owns the sperm or egg (garment) doesn’t necessarily own the baby. Therefore, one must ensure that the legal aspect are tied up so that you can be sure that whosever eventually get pregnant with whichever sperm or eggs does not begin to give you problem in future or the male or female donor of Ocyte or sperm does not give problem later. In other words, these have to be discussed and agreed.
Dr Tunde Okewale is the proprietor of St Ives Hospital, a Lagos-based centre noted for producing test tube babies. In this interview , he speaks about his modest success story and why doctors should operate within their areas of specialisation for maximum success and rest of mind.
Why did you name your hospital St Ives?
We named the hospital St Ives for various reasons. During my residency training in obstetrics and gynaecology in the UK, I worked in a small town called St Ives. It is one of the coastal towns, rich in history and tourism, and I fell in love with the town and the name. That is one. The second reason is that in Catholic parlance, the patron faith of lawyers is St Ives, and my wife is a lawyer. So, when we were looking for a name for the hospital, we settled for St Ives
Infertility is on the increase among Nigerian couples. As a specialist in that area, what would you say is responsible for the development?
Infertility is on the increase among Nigerian couples. As a specialist in that area, what would you say is responsible for the development?
There are various reasons for the rise in infertility. But the two major reasons in our environment are one, there is an increase in sexually transmitted diseases that are poorly treated. The second reason is that people are getting married very late, particularly women, and we all know that the earlier a woman gets married, the better. For childbearing, women are at the peak of their fertility between the age of 20 and 30. But for career purposes, they delay marriage until they are 35 or 40, when their fertility has started dropping.
But some couples read diabolical meanings to the problem…
Well, as a scientist and a medical doctor, I am not saying there are no diabolical reasons. But until all other scientific reasons are explored, I think it is wrong for someone to read diabolical reasons to infertility. It doesn‘t take rocket science to know that if you live a reckless sex life, you are exposed to recurring genital tract infection. The end result is infertility. If you have had various D&C, abortions, you might have problems later in life.
But people resort to spiritual homes in search of a child. Can that provide a solution?
There is nothing wrong in going to churches for help in terms of problems generally, not just infertility. But even in the churches, any thorough pastor will want to explore other means before considering spiritual solutions.
Here, you help couples to achieve pregnancy through IVF. How is that done?
Ordinarily, when a man and a woman have sexual intercourse, the woman gets pregnant. But there are people who that simple method does not work for. So, what we do is that we take the man‘s sperm and put it in a laboratory setting. We remove the woman‘s egg from her body and fertilise it with the man’s sperm in the lab. When pregnancy is formed, we return the fertilised egg into the woman’s womb.
It sounds very easy?
It is not. It is a sophisticated technological procedure. But for some couples, that is the only solution. IVF was first used as a method of assisted conception in the UK in 1978. The first test tube baby was Luis Brown. It is a well tested and safe method. And for some couples, that is the only way, especially women who have blocked fallopian tube and men who have very low sperm count.
How popular is this method in Nigeria?
For those who are well informed, it is popular. There are presently about 12 IVF centres in the country. Unfortunately, it is not something you advertise; it is only for informed people. Again, unfortunately for infertile couples in Nigeria, they see IVF as the last resort, whereas abroad, if you observe that you don‘t get pregnant as normally as you should, it is more or less the first option. The problem with IVF is that the older the woman is, the less successful it is. So you find that a lot of couples, when they are already in their forties, that is when they begin to turn up for IVF.
What has been your experience so far in this field?
It‘s okay. We started our unit in April 2007 and we had our first IVF baby in June 2008. It was well celebrated. From June till now, we have had about 12 other pregnancies in various stages. Even though people seem to be sceptical about the technology, more and more people are becoming aware of it now.
How affordable is IVF for the average Nigerian couple?
Well, everywhere in the world at present, IVF is not a very affordable procedure because of the financial input required to set up a standard IVF lab. And that is why only 12 centres in Nigeria offer it. But we are trying to make it more affordable, because those who need it most are the ones that are least informed about it. Comparatively, if you are to have an IVF in the UK, it will cost about 5000 pounds. In the US, it is between 10,000 and 20,000 dollars. In Nigeria, it varies from N350,000 to N1 million. It is not cheap; let me put it that way. But it is a method worth embracing by some couples because of its high level of success.
Did you deliberately take to this aspect of medicine?
I trained as an obstetric and gynaecologist in the UK. I worked in many units. IVF is a specialty under infertility. I was fortunate to work in units that are offering IVF in the UK. When we started the hospital in Nigeria, we were running basically obstetrics and gynaecology. We offered various infertility treatments for a long time without an IVF unit because of the cost of setting one up. What we were doing was referring those who needed IVF abroad or to other centres. But when we managed to gather enough money, we set up our own. We sent a number of our staff abroad for training. I also went for refresher courses and training in the UK and India. We collaborated with some foreign companies.
I want to assume that the biggest challenge in this kind of business is constant power supply. How do you cope with that?
That is a very good question. Those are some of the things that add to the cost of IVF in Nigeria. For our lab, NEPA and generators are like standby; the lab is basically run by UPS and inverters for 24 hours. We cannot afford not to have light for a split second. We invested a lot in UPS and inverters.
So if you were to meet the new health minister with your experience so far, what would you tell him?
There is a disconnect between what people talk about as regards the ratio of doctors to patients. There are a lot of highly trained medical personnel outside the public sector; but they are underutilised by government. There are only a few that are absorbed in the public sector, while many are left outside doing far below their capacity in the private sector. That is why such doctors go outside the shores of Nigeria. Of the 12 IVF clinics I just told you exist in Nigeria, only two are owned by government. In the whole of Lagos, the foremost government hospital, which is LUTH, does not offer IVF, not to talk of LASUTH. All the hospitals offering IVF are privately owned. In 1978, UK came with the first IVF baby. Later that year, India reported their own. By 1979, Australia reported its. In 1980, the US did. In the early 80s, there was a claim in LUTH of their first IVF baby. Now you would expect that between that time and now, there would have been an explosion in numbers like it happens everywhere in the world. India has over 300 IVF clinics. Ditto for the UK and the US. So there is a disconnect here. From 1980 when LUTH reported till now, we have not heard anything. Even now, LUTH doesn‘t have an IVF clinic. That is a problem. Government needs to invest massively in the health sector.
What government is doing is building poorly equipped massive structures, which they call hospitals. If you go to most of the world‘s renowned hospitals in the UK, you will be surprised with their simple structures. But when you enter, everything that makes an hospital function is there–equipment, personnel, infrastructure. Water runs, there is light, activities go on smoothly. But what we are building in Nigeria is structures, nothing more.
Why did you come back to Nigeria to practise?
I came back because I felt my services would be better needed here than any other place. If I was in the UK, I would be working within an IVF unit. But here, I was able to initiate the setting up of an IVF unit. The other thing is that you will ask me why I didn‘t go to the public sector. We all know that dreams die quickly in the public sector.
Did your parents push you towards medicine?
My father was not a doctor; he was a broadcaster. He was one of the pioneer broadcasters in the old Western Nigerian Television. He was one of those who set up OGBC and OGTV. My sister, Toun Okewale, is a well known broadcaster as well. I come from a family of broadcasters.
So, why didn‘t you go into broadcasting?
I love broadcasting. In fact, I love the entertainment industry, but I just didn‘t toe the line.
How was growing up like?
Growing up was beautiful. I grew up in a civil service setting. The environment was okay. We were not rich but everything was working. There were no strikes in schools. Everything was normal.
Where did you start your medical training?
I got my first degree in Medicine at UCH, Ibadan before I went to the UK for further studies and practice.
Why did you go for a lawyer?
Well, actually, when I met my wife, she studied French, but eventually, she went for Law.
Some doctors would prefer fellow doctors as wives...
I never thought of getting married to a doctor. The life of a doctor is strenuous, at times abnormal. Some doctors cope, but it would be too boring for me if two of us were doctors.
What of the kids?
Well, they are free to make their choice. One of them is in medical school already.
What managerial skills does a doctor need to run a hospital successfully?
The truth of the matter is that most doctors are not trained in management. That is why most of the hospitals have crowds and yet they run at a loss. Again, a lot of doctors are taking far more than they are trained to do. Ideally, every doctor should stay in their own area of specialisation, because it helps both the doctor and the patient. For us here, we try as much as possible to stay within our area of specialisation, which is women and children. Anything outside of that, we invite specialists or refer.
It is said that gynaecologists are often tempted to have affairs with women because of your exposure to them. Is that true?
There are laid down rules and regulations on how doctors deal with their patients. It is unethical for a doctor to have an affair with his patient. Abroad, we have colleagues who have had their licences revoked for having affairs with patients. And the earlier Nigerian patients know their rights, the better. Anybody that comes to you in the hospital is in a vulnerable situation, so you should not use your position as a doctor to take advantage of the patient. The second thing is that it is unethical for a male doctor to examine a female patient without a chaperon, especially when the patient is exposed. A lot of people are not aware of that. Thirdly, every doctor that indulges in such practice is always poor.
How do you relax?
I have time for relaxation. Like I told you, once you operate within your area of specialisation, you cannot experience stress. There is no emergency you cannot handle because you are tuned to anything. But the moment you go out of your area, you are constantly under pressure. You are not sure whether you are doing the right thing for the patient. I believe that any doctor who operates within his area of specialisation will make more money. But when you go out, you are likely to be constantly embarrassed and eventually the patient will know that you are applying trial and error method, and you will not have rest of mind.
SOURCE: THE PUNCH ONLINE