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
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