Renowned gynaecologist and obstetrician, Dr Abayomi Ajayi of Nordica Fertility talks about issues concerning fertility and infertility with passion anytime you come across him in any forum.
But he surprised his audience when, at a recent webinar, he talked about a new technology by which women can get rid of fibroids without going under the knife.
In an interview with EFFECTS, the fertility specialist shed more light on the new technology as well as the new fibroid procedures. He also talked about medical practice in Nigeria and other climes, and about his beliefs and lifestyle.
You practised abroad before coming down to Nigeria. What’s the difference between Nigerian doctors and foreign doctors as regards the practice of medicine?
Human beings and their environments differ. Nigerian doctors are intelligent human beings; that’s why they excel anywhere they go – US, UK. These guys do very well. Their only bane practising here is that there are no facilities. That is the bane of the doctors in Nigeria. When people say Nigerian doctors are not good, I seriously disagree.
When we started IVF, some people thought we would be using foreigners. I had gone and seen what our guys can do. It is the environment we need to improve; our doctors are wonderful people. Nigerians are generally intelligent people and they have this can-do spirit.
The reason I asked this question is because overseas, doctors tell you the way it is. If you are dying next week, they let you know. But here it is not so. Doctors here write prescriptions and don’t tell you anything about the drugs prescribed. Why is it so?
We need to be careful about environments. In Nigeria, if you contravene a traffic law and the police catch you, you beg. If you contravene traffic law in London, you pay a fine. If you beg in London, the guy doesn’t understand why you are begging. Why? It is not their culture to beg. Even if you beg, it becomes odd to them. They wonder: are you sure you are normal? The cultures are different.
In our culture, we are emotional people. I’m not saying it’s right; I’m not saying it’s wrong. It is difficult for a doctor to tell a Nigerian that you are going to die tomorrow. We rather say, this doesn’t look very well; we will try the best we can do. But we hope that God will help us to make you survive this…A Nigerian doctor will never tell you but in America, the doctor would say, you need to start going home and start doing your housecleaning because you don’t have more than six weeks to live.
We put God into everything that we do. I’m not saying it’s bad. We keep hoping against hope sometimes. I don’t have a problem with that. The doctors are part and parcel of the community, so they practise in a context. You can’t take them out of that context. They are also Nigerians. In Nigeria, God is the final arbiter of everything.
In our hospitals, they drive visitors out of the ward, especially when visiting time is over. In other climes, you have ample time to stay with your loved ones in the hospital. Why is it so?
One of the problems that we have here in Nigeria is the level of literacy. The story is told of a child that was taken to the ER. He was anaemic and went into cardiac failure and the doctor was trying to resuscitate the CPR but the baby finally died. His mother took hold of the doctor and said: ‘you are the one who killed my baby. Why were you punching his chest?’
In the 60s when the oyinbo people first came to us, they would tell the locals to go out. But now, things have changed. In most of the private hospitals, most of the time you stay with your patients.
If you come to me, most of the times, we even encourage that husbands come with their wives because they need to understand what is being done, the drugs that they are taking and that is the modern way to practise.
In government hospitals, some of those practices need to be changed; you need to individualize, know that people that are educated enough and would know what you are doing.
What would you say are the symptoms of fibroids?
The quality of life of women with fibroids is disturbed by the symptoms they encounter. These symptoms come either in the form of menstrual bleeding, which can be heavy. It can sometimes leave them anaemic. Some women can bleed for two weeks in a month; sometimes it can be irregular depending on the locations of these fibroids.
Sometimes, it is like you have a bump in your abdomen and people might even mistake it for pregnancy. This also can affect some organs that are nearby. It can affect the kidneys, and you might even have urinal backflow and if it is allowed to go on for a long time, if you don’t do anything about it, it can lead to renal failure.
These are some of the symptoms that fibroids can cause. The same symptoms make them book for surgeries. Commonest reasons people do surgeries is because they’re bleeding. Now, you can get rid of all those symptoms without surgeries.
Could you tell us more about getting rid of fibroids without surgery?
The new technology to treat fibroid is called High-Intensity Focused Ultrasound (HIFU). About 50 to 80 percent of women before they reach the age of 50 will have fibroids and therefore it is a common thing in this environment. But it is not everybody who can benefit from HIFU.
There are people who we can apply this technology to because ultrasound travels best without gas; anywhere there is intestine can be dangerous for it because it can dissipate the waves. So, we try not to use it on people who have done previous surgeries, that is, the midline incisions.
It is possible that the intestine has acquired a scar and that will make it impossible for the rays to go through where we want it to. So we avoid such people. We want to avoid people who are grossly obese. Anybody above 130kg, we will probably not do this for them because of the fact that the radius of the skin might not allow that.
The way it works is that you must focus at a particular radius and that’s where you fire. If the skin is too thick and you cannot get to where the fibroid is, then we cannot use this kind of technology.
For these two people, grossly obese and people who have had previous midland incisions and scars the new technology is not for them. We also don’t want to use it when your fibroids are too big, the largest about 10cm.
The primary thing is that the doctor does a scan, when he thinks that this patient can qualify then we do the second test which is through MRI to enable us locate the fibroid and that is what we use to set the machine on the day of the treatment.
The patient must lie down with her face down at least for one or two hours; that is all that is required. You just lie down on the table and we set the machine. It is like the machine slices the fibroids across level. You don’t even know that anything is going on; that is why it is not done under local anaesthesia.
If you start feeling pains you tell us so that we can stop the procedure and reposition the patient. One, two hours, we are through. The most important thing is concentrating it to burn away the fibroids.
Why do you think this is needful in Nigeria?
We see that majority of people who have fibroids are afraid of surgery. Many people don’t want to see blood. Many people have heard stories about fibroids. Some of the deaths can come from the surgery, some from anaesthetics. In a place like Nigeria, there are shortages of anaesthetics.
Again, COVID makes it also very appropriate now; you don’t want as much as possible to send anybody to sleep. These are things that make it appropriate for HIFU in our environment.
How do you relax?
I’m a soccer fan. I love Arsenal. I love soccer a lot and I work out. I have been trying to pick up golf but I have really not succeeded but I’m looking up to one day when I will be able to play golf. I have bought everything I need but I have not succeeded. Maybe one day, as I grow older, I will be able to create time to go there.
What things do you like and dislike in people?
I like things being done properly. I pay attention to details. I hate shortcuts and I hate dishonesty. Let’s say it as it is; everybody will get over it after some time. Some people say I’m old school but those are my main core values.
You just clock 60 years, what lessons has life taught you generally?
Life has taught me patience. By nature, I’m a very impatient person. The real meaning of Rome was not built in a day I understand it now.
Life has taught me that for any good thing you need to do, you need human beings despite the fact that human beings might give you problem. But you need them to do anything tangible in life. Managing human beings, working with human beings is probably the greatest training anybody can receive.