Lagos — In order to minimise the incidence of infertility in married couples, Nordica Fertility Centre, Lagos, one Bisi Ojediranof Nigeria's leading centres for world class assisted reproduction services, recently flew in experts to train Nigerian doctors on hysteroscopy services. Mary Ekah writes that the two-day course provided gyneacologists with the knowledge of practicals and technical aspects of setting up and running a basic investigative and therapeutic hysteroscopy service

Over 25 percent of married Nigerian couples are affected by infertility, a disorder of the reproductive system which affects the body's ability to perform the basic function of conceiving. It is also indicated that in Nigeria about 45 percent of all consultations in gynecological clinics are infertility-related, a situation where married couples are unable to conceive after a year of trying. It is also true that the desire of every couple is to become parents within the first and second year of marriage. Some couples have this dream fulfilled while a number of others do not. Most often, the problem if infertility is traced to the woman and other times the man.

The good news, however, is that treatment modalities available today offer a good rate of success thereby reducing the incidence of infertility. The challenge here is that there are equipment used commonly in advanced parts of the world to bring about fertility, particularly in women but are not commonly used in Nigeria, even though these equipment may be scarcely available, mainly because many Nigeria doctors have not been privileged to be trained to use them and many of those who are trained have had to go abroad to have the training. This challenge has not only frustrated the efforts of gyneacologists in Nigeria but has also posed a big challenge to couples seeking to have babies.

For example, hysteroscopy, an equipment used in looking at the inside lining of the uterus, a process that is very important to bring about fertility in women, detecting fibroid in women and diagnosing women with abnormal menstrual period, is not available in Nigeria because of the cost. However, people do not know how to use it since they are not trained to use this very important equipment.

Due to these shortcomings, Nordica Fertility Centre, Lagos, one of Nigeria's leading centres for assisted reproduction services, recently flew in experts to train Nigerian gyneacologists on hysteroscopy services. Speaking during the training held at Lagos State University Teaching Hospital (LASUTH), Ikeja Lagos, the clinical director, of the fertility centre, Dr. Abayomi Ajayi, said the training in hysteroscopy was mainly for capacity development.

Ajayi, who said the training would be a regular occurrence noted that it was a good thing to bring trainers down to Nigeria to train doctors on hysteroscopy service so that many Nigerians who are having challenges in conceiving would also have the advantage of having the equipment used on them. The training on hysteroscopy, which is also used in diagnosing fibroid, he said would be relevant towards achieving pregnancy as fibroid is a black disease common amongst the black women.

"About 40 percent of the black women have fibroids and one of the problems is that the fibroid are inside the uterus where the baby is supposed to be. And no matter the size of the fibroid you have in the uterus, it is going to jeopardise the chances of pregnancy, even if you do assisted reproduction unless the fibroid is diagnosed. The bad thing again is that sometimes the doctor misses the fibroids inside the uterus of women who have had removal of fibroid. So it is very important for us to have equipment that can look inside the uterus. This equipment does not only look inside but it is also possible to remove some of the fibroids that are inside the uterus," he said.

Ajayi stressed further that it was not that hysteroscopy service is not available because of the cost but because people do not know how to use it, adding, "There is no point buying a thing if you don't know how to use. That is why we want to be able to train people on how to use this so that they can buy it because it is not the cost of the equipment but the know-how that is the problem and that is what we intend to solve.

"It is going to be a regular training for as many people as we can take. We want them to be in small groups not more than 20 so that we can have hands-on. We are not talking about theory here; we are talking about both theory and practical", said the gynecologist who also revealed that there was a life surgery during the training at Nordica Centre while the theory and hands-on were done at LASUTH.

He revealed further that with the opening of another Nordica Clinic in Asaba, the next port of call for the training would be in Asaba by next year.

One of the faculties at the training, Dr. Abiodun Fakokunde is a consultant obstetrician and gyneacologist /honorary senior lecturer, North Middlesex University Hospital /VCL & Royal Free Hospital Medical School London.

Speaking during the training, he said, "hysteroscopy is actually using a tube to look into a tube, it is a very simple thing, and it is like using telescope to look inside the cavity of the uterus. The uterus is the womb which is like a small tube where women carry babies. So what we try to do is to look through a telescope into the womb to see what is going on inside as this has often contributed to problems with menstrual periods and trying to get pregnant. So this particular skill is actually targeted toward checking those problems."

Having been trained in Nigeria, Fakokunde said his being in Nigeria to train other doctors is a part of giving back to a society that provided him with an opportunity to go abroad. "It is a way of technological transfer in terms of exchanging ideas with my colleagues at home and it is a way forward for us. By exchanging this technology and training a few doctors who are already skilled in certain ways with this modern way of managing problems will actually improve care and make life easier for Nigerians", he said.

Dr. Kalu Emanuel, a consultant gyneacologist, sub-specialist in reproductive gyneacology and fertility assisted conception unit, Queen Mary's University Hospital, London, another trainer, said the Nordica Fertility Centre in organising the training for Nigerian doctors recognises the importance of transferring the technology that others have had the privilege to enjoy abroad and to bring it back to people in Nigeria so that the nation can provide the same quality of care that some people travel abroad to get.

Hysteroscopy, he said, is a 21st century technology, explaining that an operation that one does with a large cut on one's tummy in the past can now be done through very small holes. "Women in the past used to have a lot of heavy periods with Fibroid and they suffer infertility and it was difficult to know where these fibroids are located and how to remove them. Most women usually required cutting them open to do that. Now we can do them with instrument we pass through the virgina into the womb without any cut at all to remove the fibroid and also to improve fertility", Emanuel noted.

He added: "Nigerian patients deserve the kind of quality of care as any patients in the world. There are a lot of Nigerians abroad with skills that are comparable to anywhere in the world and we work for the people abroad and provide services to them and I think at this point, we should come back home and train our own local doctors and also provide the care to the women in Nigeria who deserve good quality care as anybody else in the world."

The London-based doctor however said that it was time our public health care system should woke up to the reality and realise that things are moving quickly and so should invest not only in infrastructure but also in equipment to improve healthcare. "Nordica is leading, in that it has all the equipment and it is also brining in the appropriate skills as well as exposing other doctors in the country to new technology in the health sector. I expect that all the doctors trained would go back and invest in equipment as well and that is what the government should be doing," he said.