Once upon a time in Nigeria. Laparoscopic myomectomy was regarded as the gold standard for women with symptomatic fibroids who wish to become pregnant.
Just one year ago, the Fibroid Care Centre@ Nordica, a private medical facility in Lagos introduced the High-intensity focused ultrasound (HIFU or MRgFUS) therapy option into the Nigerian Medicare space as an alternative to the surgical removal of Fibroid, a benign, hormone-sensitive tumour of the smooth muscles found in most African women.
Since then the centre has had 143 successful treatments while working various stakeholders including doctors, government, private sector and the general public, to which it has donated 6 free treatments through its CSR initiatives.
The non-surgical, minimally invasive, therapeutic option based on a cutting edge, relatively new global technology and which is also used in cosmetic procedures, appears to be catching on, according to Dr. Abayomi Ajayi, the Fibroid Care Centre’s Medical Director who spoke exclusively to select media on the journey so far. Excerpts:-
What have you learnt in the last year which has been probably insightful?
The most interesting thing was to see how easy it was to treat fibroid and even adenomyosis. That the patient can come in that day, do the procedure and go home the next day to do all the things she was doing.
In fact one of them stretched it, that 72 hours after, she returned to the United States though nobody recommended that for her. It shows you how comfortable she was. I never believed it was possible. I started from the old school. When I used to operate on Fibroid you spent one week in the hospital, we removed your sutures. I think it’s a big relief because it’s targeted. In fact one of our patients is now pregnant after the HIFU. Those are some of the things that might change the future of medical practice as it concerns uterine Fibroids.
The thing that was a shock to me is adenomyosis. When they do surgery, we are now seeing that a lot of the uteruses are becoming deformed from the MRI findings that we reviewed but with HIFU, you just lie down on the bed and you are good. Again, even if you need to repeat the procedure, the fact that it does not affect your fertility is a good thing because about 53percent also had infertility.
26 out of the 143 treated have had adenomyosis, constituting about 18percent. This is one of the things we’ve been saying that adenomyosis is here with us and we have to be on the lookout for it. They thought what they had been fibroid.
With adenomyosis we also learnt a few things. When we started we were placing them on injectibles after the HIFU for 3 months but with our experience with some of the patients we had to increase it to 6 months.
Sometimes in adenomyosis you might have to put in a renal coil. None of our patients have agreed to renal coil because of infertility. That is where we have some grey areas which we will probably overcome over time.
We have learnt a lot from our experience and we will continue to see. We want to see from our data, what kind of patient should we offer HIFU? We have learnt quite a few things about Fibroids.
Are you saying death rates are really reduced due to HIFU?
Two things attracted me to HIFU. The fact that Fibroid affects the quality of life of women and the fact that treatment can cause morbidity. Some people are sick after surgery either because they get infected, lose a lot of blood but with HIFU all these don’t happen. The major problems with surgery are either the risk of surgery or the risk of anesthetic.
At what age group is the prevalence of fibroid so high? It would seem that younger patients were presenting with Fibroid more than before?
I can only tell you the kind of patients we see at the centre and that does not talk about prevalence. It’s only people who have money that come to us so it’s difficult for me to extrapolate for the whole population but if you are asking for the epidemiology of those that have come to the centre, we have treated between age 24 and 50 and out of these, 53% of these also have infertility.
It’s difficult for me to say that younger people are having Fibroids. I guess awareness is much better now. Before, when a young girl got Fibroid she’s likely to continue to use all kinds of things until maybe she cannot have children, that’s when she comes forward. People now know that if you have a swelling in your tummy…
The health seeking behaviour of our people has improved and that is making people to look for solutions earlier. But even as we say so, we have Fibroids at the centre that are really very huge even in young people, but I’m going to be careful to say this is a new thing. I don’t think so because a few years ago, we’ve seen even some young people but not this proportion I agree. People are beginning to be aware that it needs treatment and is treatable, so rather than thinking it’s commoner now among young people, I think it’s more like we’re doing a better job at letting people know that.
A few years ago, even scanning was not as rampant as it is now.
The fact that some of our people also suffer infertility is also something we need to pay attention to. Majority of them still want their uterus, they still want to have children.
That is why in this environment, it is the commonest surgery.
There has been a lingering controversy about high profile individuals flying overseas for medical procedures in spite of overwhelming evidence that there are many high quality medical practitioners in the country. How can we win back the trust of Nigerians in the sector?
This thing that we call social media has given voice to both the reasonable and the unreasonable. We say bad news travels very fast and even fake news.
Sometimes some of these claims are not substantiated and you will see people forwarding them. Most of the structures we have built all over the world are being discredited by this fake news. Nigeria cannot be an exception and the health sector too. It behooves on responsible journalism to point out some of these things. Something happens in the hospital, before people even hear what has happened, the doctor is at fault. In a country like our where we don’t have many good facilities, something happens and all you hear is, ‘shut the place down, shut the place down!.
How many of such hospitals do you have? Why don’t you investigate what has happened first, if there is anybody who has run foul of the law, punish that person. They say it’s easier to destroy than to build.
When the government is putting so little into healthcare. What we are hearing is that fuel subsidy for 10 years is more than what was put into Health and Education for 10 years. Fuel subsidy!
The bad guys should not go unpunished but the good guys should be given credit.
