14042019 - 144 Killed in nine days

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PAGE 30— SUNDAY VANGUARD, APRIL 14, 2019 No female condom p •Women explain why, despite the huge benefits of the device made for them, t •Experts: Why every woman needs it By Chioma Obinna Condoms are adjudged to be the most efficient technology in combating the spread of HIV/AIDS virus and other sexually transmitted and transmittable diseases. Several studies also found that there was a need for additional effective dual protection prevention methods to protect women and couples from STIs, HIV and unintended pregnancy. The finding gave birth to the female condom in 1984 by a Danish medical doctor, Lasse Hessels. According to scientists, the female condom is an innovative barrier contraceptive that not only offers potential protection against sexually transmitted diseases but was supposed to be a major contraceptive without side effects. Since its launch in Switzerland, female condom has been made available in commercial, social marketing and public sector programmes in over 65 countries, including Nigeria. Sadly, two decades down the line, female condoms are still not popular or widely used by Nigerian women despite the rise in the unmet need for family planning resulting in unintended pregnancies in the country. Sunday Vanguard reports that Nigerian women do not see female condoms as a choice for contraception or safer sex. ‘I don’t want to see it” 32-year-old Mrs Janet Osarabor is among Nigerian women who are not using female condoms not because they are not accessible or affordable but due to ignorance and low awareness. Getting to talk to Janet was a herculean task. She was not ready to talk about female condoms. To her, it is a messy topic to discuss. “I dare not nurse the thought of using a condom because my husband is against it”, she said. She told Sunday Vanguard that she would rather go for the long-acting family planning method than to buy female condoms. “I have heard about it but I have not seen it before and I don’t want to see it. How do you expect me to insert such a thing in my private part? As long as it is not what you wear like the men, it is dirty”. Agatha, 38, was no different in her attitude to female condom. “I have heard about it but I feel shy going to buy it. What will I tell the shop owner? People will see you as a harlot,” she said. According to the mother of two, she prefers modern contraceptives instead of short-acting contraceptives like female condoms. “Again, my husband will begin to doubt my intentions. It is not what you will use without your partner knowing but in the case of other contraceptives, you can do it without telling your spouse. So I cannot use it”. To mother of three, Mrs Juliana Obe, 40, condoms have been her only method of family planning. According to her, she and her husband agreed to use condoms to space their children and that has been working for them. “Condoms are good if you use them well but I find it difficult to use the female condoms. I tried using it once but it was difficult removing it after we finished having intercourse. “My husband introduced male condoms immediately we had our first child and he has been the one buying it. I believe if there is enough education on female condoms, some women will begin to use it. Right now, I don’t think people are using it,” she stated. The stories of Janet, Juliana and Agatha are no different from millions of Nigerian women and girls as studies conducted in Nigeria showed that only two per cent of Nigerian women and girls are aware of female condom. According to experts, if female condoms are used correctly and consistently during vaginal sex, they are 95 per cent effective against pregnancy and sexually transmitted infections. According to a report by the World Health Organisation, WHO, and other United Nations organizations in 2015, condoms were adjudged as a critical Most times, the female condoms expire in my hands. Like in my facility, I will have about 500. If I managed to distribute 200, it is a miracle but male condoms are in thousands component in a comprehensive and sustainable approach to the prevention of HIV and other STIs and effective for preventing unintended pregnancies. Statistics available showed that every year, more than 200 million women have unmet needs for contraception, leading to approximately 80 million unintended pregnancies. According to medical experts, these public health priorities require a decisive response using all available tools, with female and male condoms playing a central role. Female condoms are made from thin, soft plastic called polyurethane and are worn inside the birth canal to prevent semen from getting to the womb. Incorrect use For instance, laboratory studies show that condoms provide an impermeable barrier to particles from the size of sperm and STI pathogens. Also, research among serodiscordant couples (where one partner is living with HIV and the other is not) shows that consistent condom use significantly reduces the risk of HIV transmission both from men to women and women to men, reduces the risk of acquiring other STIs and associated conditions, including genital warts and cervical cancer. Unfortunately, despite these facts, many Nigerian women have continued to be indifferent to female condom. A few who tried to use it are not using it correctly. They end up disappointed. These situations and more have continued to fuel unwanted pregnancy, abortions, HIV and STIs, among others. According to a family planning provider, Mrs Abiola Adekoya, poor awareness and ignorance, culture and religious beliefs are among the factors that continue to militate against the success of the only woman-initiated product capable of offering dual protection from pregnancy and sexually transmitted infections. Narrating her experience as a family planning provider with female condoms, she said women go for male instead of female condoms.
SUNDAY VANGUARD, APRIL 14, 2019, PAGE 31 ease!’ hey prefer the male type Stating that a female condom is a vital tool to protect girls and women’s reproductive health as well as offer them reproductive health choices, she lamented that male condoms are more accepted than female. “Women are not using it since it was introduced about nine years ago in Nigeria. Not all women have seen or heard about it. If you bring 10 women together, hardly will you find two women out of the 10 that know about it. Some women say they feel embarrassed using it. It is good than male condom because a woman can insert it for five hours before sex if it is well fixed. The problem is low awareness about it. There is a need to sensitize the woman about it. Unlike men that can enter any shop and get condoms on the shelf, many women cannot walk into a shop and demand for female condoms. They prefer modern methods”, she said. “While I was in public service as an immunization officer for women and children, I will keep thousands of male and female condoms. Women prefer to take a male than a female condom. “Most times, the female condoms expire in my hands. Like in my facility, I will have about 500. If I managed to distribute 200, it is a miracle but male condoms are in thousands”. Adekoya further recommended that female condoms should be made available in all private and public facilities and more awareness created on it. How to use a female condom Adding that few women who tried to use it were discouraged due to the technicality associated with the female condom, she said: “Before you open a female condom, women should wash their hands very well as the product is very oily. Check the expiry date and that it appears in good condition. Take it carefully out of the packet so as not to rip it and don’t use your teeth or scissors, and be careful with sharp fingernails or jewellery when you are opening it. “You can sit, squat, lie or stand in a position you find comfortable. It has two rings, squeeze the smaller ring at the closed end of the condom and insert it into your vagina as far as it will go, making sure that it doesn’t twist. The large ring at the open end of the female condom will cover the area around the vaginal opening. It will stay outside the body. “When you have sex, the penis should enter into the female condom. The woman must always guide her partner to ensure it goes in the right place and throughout the intercourse. “After sex, twist the large ring to prevent semen from leaking out and gently pull the female condom out. It has its own techniques; if not used properly, it can result in an unplanned pregnancy”. Adekoya said although female condom is a shortacting barrier method of family planning, if used correctly, it is highly effective. Corroborating her views, the National President of HealthCare Providers Association of Nigeria, HCPAN, Dr Adeyeye Arigbabuwo, confirmed that female condoms are safe for use. According him, it is all about protection against diseases and u n w a n t e d pregnancies. Dr. Sakina Bello, Senior Program Advisor – Pathfinder International in Nigeria, on his part, said female condom empowers the woman/ girl to negotiate safer sex as she can totally control its use rather than relying on the man to provide and wear his own condom. “It is equally a convenient method of contraception as you only need to use it when you have sex. Since it can be worn up to eight hours before sexual intercourse, it gives the woman enough time to prepare for the act ahead of time and avoid any interruption during sex. The condom comes prelubricated and wide, with flexible rings that heightens the pleasure for both partners during intercourse and eliminates the possible discomfort often complained with the male condoms”, she said. “On whether it is reliable, it is a contraceptive with no serious side effects. If used correctly and consistently, the female condoms are 95% effective against unintended pregnancies and sexually transmitted infections. “There is generally a low level of awareness about female condom hence the need for increased public education. According to NDHS 2013, less than 0.5% of the population is aware of female condom. However, there have been pockets of programs led by partners in a few states that have increased the awareness to some extent. Health providers have also been trained, and some can competently counsel their clients on female condom. “Interaction with female sex workers also suggests that usage among them is on the increase. Although not as widely available as the male condoms and often more expensive, it is available in all public facilities free and can be obtained from major pharmacies or super marts in Nigeria”. Health watchers are of the view that the female condom remains an effective female-initiated method that can make a major contribution to prevention efforts globally and enables women to exercise their sexual and reproductive rights. •Chris Bode Inside the new LUTH, 57 years after, by Chris Bode, CMD By Chioma Obinna Recently, the Chief Medical Director, Lagos University Teaching Hospital, Prof. Chris Bode, was reappointed for the next four years by President Muhammadu Buhari. Last week, the CMD unveiled his plans to improve the 57-yearold health institution. At the occasion, he said one of his plans is to ensure that the hospital achieves 100 per cent proficiency. Excerpts:- Challenges of the past When I came on board four years ago, the system was suffering. The greatest challenge was lack of confidence in the system, both among workers and the people who come here. Our various clients stopped believing in the system. Now, with the co-operation and collaboration of others, that narrative has changed. It’s humbling to know that the same environment that was so hostile has gradually embraced change. We had stormy relationships, stormy reception from trainees, from workers group, but I guess, through appealing to their good side and showing by example from the leadership of the institution in the past four years, the situation has improved appreciably. We have been able to change the mindset so that all workers at LUTH now appreciate what we were established to do - render services to people. That is what matters; any other thing will be excused. People are not interested in that, no matter what you do, if you do it very well, people will come to you and if you don’t they will go elsewhere. And we don’t want them to go elsewhere for many reasons because even our own livelihood depends on it and the mandate given to us would be a failed mandate if we don’t fulfil it. Repositioning hospital There has been enormous support in the last four years from the top management team, the nurses, the head of nurses and all heads of department; they have been marvellous as they embraced the experiment. The change we tried to implement has yielded very good results, with all modesty. We must thank the Minister of Health and his team. They have really risen to the challenge, done very well for us and also the workers in LUTH have been marvellous. I must say that our people know good things when they see it. I think that is what has been driving us. The entire workforce is eager to reflect the new order. The changes are manifest. For instance, our dental school that was decertified last year because we didn’t have dented chairs has now been re-certified. Through a joint effort between the university, alumni and management, we have been able to put LUTH back on the path to its former glory. Good things are happening, that’s my message and we must do more. The greatest enemy of progress is to be complacent, there is no resting here. We must commend the management board led by Alhaji Isa Sali Bello and his team for astutely leading the hospital at this time; we have been able to accomplish a lot. Changes There is calm in the system now. I can recall that there was a year we didn’t work for eight months; our salaries were paid by government. At another time, we went on strike for five months. All that had to stop. The healthcare sector can no longer afford such disruption. So we had to start whittling that down with support from members of the public, members of our staff and even government. With time, the government started listening to what the agitations were and the government was fulfilling them, promising and fulfilling; coupled with delivering on low hanging, deliverables, intermediate term and long term plans. All these have now started bearing fruitful results and I like to add that it has really brought LUTH to the fore again. A lot has been done during the past four years. We now have a reliable power supply through our gas-fired electricity, we now have a very good blood bank, good water supply; our wards are beginning to be rehabilitated and other facilities as •‘There was a year we didn’t work for eight months and we got salaries. That has to stop’ We are a government institution, but we must agree that services are not free. We need to review the concept of health care financing so that there will be universal coverage well including the acute stroke care centre. We are repositioning our radiology department. We are putting up a new structure for the care of over 8,000 HIV patients and our advanced facility centre has been up and running and is doing very well. Workers are going through further training and we have crowned it with the $11 million NSIA-LUTH cancer centre which the President commissioned in February. Plans for the next four years A lot more needs to be done, looking ahead. The reward for hard work is more work and, because our facilities have been there for 57 years now, we need to carry out complete rehabilitation of our wards, our out-patients department and many other structures. The out-patients facility is inadequate; we want to build an extension so that patients can be seen more promptly rather than being given long appointments. We are going to do the same thing for our operation theatre facilities and other facilities that need to be upgraded and expanded. We are appealing to all like-minded bodies to assist LUTH. The late Chief Isaac Olusola Dada promised to build a renal dialysis centre for us before he passed away suddenly. It is going to cost more than N200 million. It will have 36 dialysis machines and will be one of the largest in the country for modern renal dialysis. The Lions Club and the family of Chief Dada will build and furnish it on a PPP basis, experts in dialysis, institutions that supply equipment and consumables can come and use it, we will make the services affordable to ensure that Nigerians come here rather than go abroad. We are still going cap in hand. Already, we have immense support from the Sovereign Wealth Fund; they have promised to sustain the cancer centre, so it will be a modern cancer centre that render services and give meaningful returns to investors. It will serve as a beacon for publicprivate collaboration in health care delivery. If they don’t see us as valuable, they won’t bring their money to tie down. We are planning a hospital-wide information management system to reduce the paperwork, improve efficiency and reduce the stress faced by patients. Another plan is to expand operation theatres, intensive care unit and eye treatment unit. The ultimate goal is to make LUTH a comprehensive and reliable hospital in one structure so that we don’t refer any patient. We want to achieve 100% proficiency. If LUTH refers somebody to any other place, it’s like telling them to go and die because we ought to have everything. Even if our accident and emergency ward are full, I would rather you move patients straight to the ward and begin emergency care at the ward rather than tell them there’s no bed. We would do all that we can to increase bed space. Even while doing this we must appeal to all Nigerians, services in LUTH are highly subsidized between 30 and 80 per cent. Depending on the services, for an average operation, you may pay a million naira outside; here you might pay just N200, 000. Appeal We are a government institution, but we must agree that services are not free. We need to review the concept of health care financing so that there will be universal coverage. There should be a safety net provided by the national institutional scheme for those who may easily fall through the cracks. The elderly, children, pregnant women and accident victims should be taken care of under a solid health insurance scheme. Public health institutions must continue to treat patients they are not able to pay and we cannot reject anybody brought as an emergency. We found out that such obligations are a big drain on the finance of tertiary institutions, not only at LUTH, it happens everywhere. Maybe because this is a large hospital, we feel it a lot.
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