In this report, ELO EDREMODA writes on specialists resolve to close the gap of lack of expertise in gynaecological ultrasound scanning for improved female healthcare and increased lifespan of gynaecological patients in Nigeria.
Female health specialists have identified undergoing gynaecological ultrasound scans as one of the easiest ways to improve women’s healthcare. They also posit that women tolerate the process more than other stronger and very expensive medical imaging.
In Nigeria, there is a dearth of gynaecological ultrasound expertise among medical professionals. This concern birthed the idea for training to train and hon the skills of medical practitioners, so as to make the highly specialised service available and accessible for Nigerian women.
After five years of planning, Australian-based Nigerian, Dr. Uche Menakaya, and his colleague back home, Dr. Kingsley Agholor, both gynaecologists, put together a three-day ‘Gynaecological Ultrasound Training’ programme for medical doctors. The training was held from Monday, January 9 to Wednesday, January 13 at Bon Hotel and Coastal Specialist Clinic, Effurun, both in Uvwie council area of Delta state.
Thirty-five medical hands comprising gynaecologists, medical sonographers, radiologists, general medical practitioners and family medicine physicians, participated in the programme which was split into a one-day intensive theoretical class and two days of hands-on training on diverse ultrasound equipment.
The training was carried out by JUNIC Specialist Imaging and Women’s Centre, in conjunction with Coastal Specialist Clinic. Dr. Menakaya, Dr. Agholor and Professor Mohammed Bukar, a consultant obstetrician/gynaecologist at the University of Maiduguri Teaching Hospital, who were key facilitators of the training programme, in separate interviews, emphasized the need for gynaecological ultrasound specialists at different points of care.
Menakaya, who is a specialist in gynaecological ultrasound and advanced laparoscopy, said having practised in both countries and knowing what is obtainable, it became necessary to improve the health system by contributing those skills acquired overseas to his Nigerian colleagues.
According to him, “the goal of this training is to begin to build the capacity of women’s health specialists that are in Nigeria to have the skills to provide ultrasound services at the point of care for their gynaecological patients. There are advantages to this – the patients will have fewer visits to the doctor because they have everything in one visit. They will have a diagnosis of their problems made at the time of visit and treatment options given to them at the time of visit. We know in Nigeria, healthcare is self-funded, so we know that reducing your visits can help you reduce the cost of healthcare. That is from the patient’s perspective.
“From the doctor’s perspective, it can help them streamline their workload as well, rather than bringing patients over and over again. It can also help them to improve the way they counsel patients because they see the disease and they talk to the patients about it and they are able to counsel the patient appropriately about the next steps. Patients are more likely to participate in the decision-making process because they are seeing what the doctor is seeing in the ultrasound machine. What we are hoping to achieve with this is that we have a group of doctors who attend this training and after, are able to go back to their offices and start doing ultrasound services for their patients because they have had our training.”
Further speaking on the importance of women having access to gynaecological ultrasound, he disclosed that it is “the first-line investigation tool” for diagnosing common ailments such as ovarian cancer, fibroids and so on, pointing out that early diagnosis increases the lifespan of patients.
“A woman that has ovarian cancer identified early has a 70% to 80% chance of surviving. A woman that has cancer identified late has a 30% chance of surviving. There is no other motivation you need to realise that ‘yes, if I have any symptom at all, I can go and have the ultrasound’ and at the place where the person is properly trained”.
Asked about the level of advocacy and awareness on the importance of gynaecological ultrasound among women-folk, Menakaya said training of specialists and availability of the ultrasound machines come first because if the service can be offered when a woman has a problem and goes to see a doctor, she becomes aware of the service. “That is one way of advocacy,” he enthused
He urged the government to look at ways to contribute to the development of the service through funding for the acquisition of machines, legislation for the regulation of the service and provision of structured ultrasound training, emphasizing that these will “improve downstream patients outcome”. He also advocated for an improved system that encourages people, particularly women, to go to hospitals, and not put healthcare at the back burner due to cost.
A sonologist and endoscopic surgeon, Agholor, said the level of participation by the medical practitioners was impressive, expressing confidence that they will offer better ultrasound services to patients when they return to their different practices.
According to him, a major challenge in the practice of gynaecological sonography is acquiring the machine. “They are expensive! How do we buy the machine? How do we have the knowledge, training? That’s where we are trying to close the gap, to offer knowledge”.
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Stating that government can intervene in both areas, he, however, reasoned that the training of doctors and provision of amenities for hospitals were already huge burdens on the government. Hence, the need for companies in Nigeria and good-natured individuals to close the ultrasound machines availability gap through “goodwill”.
Professor Bukar said common ailments troubling premenopausal women, can be prevented through regular ultrasound scans by specialists.
The hands-on training saw participants divided into groups and later swap places to enable each group to access the various machines for transvaginal probe with phantom, transabdominal probe with models, as well as exposure to gynaecological ultrasound of normal and abnormal pelvis using “live models”.
Some participants while commending the organisers during a chat with The Nation, expressed satisfaction with the training and hoped for more of such courses to enable them to learn new skills and sharpen those gained over the years.
A Lagos-based medical sonographer, Abiola Adewusi, who has been scanning for almost two decades, said she attended the course to “sharpen” her skills.
“I still think that there are one or two things I could pick up from the training which I have been picking up so far. The training is excellent, well put together, meticulously organised. I have gotten a lot of refresher courses from this to add to the skills that I already have. Inasmuch as it’s basic training, it touches on a lot of things that when you have been in the field for too long, you might forget. I see that a lot of people that don’t have a lot of experience are gaining a lot, they are doing hands-on. I hope that this will continue to go on so that people can have the opportunity to be exposed to ultrasound training which will help their practices,” Adewusi said.
Dr. Sunday Omozuwa, a consultant Obstetrician/gynaecologist and lecturer of Edo State University, described the training as “very extensive, detailing on gynaecological ultrasound,” adding that the training received will be stepped down to other colleagues, medical students and residents doctors.
Though medical practitioners believe that gynaecological ultrasound is “cheap and available everywhere,” checks by this reporter reveal that most women in rural areas are neither able to afford ultrasound services nor find the service easily accessible.
A source, Jite John (not real names) told this reporter that over the years, she has witnessed cases, where women referred to medical laboratories for ultrasound scans, are unable to have the service due to the cost.
“In the labs around Warri, Effurun, Ughelli, Agbarho, Udu (all in Delta state), I know it costs between N2,000 and N3,500. Some private hospitals charge more. Apart from Central Hospital, Warri, other Government Hospital’s will refer you to these labs. That’s how I witnessed this incident twice. During one of those scenarios, the lab technician subsidized the cost for a pregnant lady who did not have enough money for the scan. Two others had to leave without having the scan. So it may be cheap, but it is unaffordable for many women”.
But Adewusi opined that compared to other diagnostic tools like CT scan, MRI or x-ray, ultrasound is not very expensive. Noting that in rural areas, charges range from N1,000 to N5,000, while in big cities it goes for as high as N35,000, she insisted that the expertise to operate the machine and give the required output is paramount.
She said: “The equipment is very expensive, so if you have to recuperate the money of the scanner, you have to charge a decent amount of money. And also, the person behind the scanner machine, the technical know-how, going to school, learning how to do this, acquired skill. It is a highly specialised skill. Even if you are a doctor, you still have to learn how to do the ultrasound. Relatively, ultrasound is still very cheap to do”.
Another gynaecological patient, who also spoke in confidence, admitted being a victim of an unskilled ultrasound service.
“I went for a pregnancy ultrasound scan. It was about 16 weeks then. I was told I had twins. But a month later, I visited my gynaecologist and after a requested scan, he told me there was only one baby. I have the twin scan report as I speak with you,” the patient said.
These, no doubt, beg the need for increased gynaecological ultrasound specialists who will render accurate diagnoses for women seeking medical attention.
