A Medical Talk, by Professor Nimi Dimkpa Briggs

Reflections Of An OB/GYN Icon

Reflections Of An OB/GYN Icon, by Nimi Dimkpa Briggs

Among the many books that Geoffrey Chamberlain, a prolific writer and erstwhile President of the Royal College of Obstetricians and Gynaecologists, London, has authored, is one with the alluring title of “From Witchcraft to Wisdom”, published by the RCOG PRESS (2007) with a Foreword by Sir John Dewhurst. The charm of the book with 341 pages is not restricted to its title and style of presentation but is further emphasised by the many photographs, illustrations and diagrams it contains and most importantly, the fairly detailed chronology of the evolution of Obstetrics and Gynaecology in the British Isles. A must read, if you may, especially by those who have a British slant to the subject and profession.

My thoughts immediately sprang to this book when I was confronted with the request to put down a word or two by way of reflections on the way Obstetrics and Gynaecology has gone, especially in our country, Nigeria. For indeed the subject has come a long way – good and bad, like it has in the British Isle. From the dark days when maternal deaths were considered Acts of God and so did not even merit a record to a situation where they are fiercely debated even to the point of establishing a Confidential Enquiry into every death as is being pursued by the Abiye Safe Motherhood Project of Ondo State. From the heydays in which University Obs. and Gynae. Departments were busy, stretching residents with work and boasting over 5,000 deliveries per annum, abdominal and vaginal hysterectomies on weekly operation lists and morning and afternoon clinics held, to one in which deliveries have dwindled to under 3,000 and most lists consisting of elective caesarean sections for previous sections which may even get cancelled due to electricity failure or absence of sterile materials. From the sobering days of gynaecology wards being full of stages three and four cervical cancers hardly responding to the cesium wire radiation that was supposed to ameliorate them, to the days where opportunities are offered for the complete prevention of the disease through vaccinations against the human papilloma virus. And indeed from the days in which infertile couples from tubal blockage were only at the mercy of tubal surgery with its poor outcome to the time where clinics offering assisted reproductive techniques, especially IVF have sprout up in many places, bringing succour to such couples.

My reflections of my encounter with this fascinating discipline are rooted in medical school where I even had difficulty spelling the two words – obstetrics and gynaecology correctly and as if that was not sufficiently deterring, pronouncing obstetrics correctly without some lacerations on the tongue, did not come easy either. But all these were short-lived as they were drowned by exhilarating experiences thereafter: the organised system by which teachers of the subject delivered their materials let alone their simple and smart outfits of white short sleeve shirts with bow ties and pairs of trousers, the opportunity obstetrics offered of being of service to two persons at the same time – a mother and her child (no other discipline did this) and the privilege that gynaecology gave of sharing some of the most intimate concerns of a woman with her. These were so intriguing that they arrested me and made me commit to the discipline as a life-long profession, commencing with a brilliant performance in the subject, at the final MB examination. The formative years that followed at the Lagos University Teaching Hospital, the Chester City Hospital and Birmingham Maternity and Women’s Hospitals in England were exciting; the tilt was to gynaecology more than obstetrics. But thereafter, my joining the great team in Zaria with annual deliveries in excess of 8,000 then, which was led by the indomitable trainer, clinician and researcher, Kelsey Harrison, proved to be a game changer for me. For after a one-year senior registrar’s stint, I was sufficiently hard boiled to face whatever the subject would throw at me.

My recall puts the Society of Gynaecology and Obstetrics of Nigeria (SOGON) and its members firmly in the saddle in driving a number of the clear lines of progress that have emerged over the years, just as the RCOG has done with British Obstetrics and Gynaecology practice. From the early works on anaemia in pregnancy, including haemoglobinopathies by John Lawson, Kelsey Harrison, Patrick Ibezeako; the unravelling of the mystery of twin pregnancies by Percy Nylander to the courageous and dogged determination to establish fertility regulation as part of the channels available to a woman for informed choices in her sexual and reproductive life by Wole Ojo, Oladele Akinla, Willi Chukwudebelu, Oladapo Ladipo, Joseph Otubu and Osato Giwa Osagie; to the many safe motherhood activities, especially advocacy for Women’s Rights and the emergence of Women’s Health, the anchor of this series on reflections by Brian Adinma, our dear SOGON President as a special area of interest. “Women’s Health: A Nation’s Wealth”, a Valedictory Lecture delivered by me in 2009, summed all this up succinctly. In the same vein, one cannot ignore the remarkable contributions the society’s members have made and continue to make in administration as well as the educational and health sectors –Okoronkwo Ogan, the father of the society at the Federal Civil Service Commission; Moses Majekodunmi as Minister of Health and the progenitor of the University of Lagos College of Medicine; Tiramiyu Belo Osagie, Wole Akande as Pro-chancellors of universities; Vincent Aimakhu, Kelsey Harrison, Isaac Adewole, Benjamin Ozumba, Friday Okonofua as vice-chancellors; Prosper Igboeli and Kayode Obembe as Presidents of Nigerian Medical Association; Biodun. Ilesanmi, Israel Kua as Medical Directors; Dipo Otolorin as Country Director of the Johns Hopkins Programme in International Education in Gynecology and Obstetrics and Isaac Adewole as the siting Honorable Minister of Health.

But there is no doubt that we are still far from destination. Maternal mortality, our most stinging failure, is rated to have fallen but estimated ratios are still about 500 per 100,000 births and in some areas may even be as high as 1500 per 100,000 births. Near misses continue to pile up as demonstrated by new cases of VVFs and secondary infertility. Botched abortions still cause blocked tubes alongside huge unmet contraceptive needs as the prevalence of contraceptive practice rate is still estimated to be only about 15%. Avenues for early detection of cancers on which lie prospect of satisfactory outcome of intervention are hardly in existence.

This disorder does not manifest only in our discipline; it does so in many aspects of our national life – the larger health care delivery system, social interactions, family values, morals and integrity, youth and society and much more. To sustain progress in our national life, this confusion has to be replaced with order and a sense of direction. In our discipline, this will require actions based on proper planning that is predicated on strong and accurate data that can only come from a compulsory registration of births and deaths.

Published in Women’s Health Watch. A News and Features Communication of the Society of Gynaecology and Obstetrics of Nigeria (SOGON), Eastern Sector.

Vol.4 No. 2 July – December, 2015