The Dr Louise Newson Podcast - 194 - Transforming women’s urological health in Uganda

Episode Date: March 7, 2023

Dr Namugga Martha Monicah is one of four female urologists in Uganda. She recently completed the Fellowship of the College of Surgeons (FCS) exam at the College of Surgeons East and Central and Southern Africa (COSECSA) exams, finishing top of her class. She was supported with a sponsorship from Newson Health. This episode of the podcast, released on the eve of International Women’s Day which this year centres around equity for all, looks at women’s health and access to care in Africa. Dr Monicah tells Dr Louise Newson about the barriers to women’s health in Africa, the shame surrounding it and the international support making a difference. She also addresses the stigma around the menopause and the need to move past a ‘suffer in silence’ approach. Guest’s three tips: Anyone in the world who listens to the podcast, know that there is somewhere where menopause doesn’t have to be taken on humbly and that something can be done to improve your quality of life. To the African girl child, know that despite all the challenges, the hurdles, you can still do it, you can still emerge victorious. In whatever small way, any individual can do something to improve the life of another. For more about Dr Namugga Martha Monciah, visit https://www.baus.org.uk/professionals/urolink/urolink_home.aspx.

Hello, I'm Dr Louise Newsome and welcome to my podcast. I'm a GP and menopause specialist and I run the Newsome Health Menopause and Wellbeing Centre here in Stratford-Bron-Avon. I'm also the founder of the Menopause charity and the menopause support app called Balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based, information and advice about both the perimenopause and the menopause. On the podcast today, I've got somebody who's not in the UK and someone in a country that I've not spoken to before on my podcast. So it's someone called Martha, who's a urologist in Uganda.

And some of you might know that my husband has done some work in Africa. He's a urologist, but he doesn't specialize in women, actually. He specialises in men and male reconstructive surgery. So Martha was introduced to me recently and as a company we've sponsored her for her final exams and we'll talk about how well she did in a minute. So welcome Martha to this podcast. Thank you, Dr. Newsom. Great to be here. Oh, no, it's brilliant. So you are incredibly inspirational. There aren't many female urologists over where you are. So can you just tell me a bit about you and why you decided to do urology? Well, my name is Martha.

I'm Mugga, Monica. I'm 34 years old. I'm a wife and a mother of two sons. And I was a general surgeon first before I ventured into urology. There is nothing so special. I didn't have any touching story behind my choice of urology. It just happened to be one of the rotations that I enjoyed fully. And I found the urology is quite inspiring.

And then I also had a dream of helping women with fistula in Uganda. So urology was amends to that. Wow. Yeah, so I ended up choosing urology after my genocid surgery, and that's what I did my fellowship in. Which is great. In fact, my husband was similar.

He didn't set up to be a urologist initially, but then he started to meet people like Steve Payne, actually, who's also been part of Eurilink, and found it so inspirational and really enjoyed the people that he worked with. So tell me about, for those people who are listening, you don't know what a fistula is. Do you mind explaining what a fistula is, Martha? So a fistula is any abnormal connection between two surfaces that have a mucous membrane. So in Uganda, obstetric fistula is something that is not rare.

For a lot of women, cannot afford timely care when they go to deliver babies. So they end up getting an abnormal connection between their vaginal canal and the rectum of vagina canal and the bladder. And then they become ostracized or neglected from society because they have, you know, this stench and it becomes complicated with family. They usually lose their

families. So a lot of them stay like that for some time because maybe they don't know that they're somewhere where they can get help. But once those women are identified and investigated, surgery can be done to make the situation better. So we have

a lot of people who come over to you guys. down and do sort of like surgical camps. So when people have fistilers that go into their bladder, so they have urinary symptoms, so they have leakage and incontinence. Yes, so they have continuous incontinence. And that can often lead to them being completely ostracized from the community, can't it, when they have urinary incontinence. Right.

So most times, you know, they lose their husbands and there's a lady especially touching she said she's a Christian, she really loved to go to church, but the most complicated thing about the fistula for her was that she wasn't able to go to church because then kids would laugh at her that she's smelling urine like a baby. So just to see the women get better and give their life back, that makes my day. It's wonderful. Absolutely. I mean, it's transformational surgery and certainly, I mean, over here, fistlers do occur, but they don't occur as commonly because obviously care when people are in labour is better. But we don't have that same sort of stigma, really, from incontinence, actually. And incontinence of urine can be very common, especially, as you

know, in the menopause, but people still often can carry on with their lives. And it was only when my husband came back from Africa the first time and told me that people couldn't go to church or they were not able to be part of the family and community. It makes you realise actually what a big problem it is. And certainly in the UK, women don't like to talk about urinary symptoms. They certainly get very embarrassed talking about incontinence. And do people over there find it hard to talk about? Yes. So generally things to do with reproductive health. The topics which are seen as immodest, so a lot of people keep quiet with a problem. Some of the women have stayed in continent for over 10, 20 years, and yet they didn't come to hospital to seek help.

So it's something they are shy to talk about a lot of times, so a lot of people suffer silently. Gosh, and so how do you educate them? How do you let them know that there is treatment available? We pass around, not me in particular, but what I've seen being done, my work with the fistula people is more at the hospital level when they come to get reconstructed and maybe in the post-operative period. However, the efforts by the Ugandan government include sensitizing people over social media, which radio, which is the commonest thing that goes around here

and in churches and their hospitals that keep, you know, calling out to these women and having like regular camps throughout the year for years now to try and capture some of these women. And there are some NGOs which actually go down to the communities and go house by house looking for any way. women who might be affected by these situations. Wow. Some women also get referred by their other colleagues who might have had a similar

problem in the past that got rehabilitated. So the more people are aware that there is treatments available, the better, isn't it? But how many surgeons are there over there doing your sort of surgery, Martha? So, let's see, maybe less than 10. There are maybe two surgeons distributed in the west, some in the east, some in the north, but most of them are actually gynaecologists. That's their main specialty. We have some urologists like Dr. Simo-Shen.

He's done quite a bit of work with women who have fistula. He's published a couple of books. He's a urologist. And then we have another urologist, Dr. Kiriore. in the east, but most of the other people are gynecologists. But they are not more than 20 people doing reconstruction in Uganda. They usually get support teams from the UK or from Ireland. Most times people come in to, you know, work with some organizations that are volunteers

that come in and work together with the doctors, the local team to try and reconstruct the ladies. Which is so important. And Sue, how many female urologists are there in Uganda? Oh, female urologists are not so many in Uganda. Let's see, maybe it's the four of us at the moment. We have a retired senior consultant, a Rosemary Nassanga, and we have Dr. Hope Kibansha who qualified three years ago.

Then just recently we have myself and Dr. Anna Tinker, just four ladies who are urologists. It's not a field that a lot of women take on in Uganda. For now, maybe the situation will be different in future. Well, I hope so. Certainly, you're a fantastic role model and amazing that you've done so well. And you've done actually incredibly well. So do you mind saying what you did in the exam and what your result was?

So we had our exam over in Namibia in December. And I emerged on top of my exam. class. So it was under the College of Sargeons for East, Central and Southern Africa. So country members or member countries take turns every year in hosting the exam and the big conference after. So we had candidates from different parts of Africa that have Cossica. And I emerged best in my class. So wonderful. It was good for me. It's amazing. Amazing. So does that mean you got a medal. I did get a medal, yes. Yeah. Well, you need to be very, very proud. I mean, to get the highest mark to be the best in the exam is absolutely phenomenal. And my husband actually got the gold medal

when he did the exam many years ago. And he was something he always wanted to do, but he thought he might not be able to. And my two children, I had two children then. I've now got three, but I had two. And they were, I think one was two and one was one. When he was revising for the exam, and it was a very hard time because he was working and revising as well as obviously being a full-time surgeon. But when he got the gold medal, it all just seemed worthwhile. And when I saw the photo of you with a massive grin on your face, deservedly so, when you had the results, it reminded me of how happy my husband was. And it's phenomenal, actually.

And no one will ever take that away from you, will they? I mean, once you have an award and achievement that's there for life. And your family must be really proud of you, aren't they? Yes. So I can relate to what your husband was going through. I have two little children, four and one. And I'm a wife. And my husband is also awfully busy.

So I had to juggle a lot of things. I had to work two jobs and two babies and a husband and a home to run. Yeah. So it was quite hectic. Lots of late nights, lots of time invested. So it was beautiful that it paid off. in such a way, truly. Oh, totally.

And so obviously we, as I said at the beginning, we sponsored you. But how did the sponsorship help you then? Well, so the sponsorship gave me an opportunity to go to Namibia and stay comfortably and do my exam comfortably. And also knowing that I had a sponsorship, it meant that I didn't have to work so hard at my jobs. I could take a bit of time off and concentrate on reading for my exam. preparing better. So it was a wonderful, wonderful opportunity. The girl child in Africa has a lot

of challenges growing up and just going through school and completing school. It's not something that we, there are a few of us that have gotten the opportunity that we take for granted. So you made actually the good performance, I think, could also in some way be related to the fact that I didn't have to worry about the funds and the exam fee and the travel fee and the stay and so on and so forth. I could at least settle down and read. And while I was there, it was, I didn't have to worry much, really. Everything was taken care of. So I'm really grateful to you, Dr. Newsom.

And the organisation for supporting the girl child in Africa. Well, you know, we're so pleased. And as you know, my husband's part of Eurolink and he goes out to Africa usually twice a year. And he comes back, very humbled. The first time he came back, he was absolutely exhausted. And sadly, he had had his computer stolen. and his money stolen and he had came back with awful diarrhea, so he wasn't feeling very well. But he still said, Louise, this is the most amazing week of my life, actually, and I've learned so

much, and I feel so humbled by the people, and everybody is so friendly and so grateful. And each time he's gone, he's learned more and more. And, you know, I think for us, we forget how privileged we are over here. And it's so important to be able to give and share because helping people is why we went into medicine in the first place, isn't it? Right. So I feel very strongly that everybody deserves access to treatment that's going to help improve their lives, but also the quality of their lives. But actually the work you're doing is not just improving the individual. It's all those people around them as well.

And I think that's why working in women's health can be really. really transformational for families and communities, probably more than men's health in some ways. Yes, because I think women play a big role in society, no doubt, in any society, and in the African society especially. So it's very important to have a healthy population, but a healthy population of women especially, yes. Absolutely. And I know when we spoke before, Martha, you were saying that your education about the menopause has been a bit like mine at medical school, I didn't really get any education. And people don't think about the menopause in a way that perhaps they should.

Would you agree with that? Yeah, so absolutely. So in Africa, when I saw your menopause specialist, I was like, well, what is that? In Africa, it's like the women have to accept that, you know, menopause is just something that happens, you know, part of life. So don't complain, take it gracefully. Yeah. But I've taken some time to read about your work. It seems like really, really important work.

And you're helping a lot of women. Down here, it's not even like a lot of women won't come to hospital and complain about the postmenopausal syndrome and the symptoms and all the nasty things that happened because they feel that it's just part of gross. It's just something that you have to go through. So they suffer in silence, so to think. Yeah, and certainly over the last 20 years,

women globally have done that even in the UK as well because we've always been told, well, it's a natural process, all women go through it so we can just battle on and carry on. But actually for a lot of women, and I'm sure it must be the same over for you than it is over here, that they have a lot of psychological symptoms. So a lot of women feel very low. They feel very demotivated. They have feelings of reduced self-worth and really find it very difficult to. function and also quite a few women have physical symptoms including muscle and joint pains and headaches. And although some women will obviously soldier on, it can be really, really difficult and it means that you can't be the best version of yourselves. But the other thing that worries me is the

health risks as well. So, you know, the risks of heart disease and obesity and diabetes, which can affect all communities. And then the other thing is the urinary symptoms that can be involved. So women who've had fistilers, once they become menopausal, the tissues in the perineum can become very thin. They can lose their collagen, they can lose the vasculature. So urinary symptoms can really become so much worse during the menopause, can't they? Yeah, right.

The mucosa or the vaginal lining and the perennial lining becomes quite thin, so that complicates the fistula as further. Some women have fistulars during their child reproductive age, but heat menopause with the fistula, unattended too. We've seen a few of those coming through. In the space of menopause here in Africa, there is a lot of work that needs to be done, a lot of education, a lot of advocacy, yes. Yeah, absolutely.

And one of the things also is thinking about how we can enable vaginal estrogen to be given to women who are menopausal, especially with those women who have symptoms, because we know the majority of women have some localized symptoms, whether it's related to vaginal dryness or urinary symptoms. Yet we know that vaginal estrogen treatment is very cheap, but it's not available, is it, in Africa? No, no, not necessarily. I think that some estrogen creams are available in some of the pharmacies, but they are quite costly that a lot of women cannot afford. And certainly when I've been trying to find out about it, some of it comes from America and it is a lot more expensive. But in the UK, it is a lot cheaper and there must be ways of being able to get it out over to you.

And there's something that I'm really keen to try and explore how we can do that. Because certainly even if people have surgery, we know that wound healing can be so much better when they have vaginal estrogen. And some women might not need the same type of surgery if they have vaginal treatment at the the right time, you know, when their symptoms first start to be a problem rather than waiting until they're more severe. Right. So there's a lot of work that's needed to be done, isn't there? There's a lot of work that needs to be done.

There's a lot of work that needs to be done absolutely. But that would be very helpful. Availing estrogen to women that need it would be very, very helpful. Well, there's lots of hurdles, but I'm quite determined. And there's, you know, I think we need to keep getting the conversation. over. And I know that Eurilink, some of the surgeons, including Susie Venn, who you know are coming out again soon to try and really assess

female urology because in the past they've been focused more on men with Eurilink. And now they're focusing quite rightly so on women as well. And it would be very interesting to see what they can do and the changes that they make. And I know that they're going to come and visit us in the clinic as well, which will be really good. Yes, yes. Dr. Susie has, I think, has a vast experience in traveling to Africa, I think to Tanzania. And I think she does

quite have a number of fistula surgeries as well over there. So I'm sure she has some contacts already. I'll also put you in touch with Dr. Sima Shen, who also has some contacts already of the people who keep visiting and helping us with the surgical camps.

And they're from the UK and the world. Yeah, so they could also be your link. Maybe one day you'll come out and meet some of the women when there is a camp. It would be a really nice thing. Yes. I'll send over the contacts and we see what you can do. Yes, I would love to. And actually, for many years, I thought, how wonderful to be able to do charity work like my husband does. But then I've always thought, I don't have a skill. I'm not a surgeon. I can't sew people up. I can't do anything. But actually,

knowing indirectly from my company over here in the UK we can help people is really important. And you might know we've done quite a lot within HIV charity Sophia Forum where we've written information actually about women living with HIV because we know many women with HIV are more likely to have menopausal symptoms and less likely to have treatment. And we're also now doing some work in the UK, but we hope it will be given elsewhere for women who have had FGM female genital mutilation, because a lot of these women really suffer when they're menopausal, but they don't understand why.

So we're working with some communities to get the right information so people can understand what's going on with their bodies. Right. That sounds like very good work, Dr. Newsom. Well, it's so important tonight you were saying at the beginning. It's about how we educate people, so they understand what's, happening and understand if there is treatment because it's the same in any area of medicine.

If you don't know what's happening, it can be a very frightening and isolating, aren't it? That is true, especially here. So I think there's a lot to do in the education space and sensitization space and one community at a time, I think a lot can still be achieved. Yes, absolutely. So now you've been introduced to the menopause. you're not going to be able to ignore it. And, you know, I think there's some really exciting times ahead. And I really want to be able to improve the health of future generations as well. That is very, very beautiful.

So before we finish, Martha, I always ask people for three take-home tips, really. So three things that they might learn from after listening to the podcast. So I'm really keen to ask you three things that people in Africa might be able to learn or benefit from just from having you as now a trained urologist. Okay, so just to, from the podcast, of course, you're doing some work with menopause. A lot of women, if anybody here were to listen to a podcast, they would know that they're somewhere out there in the world where menopause doesn't. have to be taken on just humbly and embraced that something can actually be done to improve the quality of life. And to the African girl child, to know that despite all the challenges, despite all the hurdles, you can still emerge, you can still do it, you can still emerge

victorious. And the sad and lastly is that in whatever small way, any individual can actually do something to improve the life of another. Absolutely brilliant. And I think the more we connect, the more we can speak, the more we can help each other, that's going to really make big changes going forward. So I'm very, very appreciative of your time. And I just want to publicly once more, so congratulations, because I know the work that you did was so hard, but so well deserved that you got the gold medal. So well done, Martha. Thank you. Thank you, Dr. Newsom and thank you for making it possible. For more information about the perimenopause and menopause,

Please visit my website, balance-manopause.com, or you can download the free balance app, which is available to download from the App Store or from Google Play.