I was honored to be able to participate one of the Kenyan vasectomy mission sponsored by No-scalpel Vasectomy International (NSVI). This would be my second personal vasectomy mission trip. This vasectomy mission occurred in Kisumu, Kenya at the Marie Stopes Clinic in Kisumu.
Kenya is a very populated country and they were in need of any and all methods of birth control. Most contraceptive efforts have been targeted towards women. There were very few vasectomy providers in the entire country. Most of the vasectomy providers were Urologist workin in large cities. If a man wanted a vasectomy they would have to travel long distances and have their procedures done by specialist. Unfortunately, even though these Urologist were specialist in vasectomy they performed very few of these procedures in a given year.
Dr. Charles Ochieng was the Kenyan physician sponsoring of the vasectomy mission. He is the leadNVSI Kenyan Mission Director. Dr Ochieng is an ardent supporter of vasectomy. He realizes how important vasectomy was when he tried unsuccessfully to get a vasectomy in Kenya after the birth of his second child. He found it was almost impossible.
As a result , he traveled to the United States to obtain vasectomy training from Dr Douglas Stein in Tampa, Florida. Dr Stein saw the ambition and potential in Dr. Ochieng and encouraged him to sponsor a vasectomy mission in his country of Kenya. To do this, Dr Ochieng had to join the Philippines surgical mission in order to learn the skills required to both perform vasectomy and also lead an international surgical mission.
No Scalpel Vasectomy Mission: Kisumu Kenya
The mission was warmly received by the people of Kisumu. During the three day mission over 30 vasectomies were performed.
In my current clinic, I perform about 30 vasectomy procedures per week. Although 30 vasectomy procedures performed during a 5 day medical mission does not seem like a lot that number was huge for the Kenyan team. The biggest challenge was finding any willing patient in a country that has little knowledge of vasectomy and very strong ideas about male virility. It was a challenge but it was not impossible.
The 30 vasectomies performed in Kisumu over the course of 3 days were more than all the vasectomies performed in the entire country of Kenya over the last 10 years!
Why is vasectomy important in Africa?
We had the privilege of meeting with members of the Tupange Project. This group is funded by the Bill and Melinda Gates foundation and is responsible for studying family planning methods and providing access to affordable family planning.
They shared statistics with us showing that general knowledge about vasectomy was very high in Kenya but vasectomy was almost nonexistent. In the last three years, they did not record any vasectomy procedures as having been done in the entire country.
Why vasectomy is not done in Kenya?
Vasectomies were not being performed for many reasons: lack of trained doctors, more readily available funding for female tubal ligation, and male perceptions that vasectomy was the same as castration. It was readily apparent to me if you don’t have any trained doctors then the procedure will not get done not matter what the other reasons may be!
It was also very revealing to see the profound importance placed on female contraception and sterilization. No importance was placed on vasectomy and no governmental organizations, non-governmental organizations or non-profits made any effort to promote vasectomy.
Female tubal ligation is profoundly important to Africa but it does come with a burden because ectopic pregnancy is a death sentence in an undeveloped country.
Ectopic pregnancy: A death sentence
Ectopic pregnancy can be a death sentence in a developing country.
Ectopic pregnancy is more common than you may think after tubal ligation. In the United States, ectopic pregnancies are more easily treated because of patients easier access to medical care. You get pregnant, you have pain, and you go to urgent care. You get blood work and an ultrasound and if the pregnancy as diagnosed as being ectopic you get methotrexate medication. You then follow up with your doctor as the ectopic pregnancy resolves.
Even if you can’t pay for the treatment…you will be given the treatment.
If you are in an undeveloped country you get an ectopic pregnancy, you have pain, you have bleeding, and then you have more pain. You hope the pain goes away on its own….you may not even know you are pregnant. You stay at home in your rural village until the pregnancy ruptures your fallopian tube and you pass out. Someone then puts you in the back of a pickup truck…or on a motorcycle and drives you 30 to 50 miles to a local, rural hospital. If you are luck you will get surgery and if you are luck you will live….but then someone also has to pay for that surgery because there is no such thing as ‘health insurance’. If you cannot pay then you may not get any treatment.
In comparison, having a vasectomy is so much easier than getting a tubal ligation. You get a vasectomy. If it fails you may never know. If it fails and you do find out then the worse thing that happens is you cause pregnancy and have a baby. At least you do not die.
International contraceptive aid: Biased towards women
Most international contraceptive aid is biased towards women rather than men. Why?
Men’s contraception is not sexy. You have condoms and abstinence…and perhaps withdrawal. That is it…and nothing else. Withdrawal and abstinence don’t work very well. Although condoms work, we don’t use condoms as thoroughly as we should. Unfortunately, there is no male contraceptive pill or injection.
The running joke in male health is that we are only 10 years away from male hormonal birth control. Unfortunately, we have been saying that since the 1970’s! Male hormonal birth control is complicated by the fact that it is extremely hard to stop millions and millions of sperm from being created. There are also the concerns of side-effects and will these side-effects make men not want to use these hormonal methods.
The only real option for men is having a vasectomy. Vasectomy is a procedure. Procedures cost more than birth control pills. Vasectomy is permanent. There are unfounded fears about vasectomy that are very strong in places with lower educational standards.
In comparison, women have many more options. You only have to stop one egg per month rather than millions of sperm being constantly created. Women also bear more of the burden of pregnancy. Lets face it they have to carry the pregnancy for 9 months.
Most research efforts and international contraceptive efforts are targeted towards women. Why?
It is simple because it is easier to stop the one egg a month, woman are usually more motivated to try to prevent pregnancy when they have to bear all of the risks and care for the child, and it has ‘traditionally’ been the burden of the woman to be concerned about fertility or the lack thereof.
More emphasis is also placed on control of female reproduction as a mechanism to help fight the spread of HIV. In many developing countries HIV is prevalent. The leading cause of the increase in HIV is babies infected when they are born to mothers who have HIV. If you can limit unplanned pregnancy and unplanned births then you can help fight HIV infection within a population.
The importance of vasectomy
Vasectomy is an important procedure and critical to our efforts of controlling our personal reproduction and population growth.
We would also like public health leaders to realize vasectomy also helps prevent unintended pregnancy. If you prevent unintended pregnancy you decrease maternal death and morbidity. In Africa you also decrease HIV transmission from infected mothers to newborn babies.
Vasectomy can greatly help in the war against HIV and can contribute to the reduction of maternal death and morbidity both in Africa and across the world.
Kenya is ready for vasectomy: The time is now!
With the second No-scalpel Vasectomy International vasectomy mission completed and a national director motivated to start providing vasectomy to patients and training other Kenyan doctors to perform vasectomy, Kenya is ready to see an increase in vasectomy utilization.
Kenyan men must heed the call and step up to the plate to help their partners with reproductive responsibility.
