ADOLESCENT'S FIRST GYNAE VISIT

 A teenager’s first gynaecology visit can be quite daunting. The most common reason for their check-up is usually dysmenorrhea or heavy menstrual bleeding. Some girls even get admitted to the hospital with severe anemia to receive a blood transfusion. Some mothers bring along their young daughters to familiarize them with gynae visits, while others come for birth control counseling. We rarely get consults for early or delayed puberty.   

Puberty typically begins between the ages of 10-14 and lasts around 2-3 years. During this time the girls experience physical and emotional changes as their bodies develop and prepare for reproductive maturity. The breasts begin to grow and develop, and there is hair growth in the pubic and axillary regions. Hormonal changes lead to acne on the face and the body. Girls experience a growth spurt, gaining weight and height. The final step in the girl’s puberty is the onset of menses.

It is important that every girl develops at her own pace, and some may start puberty earlier or later than others. Due to an ovulatory cycle, the periods may be irregular and the girls might miss a period and bleed for weeks the following month. It is important to obtain a good history from the girls and ask them to keep a diary and track their menstruation. It might seem difficult but it is important to ask the girls if they are sexually active and what they use for birth control. It is important to ask if they have missed any school days due to severe pain or bleeding.

A few baseline investigations can help rule out anemia, bleeding disorders or thyroid dysfunction. If all these appear normal we can offer these girls several options such as conservative management along with iron supplements and medication that reduce the menstrual blood flow, or if the teenager is keen we can start some sort of combined contraceptive such as the pill or patch. It can help regulate the menses, reduce acne, and prevent the progression of endometriosis if they have a bit of it lastly it is a reliable contraceptive agent.

 

That is me, being the bookworm teenager in grade 8. Always busy with my books. I wasn't into sports or anything else. 

That is me in the first year of medical school continuing what I love the most. 

BURNOUT

 Burnout is often related to prolonged stress and exhaustion related to work or caregiving responsibilities. It can lead to mental and physical exhaustion, reduced performance, irritability, and withdrawal from social interactions. With time the person’s work performance decreases and feels dissatisfied with work and personal life.

It took me a while to understand my symptoms are related to exhaustion and burnout. It is very profound, and it can’t be fixed with a good night's sleep or a relaxed weekend. This happened to me at the end of my registrar training. From the previous year, I had started preparing for the fellowship exams. This is when time was divided between work and night shifts and studying. The exams passed and I realized I had to re-write my research document. Another year went by with me sacrificing all my free time writing and doing corrections. On top of this, as my training time was coming to an end, I had to start struggling to find a job. It wasn’t a consultant job as my paperwork wasn’t done/ I ended up working in a level one hospital as a medical officer. I did not even have interns. I had no job satisfaction. I was there to pass the time and pass my master of medicine and get a salary. I was heavily pregnant at that time.

Maternity leave was also overwhelming. After a month I started assisting in theatre and doing locums to make ends meet. I finally started working as a consultant. I still felt overwhelmed with the new responsibilities and the workload. I hardly took 10 days of annual leave that year. This is the second year of working in the new hospital. I feel more relaxed. I have more job satisfaction.

The baby is about 17 months, she sleeps through and is more manageable to look after. I joined the local gym again. I took leave the first two weeks of January to recharge and relax. I have resumed the activities I enjoy such as reading, painting, going for walks, and little crochet projects. It took me a while to feel like myself and recover from work and study exhaustion.

Work-life balance is extremely important to reduce the risk of burnout. It is important to prioritize self–care, set boundaries to seek social support, and address any underlying issues leading to stress.

This is our obstetric unit, and we are all exhausted after our busy shift in Bara Hospital. 

 

 

INTERNATIONAL SIBLING'S DAY

 The 10^th of April is International Siblings Day. It is meant to celebrate the bond between siblings and honour the special relationship they share. It is time to recognize the support, love, and connection that siblings bring to each other’s lives. Whether you have a brother, a sister, or multiple siblings, it is an opportunity to show appreciation for their presence and the unique memories and experiences you have shared together.

I have a younger brother, and we have a five-year age gap. I wasn’t really happy back then when he was born.  Even though my mom was a housewife, she was not coping with looking after me and my brother. By the time I was 7 and going to grade 1; Grandma who used to live with us was taking care of me most of the time. I found it difficult to connect with my little brother then. We started enjoying each other’s company when I was in grade 5 and by then he was about 5 years old. He happened to be a more social and happy child than me.

In 2006, he moved to SA and I stayed back home to finish studying in medical school. We were very disconnected and I felt very lonely. Even when I reunited with the whole family back in 2013, I was struggling with the new culture and the family’s lifestyle. He was studying software engineering and got his first job while I was busy sorting out my paperwork with the Health Profession Council of South Africa. He still has a fun and outgoing nature, and I am the quiet and introverted one. 

He helped me a lot in adjusting to the South African lifestyle. He used to show me around, teach me how to drive, and help with all my smartphone, computer, and technology-related problems.

We both enjoy eating out, staying fit, traveling, and having Turkish coffee. We mostly meet at my parent’s place on Sundays for lunch and coffee. We have our disagreements, but we have been getting along pretty well over the years! He certainly has a more exciting social life than I do and has traveled to more countries. Having siblings is definitely a blessing in our lives.

One of my favorite photos of us, when he was about 6 months.

He is about 2 and we are both playing in our great-grandmother’s house in the summer. 

 

CERVICAL CANCER IN SUB-SAHARAN AFRICA

 Cervical cancer poses a significant burden in Sub-Saharan Africa, due to limited access to preventive measures, early detection, and treatment services. At our facility, we usually diagnose three to four new patients with gynaecological cancer and mainly cervical cancer every month. They are often quite young and have concomitant HIV infection. Women often present with severe anaemia, pain, foul-smelling vaginal discharge, or even kidney failure.

 Last month I had to counsel the family of a young patient in her 30s who was very sick and delirious with end-stage cervical cancer and her biopsy results were still pending. The family members were her aunt and her sister. They were devastated to hear the news and they were not coping looking after her and her 3 young children, the youngest who was 18 months old.

 According to the World Health Organization (WHO), approximately 25% of all cervical cancer cases worldwide occur in Sub-Saharan Africa, even though this region represents only about 14% of the world’s female population. Many women do not have access to regular cervical cancer screening programs, such as pap smears or HPV testing. Poverty, limited education, and cultural beliefs all limit women’s access to cancer prevention and treatments. HIV infection is prevalent in this region and this also increases the risk of cervical cancer.  Vaccination programs are limited in many countries in this region which contributes to the high burden of the disease.

 The healthcare infrastructure has numerous challenges such as shortages of trained healthcare professionals, limited diagnostic facilities, and insufficient treatment centers. The biopsies taken take four to six weeks to be reported by the pathologists and the waiting list to start treatment is six to twelve months for the patients to get chemotherapy or radiation.

 We all hope for a better future for our women in this region of the world. There needs to be more public awareness to educate communities on the importance of cervical cancer prevention, early detection, and treatment.

Below is Charlotte Maxeke Johannesburg Academic Hospital which is one of the referral oncology centers. 

 

 

 

 

 

 

 

 

HOW I BECAME A GYNAECOLOGIST

 Medicine is a long and confusing journey. Going to medical school in my hometown, I had no idea what I was stepping into. One of my family friends who was a qualified dentist tried to convince me to do dentistry because the training is easier and there are no internship night shifts. My university marks were borderline for the medical school near home and I could be accepted in another province. My family suggested I choose pharmacology as a second option so I managed to stay close. I had made up my mind and I wanted to become a doctor.

Medical school and the difficult exams went smoothly, we were slowly introduced to bedside teaching and the hospitals and I found it very fascinating. Some of my friends didn’t enjoy dealing with patients and they had already made up their minds to exit clinical medicine or do radiology or pathology. Community service was in the rural areas. I was doing family medicine in a rural clinic. Dealing mostly with outpatients, prescribing paracetamol or chronic meds for diabetes and hypertension. I remember how the community service dentist used to suffer and sweat with loads of locals coming for tooth extractions every day!

I had made up my mind about emigrating to South Africa after my community service. The first two years of immigration were spent dealing with the registration process to get into the south African internship program. It was a difficult time waking up every morning feeling bored with no purpose. When there is no work there is no money and no fun! I learned a lot in my two years of internship and now I understand the reason South African doctors get a lot of respect internationally. In Medical school, I went through a phase where I wanted to become a cardiologist. The books and the theory were nice, but the internal medicine rotation, dealing with chronically ill patients, seeing the cardiac echo, and the cath lab weren’t what I wanted to do for the rest of my life. Stepping into a busy labour ward was love at first sight!

I always wanted to do my SA internship at Chris Hani Baragwanath Hospital, but I did not get it. I made it to Bara for community service and spent 12 months in maternity rotation and grew very quickly. I saw it all. Getting through the primary exams of obstetrics in Bara gave me the opportunity to get into the specializing program the following year. It was a four-year program with the COVID pandemic, a wedding, and a pregnancy on top of the crazy night shifts, exams, and a research project.

 

Myself and the facility midwife in Community service back home in 2012, and a Christmas shift at Bara Hospital in 2018 with our nursing staff.