eMagazine January 2023

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OUR PEOPLE, OUR MISSION Global Health eMagazine January 2023 Perspective Highlights Reflections Innovation and Technology Nursing Division Women’s Health Education Global Local Art to Remind Us of Who We Can Be Article of the Month Video of the Month Our Beautiful Planet Welcome Congratulations Among the Letters Global Health Family Calendar Photo News Photo Gallery Resources The Voice of Uganda Fibroids: The Silent Pandemic Written by Joshua Matusuko Medical student at MaKCHS One morning while clerking female patients admitted to the gynecology ward at Kawempe National Referral Hospital, I noticed that more than 50% of patients were suffering from uterine fibroids. One particular patient, a 36-year-old nulligravid woman, had a 12-year history of irregular menstrual bleeding lasting more than two weeks, pressure symptoms, and a pelvic mass. She had been waiting for her scheduled myomectomy for over five months and still had hopes of one day carrying a child. On further clerking of patients with uterine fibroids, one complaint common was that they were in line for surgical therapy (myomectomy and hysterectomy. Once diagnosed and the decision is made for surgical therapy, patients at Kawempe had to wait between 5 to 12 months to the day of surgery, primarily due to the very high number of patients on the waiting list, with some patients having to wait almost an entire year. Uterine fibroids are the biggest causes of benign uterine masses and currently one of the biggest gynecological concerns in the country. Some studies have indicated a prevalence as high as 28.2% with about 70% being symptomatic (https://doi.org/10.24248/ EASci.v4i1.x © Adawe et al). Management options in private facilities normally are extremely high in cost for the average Ugandan with gynecological consultations only ranging 50,000 - 150,000 Ugandan shillings (UGX) (13.4 - 41.23 USD) depending on the private hospital. For women who want non-hormonal medical treatment, especially for those who want to have children or do not feel comfortable with hormonal therapy, tablets such as Tranexamic at a cost of 1,500 UGX per tablet and can be taken for as long as the doctor determines. Meanwhile Mefenamic acid costs 500 UGX per tablet. Hormonal treatments which normally offer a wider range of options such as combined oral contraceptives cost 8,000 UGX per month while injectables cost 5,000 UGX per injection. There are more expensive tablets such as Ulipristal which costs 8,000 UGX per tablet, making the total cost 240,000 UGX per month. One may need to take these for three months. There are also injections that help shrink the fibroids such as Zoladex and Luprodex and cost 350,000 - 400,000 UGX per month. Then for patients in for surgical treatment, one of the new surgical interventions for fibroids in Uganda is Uterine Artery Embolization (UAE) which 14
OUR PEOPLE, OUR MISSION Global Health eMagazine January 2023 costs 10 to 12 million UGX (3000 USD). Myomectomies and hysterectomies can cost 2.5 - 6 million UGX depending on the hospital. With costs being so high, many patients flock to government facilities like Kawempe, hence the longer waiting time and decreased quality of treatment outcome. This has resulted in a large proportion of patients having to live with poor or no treatment, leading to worse prognosis. More subsidized or free treatment is needed to curb this increasing silent condition. More women suffer from fibroids than we know with many not receiving the necessary treatment or not receiving it in time. Perspective Highlights Reflections Innovation and Technology Nursing Division Women’s Health Education Global Local Art to Remind Us of Who We Can Be Article of the Month Video of the Month Our Beautiful Planet Welcome Congratulations Among the Letters Global Health Family Calendar Photo News Photo Gallery Resources St. Patrick’s Cathedral, New York City (Olwen Gurry) 15
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