Dr Bosede Afolabi

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What inspires and drives you?

I am driven by my passion for healthcare in Nigeria in general and more specifically by my passion for improving maternal healthcare in Nigeria. I love what I do, I really enjoy looking after pregnant women and women who have reproductive system challenges. I have been doing that for about 22 years and it doesn’t get better than this in terms of job interest. I started off in Obafemi Awolowo University Ile-ife and this was a place where I felt that I got to be part of an institution that also shapes your mind. I learnt to think in a different way. I learnt to want to be part of my community as opposed to just do things for myself alone. From the experiences I had there, I decided that after specializing in whatever field that I was going to specialize in, I will definitely make sure that whatever I do, impacts the Nigerian healthcare system positively. Sickle cell in pregnancy is one of my research and clinical areas. In each field, even in O&G, you also have sub-specialty areas and mine is maternal and fetal medicine. Parts of maternal medicine are conditions like sickle cell in pregnancy, high blood pressure in pregnancy, etc. I also have a doctorate in O&G, which is like a PhD in medicine; separate from my normal fellowship. That is because I like academic thinking as well as my clinical work. The doctorate was on sickle cell disease in pregnancy and from this I got to work with these women so much more that I sometimes intuitively know what their problems are even though their problems are very complex a lot of the time. So basically, that’s me in a nutshell- somebody who was shaped by a very inspiring community environment in my university days and who now uses all those concepts and insights learnt to input their passion into the work they do. In my case, it’s maternal health.

What would you describe as your guiding principle?

When it comes to my work, doing the best I can, to the best of my conscience and ability and also trying to ensure that every patient that I meet, treat and work with gets the best possible care that they can. That is as per work. As a human being, I believe that excellence and striving towards excellence is important. I also believe that one should do ones work properly, conscientiously and maintain a work life balance to a large extent.

Do you feel fulfilled having returned to Nigeria after your training abroad?

Absolutely! I didn’t go to the UK to try and make a living. I went there to just train quickly and optimally so that I could come back and be part of this system because whether you like it or not, in those other countries they have got to the pinnacle of their healthcare - these are communities that have been developing for hundreds of years. But here, we still need our own people; we still need to put in our best into our healthcare system so as to make things much better. For me it is much more important and significant to be here. In a country like ours where everything is not as good as we would like it to be, you can make much more of a difference here than places where they are virtually fully developed. For me it just didn’t apply- the thought of me staying there. Over the past 17 years since I have been working in Nigeria though I can’t deny that there have been times that I have thought ‘gosh’ what sort of work - life is this? But basically at the end of the day, this is still where I fit in the best as far as I am concerned.

What would you describe as your greatest challenge?

Infrastructure is a major issue as we all know. We don’t have to teach ourselves this. Some basic things like electricity, transportation, water availability and the integrity of buildings. Those are the major issues, particularly the first three I mentioned. No matter what sphere you work in, electricity is always a major issue. It’s particularly challenging in the healthcare system when you can’t predict how your electricity will function. So those are the greatest challenges. We also have leadership challenges obviously but that’s more general and far reaching. Basically in the immediate sphere, those three things I mentioned and that makes it difficult to plan. You know Nigeria is a country with human resources. We have a large number of people. Whenever you have that kind of thing, it is a blessing. But the corollary is that you need to be able to plan to manage such large numbers. If you can’t or you don’t have data to do so and you don’t have the correct administrative efficiency to do so, then unfortunately that blessing of numbers becomes opposite. So that’s the major challenge in Nigeria. They are not insurmountable though and I think with time we will get there.

What are the commonest causes of maternal mortality in Nigeria and how can it be reduced?

If we are talking about clinically, these are things we know. The immediate causes are hemorrhage (bleeding), blood pressure issues in pregnancy (pre-eclampsia/eclampsia), sepsis (infection) as well as abortion issues. So we know the things that are killing our women. But as far as the actual issues that we can attend to, the ways to reduce maternal mortlaity (which is something a lot of us working in that field know) is by removing the delays to be able to get appropriate healthcare. These delays include: First of all the delay of making a decision in the first place. For a woman to say “I definitely need to go to the hospital” and this has to do with education. If you are poor and ignorant, then you don’t really know when the right time to go to the hospital is. You will think that when you feel this way the next person you should go and meet the old woman that has always been doing it in your community. You go and tell her you feel this way and then she tells you ah! This is what happened to mama so and so; this is what you are supposed to do for it and you do that and ignore the appropriate healthcare system. The second delay is delay in getting to the healthcare area. If you can’t access the health care area either because you don’t have the facilities to do so - maybe no money, no transportation or there is transportation but the roads are blocked or the roads are poor, then you are not going to access the healthcare you need. That is the second major delay. And the third delay is getting the appropriate care when you do get to the healthcare facility. In our facility for example, we do our best and we manage to save much more lives than the few we lose. Unfortunately because we are such a big place, people come here when they are almost gone that is one, and then also we are a tertiary center and so we deal with very severe illnesses. Having said that, we do sometimes have challenges- If the electricity goes and the generator is not working because it has been over worked, what is going to happen? Or some strike just called off or there is no blood. So such things sometimes would slow access down and those are the three major issues we would need to fix. Some of them are quite huge, the issues of education and poverty. But they are not undoable; they just need determination and a bit of time. The issue of access is also doable. Once a woman is pregnant, she knows that throughout that period of time, she should always be empowered with enough money, access to transportation and she knows her route to the hospital or the closest place to her. So that if anything happens, she can get there without her husband being around. She should always have that support group and of course our own healthcare system, we have to make sure they are optimal 24/7 as far as the infrastructure is concerned.

How have you been able to achieve a work-life balance and what is your advice to upcoming female doctors?

It is still a man’s world. Even in supposedly more developed countries, it is a man’s world, talk less of ours. And despite the fact that in the south-west women tend to have more opportunities, we are still not considered equal in a lot of ways, so it is tougher for sure. Aside from that, the woman is the natural child rearer - both biologically and socially and the woman is also the natural nurturer. So a lot of the time, the role of home maker falls to her and it makes it a bit difficult- especially if you don’t have a supportive spouse - to do so much in her field which is very demanding and also be able to contribute at home. As men are getting more informed these days, it’s getting easier. More women are going into Obstetrics and Gynecology and they are supported by their families. One of the ways that I feel that women should work towards this, is first of all to realize that a specialty like ours for example: I think it is the best specialty in medicine because you help bring life into the world and there is nothing better than that. It has its ups and down- it is medicine after all. It is really fascinating and as a woman you empathize with fellow women more. There is almost nothing in Obstetrics and Gynecology that I myself haven’t gone through or I myself can’t imagine, so when a woman tells me that she has severe period pain, I know where she is coming from. I am not saying that men can’t do it, men do it and they have been doing it well for many years, but I think it’s a very natural place for a woman to be in, so they shouldn’t be afraid of it and more than anything else they should actually try and imbibe it more. Now the problem is that it is an extremely demanding specialty. Other specialties, more often than not, a lot of the problems that happen occur more during the day time. In obstetrics, it’s shared. More than half is at night and the other part during the day time. So there is no way you will practice O&G and not have sleep issues and the demand on your time at odd hours because babies want to be born around the clock. So it is a very demanding specialty for that reason. Again what one does is that, one should plan. You can’t get away from anything in life without planning appropriately. What do I do? I have support staff. I have people who take the pressure off me for a lot of other things. I have in my home the person that does most of the house work. I tell people as a joke that you can’t expect me to know how to cut a person from top to bottom and also be the one that knows all the corners of the market. It is not possible. If I have somebody who can take those aspects of my life off me, then I can get that done appropriately. So I have support staff that I delegate duties to and I plan my life to a large extent. That is basically the way to get through. Planning and making sure you delegate appropriately and focusing on the important stuff and also remembering to balance your life. If you get too totally absorbed with work, life issues will slow down. I also make sure that I exercise and I eat well, because if we don’t take care of that part of one’s life, you find that it affects the other areas.