| ULIZA DAKTARI | FAMILY PLANNING

[00:00:14]Linda, today we're celebrating all those people we call mom, all the mother figures in our communities, our aunties, all those people who have nurtured us and grown us through and through. We see the work that you do. We see your tireless efforts. We feel your love every single day. So today, we're wishing a happy Mother's Day to every single person who responds to that name.

[00:00:43]And I wish my very own mother, Juan, Mrs. Joe, and Betty Busalo a very happy Mother's Day today. And I would like to also wish our special guest on the show a happy mother's day as well. Kibana, Dr. G.

[00:00:55]>> Happy Mother's Day to you, too.

[00:00:57]>> Asanteana.

[00:00:59]Now I am Dr. Lauren Mangesta, Dr. Wina Mama, an obstatrician and gynecologist and I'm best at a care which is at the upper hill medical center. Now last week we started a discussion with Dr. Now for those who missed the show last week let me ask Dr. Terry to introduce herself again and remind us uh what kind of work she does. Dr. Thank you so much Dr. Lauren. So ladies and gentlemen, my name is Dr. Janet Genji also known as Dr. H found and CEO of Dr. Trust. I'm a consultant obstetrician and gynecologist. I work at Kenya Kenyat University Research Referral Facility.

[00:01:47]Sorry, Kenyat University teaching research and referral hospital commonly known as KUTRH. We just shorten it. it becomes much easier >> and I'm happy to be here yet again.

[00:02:00]Now last week we looked at family planning the different types. We talked about hormonal methods and non hormonal methods some of the side effects some of these methods. So today we're going to be looking further at your questions to make sure that we have a better understanding of exactly what this means. So please talk to us that is on our SMS lines at 22422.

[00:02:26]Engage us on our socials. That's so um maybe we just do a very quick one minute recap on the different kinds of family planning.

[00:02:50]injections.

[00:02:55]So maybe just a very small summary on the different options, right? So we spoke of the different kinds that were there for family planning and we said that there are what we used to call traditional methods and modern methods.

[00:03:11]>> So traditional methods used to be uh how maybe like we could count on calendars and you'd know these are safe days and unsafe days. would use beads. Some people would use like temperature assessment just to know the days of ovulation where there'd be fluctuations in temperature. Those were the traditional methods that used to be there. Um then of course there was also all these other methods that don't need anything else uh where you would even have uh withdrawal methods and stuff like that that does not use anything.

[00:03:39]>> Mhm.

[00:03:39]>> But then now there came modern methods.

[00:03:42]Now the modern methods are divided into what could be hormonal methods and non hormonal methods. So the non hormonal methods are the ones which we know that would be stuff like use of condoms, diaphragms, spices, things like those.

[00:03:58]Then the hormonal ones which now regularly are the ones that are used would be some of them are short acting and some are long acting. M >> um and then now you'd have the short acting ones which are pills which you have to take every day or you would use injectables which you inject every 3 months and then the longer acting modern hormonal methods like implants which you'd put on your arm >> uh or a coil which would be inserted uh into your womb right and some are hormonal and some are not hormonal. Then there's also now permanent methods where in women we tie their tubes which is called tubalation and in men the tube equivalent which is a vasectomy they have options for themselves. So yes, we're going to get into our questions.

[00:05:02]and a bit of discomfort.

[00:05:06]Expected side effects. Yeah. Some of these family planning methods. So, the hormonal ones because most of these things hormones.

[00:05:24]We said this too.

[00:05:25]>> Yes.

[00:05:26]>> These are the ovaries and they're responsible for generating hormones in your body. Mhm.

[00:05:30]>> The two hormones moenator estrogen and the other one is called progesterone >> for the sake of our audience estrogen hormone E progesterone hormone Porm E hormone P and every month hormones who produce >> at different amounts at different times 28 days let's just speak the 28 cm E it arise at some point up to day 14 ovelation occurs >> and then after that hormone hormone and then the cycle starts again Pful periods and on and on.

[00:06:32]>> So it's a dance last time. It is a dance hormone contraceptive because hormones.

[00:06:57]Mhm.

[00:07:07]VT vinage. So the inner lining of this uterus starts to thicken in anticipation for a conception for a baby to implant.

[00:07:17]>> If it doesn't happen then that entire arrangement collapses and it collapses and comes out in the form of period.

[00:07:25]Therefore, when you're using hormones, they affect how that lining forms. It even forms slowly, slower than usual because the hormones have already been adjusted. They're not working the way they usually work.

[00:07:39]>> So, every month expect period later on after a period of time. So, it explains why our party period Because the hormone is already working to suppress ovulation from happening.

[00:08:00]That's why. So it is normal because it's not normal for you to not have your periods both on pills and on um depo. Could you comment on that? So it depends because different girls and different women have got different cycles because we all different individuals.

[00:08:33]>> So this is an individualized issue such that even you and I how we have our cycle is very different and as is the rest of us, right? So we'll notice in such a way.

[00:09:09]So there are so many structural things that might require to be assessed in this womb, not only the hormonal elements because this womb is a structure in and of itself, right? So we need to confirm and you can see in my drawings here, it has many structural things.

[00:09:28]So at the end of the day that you might be having a structural issue, a structural defect or a hormonal issue.

[00:09:35]So I would advise them problem.

[00:09:48]It's important to also do your investig Um and it is in this way family planning I'll give you an example. Let's say the man is a smoker.

[00:10:45]If there's a Yeah. Easy Family.

[00:11:31]I'll even take the coil after the break and I'll put it here so that it's a small T-shaped.

[00:11:50]We trim the strings here just enough.

[00:11:53]foreign.

[00:12:08]So psychologically Mhm.

[00:12:49]So some of the complications that sometime can come up and how do we address them?

[00:12:58]I totally agree. Remember even in the last episode to I'm sure all of us so it's easier to put it like that just sits on a roof like just like that. It could even drop at any point like like that. So other than the walls of the uterus of course the walls of the uterus because close together in place for people sometimes very heavy sometimes even it can make the coil to even dislodge downwards and you know this is the So, everything can really decide to migrate.

[00:14:03]things are there and we have special instruments that we use to try and assess where the coil is. We can find them. We can even use ultrasound guidance. There also surgical options where we can go and actually now use the cameras to retrieve the coil.

[00:14:21]Might require even a bigger surgical intervention to find it. So you just need to see the gynecologist.

[00:14:35]family planning. So, please stay tuned.

[00:14:37]Don't touch the dial. We'll be getting into that right after the break.

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[00:17:01]This is all my fault, dear. Because I didn't tell one the true were in this place because of me.

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[00:17:44]your back to school payments your kids school fees by paying directly via Empa pay bill 400222.

[00:17:55]Back to school payments have never been made simpler thanks to Coank and welcome back. Now Mill from never conceived. What family planning would you advise?

[00:18:27]Right. So um I know one of the concerns here is will I be able to conceive when I now want to conceive. I agree. Now remember that family planning was meant to come just to plan the families in that sense.

[00:18:59]>> Therefore, so all these modern methods that we're talking about, there's a rule for them even for that person who does not wish to have a baby right now. And that explains why those are the tenets of family planning to ensure that there is birth spacing to ensure that pregnancies we don't call them unwanted pregnancies anymore. We call them so remember you want to maybe try and maybe grow in your career or maybe deal with a health issue or maybe and everything. So there's room for you to use this family planning methods and you can use any >> okay >> but let's remember that this is also individualized >> because high blood pressure diabetes heart disease blood all these things.

[00:20:15]So such hello.

[00:20:40]No.

[00:20:50]Hello.

[00:20:54]Hello.

[00:21:15]Uhhuh.

[00:21:38]Okay.

[00:21:49]So to finish the last question.

[00:22:13]Yes.

[00:22:25]The same question applies. Chances are the answer.

[00:22:52]Mhm.

[00:22:54]44 stage ovaries.

[00:23:17]And after age and after 40 decline even further first and foremost in terms generally for everyone.

[00:23:56]Blood pressure.

[00:24:08]blood pressure.

[00:24:10]Any family planning? So, she's stranded.

[00:24:13]And then we have a call. Hello. Hello.

[00:24:16]Hello.

[00:24:25]Mhm.

[00:24:33]Mhm.

[00:24:37]Mhm.

[00:24:42]Mhm.

[00:24:49]Yeah. Okay.

[00:24:54]40.

[00:25:00]High blood pressure.

[00:25:20]Hormone E, hormone We can't even begin to know where the problem is.

[00:25:52]Mhm.

[00:26:03]Stroke heart attack hormones. Remember who appears in metabolism.

[00:26:27]hormones.

[00:26:36]So all these hormones recipe for disaster. Recipe for disaster. That's very true.

[00:27:22]Hello. Um, is there a disadvantage of using postino2 for a long period of time?

[00:27:29]I have a question for 1 year32.

[00:27:42]So emergency I think oops with oops supposed to be an emergency drug even if you're going to use Oops.

[00:28:23]Which now it becomes a problem. But >> it is an emergency pill. The moment you're having to use P2 for a year, >> it means you need a more consistent method of contraceptive.

[00:28:39]>> On a serious note, it means any of the other modern methods. This emergency contraceptive was imagined for various things.

[00:28:51]Oops. M or the unfortunate sexual assault level of assault and you do not you know obviously you want to make sure that you pregnancy as a result. That was what the emergency pill was intended for, >> not for you to use every single day as a form of contracept.

[00:29:14]>> And of course that case hormones so much and remember hormones lining periods. So just work backwards. If you used things in excess, you did not generate a lining and as a result you did not have a period.

[00:29:33]>> Yes. N toolic Caroline. I have a 5-year implant which started to misbehave at year three. My periods are going for more than 2 weeks and then I was advised to use pills to balance the hormones. Is it safe to continue using pills while I have the implant? So territory the other times the family planning not necessarily for family planning but for regulating hormones.

[00:30:01]to sometimes our young girls who also sometimes need to use these methods for a period of time. I agree. Thank you so much. So now >> contraceptives or these pills or this uh cuz it's medication.

[00:30:16]>> So let me call them medication for this particular answer.

[00:30:19]>> These medications are used for family planning but not only for family planning. Mhm.

[00:30:37]But in actual fact, no.

[00:30:43]If you have irregular periods, we use >> to regulate your periods. And specifically, we prefer using pills.

[00:30:52]>> We use very heavy. We can use the pills. We can even insert a hormonal coil as >> it just happens to be a contraceptive fever. So you can have the same da but does more than one thing. So those are some of the things heavy endometriosis endometriosis these black black spots.

[00:31:32]All right. Sometimes we can use this medications for such particular issues.

[00:31:37]So contraception. So especially for adolescent girls where parents sometimes even have to write a letter for them.

[00:31:53]So we need to explain to them at this particular instant last week we talked about pills.

[00:32:07]So it's important to remember 21 days 28 days.

[00:32:37]So please start in the direction that the arrow indicates and follow the arrow.

[00:32:58]They want what we call permanent family planning. So after the show we're going to be looking at vasectomy options.

[00:33:09]So please stay tuned. Don't touch the dial.

[00:33:23]and welcome back.

[00:33:28]What are the options that are out there for men?

[00:33:32]Now, the options that are out there for men, unfortunately, or I don't know if it's fortunately, I hope I hope we could get more. But right now, the only option that men can have is all a non hormonal.

[00:33:45]>> Mhm. So it's use of condoms right and uh for more permanent methods it would be to perform a vasectomy. So if you have achieved something which in medicine we call desired family size then as a couple you in the process of family planning you can decide how shall we go about this. uh maybe even the lady has been using these modern methods for a very long time and they seem to you know be giving her effect after effect after effect right so now we want to figure out how to use the permanent methods I'm going to use this model to explain because remember this was the internal reproductive system of a woman so this is a womb and these are the tubes so we can decide to tie these tubes you can see this large one that turns into pink over here and this on this other side so we usually tie the tube. At this point, we tie the tube or we can even remove the whole tube and just kind of like just you know clean it off, slice it off and and remove it all together. It's a permanent method >> that nowadays due to modern medicine that's the end.

[00:35:05]>> So such that IVF so if you wanted more children now they would harvest. But I want to describe what this means.

[00:35:13]>> This being the ovary So it's like the way you'd move like through a bridge from one end to the other end. So you want this egg to enter the bridge.

[00:35:30]>> Fertilization happens inside that bridge. So the the sperm egg is going to find the egg in the bridge and then after that it will roll down and go to the other side which is now the womb.

[00:35:40]>> Mhm.

[00:35:41]>> Now all we doing is removing the bridge.

[00:35:45]We're not removing the ovaries. These are what make a woman a woman. And I know people sometimes worry, you know, but the ovaries remain. It's just the bridge that we are kind of like putting a block in that bridge.

[00:36:03]>> So it means Dr. we are still we are still ovulating. Totally.

[00:36:06]>> The ovaries are still producing their hormones and you're still getting your periods because that is another question I keep getting. Will my periods keep coming?

[00:36:16]Because the eggs are actually still hatching for lack of a better word.

[00:36:21]>> And remember this egg communication is one that used to communicate with the lining. So the communication is a egg lining coms. This is just the bridge. So you'll still ovulate.

[00:36:31]>> You will still have a period but you do not have a bridge. The only time you don't have a period is if we remove this womb.

[00:36:39]>> All right. Now even in males the same bridges we have >> men have bridges too. So vasectomy is the equivalent of a tubal legation >> where now we go through the men a small incision and a local anesthesia >> to it's through the scrotum to get to the bridges also called the vas >> and then we also tie and cut >> the bridge. Can we please tell the men that there will not be any less of men when they do this vasectomies?

[00:37:17]>> Sure. I agree. Because the equivalent of the ovaries in a man is the testice.

[00:37:24]There's two of them.

[00:37:26]>> They are responsible for generating testosterone. Remember our hormone E for estrogen, our hormone P for progesterone. In the male counterparts, there's hormone T. So hormone is what makes a man a man >> how viral he is how how everything that is all manly it remains it's just that in the process the same testes that produce that sperm will reach through the bridge find a malipuama >> mhm >> but remember that all the other processes in a man >> are also still there the prostate gland the seinal vesicles that provide what usually comes out that still comes out but it will be without the sperm the eggs themselves >> so they'll be blank but everything else that is required to happen will happen for a period of 3 months please I need to repeat that very clearly because for a man >> the moment atomy is done they still have stock >> for three months after which >> after 3 months is when now everything now from there will be black >> okay So these are the permanent methods planning. These are the options for those who have achieved family size.

[00:38:45]Yes, but she has a lot of discharge.

[00:38:52]Sometimes it's smelly all through imbalance which is not true. So um with some of the side effects um when are these side effects bothersome enough for us to see I'll tie that question with everything that was also being asked in many of the questions you saw doc where they were asking side effect there is none that doesn't have a side effect it's a question of just deciding >> mh What is going to be my portion in this? I can live with this. I cannot live with this. I can work with this. I cannot work with this.

[00:39:34]>> Now, let's zero in on the coil >> whether hormonal or non hormonal. But let's talk about the non hormonal one.

[00:39:40]So remember the non hormonal, it means you're still ovulating. So you can still get pregnant.

[00:39:46]>> Sometimes you can even do get an ectopic pregnancy.

[00:39:48]>> Sometimes you can get heavy bleeding within the same coil. Remember that this is a foreign object. I had this coil somewhere. I think I I don't know where.

[00:39:57]Oh, it's right here.

[00:39:58]>> So, this coil is a foreign object and it sits in here like that. Remember the strings that you were talking about?

[00:40:04]>> So, this is a foreign object made of copper in there.

[00:40:07]>> These strings are also communicating with the outside world.

[00:40:11]>> So, this is an area has it has no door.

[00:40:14]It's a hollow space. So, even infection can ride up the strings, >> come through the cervix and create infection in here, >> right? And it can sometimes manifest with a lot of discharge, a lot of infection. And when sometimes this infection goes unchecked or untreated.

[00:40:31]Then if you look at these tubes that we're talking about, this is a healthy tube.

[00:40:37]This is an unhealthy one. You can see how big and pink and you know, easy. In fact, chances are it's blocked.

[00:40:45]>> Yeah.

[00:40:46]>> Such that even So even when you have a tube like this, your chances of conception already 50%.

[00:40:58]Cuz chances are very high that this tube is is it might have pass inside. It might have fluid inside. It might have fluid that is also toxic to the whole uh complex of the egg and the sperm. So it's not a good tube to have. And this can occur when you're having repeated infections through these strings that bring infection. Now uh Nairobi is one ginormous bedroom >> and if you know you know what I mean. So the risk of getting infections becomes very real and it's propagated through these strings >> and there requires to be some serious hygiene and some serious safe practices amongst us in order to make sure that this coil does not give you more harm than good.

[00:41:50]>> Okay. Um I would like to speak to Winnie a 19year-old who texted in distress and she doesn't know what to do. That simply sounds like it could be something called candidasis or a fungal infection.

[00:42:05]It can be treated very easily. So please don't panic maybe for three nights or seven nights and that will clear. So please get that medication as soon as possible. Dr. would like you to give us your parting shot as we close this very exciting discussion on family planning.

[00:42:24]>> Right. So guys, this is what I have to say. As for the youth, please, back in our days, we used to use condoms because it was the thing that was there and it was written in every billboard you could think of in this country. It saved lives. It has dual protection.

[00:42:42]It's not only pregnancy to also protect us from sexually transmitted infections.

[00:42:47]>> The generations that we see today, you're more afraid of pregnancy than anything else. Um and of course nowadays also with the advent of medications that we have gotten you know to treat HIV and prevent it from turning into AIDS we have not been able to see the whole spectrum of how everything turns out and as a result to become a bit more you know not very safe the way we do things.

[00:43:11]Then we add these other medications in a trou where we were told we even take them before.

[00:43:17]>> Oh my god guys, we need to be very very careful as far as this is concerned.

[00:43:21]It's not only about family planning because everybody even at the point they encompass and everything the plan and the aim was to finish school probably get a good job and be able to now plan your family with your desired person.

[00:43:34]And these things are here to help us.

[00:43:36]Please don't be afraid. Visit any hospital near you. Talk to us through whichever channels we have. Let us get to youth friendly centers. Ask every question and don't be afraid. Don't be shy. We are here so that we can be able to assist you. There's no judgment here.

[00:43:50]All we want is just to create a society that is planning families.

[00:43:55]>> Thank you >> Dr. Gingi. Thank you beyond words. It has been quite a pleasure having you last week and this week. Thank you for sharing your wealth of knowledge and experience with us.

[00:44:04]>> Thank you. Nam. So our shows are streaming on view sasa for those who missed those shows and you can also check out on YouTube for links for last week last week's episode as well as this week's and we'll also be sharing uh duct pages and contacts so we can reach out to her as well. So until next week when we'll be back here at 8:00 p.m. for lizard duct please continue watching and please continue learning and again to our mothers.