Where have all the good gynos gone?

One of the things I really miss about being a college student in the U.S is access to reproductive healthcare. A year or so ago, I could simple walk down to the health centre in between classes, pay little or no money and within a few minutes of waiting, be ushered in to see a friendly and understanding nurse practitioner. This non-judgemental and knowledgeable woman, would not blink at answers to questions about the number or gender of previous sexual partners. She was happy to recommend a free trial of the latest in contraceptive innovation like the Nuvaring (which I am sure had been asked to punt by pharmaceutical representatives). She even left me voicemails of my test results or mailed them to me on a cheerful card so I did not have to come into the centre a second time. Going to see the gynaecologist is rarely a fun experience, but it really should always be so easy.

Now, things are not so easy. Firstly, as an intern, fresh out of college I am uninsured. Still I consider my reproductive health important enough to stick the cost, assuming it doesn’t turn out to be too hefty. Obviously, things are different in Africa. A lot of prescription-only drugs are available over the counter at most pharmacies, for you to self-medicate your vagina into oblivion. Needless to say, my own, very limited medical knowledge is not my first choice to rely on. I haven’t been in this city for a year so I haven’t been able to suss out the friendly, liberal gynaecologists, but from personal experience of having over-friendly doctors get grabby with my pre-pubescent breasts, I know I can’t be too careful.

I can’t really ask my aunties, because, whether it be culture or just family relations, I am not comfortable having that conversation with them. For various reasons, people here don’t go to the gynaecologist annually, they only go when something is wrong or when they need something specific. So asking my aunts about it would be tantamount to admitting I am sexually active. The fact that I am really should not surprise them, I am an adult after all, and that whole waiting-‘till-marriage thing was largely mythological, even when they were coming of age. Still this doesn’t mean that it’s something we can talk about freely, something we can talk about at all.

So maybe my friends can help me out on this one, right? After all they are my age, and facing similar challenges. Not exactly. Well, they are facing similar challenges, but coming of age sexually in this culture of silence has led them to deal with these challenges quite differently. This is the way my friends deal with the probability of pregnancy: they take a pill called Fragyle after having sex. Having heard this I assumed that Fragyle was some kind of emergency contraceptive, and after regurgitating what I have read about the problems related to taking EC regularly, I left them to their decisions. Then, on visiting a pharmacy myself and having a confused and misunderstanding-filled conversation with the assistant there, I found out that Fragyle is in fact diarrhoea medicine. That’s right; diarrhoea medicine is what my friends use to prevent pregnancy. As to whether it works, only a medical researcher and a clinical trial could tell you that. The two friends who have used this method religiously in the months that I have known them are so far without child. Not that that tells you anything, it’s not nearly as easy to get pregnant as all the abstinence-only horror stories would have you believe. All they know is that it costs a good 80% less than Postinor-2 and its generic alternatives (though I doubt that they’ve even tried it). Needless to say, neither of my two friends knows where I can find a cool gyno or even a reproductive clinic.

So it is less than surprising that Ugandan girls are getting kicked out of school everyday because they find themselves pregnant, and it’s not a big shock that HIV/AIDS is so prevalent in this part of the world, and that young women aged 18-35 are one of the primary groups at risk.
Last week the headline of one of the major newspapers was “Girl gives birth during P. 6 [seventh grade equivalent] exams”. I am lucky that I have the education and money to realise the importance of finding good reproductive healthcare. For me, the search continues.