Hamza Kafeero and Sharifah Nampijja (not real names) endured a difficult three years of ridicule simply because they had not had children three years into their marriage.
Thirty two-year-old Kafeero and his wife sought help from a number of hospitals and clinics, and Nampijja even resorted to herbalists. They were eager to have children and ready to do anything possible to make it happen.
“We saw different gynaecologists, with each giving us a different prognosis and medication,” says Kafeero.
Despite the many trips to different hospitals, their problem was never solved. Kafeero’s wife interjects, saying as time went by, stress and tension set in.
“Some doctors were telling me it was stress stopping me from conceiving, but how was I to avoid stress with people talking behind my back. It was unavoidable,” Nampijja says.
She adds that she did everything that doctors advised her to do, though some were bizarre. “Among the things, I was told to stop putting on knickers, leggings, and high heels,” she says.
With the hospital not offering any solution that seemed to be working, Nampijja opted to go to herbalists. “We were prepared to [try all options], but not witchcraft. We visited almost every stall selling herbal medicine in Kampala. At one point, I was given 20 litres by a herbalist with instructions to take it in three days,” says Nampijja.
The husband adds: “We had become medical nomads moving from one hospital to another with no success.” After sharing their challenge with friends, the couple was directed to the women’s hospital to try their luck.
“It was through friends that we learnt of the Women’s Hospital International and Fertility Centre. We first went for consultation, but we didn’t have the money and we told the doctor so,” says Nampijja.
“During the consultation, Dr Tamale Sali told us one of the tubes was blocked, something that we had not been told in the different places we had gone to,” she adds.
A year after consultations with the women’s hospital, Kafeero checked on the hospital’s social media account and found a call for childless couples to send in a video clip of their baby search experience.
“It was not easy to convince my wife to take part in the video clip; she was pessimistic about it. Fortunately, shortly after uploading the video, a one Dr Sam from the hospital called, saying we had been chosen for free IVF treatment.”
For Nampijja, the news was too much to take in.
“I couldn’t believe the news; out of excitement, I even cried. I could not believe because we had tried to look for money but in vain. The call was made on a Thursday and we were asked to report to the hospital on a Monday.” To Kafeero and Nampijja, this was an opportunity they could not take lightly. “We were at the hospital on that morning of the appointed day; tests were done and medication started immediately,” says Kafeero. Nampijja underwent three months of medication, a period which increased the tension on her side. “Three months of medication put me on tension; I was not sure whether this was my chance to become a mother. I was supposed to [go] back for tests 14 days after the implant,” she says.
“But within those days, I was always on the Internet checking for signs of positive implant. I went and bought 10 pregnancy tests every day. On the ninth day, I got a faint positive and I was so excited, from then on to the 14th day when I was supposed to return to hospital, I checked to see whether the positive would be clearer than the first one I had seen,” she adds.
The hospital confirmed what the couple already knew and was given the list of dos and don’ts. Two weeks later, it was confirmed that Nampijja was carrying twins.
“I was praying for at least one embryo to develop, but when I was told I had two, I was overjoyed. That is a moment I have no words to explain. We were so happy.”
Kafeero adds: “There were people talking behind our back and they had to eat their words. I have no problem with such people because they didn’t know what they were talking about. Infertility is just a health problem just like any other sickness.”
“To those out there going through what we went through, they should not lose hope. Just like we did, they should approach the hospital and explain their situation. Though we [did not pay], we got the same treatment and care like paying patients. The only cost we incurred was transport but everything, including meals when we were admitted at the hospital, was provided for at no cost. Even after delivery the babies were taken care of at no cost. We never paid a single cent,” he says.
Kafeero and Nampijja are now proud parents of two baby girls, thanks to the social corporate responsibility of the Women’s hospital. Under this programme, the hospital director, Dr Sali says every year, they give back to society by treating 10 patients at no cost under what they call the Free Of Charge FOC programme. Unfortunately, he says, some people have tried to abuse the system by pretending to be poor.
“We identified two couples who pretended to be poor, but fortunately we got to know their status early enough.”
Call for legitimacy
The appeal. For the 12 years after its introduction in Uganda, there is no law to regulate the use of Assisted Reproductive Technology. “Just like the mobile phones the law is playing a catchup game with this technological advancement in the health sector,” says Dr Robert Busingye, the president of the Uganda Fertility Association.
How assisted reproduction works
KAMPALA. Assisted Reproductive Technology (ART) is taking root in Uganda but before it is fully achieved, Uganda needs to revise its taxation on the provision of this service.
ART was first reported in 1978 in the United Kingdom when the first In Vitro Fertilisation (IVF) baby was born. It was not until about 2005 when the technology reached in Uganda. Mr Obadia Lalobo, the managing director of Paragon Fertility Centre, says Uganda has made significant strides in this field in the last 15 years.
“It’s not a primary or secondary health care. Infertility treatment is tertiary care and is highly specialised. As a result, the nature of its practice requires a certain level of training that is currently not being offered in Uganda, leave alone Africa.”
Like most innovations in Uganda, legislation comes chasing them. For the 12 years after its introduction, there is no law to regulate the use of ART.
“Just like the mobile phones, the law is playing a catchup game with this technological advancement in the health sector,” says Dr Robert Busingye, the president of the Uganda Fertility Association.
Mr Lalobo says his centre has been involved in formulating a draft legislation. “We are part of the fertility association that prepared a draft legislation that was presented to the medical council now before Parliament for proper regulation of the industry. Legislation on what is being done with these human specimens is needed. What you collect and fertilise should be documented.”
Currently, the commonly offered services in Uganda are IVF and surrogacy. Mr Lalobo, however, says the costs involved are still high and the practitioners labour to justify it.
“Of the Shs15m paid for IVF only 20 per cent goes to labour; the rest is spent on the consumables.” Establishing the facility requires intensive capital investment. “Startup alone require up to $400,000 in equipment alone, minus infrastructure, and drugs.
Dr Busingye says there is scarcity of specialists, hence relying on imported one because “Uganda does not train embryologists and these are key in the sector; centres hire them from abroad to work on a cycle.”
According to Dr Lalobo, “each pair the embryologist handles is charged $200.” Besides the human cost, there is specialised equipment and other sundries needed.
In Uganda, IVF patients are mostly women in their 30s and above. And the older she is, the more complicated it becomes to induce her egg production.
“To stimulate egg production in a 24-year-old, you need a quarter of the medicine used on a 35-year-old woman,” says Mr Lalobo.
Unlike other types of treatment, ART is considered tertiary medication, meaning it is a luxury thus subjecting its medication and consumables to taxation, which are all imported.
“One patient needs up to three vials each costing $300, they are used once and that’s less than 10 per cent of what is needed for the treatment, Mr Lalobo explains.
Also, drugs used in ART are not on the list of the National Drug Authority essential medicine, making them not readily available on the local market. Each fertility centre imports its own according to its demand. “The National Drug Authority requires us to pay import licence for each drug separately because they are not listed as drugs for primary or secondary health care.”
Since its inception at Paragon, the treatment has gone to Shs15 million from Shs12 million when it started in 2011. Despite the regulatory and the pricing challenges, there is a human challenge on the side of men.
“Men with a fertility problem are the most uncooperative. They are reluctant, when it comes to giving sperms,” Mr Lalobo says.
Despite those challenges, he says their success rate of four to five women conceiving in every 10 patients is impressive.
With the introduction of IVF, it comes with other subsidiaries, among them surrogacy. Women who produce eggs but their wombs cannot carry a baby resort to this system to have children. However, some people taking advantage of the absence of legislation in the service try to abuse it. “We had a gay couple asking to have a child through surrogate. Another was a case of a-five-person baby where the principal (a couple) [is going to use donated eggs and sperms and find a surrogate] to carry the baby. We insist on a couple of man and woman not a man coming and saying ‘I am alone I have the money get me the egg and the woman’. We shall stick to that until [there is] legislation to [to regulate it],” says Mr Lalobo.
For one to be a surrogate, she has to be an adult and a mother. She must be physically fit, and without organ defects.
At Paragon Fertility Centre, the procuring couple pays Shs600,000 for an apartment in Bugolobi flats where the surrogate stays during pregnancy. They also give her Shs300,000 as monthly shopping allowance, between Shs700,000 and Shs1 million as a monthly pay and between Shs1.5 million and Shs3 million upon delivery. However, Mr Lalobo says delivery is strictly by caesarian section. The total cost comes to $9,000, medical bills inclusive.
Egg and sperm bank
To cater for people who are not able to produce reproductive specimen, Paragon, like other fertility centres, also started a sperm and egg bank. “We don’t import them like it is in Europe; we get ours locally from the community. For men we pay between Shs500,000 and Shs1 million on condition that the donor has attained a certain level of education, is of sound mind and is healthy. For the ladies, it’s her health and age that matters. The younger she is, the healthier the eggs and we pay from Shs1.5million to Shs2.5 million.”