0:09

Hello. I'm doctor Louise Newson,

0:11

and welcome to my podcast. I'm

0:13

a GP and menopause specialist, and

0:15

I run the Newsome Health menopause and well-being

0:18

center here in structuredronhaven. I'm

0:20

also the founder of the menopause charity

0:23

and the menopause support app called

0:25

Balance. On

0:30

the podcast, I will be joined each week

0:32

by an exciting guest. To help

0:35

provide evidence based information

0:37

and advice about both the perimenopause

0:40

and the menopause. On

0:46

the podcast today, I've got somebody

0:48

who's not in the UK and someone

0:50

in a country that I've not spoken to before

0:52

on my podcast. So it's someone called

0:55

Martha, who's a urologist in Uganda.

0:58

And some of you might know that my

1:00

husband has done some work in Africa. He's

1:02

a urologist, but he doesn't specialize

1:04

in Actually, he specializes in

1:07

men and male reconstructive surgery. So

1:10

Martha was introduced to me recently, and

1:12

as a company, we sponsored her

1:14

for her final exams and We'll

1:16

talk about how well she did in a minute.

1:18

So welcome Martha to this podcast.

1:21

Thank you, Newson. Great

1:23

to be here. Oh, no. It's brilliant.

1:25

So you are incredibly inspirational.

1:29

There aren't many female urologists over

1:32

where you are. So can you just Tell me a

1:34

bit about you and why you decided

1:36

to do urology.

1:39

Oh, well, my name is Martha. Number

1:41

of gun monika. Thirty

1:43

four years old. My wife and

1:45

a mother of two sons -- Mhmm. -- and I was

1:47

a general size on first before I

1:49

ventured into urology. There's

1:52

nothing so special. I didn't have any

1:54

touching story behind my choice of urology.

1:56

It just happened to be one of the rotations that

1:58

I enjoyed fully Mhmm. And I

2:00

found the quite

2:03

inspiring. Yeah. And then I

2:05

I also had a dream of of helping,

2:07

you know, women with Face July Ganda.

2:10

So in was a means to that.

2:13

Wow. Yeah. So I ended up

2:15

choosing urology after my general surgery,

2:17

and that's why I I did my fillers

2:19

Japan. Which is great. In fact, my husband

2:21

was similar. He didn't set up to be

2:23

a euronicist initially, but then

2:26

he started to meet people like Steve Payne,

2:28

actually, who's also been part of Eurow Link

2:30

and found it so inspirational and

2:32

really enjoyed the people that he worked

2:34

with. So Tell me that for

2:36

those people who are listening, you don't know what a

2:38

fistula is. Do you mind explaining what a

2:40

fistula is, Martha? So a fistula

2:43

is any abnormal connection

2:45

between two surfaces that

2:47

have a mucus membrane. Mhmm. So

2:49

in Uganda, obstetric fistulas

2:52

are something that it's not rare

2:55

for lot of women can also afford

2:57

timely care when they go to deliver

2:59

babies. So they end up getting an abnormal

3:01

connection between the vaginal

3:04

canal and the rectum of vaginal

3:06

canal and the bladder -- Mhmm. -- and

3:08

then they become ostracized or,

3:10

like, neglected from society because

3:12

they have, you know, this change and

3:14

it becomes complicated with family. They usually

3:17

lose their families. So a lot of

3:19

them stay like that for some time because

3:21

maybe they don't know that they're somewhere

3:23

where they can't get help. But

3:25

once those women are identified and

3:28

investigated,

3:29

Sajari can be done to make the situation

3:31

better. So we have

3:33

a lot of people who come over to Uganda.

3:36

And do sort of like surgical

3:39

comps. So when people

3:41

have visitors that go into

3:43

their planter, so they have urinary symptoms.

3:45

So they have leakage and incontinence. Yes.

3:48

So they have continuous and continuous.

3:50

Mhmm. And that can often lead

3:52

to them being completely ostracized from

3:54

the community concept when they have urinary

3:56

incontinence.

3:57

Right. So most times,

4:00

you know, they lose their husbands and

4:02

and they there's a lady especially

4:05

touching. She said she's a Christian,

4:07

she really loved to good touch, but The

4:09

most complicated thing about the fistula

4:11

for her was that she wasn't able to get charged

4:14

because when kids would love at

4:16

her that she's smelling urine like a baby,

4:18

So just to see the women get better

4:21

and give their life back,

4:23

that makes my day. It's it's

4:25

wonderful. Absolutely. I mean,

4:27

it's transformational surgery. And

4:29

certainly, I mean, over here, fist

4:31

lids do occur, but they don't occur as

4:33

commonly because, obviously, care

4:35

when people are in labor is

4:37

better. But we don't have

4:39

that same sort of stigma really

4:42

from incontinence. Actually, an incontinence of

4:45

and can be very womens, as

4:47

you know, in the menopause, but people

4:49

still often can carry on with their lives.

4:51

And It was only when my husband came

4:53

back from Africa the first time and told

4:55

me that people couldn't go to church or they

4:57

were not able to be part of the family

5:00

and community. It makes you realize

5:02

actually what a big problem it is.

5:04

And certainly in the UK, women

5:07

don't like to talk about urinary symptoms.

5:09

They certainly get very embarrassed talking

5:11

about

5:12

incontinence. And do people

5:14

over there find it hard to talk

5:16

about Yes. Yes. So, generally,

5:20

things to do with reproductive health, the

5:22

topics which are seen as important.

5:25

So a lot of people keep quiet with their

5:27

problem. Mhmm. Some of the women

5:29

have stayed incontinence for

5:31

over ten, twenty years.

5:34

And yet they didn't come to hospital to

5:36

seek help. Mhmm. So it's something

5:39

they are shy to talk about a lot of

5:41

times, so a lot of people suffer for silence.

5:43

Gosh. And so how do you educate them?

5:46

How do you let them know that there is

5:48

treatments available? We pass

5:50

around not me in

5:51

particular, but what I've seen being done.

5:54

My work with the fistula before is more at the

5:56

hospital level when they come to

5:59

get reconstructed and maybe in the

6:01

post operative period. However,

6:03

the efforts by the Ugandan government

6:05

include sensitizing people

6:07

over over social media,

6:09

which radio, which is the commonest thing

6:11

that goes around here and in charges

6:14

and their hospitals that keep, you know, calling

6:16

out to these women and have having, like,

6:18

regular throughout the year, four years

6:20

now to try and capture some of

6:22

these And there's some NGLs which actually

6:25

go down to the communities and

6:27

go house by house looking for

6:29

any women who might be affected

6:32

by these situations. Wow.

6:34

Some women also hear I mean, get

6:36

notified by their other colleagues who

6:38

might have had a a similar problem in the past

6:41

that got rehabilitated. So

6:44

the more people are aware that

6:46

there is treatments available, the better isn't

6:48

it, but how many surgeons are

6:50

there over their doing your

6:53

sort of

6:53

surgery, Martha. So

6:56

let's see, maybe less than ten,

6:58

but maybe two sergeants distributed

7:01

in the west, some in the east, some

7:03

in the north, but most of them

7:05

are actually gynecologists. That's

7:07

the main specialty. We

7:10

have some urologists like doctor

7:12

Semisheng. He's done quite a

7:14

bit of work with women who have

7:17

hospitalized. He's published a couple of books.

7:20

He's a and then we

7:22

have another urologist doctor Kiri

7:24

in the east. But most of the other

7:26

people are kinda colleges,

7:29

but they are not more than twenty people doing

7:31

reconstruction in Uganda. They usually get

7:33

support teams from the UK or from

7:35

Ireland, most times, people

7:37

come in

7:38

to, you know,

7:39

work with some organizations that are volunteers

7:42

that come in and work together with the

7:44

doctors, the local

7:45

team, to try and reconstruct that

7:47

lady. Which is so important. And

7:49

so how many female urologists

7:52

are there in Uganda?

7:53

Oh, you know, really. It's not

7:55

so many in Uganda. Let's

7:59

see. Maybe it's the

8:01

four of us at the womens. We

8:03

have a retired senior consultant, Rosemarina

8:07

Sanger, and we have

8:09

doctor Hope Kibansha who qualified

8:13

three years ago. Then just recently,

8:15

we have myself and doctor Anatinka.

8:18

Just -- Yeah. -- four ladies who are

8:21

a urologist. It's not a field that

8:23

a lot of women take on in Uganda.

8:26

Right. For now, maybe the situation

8:28

will be different in future.

8:30

Well, I hope so. Certainly, you're

8:32

a fantastic role model and

8:35

amazing that you've done so well.

8:37

And you've done actually incredibly well.

8:39

So do you mind saying what you did in the

8:41

exam and what your result was?

8:43

Oh, So we we

8:45

had our exam organized in Namibia

8:47

in December, and

8:49

I I merged on top of

8:51

my class, so it It was under the

8:53

College of for East Central and Southern

8:56

Africa. So country

8:58

members or member countries take everyone

9:01

hosting the exam and the

9:03

big conference after. So we

9:05

had candidates from different parts

9:08

of Africa. That I have

9:11

Joseca, and I

9:13

managed best in my class.

9:15

So wonderful. Was

9:17

good for me. It's amazing. Amazing.

9:20

So does that mean you go to a middle?

9:22

I did get middle. Yes. Yeah.

9:24

Well, you need to be very, very proud.

9:26

I mean, to get the highest mark

9:28

to be the best in the exam is

9:31

absolutely phenomenal. And My

9:33

husband actually got the gold medal when he

9:35

did the exam many years ago, and

9:38

he was something he always wanted to do, but

9:40

he thought he might not be able to. And

9:42

my two children, I had two children, then

9:44

I've now got three, but I had Newson. And they were

9:47

I think one was Newson, and one was one.

9:49

When he was revising for the exam, and

9:52

it was a very hard time

9:54

because he was working and revising

9:56

as well as obviously being a full time surgeon.

9:59

But when he got the gold medal, it all

10:01

just seemed worthwhile. And when

10:03

I saw the photo of you with a massive

10:05

grin on your face, deservedly.

10:08

So when you had the results, it

10:10

reminded me of how happy my husband was,

10:12

and it's phenomenal actually.

10:15

And no one will ever take that away from you,

10:17

will they? I

10:17

mean, once you have an award and

10:19

achievement that's there for life and

10:21

your family must be really proud of you, aren't

10:23

they? Yes, sir. So it works. I can

10:25

relate to what your husband was going

10:28

through. I have two little children,

10:30

four and 194. and

10:32

and my wife and my husband is so

10:34

awfully busy. So

10:37

I had to juggle a lot of things there to

10:39

work through jobs and two babies

10:41

and a husband and a home to run. Mhmm.

10:43

Yeah. So it it was quite hectic.

10:46

Lots of late nights, lots of time

10:48

invested. So it was which was

10:50

beautiful that he paid off in Saetawen,

10:52

truly. Oh, totally.

10:55

And so so,

10:56

obviously, we as I said at the beginning,

10:58

we sponsored you. But how did this sponsorship

11:00

help you then? Well, so

11:02

the sponsorship gives me an opportunity

11:05

to go to Namibia and stay

11:07

comfortably and do my exam

11:09

comfortably. And also

11:11

knowing that I had a sponsorship, it meant

11:13

that I didn't have to work so hard at

11:16

my job I would take a bit of time

11:18

off and concentrate on on reading

11:20

for my exam and preparing better.

11:22

Mhmm. So it was a wonderful wonderful

11:25

opportunity. The girl child in Africa

11:28

has a lot of challenges growing up

11:30

and just going through school and completing

11:32

school. It's not something that we

11:34

reduffed of us that have gotten the opportunity

11:36

that we take for granted. So you

11:39

made actually the the

11:41

good performance I think could also

11:43

Newson way be related to the fact that didn't

11:46

have to worry about the funds and

11:48

the exam fee and the travel fee and the

11:50

stay and so on and so forth. Mhmm. Could

11:52

at least settle down and read. And

11:54

while I was there, it was, I didn't have

11:56

to worry

11:57

much. Really, everything was taken care

11:59

of. So I'm really quick all to your doctor

12:01

and the organization for supporting

12:04

the girl child in Africa. Well,

12:06

you know, we say pleased and

12:08

As you know, my husband's part of Eulink,

12:10

and he goes out to Africa usually

12:13

twice a year and he comes back.

12:15

Very humbled. The first time he came back, he

12:17

was out slightly exhausted and sadly,

12:19

he'd had his computer stolen and his

12:22

money stolen, and he'd

12:24

came back with awful diarrhea, so he wasn't

12:26

feeling very well. But he still

12:28

said, Louise, this is the most amazing

12:31

week of my life actually and I've learned

12:33

so much and I feel so humbled by the people

12:35

and everybody is so

12:37

friendly and so grateful. And

12:40

each time he's gone, he's learned more and

12:42

more. And, you know,

12:44

I think for us, We forget how

12:47

privileged we are over here, and

12:49

it's so important to be able to give

12:51

and share because helping

12:53

people is why we went into medicine in the

12:55

first

12:56

place, isn't it? Right.

12:58

So I feel very strongly that

13:00

everybody deserves access to

13:02

treatment that's going to help

13:04

improve their lives, but also

13:07

the quality of their lives. But actually, the

13:09

work you're doing is not just improving the

13:11

individual. It's all those people around them

13:14

as well. And I think that's why working

13:16

in women's health can be

13:18

really transformational for families

13:20

and communities probably more than men's

13:22

health in some ways.

13:24

Yes. Because I think women play

13:26

a big role in society, no doubt in any

13:29

society. And in the African

13:31

society, especially, so it's

13:33

very important to have a healthy

13:35

population, but a healthy population

13:37

of women, especially, yes. Absolutely.

13:40

And and I knew when we spoke before,

13:42

Martha, you were saying that your education

13:45

about the menopause has been a bit like

13:47

mine at medical school. I didn't really get any

13:49

education. And people don't

13:52

think about the menopause in a way that

13:54

perhaps they

13:54

should. Would you agree with that?

13:57

Yeah. So, absolutely, so in

13:59

Africa, when I saw your your

14:01

menopause specialist, I was like, well,

14:03

what is that? In

14:06

Africa, it's like, the women have to accept

14:08

that. You know, menopause is just something

14:10

that happens, you know, part of life.

14:13

So don't complain. Take it gracefully.

14:15

Mhmm. Yeah. But I've

14:17

taken some time to, you know, read about

14:20

your work since, like, really, really important

14:22

work. And you're helping a lot of women.

14:25

Here in down here, it's not even,

14:27

like, a lot of women won't come to hospital

14:30

and complain about the menopausal syndrome

14:32

and the symptoms and all the nasty things

14:35

that happened. Mhmm. Because they feel

14:37

that it's just part of gross It's

14:39

just something that you have to go

14:40

through. So they suffer in

14:42

silence. So to Yeah. And certainly,

14:45

nevertheless, twenty years, women globally

14:47

have done that even in the UK as well

14:49

because we've always been told when

14:51

it's a natural process, all women go through

14:54

it so we can just battle on

14:56

and carry on. But actually

14:58

for lots of womens, and I'm sure

15:00

it must be the same over for you than

15:02

it is over here that They have

15:04

a lot of psychological symptoms, so

15:06

a lot of women feel very low.

15:08

They very feel very demotivated. They

15:10

have feelings have reduced self

15:13

worth and really find

15:15

it very difficult to function and

15:18

also quite few women have physical

15:20

symptoms, including muscle and

15:23

joint pains and headaches. And

15:25

although some women will obviously, soldier

15:28

on, it can be really, really difficult,

15:30

and it means that you can't be the best

15:32

version of yourselves. But the other

15:34

thing that worries me is the health risk

15:36

as well. So, you know, the

15:39

risks of heart disease and

15:41

obesity and diabetes, which

15:44

can affect all communities. And

15:46

then the other thing is the urinary

15:48

symptoms that can be involved. So women

15:51

who've had fistulas 194

15:53

they become menopausal, the tissues

15:55

in the perineum can become very

15:57

thin. They can lose their collagen.

16:00

They can lose the vasculature. So

16:02

urinary symptoms can really become

16:04

so much worse during the

16:06

menopause, can't they? Yeah.

16:08

Right. The mucosa or

16:10

the vaginal lining and the perineal

16:13

lining becomes quite thin. So

16:15

that complicates the fistulas.

16:17

Father, some women have fistulas during their

16:19

childhood productive age, but heat men

16:21

opposite the fistulas unattended

16:24

too. Seen a few of those

16:26

coming. So In the

16:28

space of many of us here in Africa,

16:31

there is a lot of work that needs to be done

16:33

A lot of education, a lot of ad hoc

16:36

things. Yes. Yeah. Absolutely. And and one

16:38

of the things also is thinking about how

16:40

we can enable vaginal estrogen

16:42

to be given to women who

16:45

are menopausal, especially with those

16:47

women who have symptoms because we know

16:49

The majority of women have some localized

16:51

symptoms, whether it's related to vaginal

16:54

dryness or urinary symptoms. Yet,

16:56

we know that vaginal estrogen treatment

16:59

is very cheap, but it's not available.

17:01

Is it in Africa? No. No. Not

17:03

necessarily. Some I think

17:05

that some estrogen creams are available in

17:07

some of the

17:08

pharmacies, but they are quite costly

17:10

that a lot of women cannot afford. And

17:13

certainly, when I've been trying to find out about

17:15

it, some of it comes from America and it

17:17

is a lot more expensive. But In

17:19

the UK, it is a lot cheaper and there

17:21

must be ways of being able to get

17:24

it out over to you and there's something

17:26

that I'm really keen to try and explore how

17:29

we can do that because certainly

17:31

even if people have surgery, we know

17:33

that wound healing can be so much better

17:35

when they have vaginal estrogen. And

17:37

some women might not need the same type

17:39

of surgery if they have vaginal

17:42

treatment at the right time, you

17:44

know, when their symptoms they start to be

17:46

problem rather than waiting until they're more severe.

17:48

Right. So there's a lot of work that's

17:51

needed to be done, isn't there? There's a lot

17:53

of work that needs to be done There's a lot

17:55

of work that needs to be done absolutely. Mhmm.

17:58

But that would be very helpful, availing

18:00

estrogen tool and that need

18:02

Yeah. -- would be very, very helpful. Form?

18:05

Well, there's lots of hurdles, but

18:07

there's I'm quite determined and there's, you

18:10

know, I think we need to keep

18:12

getting the conversation over. And

18:14

I know that Yurielink, some

18:16

of the surgeons, including Susie Van,

18:18

who you know, are coming out again

18:21

soon to try and really assess

18:23

female urology because in the

18:25

past they've been focused more on men

18:28

with uroLINK. And now they're focusing

18:30

quite rightly so on women

18:32

as well. And and it would be very interesting to

18:34

see what they can do and the changes that

18:36

they make. And I know that they're going to come and visit us

18:38

in clinic as well, which should be really good.

18:41

Yes. Yes. Dr. Susie

18:42

has, I think, has a vast experience

18:44

in traveling to our frica, I think,

18:46

to Tanzania. Mhmm. And I think she

18:48

does quite a a number of fistula

18:50

surgeries as well over there. So

18:53

I'm sure she has some contacts

18:56

already. I'll also put you

18:58

in touch with doctor Sebastian who also

19:00

has some contacts already of the people

19:02

who keep visiting and helping us with that urological

19:05

They're from the UK world. Yeah.

19:08

So they could also be a

19:10

link. Maybe one day, you'll come out

19:12

and meet some of the Mhmm. --

19:14

when they succumb, it should

19:16

be

19:16

a really nice day. Yes. I'll

19:19

I'll send over the contacts and

19:21

you see what you can do.

19:22

Yes. I would love And actually, for many

19:24

years, I thought how wonderful to be able to

19:26

do charity work like my husband

19:29

does, but then I've always thought I don't have a

19:31

skill. I'm not a surgeon. I

19:33

can't so people I

19:35

can't do anything, but actually, knowing

19:37

indirectly from my company over

19:39

here in the UK. We can help

19:42

people. It's really important and

19:44

You might know we've done quite a lot with an

19:46

HIV charity, severe forum

19:48

where we've written information actually about

19:51

women living with HIV because we

19:53

know Many women with HIV

19:55

are more likely to have menopausal symptoms

19:57

and less likely to have treatment. And

20:00

we're also now doing some work

20:02

in the UK, but we hope it will be

20:05

given elsewhere for women who have

20:07

had FGM female genital

20:09

mutilation. Because a lot of these

20:11

women really suffer when they're menopausal, but

20:14

they don't understand why. So we're working

20:16

with some communities to

20:18

get the right information. So

20:21

people can understand what's going on with

20:23

their bodies. Right. That

20:25

sounds like very good work, doctor Well,

20:28

it's so important to note you were saying at the

20:30

beginning, it's about how we educate

20:33

people so they understand what's

20:36

happening and understand if there is treatment

20:38

because it's the same in any

20:40

area of medicine. If you don't know what's

20:42

happening, it can be a very frightening

20:44

and isolating content.

20:47

That is true, especially here.

20:49

So I think they they got a lot to do.

20:51

In the education space and sensitization

20:54

space. Mhmm. And and

20:56

one community at a time, I

20:58

think a lot can still be achieved.

21:00

Yes, absolutely. So now

21:02

you've been introduced to the metaphors.

21:06

You're not going to be able to ignore it.

21:08

And, you know, I think there's some

21:10

really exciting times ahead and I really

21:13

want to be able to improve the

21:15

health of future generations as

21:17

well. That is very, very beautiful.

21:21

So before we finish, Malvera,

21:24

I always ask people for three

21:26

take home tips really. So three

21:28

things that they might

21:31

learn from after listening to the podcast. So

21:34

I'm really keen to ask you

21:36

three things that people

21:38

in Africa might be able

21:40

to learn or

21:43

benefit from just from having

21:45

you as now a trained urologist.

21:48

Okay. So just

21:50

to from the podcast, of course,

21:52

you're doing some work in menopause.

21:55

A lot of women, if anybody here

21:57

actually to podcast, they would know that

22:00

they somewhere out there in the world

22:02

where menopause doesn't have to be

22:04

taken on just humbly and embarrassed

22:07

that something can actually be done to improve

22:09

the quality of legs and

22:12

to the African girl child to know

22:14

that despite all that challenges

22:16

despite all the hurdles, you

22:18

can still emerge. You can still do it. You

22:20

can still emerge victorious. And

22:24

the sad and last me

22:26

is that in whatever small

22:28

way, any individual can actually

22:30

do something to improve the lives of

22:32

another.

22:33

Absolutely brilliant. And I think the more we

22:35

connect, the more we can speak, the more we can help

22:38

each other, that's going to really

22:40

make big changes going forward. So I'm

22:42

very very appreciative of your time.

22:45

And I just want to publicly once more,

22:47

so congratulations because I know

22:49

the work that you did was so hard,

22:51

but so well deserved that you got the gold

22:53

medals, so well done

22:54

offer. Thank you. Thank you, doctor Newson,

22:57

and thank you for making it possible. For

23:02

more information about the perimenopause and

23:04

menopause, please visit my website

23:07

balance hyphen menopause dot

23:09

com or you can download the

23:11

free balance app, which is available

23:13

to download from the App Store. Or from

23:15

Google Play.