Seychelles:“I suspected something was wrong”

By Juliette Dine,

Mahe, 17 May: There are significant numbers of women and adolescent girls living with either cyst or fibroids in Seychelles. Two health conditions that attack ovaries and challenge women’s ability to have children. At the moment the Ministry of Health do not have any statistics on the number of cases reported at the hospital and district clinics. These issues are also not discussed in schools.

Jasmine Talma is a 25-year-old young lady residing at Beau-Vallon. For the past nine years Jasmine has been living with polycystic ovarian syndrome without really knowing what this condition was.

“At the age of 14, I got my period, but it was irregular, sometimes I didn’t see my period for six months and even more. At the age of 16, I began to worry and went to see a gynaecologist to know what was going on” she explained.

Jasmine affirmed that aside from the internal change her physical appearance was also changing, she gained weight without any explanation and her face was covered with pimples.

Did the doctor explain what was wrong?

“No, not really. He only told me that I have cyst on my ovaries and got me on contraceptive pills to regulate my period. I went back to the Doctor at the age of 23 in January last year (2018), and only then did the Doctor explain what was really going on with my body and told me what polycystic ovarian syndrome (PCOS) was exactly”.

What was your state of mind at that time?

“I suspected that something was wrong with my reproductive health, it only confirmed my suspicion, it made me feel sad but at the same time relieved because I finally I got a name for my condition, and became more aware of what I should do.”

Did you have to change your diet?

“Yes, that’s something I chose to do on my own. After doing some research I found out that many women have seen the benefits of removing diary products and gluten from their diet. Many women have seen improvement with their body. Their skin has lightened, they have lost weight, they get less pain and their symptoms have improved.”

“Personally I am trying to eat more fruits and vegetables. I have cut down on flour based product such as bread, I have cut down on lemonade and make my own homemade juice”.

How did that affect your love life?

“It hasn’t change much, just when I felt ready to have a child and I keep trying but I don’t get pregnant. Aside from that my partner supports me and we are taking things slowly and will see how it goes, without stressing about it”

“It’s been one and a half year since I’ve been trying to have a child, but before this year I wasn’t really serious about improving my symptoms”

How do you feel when someone tells you that she is expecting?

“I feel happy for that person because it’s a big thing to have a child but at the same time I feel sad for myself. At the same time I use this as a motivation to heal myself and keep going”

Was this health issue discussed at your school?

“We did reproductive health in science class at school but did not address the topic of causes of infertility”

Do you think that both private and public schools should include this issue in the school curriculum?

“Yes, I think they should emphasise on this, because sometimes people think that it will not happen to them but it can happen to anyone. Young girls should pay more attention to their reproductive health and if they do not see their period I urge them to take it seriously and go see a doctor.

You’ve mention that one of the symptoms is weight gain. People often comment on other people’s figure especially if someone has gained excess weight in a short time. What is your opinion on that?

I’ve been through that; before taking contraceptives I was slim but when I started treatment, I put on weight”.

“Once you’ve gain excess weight it’s difficult to bring it down. I would like to tell women who are in this situation not to lose hope but keep trying”.

“I would like those who pass on these kinds of comment to respect other people because you don’t know what the individual is going through. Sometimes I agree unhealthy food contribute to weight gain but there are many cases where people gain excess weight and it’s out of their control. The public don’t really understand that sometimes your hormones can upset many things in your body. But I would like to advise women who has gained excess weight to try with a healthy diet first and then include exercise”.

Seychellois people also like to make such comments as; ‘isn’t it time to have kids’ What do you think of such comments and how does it make you feel?

“Sometimes I just laugh and say we are trying, we are trying.., but sometimes it also has an emotional impact on me, because I am trying and I am not succeeding. But as a patient you must take it lightly don’t take everything seriously. You must also explain things to the people close to you, letting them know that it may take time”.

On a final note, Jasmine says: “Ladies do not be afraid or ashamed if you have PCOS because it’s not a condition which is caught like Aids or an STD (sexually transmitted disease). It’s something that you’re born with or it’s developed due to lifestyle choices. Be kind to yourself and patient during your journey to healing yourselves”.

Dr Robert Michel has been practising as a gynaecologist for the past 25 years. Dr Michel says that only a category of people has PCOS. One out of ten women in the world have this health condition, this does not mean that they cannot have children, but it’s more difficult for them to get pregnant.

He states that nowadays this health condition is easily detected in Seychelles because there are equipment available facilities to run test.

According to him a bigger group of women with this health condition can have kids with the help of medical treatment. “Diagnosis of this condition is simple; when a girl is developing in her adolescent stage a normal menstrual cycle is supposed to flow every month but some get their first period and afterwards notice that their period becomes irregular and skip a few months apart”.

Dr Michel says that this group of people shows signs that they have potential to fall into the category of people who has PCOS. Another sign with this group of adolescent girls is that they put on weight exponentially for examples 10Kg in a year. The fatter the adolescent gets this affect her period pattern more. Other signs include excess hair on her body.

Actually the Ministry of Health do not have a data base on the number of patients who have been diagnose with PCOS in Seychelles.

“PCOS in Seychelles is really present and patients are being diagnose every time”

“We have difficulty explaining to patients  what is going on; they think that it’s a disease that can be cured with medicine. That’s an error of concept. A syndrome is a condition you have inherited that stays with you and cannot be reversed, from the time you have been diagnosed until menopause and then you die like everyone. It is important for young girls who have these symptoms to come forward and find out if they have PCOS.

Do you feel that there is enough education on this and does the ministry plan on educating adolescents about PCOS in schools?

“No, there’s no need to talk about this in class. At school you will discuss on how things are normally supposed to be. It’s easier for people to understand how things are supposed to be, when it’s not working normally then you shall go to see a Doctor.

“There is health education in the schools, but I am not saying that we cannot reinforce. Something that would be helpful for teachers is that they get a curriculum that’s up to date with the current health problems in the country. It will make more sense and will help broaden the teachers’ knowledge in health education. There’s a need to evolve. Getting information and understanding information are two different things”.

Given that each person’s case is different, do they get different treatment?

“Most people in that group are obese and there are some who are thin as well. The commonality between them is that they have ovulation problem. Treatment varies it depends on patients. We give combine oral contraceptives to put the cycle on track. There must be a diagnosis for the doctor to know how to choose the best type of treatment for each patient according to her health condition”.

“The individual needs to put in as much effort as the doctor is putting. Some people believe that once they have received treatment and the cycle goes back on track, they think that things have gone back to normal, that’s an error! Things hasn’t changed, it’s just that the doctor has put the cycle on track in an artificial way with contraceptives. While on the pills patients should make positive intervention to improve their health condition and lose weight”. “Some patients every time they come to the hospital, they are 5Kg or 10 kg heavier, their intervention is minimum. So I will advise people to get diagnose early, and educate themselves on what the condition is”.

Poly means many. The cysts are small membranes in the size of a lentil seed with water in it, that sits on the ovaries. No operation is needed says the doctor.

Do you get many cases where patient have not seen their period for around a year and just one day walk in the hospital?

“Almost all of the cases are like that. It would help if there’s better communication between a young girl and her mother. I believe that mothers are in a better position to know what’s going on with their girls, but if there’s no communication that’s when they err.”

Marcelle  who is 53 years old, was diagnosed with fibroid at the age of 27 in 1993. “I didn’t feel well, my feet was swelling. When I wore shoes my feet became bigger in size like yeast in bread. I had to remove the shoes and carry it in my hands”

What other symptoms did you get?

“My tummy was hard and then sometime I felt like something was moving inside of  me. It has the same effect as having a baby in my belly”

“When I went to the doctor, he did an ultrasound and laparoscopy. He told  me that I had nine fibroids and I got an appointment for operation. I did the operation and the doctor removed eight out of the nine fibroids. He told me one of my tubes was twisted to the side and the other is blocked with a fibroid. The one with the fibroid he explained, he cannot touch it, fearing that it might bleed nonstop.  So he set right the twisted tube because before I was unable to have kids, when he did that he told me to wait for 2 years before getting pregnant and  not to take contraceptive pills, because they increase the size of the fibroids. The doctor prescribed injections for me and I took them in my district clinic, every six weeks. The injections was good, I never had any complications. After two years I got pregnant with a baby boy. Three years later I was pregnant again with another son. When I was about to give birth to him there was another fibroid competing with him. That was the same fibroid that got stuck in my fallopian tube that the doctor told me he will not remove. The fibroid moved down and grew, it was competing with my baby boy’s head. My baby’s head was 10cm and the fibroid was also 10cm. I was lucky it didn’t affect my baby, because fibroid can suck the blood out of the child and leave only a sac behind. But I had to do an emergency caesarean. The doctors removed my baby and I went in Intensive Care Unit (ICU) for two days to control the bleeding. Altogether I stayed for ten days at the hospital”.

Four years later Marcelle got pregnant again with a baby girl without any problem. She asked the doctors to sterilise her because she had sugar in her blood (the beginning of diabetes) but the procedure was not done correctly and later got pregnant with another daughter.

“After that the fibroids came back. I was admitted several times at the hospital. I was unable to sit properly in the bus, I was uncomfortable, and once I was bending down to pick up something I felt the blood pouring down, wetting my feet. With this health condition I preferred to stay at home, working was a problem because every time you would have to go to the washroom. It’s been around five years since I did the last fibroid operation, that time it had slide down my uterus and the bleeding was worst. Once I had an encounter near the Botanical Garden; I was on my way to the hospital, the Botanical Garden employees had to throw soil around my legs because it was like a pool of blood. Since the operation I haven’t had any bleeding nor fibroids again, so far everything is fine”.

Marcelle  had to make some adjustments to her diet because of diabetes. “I reduced my rice intake and ate more vegetables, because the fibroid gave me anemia”.

“For all the young ladies out there go see a doctor the moment you feel something is wrong or ask a wise person for an advice” Marcelle suggested.

Do you think that this topic should be talked about in schools?

Yes, ministry of health should go in the schools at least twice a year to educate students in the schools about this.

Marie, 47 years old is a mother of three children. For over five years Marie has been experiencing abnormal period flow. Sometimes she bleeds heavily for many days and it also happen that sometimes she doesn’t bleed at all.  Earlier this year she found out that she has fibroids growing inside of her.

“Lately I’ve been bleeding a lot, before I bled but it never came to my mind that it could be fibroid, I was younger, I didn’t pay much attention to it, sometimes I got a heavy flow and on other days I see just a trace of blood. Suddenly this year I’ve been bleeding with large blood cloth, as if I was bleeding to death for more than ten days. I felt worried and went to my district’s clinic and the doctor gave me hormone pills and told me to return to the health centre if the bleeding persist so that they shall refer me to a gynaecologist. I saw it as abnormal, ten days I was still bleeding heavy, usually I get a period of three to five days. My friend advised me to go back to the doctor, which I  did, and they gave me pills for 21 days to reduce the bleeding. After that 21 days the bleeding didn’t stop. I said to myself “I won’t go back to the public health centre, I will go to a private clinic. There I will be able to do an ultra sound faster without having to wait for a long appointment”.

“I went to Doctor Murthy’s clinic and did my ultrasound. He told me that I have fibroids and advised me to see a gynaecologist. I went to casualty on that day (Sunday) wondering how I will see a gynaecologist. I explained my situation to the doctor. Luckily  the doctor was a Seychellois woman. She understood me and wrote an exchange of information and told me to go to orthopaedic clinic (SOPD) on Monday morning and explain my problem to the nurse and she would arrange for me to see a gynaecologist.”

“When the doctor examined me I was still bleeding heavily. He told me that there was polyps on my cervix and took samples to conduct a biopsy to check if there was any sign of cancer. The result confirmed that it was not cancer. They had to do another ultra sound, and the doctor finally confirmed that I have fibroid. Up to now, every three months, I attend to my appointment with the gynaecologist, because the fibroid is not growing fast but taking its time.

Marie says that until now she and her doctor have not reached the point of talking about operation, they are simply monitoring the development of the fibroid.”

What was your state of mind when you found out?

I wasn’t worried because I was more scared of cancer. I knew that fibroid can be treated by doing an operation whether by removing the fibroid or the whole uterus. If it was cancer I would be more worried. Since I have some knowledge in health education, I was a health worker, I wasn’t that worried; it just made me more at ease when I was told exactly what I was going through.

When you were at school did you learn anything about fibroids?

“Never. During my adolescence I never knew what fibroid is until I went for health studies at the National Institute of health and Social Studies. I learned a few things about conditions that affect woman, but it was basic because I wasn’t studying for nursing. I feel that it’s necessary for young girls to gain the knowledge so that if they ever face it they will know how to deal with it.

Do you get negative comments from people regarding your appearance?

“Yes, especially about my belly, it tends to become big when I am about to get my period as if I am pregnant, and people don’t know about it, they say ‘look at your belly, look at this, look at that’ without realising that  you have a complication. But these comments do not affect me as such. As a person I like to take things easy, I do not take offence”.

“For those who makes such comments I would like them to ask the individual if she is  in good health rather than making such remarks as if they are bullying the person”.

According to Dr Michel there are 4.5 to 6.5 percent people who have fibroids the whole world. Fibroids is a health condition that have a significant genetic relationship. African American are more prone to get fibroids than white people. It is quite common in Seychelles, it is hereditary in the family.

Can it get really bad that it can affect women’s potential to have children?

“Yes it can get worse, but usually most people by the time they develop fibroids they have already had children, so it’s not a condition that you get at a very young age in life, although there are exceptions. It doesn’t restrict fertility, but it becomes challenging for some people in their 30s who haven’t had any children to find out they have fibroids!

There are many people who never knew that they have fibroids and never did any check-up and when they present themselves at the hospital pregnant they receive the new, and in this situation the patient has to deal with both the pregnancy and the fibroid at the same time. The pregnancy has to come to term before doctors can intervene to remove the fibroid. There are times when fibroid affect the child negatively, when the fibroid is too big the mother can miscarry the child or the child may develop deformity features inside the uterus. In some cases women with fibroids go through normal pregnancies.

How is fibroids treated at the Seychelles hospital at the moment?

We are following the way things are done around the world, working on protocols, case by case scenario. Having fibroids doesn’t necessarily mean you need to undergo an operation, but if there is a need to do it, it will be done.

“In a week we do at least two or three hysterectomy to remove fibroids, especially for people who are having health issues because of the fibroid. In a year we conduct this operation on at least a hundred people”.

“In certain cases if a women doesn’t have any children and the fibroid is preventing them from having kids, we remove the fibroid but keep the uterus, this operation is called myomectomy. There are also treatments to reduce the growth of the fibroid and reduce bleeding”.

Amongst the cases, are there any that has developed into cancer?

“It can happen but only a small percentage. Fibroid is not a cancer, it falls under the category of B9 tumours, even if there is a small percentage we rarely get cancerous fibroid in Seychelles”

This article was written by Juliette Dine. It is part of Gender Links #VoiceandChoice series. It was first published in the Seychelles Nation