Tweet 26 Share 0 1 2 3 4 5 6 DESKTOP VIEW BACK TO TOP Factory that runs full blast but with zero production! “I have four children — two boys and two girls — and need some advice on family planning,” Kitut ADVERTISEMENT “I have four children — two boys and two girls — and need some advice on family planning,” Kitut went straight to the point when he came to see me. Contraception and spacing of children have always been topics of common interest and patients raise it with their doctors irrespective of the specialty of the doctor. As I was thinking on what method would be most appropriate for Kitut, he continued: “I am a devout Catholic and would prefer natural methods.” “Of course,” I replied with deference to his religious sensitivity. “I can suggest two. One is abstinence during the days of the month when your wife is fertile.” I then gave him details of what is known as rhythm method or safe period. “If you decide to take that route, I suggest that both you and your wife see a gynaecologist for further advice,” I added. “And the other?” Kitut asked brushing aside my suggestion to see a gynaecologist. “This one is mainly related to the male partner and rather difficult to observe.” Since he did not seem to be put off, I continued: “We call it ‘Coitus Interruptus’ and it means what it says. It amounts to withdrawal before discharge.” It seemed to me that this method appealed to him and he asked some more questions on it. “The snag is the will power to withdraw just when you are reaching the climax,” I warned him of the pitfall. “I am a self-disciplined man and I am sure I can do it,” he said as he left. It was a couple of years later when I saw him again. His crestfallen face indicated that the method had failed. “What happened?” I asked. COITUS INTERRUPTUS “We tried both the methods you suggested and both failed miserably,” replied Kitut. “In the case of rhythm method, the unsafe period proved too long for me. In the case of the other, what did you call it?” he asked. “Coitus Interruptus,” I reminded him of the technical term. “You were right,” Kitut conceded. “I found it impossible to get off at the previous station and could not help going all the way to the terminus.” As I laughed uproariously at the way he had interpreted “Coitus Interruptus”, Kitut became quite serious. “My wife is pregnant with our fifth child,” he said not hiding his disappointment. “Having had four deliveries, I am sure your wife has an obstetrician,” I remarked. “Except that now we can afford a private hospital and the privilege to choose our own obstetrician. Could you recommend both?” As I was wondering who to refer him to and which hospital, he added: “In spite of what you doctors say about population explosion and the need to cut down on the number of children, in our case every child has been a baraka and has brought us luck.” I gave a letter to Dr Martha Jalipo. “She can also advise you and your wife about family planning after she has delivered your child.” Two years later, Kitut surfaced in my office again. “I like to discuss the matter of birth control with a man,” he said to explain why he had come back to me for advice, when I had suggested earlier that he consults Dr Jalipo. “Now that you have five children, shouldn’t we be thinking in terms of permanent sterilisation?” I asked. “I don’t like the idea of permanency in matters like this,” Kitut replied. “Anything can happen and I think shutting shop for good does not sound right.” “For temporary contraception, we now have a good range of options for women,” I explained. “There are now coils and pills available.” There was a thoughtful expression on Kitut’s face and then emerged the words of caution: “To allow a woman to control her fertility is, in my view, un-African and I would like to be in control myself.” “For you, we have the condom or ligation of vase,” I replied. “I don’t like the latter,” Kitut raised two objections. “It is more or less permanent and I have already given you my reason against permanency. Secondly, I don’t like the idea of you coming anywhere near my private parts with your scalpel. One slip of the knife and I am kaput!” I was heavily booked that day and did not have the time to explain that nothing of the sort was likely with vase ligation and therefore dwelt briefly on the proper use of condoms. Six months later I met Kitut at a wedding. Marie and I had been invited by a patient of mine and Kitut was part of the in- law’s party. As I was talking to a guest, I could see Kitut waiting patiently to see me. I could guess why! “Things have gone awry again,” he said apologetically. “I soon realised, like many others, that using a condom is like eating chocolate with the wrapper on. So, once in a while, I discarded the wrapper. Either that or my chemist gave me condoms from an old stock and it leaked.” I referred him back to Dr Jalipo for his wife’s delivery. They were now expecting their sixth child. Once again I was hoping that after delivery, Dr Jalipo would talk to the couple and spare me the burden of advising on matters outside my specialty. Alas! Two years later, Kitut was back in my office. “We now have half a dozen children, three boys and three girls, and we are ready for permanent sterilisation.” “You have two choices,” I repeated what I had said before. “Tubal ligation on your wife to be carried out by Dr Jalipo, or vase ligation on you by me.” “Tubal ligation,” Kitut’s decision was quick. “You obviously trust your wife more now,” I said to remind him of his misgivings when I had suggested it earlier. “That plus the fact that I am very scared of the surgeon’s knife,” he replied. “Fine,” I said. “Please take your wife to Dr Jalipo and I will ring her.” A couple of years later, I saw Mrs Kitut’s name on my appointment list. “Surely this is a mistake,” I said to my secretary. “You mean Mr Kitut, don’t you?” “I can swear it was Mrs Kitut who rang me to make an appointment for herself,” my secretary sounded quite sure. She was right because it was Mrs Kitut sitting in front of me a week later. “I am pregnant again,” she announced. “But I thought you had your tubes tied,” I said. “I did,” replied Mrs Kitut. “I can’t believe that you are pregnant after Dr Jalipo carried out tubal ligation on you,” I said. JUA KALI NURSING HOME “It wasn’t Dr Jalipo,” she replied. “Bwana mkubwa found her quotation for surgery and the hospital charges too high, so he took me to a Jua Kali nursing home in Kariobangi.” I couldn’t believe my ears. “Why have you come to see me?” I asked. “Because I haven’t told Bwana Kitut. He will hit the roof if he knows. I came to request you to gently break the news to him,” she pleaded. Things I am called upon to do for my patients, I mumbled under my breath and wasn’t looking forward to my next encounter with Mr Kitut. I need not have worried because he took it philosophically. “Seven children after applying all methods of family planning under the supervision of an eminent surgeon and an equally experienced gynaecologist do not say much for your science,” he remarked. “Take your wife to Dr Jalipo this time and not to a Jua-Kali joint,” I advised. Two days later, Dr Jalipo rang me. “You won’t believe it,” she exclaimed. “Ultrasound shows that Mrs Kitut is carrying a twin pregnancy.” “As they say, it never rains but pours,” I replied. “Anyway how come she became pregnant after tubal ligation?” “Sometimes the ligature on one tube slips. That’s why we now remove a small length of the tube, tie both ends and bury them.” “How can we find out?” I inquired. “As they say the proof of the pudding is in the eating,” Dr Jalipo explained. “If she is pregnant, it proves that one or both of her tubes are patent. After she has delivered, we can always do a salpingogram, run a dye in the tubes and find out if one or both are patent.” “Can we make sure that before delivery, we have consent from the couple that you can operate again and tie both her tubes properly,” I suggested. “I have talked to Mrs Kitut and she is ready. She wants you to persuade her husband.” As I was wondering why I came in the picture, she added: “She tells me that her husband has a lot of time for you and will listen to you.” Kitut proved compliant and consented to his wife’s tubal ligation readily. Surgery also solved the mystery about her conceiving after alleged tubal ligation. “I was right,” Dr Jalipo proudly said to me. “At operation I found one tube patent so I did a revision tubal ligation with the new technique on both sides.” Last year, I saw Kitut in my office and shot out of my chair. “Not another pregnancy to report I hope?” “No. I just came to tell you that this time it has worked.” He went on, “You know, with a slight variance, I feel a bit like Noah who formed a successful company and called it Noah’s Ark, when whole world was under water and in liquidation. I now own a factory which runs full blast with zero production!”
Posted on: Sun, 30 Mar 2014 11:51:02 +0000
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