Breaking down the barriers of vasectomy ...

...a tall order for family planning officials Accra, July 17, GNA - Cynics are having a field day with vasectomy. They jeer, laugh and describe as rubbish why a man should subject himself to surgery that will render him infertile for life. "I will rather ask my wife to use female family planning methods than use vasectomy that will make me infertile for life," 29-year-old Abraham told the Ghana News Agency (GNA). Indeed, he added, he would prefer to use "the almighty condom than go through vasectomy, which cannot be reversed." Abraham, who is married with three children, is dead set against vasectomy and argues, "If I should undergo the surgery and my three children and wife die through an accident what will I do if I should remarry? How can I replace the children I have lost? What will be my fate because I have been told it cannot be reversed?" This is an extreme case, but that is the stonewall against which family planning officials must break down in their bid to make vasectomy a key family planning method in Ghana. Another extreme case is men equating vasectomy to castration. And in a society where children are seen as assets and the ability of the man to make children is key in the family, any method that would stop the man from doing just that would definitely face problems. However, the reality of globalisation and the need for behavioural change make vasectomy a useful tool for family planning. The Ghana News Agency (GNA) spent several hours at a family planning clinic in Accra where vasectomy was being performed as it sought opinions on the method that has been described as "very safe and reliable". Ten gentlemen occupying top positions in the civil and public services the GNA spoke to on this topic initially were reluctant to talk. Six of them welcomed the method but said they would not choose it as a family planning method whilst the other four were totally against it. But a gentleman in his late 40's and a father of six who has undergone the surgery has described his new status as "liberating." "Vasectomy is the safest and simplest of all family planning methods," he told the GNA on condition of anonymity. "I have gone in for vasectomy because I have six children and would not want to have any more," he added. "Initially, it was difficult for me to decide but I stood firm and took that bold decision because I have difficulty in controlling my sexual desires. I am now a free man and can have sex with my wife without fear of her getting pregnant." The question many people ask is what is vasectomy? The magic of vasectomy begins with a minor surgical procedure and the volunteer is free for life to carry on with his normal sexual life without making his wife or partner pregnant. Dr Isaac Kofi Bentsi, an Urologist at the Korle-Bu Teaching Hospital, told the GNA that a man could undergo the operation and still have an erection and climax during sex. All his hormones, including his beard and voice, would function normally. The quantity, scent and colour of fluid during ejaculation, is the same. His sexual drive and ability to have sex would not also change. Surely, this should put men at ease. Explaining how the 20-minute operation is performed, Dr Bentsi said the patient is awake during the surgery but under local anaesthesia. Sperms are produced in a man's testes and it is the sperms that enter the woman during sex to fertilise the egg to make her pregnant. When a man climaxes, the sperms travel through the two tubes, mix with semen and then comes out of the penis. During vasectomy, the two tubes are cut and blocked to prevent the sperm from mixing with the semen to result in pregnancy. Without the sperm, a man would no longer impregnate a woman. Dr Bentsi said the method currently practiced in the country is the Nonscapel Vasectomy (NSV), which was developed in China. Under this method, one does not need a scalpel to cut the skin. Rather, the doctor pierces the skin of the scrotum then gently stretches the opening to reach the tubes and blocks them. When this is done, the doctor cuts the tubes and removes a small piece of each, cuts the ends and then ties them. Because the puncture is so small that stitches are not needed. This type of method has fewer complications, is less painful and allows for early resumption of sexual activity after surgery and offers several advantages. "Because this type of method does not require any incision in the scrotum, it is more comfortable and helps reduce a man's fears about vasectomy," Dr Bentsi said. His assurance is that the operation does not give any long-term medical problems and does not affect a man's masculinity. His body continues to produce the hormones that make him man and his erections and climaxes are the same. "The chances of serious problems are very small. Though some medical problems could occur, they do not occur very often and would disappear with simple treatment." Dr Bentsi cited some problems likely to occur as infection, swelling around the puncture site or inside the scrotum and bleeding under the skin, which may cause swelling or bruising. A man after the operation should not engage in any heavy physical labour for at least 48 hours but could have sex as soon as he is comfortable and whenever the desire is there. However, he should remember to use some other methods of planning until his semen has been tested and confirmed to be free from sperm. To confirm that a man who has undergone the operation is free and could have sex without fear of impregnating his partner, he has to ejaculate 20 times and that could happen within 12 weeks. During this period, the condom should be used. Is vasectomy castration? Dr Bentsi says no. It is simply a process that will make a man have sex normally and effectively but without making babies. Given social and cultural conditions in Ghana, it would take a long time for this family planning method to catch on with the men. And this is clear from the cold statistics. Only a little over 52 Ghanaian men had officially undergone vasectomy operation by March. Twenty-six of them underwent the operation last year, while another 26 did it between January and March this year. But there is an improvement, albeit slow. Mrs Patience Darko, a representative of Engerderhealth, a Ghana Health Service (GHS) collaborative partner in the family planning campaign, attributes the gradual patronage of vasectomy operation among men to the intensive public education going on. Mrs Darko said vasectomy has been one of the family planning methods in the country but due to lack of knowledge and awareness, most men are finding it difficult to patronise it. She said GHS has trained doctors, nurses, counsellors and other health officials from some selected hospitals to provide quality service to men who wish to undergo the operation. Mr Daniel Owusu-Afranie in his late 30s with two children who is expecting to add one more says even though he is not against it he will not opt for it. He gives important reasons why many men may be reluctant to go in for - the context in which the message is being presented and the language factor. Vasectomy in itself is a foreign method from the western world, he pointed out. Therefore, there is the need to package the information well for people to understand it. "If we really want more men to go in for this method which, according to experts, has rare side effects and is referred to be the safest method, then we need to find out the core of our problems, which is poverty.
"If one is educated, he or she will be in a better position to appreciate and understand what vasectomy can do." However, if one is poor and illiterate and considers children as the wealth of a man, telling such a person to go in for vasectomy would amount to "double jeopardy," he said. Mr Owusu-Afranie also traded the slow rate at which vasectomy is catching up to the language factor - Ghana does not have the appropriate word for vasectomy in the local languages. In twi, for instance, translating the word vasectomy could be "ye kosa wo", which means castration. This does not give the correct meaning and so could be scaring many people away. The solution? Health experts should collaborate with the linguistic departments of the universities to look for a word to describe vasectomy - "a word that will not scare people away but would be appreciated and welcomed," he said. He also urged the experts to ensure that the message is packaged in a way that will remove all the myths surrounding it. Some 42 million men worldwide have undertaken the method with only 120,000 of them coming from Africa. That tells a story. And the low patronage could be due to lack of effective public education messages, the society and culture of the people, incomplete and incorrect information on the method and the perceptions that it is tantamount to castration. The family planning officials have to work harder to beat the cynics.
(A GNA Feature by Mrs Asante Agyei)