FRANCES WURIE SESAY : THE GOOD DOCTOR THAT IS POSITIVELY INFLUENCING THE SEXUAL REPRODUCTIVE HEALTH SYSTEM IN SIERRA LEONE
January 6, 2021
Dr. Wurie Sesay started studying medicine in her home country Sierra Leone, and then she went on to do post graduate studies in Uganda. She is a wife, mother of two sons; eight and seven. She is a daughter and a sister. When she is not figuring out how to thrive in these roles, she teaches and lectures at the College of Medicine, Sierra Leone at the Department of Obstetrics and Gynaecology. Her latest title is TV Host, she hosts the “The Woman’s Place” complemented with a video series on women’s health that is shared on social media platforms with titbits on general concerns around sexual reproductive health. She’s also co-owner of IK Designs, an interior design company using recycled bottles for home décor. We had a Zoom conversation with the good doctor to find out how it all began, her secret ingredients to success and like her patients seek counsel around better sexual reproductive health. Her insights might help you or someone you know. Do make time to read, share with friends and let us know your thoughts.
Ariana Diaries: Would love to hear the backstory, why obstetrics and gynecology?
Dr. Frances Wurie Sesay: So I knew I was good with my hands, I knew I wanted to do something surgical. When I graduated from medical school, I wasn’t sure which discipline of surgery I would do. Was it general surgery or obstetrics? It was only after; my first pregnancy which was a twin pregnancy, that it became clear. I lost one of those babies and then it clicked, the answer was obstetrics. As I had walked through a path that I never thought I would walk through and I got to feel what other people had experienced.
I figured that if I could be in a field where I could help somebody or really empathize when someone else is going through something of this sort, it could make a difference. So, that’s when I decided. I had a classmate, God rest his soul. He died maybe four years ago. He was the one, who really pushed me into taking the necessary steps. Interestingly, shortly after, my husband got a job in Accra, so while we were there, I did my primaries and fate led us to Uganda. I applied to Makerere University and they accepted me. I was like “Ok, great, now I’m going to concentrate on this! After three years of residency I came back home.
Ariana Diaries: Quite intriguing, why did you come back home? A lot people after specializing in different fields do not come back home.
Dr. Frances Wurie Sesay: Exactly. You know, we have a lot of work to do. Let me just start by saying that. Going over the salary scales for doctors, will make you wary. Unlike other fields of studies, let’s take the scheme of service that lawyers have, they are not under the civil servants kind of scheme. This makes a huge difference. So generally I must say that we’re really looking forward to the day when doctors will be out of that national scheme of service and own ours. It’s very painful when you compare the salary scales to the level of expertise.
I want to believe that a lot of people go elsewhere because of that, but for me, even if I weren’t married, even if I didn’t have kids, this is home.
I figured this a long time ago! Especially in this country, where we have one of the highest maternal mortality rate, where else can I be? I mean I’ve already spent three years in Uganda, helping their women, you know, for free basically. In real sense I was paying for the postgraduate studies, so paying to help their women. I thought to myself, why not bring it back home where it’s really needed because we don’t have enough people. I saw that play out in the last year as I’m already stretched.
We don’t have enough people and there isn’t any other place that I think my services are more needed than right here at home. I mean it’s a plus that you’re among family, you’re among friends, but for sure it’s more rewarding when you go to bed at night and you know these are my sisters, these are my mothers, these are my country women, these are people who definitely realize I’ve made an impact in their lives so to speak. So, there was no question as to whether I was coming back, there definitely wasn’t.
Ariana Diaries: Heart warming decision there Doc. You have mentioned the need, let’s spell it out. We are constantly hearing stories of maternal deaths, miscarriages, still birth and neonatal death not to mention the growing challenges of conception even among very ‘young people’
Dr. Frances Wurie Sesay: Allow me to give some context to these issues and just talk about the problem in general. Pregnancy loss affects about thirty percent of pregnancies, if not more. Sometimes you lose the pregnancy before you even know that you’re pregnant. God has a way that our bodies work, in that, if the pregnancy is not going to be viable, if there’s some sort of chromosomal abnormalities, if the baby is not going to come out okay, there’s a high chance you will lose that pregnancy.
But you know, in our environment where STI rates are high, that’s also another cause of early pregnancy loss. If you consider older/aged women, we start thinking about the quality of the eggs as well.
Let’s take this example: men, they can make sperm till they die basically. For women, the eggs we have are the ones we’re born with. As time goes by and you age, they become old; for lack of a better word, bad. When those eggs are fertilized, they’re not as good in your late thirties, forties maybe as they would be in your twenties, early thirties maybe. So for sure, chromosomal abnormalities, infections and underlying conditions all play a role in early pregnancy loss.
If a woman has diabetes, if a woman has hypertension already, if a woman smokes cigarettes, if a woman consumes high quantity of alcohol, all of those things may contribute.
For example, if you have HIV and you’re not on medication; if you’re compliant with medication, that’s different but if you’re not on medication, that’s also something that could also affect your pregnancy. So, it is kind of funny you asked this question because that’s what my next video is going to be about.
Ariana Diaries: Really? Tell us more, I am sure that our audience is hooked at this point.
Dr. Frances Wurie Sesay: Yeah, it’s a lot of issues that come together. I mean I know in the society when something goes wrong with the pregnancy, it’s almost always a woman’s fault. Truth is she doesn’t need to do anything. It’s nature, sometimes it’s just biological but definitely there are times when there’s something going on like I said. Let’s say she has severe malaria, something we don’t often associate with pregnancy loss, but malaria can definitely affect one’s pregnancy.
That’s why antenatal visits during which malaria prophylaxis is given, are so important.
Ariana Diaries: I hear you mention underlying conditions which triggers one of our favourite words on the blog- Lifestyle. How can women seeking children support themselves better and avoid losing their pregnancies or babies?
Dr. Frances Wurie Sesay: That would be for the things that are preventable. I mean like I said the ones that are preventable for example, hmm! So one can’t do anything about getting older. However, lifestyle and health changes would be paramount in women with conditions such as diabetes, hypertension; women who are obese as well, who want to start a family.
Ariana Diaries: Just a moment doctor. When you say older woman, how old?
Dr. Wurie Sesay: The age? (With a chuckle) That is an interesting one, ( then some laughter) so olden days text book definition used to say anybody who is above 35, anybody who is above 35 is considered old in terms of obstetrics and pregnancy issues. Nowadays you can push it up to 38 – 40. But truthfully, nowadays women aged 45 or so are still delivering healthy babies.
Ariana Diaries: That is harsh! Unfair for women, So we are losing potential babies? With our periods!
Dr. Wurie Sesay: So you just lose one every month with your periods/ menses, that’s hard! because you are ovulating, but the important things is if you have that knowledge and all the conditions, (socially and financially) are right you start planning your family maybe in a good or acceptable time you know 20s to 30s, early 30s because you know that they are at the optimum stage. I would say, strength or integrity in terms of good reproductive characteristics, because the older you are, the higher the chances of all those chromosomal abnormalities that can occur because they are old eggs.
But if you are not ready for babies, its best to find a consistent contraceptive method that works for you.
Ariana Diaries: That’s a lot to digest. You mentioned STI and STDs, that’s a growing concern especially among young people who experiment with sex. Ideally, we preach abstinence, it’s getting harder for the young people to stick with that. Interestingly, we know a lot of parents that come to the blog for information, so what would we like, your own genuine word of advice to parents with teenage children: girls and boys. How would you advice them in terms of sexual reproductive health?
Dr. Wurie Sesay: I am happy you said girls and boys because I think quite often when we talk about sexual and reproductive rights or health we talk about girls and we ignore that it takes two. So we need to talk about the boys as well.
For sure the message all around for any girl/boy who is not ready. I mean psychologically, physically would be abstaining. But as you said also we have to be realistic enough to know that, ermm! Teenagers are having sex in this country. When I talk to mothers, (funnily enough I had that discussion recently) with one of my nurses who brought her daughter who is 19 into the clinic. When I asked, do you converse, do you guys talk about this? She was like NO, and I was like that’s where the problem is.
We allow our children to get their information elsewhere. This information mostly does not even make sense. It’s wrong because those other teenagers are getting it maybe from the internet or from other friends.
Even though parents may feel they know have the answers or may feel uncomfortable with such topics, this conversation is worth having in the home. Talk about menses, abstinence, sex, contraception… they are all important topics.
Instead of ‘you’ll get pregnant if you go near boys, ’ how about, ‘please I know your hormones are raging as you are in puberty, talk to me if you have questions. If you want to have sex, you should use a condom or better still let’s go to the gynaecologist.’
As a parent, you can even stay outside if you feel uncomfortable whilst your child discusses with the gynecologist.
I usually have an open door policy for young girls. I have seen girls as young as 11, I mean they have my number and they have a WhatsApp number where they can send a message to if they have any questions. I respond within 24hrs as the case may be, but I try to make them feel comfortable. It’s so sad that generally when we start talking about our bodies and menses and sex, it becomes a taboo in this part of the world. It should not be like that. If people are armed with the right information they are at better place to make informed choices. When you start saying well just don’t have sex, and so what? What will happen? Our kids thrive on curiousity, they move on to find out what the big deal is.
But if we sit down and explain don’t have sex because you might get this kind of infections, don’t have sex because you might get pregnant, and you are not ready yet. I want you to complete your schooling, I want you to get you know, get to be responsible enough, get to know your body well, let your body mature. If we are honest and open with our adolescents and teenagers, I think we will be better placed in society.
There’s this rule about consent, if a girl is underage there are certain things with regards to Sexual Reproductive Health that the parents or guardians have to be involved.
Let’s take this case: There is a girl I wanted to give oral contraceptive for some sort of menstrual irregularity and I have to call her father in because her mother was not in the picture. I had to call her father in and explain that if you see this pill, it doesn’t mean she is sexually active, I am giving it for completely different reason. He was grateful, he was accommodating, he was happy because he said to me “when my daughter came and said well the doctor said they need to give me a pill, I was like NO! But when we had that conversation, he then realised that the pills have so many different uses. It’s not just to prevent pregnancy you know! It was a good conversation. For me I think that is what I really rely thrive on. I mean that open dialogue between parents and adolescents alike.
It’s very important that we teach responsibility. I think often in our society we let boys go Scot free and the repercussions are usually on the girls and I think we have to teach them the fact that they are equal partners when it comes to you know taking charge of their sexual reproductive rights/health so that they are so responsible. I am a mother of boys right! So I’m thinking, obviously I teach them respect, how to be you know aware of their bodies, you know like to know like this is a no go area, that kind of thing. But as they get older my role also is to dwell on that respect for women. That’s very important. But then respect for themselves as well.
So, I really think it starts at home. I think we need to have comprehensive sexual classes in schools, age appropriate obviously.
But again, I think for most of us young doctors, well I take myself as young but anyways doctors coming in the country, must create and open and safe space, where people feel comfortable to come to discuss.
Bottom line, it doesn’t matter about age, find somebody you feel comfortable talking to:
Create that space for yourself!
You know when you identify that person that you know. I can call Dr. this and this. I can send a message, they are going to answer my questions, if I have a concern as the case may be that is important.
Ariana Diaries: What a wealth of information there! Wonderful. I am sure it’s no news to you that on average most young women and men are scared of going to the hospital not to mention sexual reproductive health that has so much stigma. How do we start this conversation?
Dr. Frances Wurie Sesay: So, we are not in a culture where annual check ups are a norm. Partly due to some lack of knowledge, but also because of cost. Let’s be realistic, we don’t have insurance. For somebody to just say “I am going to make an appointment, when they are not ill”. First of all people don’t even have personal doctors, most of the time.
They just go to the nearest health center or hospital when they are sick or think of something of that sort. So when I did the first TV Show, I was talking specifically about when to go to your gynecologist.
I mentioned having an annual visit especially if you are sexually active. I mentioned that for a young girl, an adolescent girl, one who has started her menses or the one who is 16, 17 who has not started her menses, does not have any breast buds that a visit is important as a general check-up. If she has started her menses to talk about hygiene, to talk about mood swings, to talk about what to expect.
Women have to learn how to do is do their monthly breast exam, on their own at home, in the shower or when they are lying on the bed, after their menses. That is important.
What you also have to be is observant, we have normal vaginal discharge, So, what’s abnormal! What’s abnormal is if there is an awful smell or if you have any vaginal itching, colour change. Discharge doesn’t have to do with you being promiscuous. It doesn’t mean that at all. There are different reasons as to why you would have less discharge or even more copious discharge, especially depending on the time of your monthly cycle but there should be something there that is not offensive. That is kind of cream white or clear, which does not have any foul smell and does not itch. That is normal.
If women are aware of those aspect of their bodies and those aspects of their health. They then become their own ambassadors.
They know when something is wrong. So, it’s like hey! This is different from last month, something going on here, now I need to go to the Dr. for sure. That’s when you go when there is a problem but in the absence of any problem, what is important is a wellness visit.
You should visit you Gynaecologist for the following reasons:
To do a regular pelvic exam- a annual exam, which checks the lower part of your abdomen and your private to ensure there is nothing wrong.
Also to have a conversation, are you eating well? Are you sleeping well? Are you on any vitamins, or make sure you don’t have any underlying conditions, are you mentally ok? You are dealing with this human being holistically, it’s not just about physical well being. You have to think, because if this woman has like marital issues, stressed with the job, stressed with the kids, whatever the case may be it affects her as well. It affects how her body works. So, all of that, that’s why I keep saying priority is having somebody you can talk to. We act sometimes as counsellors. When you sit with your patient if something is going on she should feel comfortable enough to tell you. ‘Na dis dae morna mi or na dis dae mona mi ‘and you’ll probably put two and two together and say this probably the reason why this is happening or that is happening.
It’s very important that we advocate for yearly visits even though I am very cognizant of the associated costs! That is where the challenge is, hopefully we will get to a point where we have a national insurance scheme that would be one of the pluses, where people take charge of their health especially if they do this wellness checks. They will be able to detect things early on so hopefully, then we will be able to treat them early on and it would never become the advance stage of whatever it is, that is what is important.
Ariana Diaries: Where should I go when I seek to find answers around Women’s Reproductive Health in Sierra Leone?
Dr. Frances Wurie Sesay: For breast issues in particular, I will say Well Woman Clinic, they are doing good with advocacy around breast health and cancer. They teach women how to do the self – breast exam. Sr Adija is good with that.
There is also an oncology team at Connaught, of which Dr Cummings-John is a part!
All government hospitals have a family planning unit where contraceptives are available.
But women should feel free to talk to their doctors about their concerns about fertility, contraceptives, general wellbeing, and the like.
Ariana Diaries: Tell us about your platform: The Woman’s Place.
Dr. Frances Wurie Sesay: When I was in Uganda, I realized that there was a gap in the health knowledge women coming into our clinics had. So, I said okay, it doesn’t mean because somebody has access to the internet they are getting the right information. Better yet, what about those who had o internet access or weren’t literate?
So, I figured. If that’s the case in Uganda with a population of 48 million or so where they have a lot more college educated people than we do in Sierra Leone. Then there must be a serious gap in getting the right information around women’s health. I talked to a few of my colleagues, talked to a few of my sister’s friends who were a bit younger and it was basically the same because certain questions remain unanswered and so idea of The Woman’s Place came up.
The show addresses a particular subject on a weekly basis or biweekly basis and discuss and have people ask any questions that they want. It does not only broaden horizons about that particular subject but it would also make them think so that when they go to their doctors, they are better equipped with information, they know now what to ask and if there is something they are going through they can or if it’s something that they could have.
Let’s talk about fertility and how it’s largely blamed on the Woman. So, on the show, I wanted to be very open about the fact that there are male factors as well. We should not neglect the fact that you can have a perfectly okay woman but then you have a man with sperm issues. Let’s be open and talk about that and find possible ways of you know, rectifying the situation. I wanted to have a show where we can talk about menopause because it’s like when a woman gets to that age and it’s like ” na attitude, you too sabi or e just dae vex, e just dey hala”
I wanted us to be open about sexual health for adolescents, because I don’t want those things to be taboo. Saying “oh when you ol16 you no for get sex” simply does not make it so.
General wellness, positive lifestyle changes, adolescent health, menopause, infertility and sexual health, including sexual satisfaction are some of the topics that inspired the show. I wanted come up with topics that are seemingly taboo in this environment but these are things that affect people’s lives. So especially me being a gynecologist, I am not fine by the fact that some women don’t find sex pleasurable. Why? Let’s talk about it, encourage them to try this or that out, I mean it’s an important aspect of life. This show is for information sharing, conversation stimulating. It’s thought Provoking!
Ariana Diaries: How do you measure impact for your show and or make it interactive?
Dr. Frances Wurie Sesay: I have people who will send me private messages, I have people who I would meet in the street and they will talk to me about it. Like I watched this, this was nice. So many mothers have brought in their adolescent girls. You don’t always get to have that one on one with everybody but on that kind of platform there’s a semblance of it. After the show is aired, it’s on Facebook. People go back and ask questions and then when I can, I respond and if it’s something I’m not dealing with as an individual, I can now refer them to somebody else.
The show slowed down during this pandemic but I am hoping that in February we will start again. That is why I started the 5 minute videos on Facebook, clips on interesting subjects, where again, people can ask questions.
Ariana Diaries: Well done! Now to one of our favourite questions. With all that you are doing in order to support other people, your family and grow your career. How do you take care of yourself?
Dr. Wurie Sesay: This is a very good question. I am thinking actually how to answer that question. I pray, I think that is the first thing for me. I have to be in touch with God, I am a Muslim by faith, and I make sure that I am connected.
I do take time out to get my pedicures. I don’t do manicures because my hands are always in water but I do pedicure, at least every two weeks. That’s my me time where I just sit there and don’t have to think about anything and I get pampered a bit, but I think the priority for me is prayer.
Family is also vital as they keep you grounded. Because at the end of the day when you do come back home it’s all about what happens in your house right. You hear them! (kids voices in the background).
If you are grounded it will keep you focused but definitely being touch with God especially in this line of work. You are kind of almost never alone. You kind of invoke that spirit on a daily basis, you’re touching lives and you’re bringing other people along. You become a part of people’s lives, let me say it that way. When you follow through with infertility issues, they get pregnant, they have a baby, and they feel complete. You’ve touched them in certain ways.
If you’re thinking about a cancer patient and you have you know been able to manage somehow, you’ve touched their lives somehow. I always tell patients, what’s important is not what we say per se, it’s how the conditions affect their lives. If we are able to turn it around then we have done a good job.
It’s not for us to say ‘ well ar sabi dis, ar sabi dat” it’s not like that. It’s about the changes that we make in your life, how this benefits you, so for me I think that what it is! Prayer and family, having a quality me time. I won’t lie prayer is two ways. The prayer that I pray and also those prayers that I receive every day.
On a daily basis, this is rewarding; “God bless you” “God bless your pikin dem” God make you get wetin you want” are the greatest blessings. Those prayers are where the blessings lie.
Ariana Diaries: Your story is so refreshing, I feel like we can go on forever and ever. I’m curious and this is definitely the last question. Where do you see yourself in 10 years?
Helping women, helping young girls, still nurturing our next generation. I will still be in clinical practice for sure. I think I have a good 20 years in me,, God willing so definitely in 10 years that what I will still be doing, clinical practice, helping families, helping young girls be aware of their potential, making sure they respect their bodies.
Hopefully I will continue loving what I do because right now there isn’t anything else I would rather do. When I come home after a 24hrs duty, I am tired but I still have to be a wife and mom, I get up and still go back and do the same thing all over again. So, obviously the passion that I have for the job I am hopeful will still be there in 10 yrs. but definitely in 10 years I still see myself doing exactly what I have been doing for the last 10yrs (laughs). I see myself learning more, growing as a person, as a doctor.
Ariana Diaries: It’s time for me to say bless you! Bless you doc.
Get in touch with Doctor Frances Wurie Sesay on Facebook : https://www.facebook.com/frwurie or The Woman’s place on Facebook