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30 June - 06 July , 2012

"Rural women are superstitious & fall prey to misconceptions easily" – Dr. Rubina Hussain
Dr. Rubina Hussainby SALEHA ABBASI

Dr. Rubina Hussain is the most sought after gynecologist in the country. She is currently the Chairperson of the Department of Obstetrics and Gynecology at Ziauddin University & Hospital, the Chairperson of Royal College of Obstetricians & Gynecologists Representative Committee of Pakistan, President of Pakistan Menopause Society and also the Founding Vice President of South Asian Federation of Menopause Society. Dr. Rubina has made some outstanding contributions in the field of obstetrics and has authored several publications. Her special interest lies in menopause and preventive medicines in women's healthcare. Recently MAG had a chat with her regarding maternal healthcare. Excerpts:

Do you enjoy your work?
I work six days a week and it gets quite hectic. However, I do not mind that at all because I enjoy my work. If God was to give me nine lives, I'd still do what I am doing now. Hence, when I am at work I am the happiest because my profession gives me immense satisfaction.

What do you like the most about your work?
The best thing about my job is patient satisfaction, which is the most rewarding thing. So, for me my patients' satisfaction is of utmost importance. If my patients are happy, I am happy.

What are some of the biggest challenges of your job?
There are a lot of challenges that we have to deal with on a day-to-day basis. For instance, we get a lot of high-risk patients from all over the country, treating them is a huge challenge in itself.

What are the advantages and disadvantages of using oral contraceptives for women?

Oral contraceptive is a very good option for women, provided they are regularly checked, examined and counselled. Overall, it is the best option given to a woman with only one percent failure rate. However, the problem is that doctors nowadays do not give enough time to their patients. For instance, they prescribe injectable contraceptives but do not explain that it may lead to irregular bleeding. However, if a woman has breast cancer and is on the pill, it might aggravate the situation. So, it is not advisable for women with an underlying condition like breast cancer, to take oral contraceptives.

What do you recommend for women who are having difficulties conceiving?
They just have to follow our international protocols for sub-fertility. Nowadays, it is all about evidence-based medicine.

What are the five most common problems which plague pregnant women?
There are five leading causes of maternal mortality in which we are currently doing a lot of research. One is hemorrhage – either during pregnancy or after delivery. Another is hypertensive disorder such as eclampsia – when the blood pressure reaches to the extent that it may cause obstructed labour; others are infections and complications of miscarriage or abortion. Hence, these are the international leading causes of maternal mortality reported by many different studies.

What are the psychological problems that women encounter during pregnancy?
This is a very important aspect and a much neglected one also, especially post-partum hemorrhage and post-partum psychosis. These are the two major issues and women suffering from these conditions need a lot of support from their families. Women can experience a range of emotions during pregnancy, even if they and their husbands have planned the pregnancy from the start. They have mood swings because of hormonal fluctuations, may get worried about their babies' health, remain uncertain about the changes in their bodies, and their abilities to be mothers and so the list goes on. However, I believe that the psychological implications during and after pregnancy need to be properly identified and addressed.

Can you identify any trends or changes in female health that you have seen in recent times?
I do not know if people are aware of the Millennium Development Goals. There are certain objectives which Pakistan is signatory to. Moreover, there were certain things which we had to take care of, like poverty, improvement of maternal and child health etc. Unfortunately, if you consider the overall ratio, most women in our country are living in rural areas and there are some major health problems which we have not yet been able to solve in order to meet the Millennium Development Goals. Similarly, rural women are superstitious and fall prey to a lot of misconceptions regarding pregnancy. On the other hand, urban women are more health-conscious; they come for regular check-ups, exercise and take proper diets. So, as a country we are way behind in maternal healthcare mainly because of poverty and lack of availability of skilled birth attendants.

What are some of the factors leading to the high maternal mortality rates in the rural areas of Pakistan?
They are the same five causes that I mentioned earlier: hemorrhage, obstructed labour, hypertensive disorders, infections and complications of miscarriage or abortion.

Please give some tips to women on how to maintain the best reproductive health?
Women should maintain a healthy lifestyle, have five small frequent healthy meals, have everything in moderation and exercise regularly. The key is to maintain a healthy lifestyle and just staying happy in general. By going for regular check-ups, women can also avoid silent killers like ovarian cancer because if it is diagnosed later in life then the prognosis will be poor. Furthermore, there are regular screening programs for malignancies as well, which women should undergo frequently.

What are some of the diagnostic tests that every pregnant woman should include in her routine health check-up?
She should go for hemoglobin and glucose tests, and urine protein tests, on regular basis and at least one ultrasound. We recommend one at 13 weeks for nuchal translucency, at 20 to 22 weeks for an anomaly and in between if indicated.

The maternal death rate in Pakistan continues to be horrifying. How can we control the situation?
Education plays a key role. Moreover, expectant mothers need healthy diets and iron supplements. Unfortunately in our country we have to deal with so many myths especially in the rural areas regarding what to eat and what not, as some might have a 'warm' or 'cold' effect. Dates are rich in iron and are yet often forbidden as they are supposed to be warm. Take Sri Lanka for example, it is also a developing country like Pakistan with a literacy rate of 90 per cent; it has excellent safe childbirth rate. Young mothers in Pakistan are subdued and ruled by others, but in countries like Sri Lanka, the government plays a positive role in healthcare to avoid such problems.

What is next in line for you?
We at South Asian Federation of Menopause Society are planning a very big conference in Karachi later this year and in the beginning of next year. Our basic aim is to create awareness amongst the public on how to prevent complications of menopause and how to remain young for longer.

Any health tips or advice you would like to share with our readers?
Be safe, you only live once so take care of yourself. People get depressed when they have problems, but instead of getting depressed, fight it out. Taking care of yourself is important, so look after yourself physically and emotionally. You are the best in the world!

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