I love how fast this field moves, and grows. It is refreshing, and it keeps me on my toes, and it demands: if you’re not ready for change, you’re not ready for MEDICINE!
Three years ago, during a Family Medicine rotation, a young Zimbabwean girl came to us for removal of a stick-like thing in her arm. Initially I did not believe her that it was a contraceptive – I thought it was a traditional medicine! But she was so convincing that I Googled “subdermal contraceptives” and it turned out she was right.
Subdermal contraceptive devices were SO rare in South Africa that we had not even learned about them in classes. We had no idea how to remove said implant, and kind of improvised.
Three years later, I can put in these contraceptives with my eyes closed (but I wouldn’t, sharps are involved).
Less than two years ago, South Africa had a massive roll-out of Implanon. It offers a great option for women who don’t want to be injected every few months, but who don’t want to commit to a ten-year IUCD either.
In the past four months, I’ve probably inserted more than a hundred of them, and it now takes me about three minutes to do it. I’ve taught fellow interns and even nurses to do it, too. I like doing them. It’s quick and easy and it puts the choice to have – or not have – children firmly within the woman’s grasp.
And even so, medicine keeps moving. Already preliminary evidence suggests that women on the Tenofovir/Efavirenz/Emtricitabine combination of ARVs experience reduce efficacy of subdermal contraceptives, which is a real pity given that so many of our young women seeking contraception are indeed on this medication.
Medicine keeps moving. It’s exciting, provided you keep up. I love it.