Nordica @20: Our new technology is a game changer – Dr. Abayomi Ajayi

HITM: Congratulations on the 20^th anniversary of Nordica. Can you let us into how it all started for Nordica Fertility Centre? What values drive the Nordica Brand?

Dr. Abayomi Ajayi: I am a gynaecologist and I used to work in Lagoon Hospital. One thing I saw in infertility when I was training to become a gynaecologist, and even in health care generally, is that there is still asynchrony between the players (service providers) and the customers. It is getting better now but it is still there. Maybe part of it is awareness issue but not only on the customer’s side but also on the provider’s side. Hardly do you see anybody trying to understand what the patients really want. So I saw a gap.  Apart from talking about infertility, there is also the service part. The doctor, or shall I say health care in Nigeria, is mainly for hardware not software but the two must come together. You know they say health is not only the absence of disease but also emotional and spiritual wellbeing. So, I think that is something that many people miss in Nigeria, especially, people in the public sector. But that is not to say that the private sector is also completely immune from it. Those are some of the things that made me to say look there is a gap. Apart from infertility, which in itself is an obvious gap, there is a service gap. That is was what led to Nordica.

“Our core values, we call it “TRIIC” which means Team-playing, Responsiveness, Integrity, Innovation, and Confidentiality”

People think that the vision and the mission of the organisation were well crafted from the beginning. No! We just did not wake up and say we wanted to be the preferred assisted conception provider globally. One of the things we set out to do was that we wanted to be able to give you the kind of care you will get if you step out of the country. But when they say health is wealth, they are not stupid. If the health sector is not well developed, all of us are poor people. That is why my heart bleeds any time they say they close a hospital (for a misdemeanor). How many good hospitals do we have in Nigeria that you are closing one? We need to look critically at the health sector in Nigeria, all of us, not only the doctors. I have not absolved the doctors who are also as guilty. So, we just did not open Nordica and say we want to chase money. We sat down and said look, what are the gaps? Yes, we want to engage in infertility treatment; fine. But generally what are the health gaps in Nigeria? How do you want to be treated if you are a patient? Those are the driving principles for us till now.

Our core values, we call it “TRIIC” which means Team-playing, Responsiveness, Integrity, Innovation, and Confidentiality. These are very important to us and have been driving us for the last 20 years and will continue to drive us. I do tell people that a doctor’s word is his bond. The most important thing about a doctor is integrity. The moment you remove integrity from a doctor, he is a “419” (a fraudster). If I take you to the theatre and I say I am going to remove your appendix, you are not there, you cannot see. So if your appendix is not inflamed and I come back and say that the appendix was terrible, you would not know. But is that good for me to do? So integrity is one of our core values. A patient once came to me and said somebody had told her I was a prophet of doom. This is just because I was trying to let her understand the implication of the decision she was making and she was busy saying “it is not my portion”. But everything I told her came to pass and then she came back to me to do exactly what I initially recommended. That is why the system should not make the doctor to be too hungry, otherwise, that important integrity part of them may be taken away. Unfortunately, we are turning our doctors into beggars, 419ers and we will pay for it. I am not saying that we should not develop other sectors like Nollywood (entertainment) but you cannot develop them at the expense of healthcare. It is not possible!

“We just did not open Nordica and say we want to chase money. We sat down and said look, what are the gaps”

A former Minister in Nigeria once had an accident and was taken to the UK unconscious. With all his money, they could not admit him. They had to be phoning looking for who will stand for him. I say if it is his dead body that they brought to a hospital in Nigeria, they will recognise him. They will at least give him the honour that he deserves. So why are we not developing our healthcare? And do not tell me that the doctors are not available here. Many skilled people are here. Majority of the doctors outside the country want to come back to Nigeria. The problem is there is nothing for them to come back to.

“Do not tell me that the doctors are not available here. Many skilled people are here”

HITM: Is it facility or welfare issue?

Dr. Abayomi Ajayi: Both of them go together. I tell people, if we are on a plane, Lagos to Abuja; and somebody collapses, if you are Red Cross and I am a doctor, there is no difference between us. What makes a difference is when you have equipment because the best thing the two of us can do at that point is CPR (laughs). Without equipment, the doctors cannot do much. Most of the things in health care now are private sector-driven. So what are we doing to encourage the people who are staking their family wealth, their future in all these? Our people are rushing to India. Why? It was a deliberate effort of the government there. They gave the hospitals 6% loans to develop their hospitals and that is where Nigerians now want to kill themselves to go to. Why can we not do it here?

HITM: Is it possible?

Dr. Abayomi Ajayi: Very, very possible! And do not tell me that you went to open one specialist clinic in the whole of Abuja. How many people will it service? Or in Lagos where there are 22 million people, you open one specialist hospital. What you need to do is empower the private sector people who can do this job. There was a time when banks had money. I was saying to them, look for consortiums, bring these doctors together, what they lack is that they cannot manage. You the consortiums, train people who would be able to manage those things. See, healthcare is a very good business if you do it properly. Do not tell me you will not make money. The greatest employer of labour in the United States is healthcare. So, like we say, if we have 220 million people in Nigeria, healthcare business is huge. It is better than oil and gas because it will not dry up! What is even more important is that it keeps all of us alive because majority of us are just one disease away from our grave or poverty.

“Nigeria is still 40 years behind in healthcare”

HITM: Okay, let us go to the milestones that Nordica has recorded in the last 20years. What would you consider as the successes of this organisation?

Dr. Abayomi Ajayi: Many things oh! But for me, the way I see things is a little bit different. What I see as the major contribution that we have made is to take away what I will call hocus pocus from healthcare. Unless the consumer understands what you are doing, you are labouring in vain. Health education is so important. People need to understand. Before now, they used to say that obesity is the evidence of good living. That thinking has changed now. Everybody now wants to be lepa (slim). So you are in the gym doing all kinds of things. How did that happen? Education! So the way to change people’s behaviour is through education. You can buy a car or even a jet for USD40million or USD100million. If it crashes, you can buy another one. But if you destroy your liver, okay go for liver transplant and tell me what your quality of life will be. So why do we not teach everybody how to look after themselves?  

For me, one of the major things we have been able to achieve is to take healthcare away from hush hush. Yes, we have had so many babies now. I do not even count anymore because that is not what keeps me going. That is not what wakes me up in the morning. What wakes me up every day is that there are new territories to be conquered. Nigeria is still 40 years behind in healthcare. Generally, we have done or we are doing very well in some aspects of healthcare and IVF is one of them. There are so many clinics in Nigeria that can be compared to those abroad. I guess we have also not done badly in some other areas like orthopaedics and cardiology. But it would appear that these services are for only the rich. So we need to do a little bit better. I do not know whether it is in my own life time that the teaching hospitals will be able to do all these things we are talking about. We have also seen the World Bank said that in Africa, 60% of healthcare is in the private sector. There is definitely a shift to the private sector. Why? Because you can predict the outcome you will get. Until we get to the point where if somebody is shot in the chest, there are centers that you can take them to and they can tell you that based on our assessment, this guy has 60%, 80% survival chance. Then we are not doing anything yet. We would be more like Babalawo (native doctor).

“There are so many clinics in Nigeria that can be compared to those abroad”

HITM: Trial and error?

Dr. Abayomi Ajayi: Yes. You know what pains me? I have seen so many people all over the world, Nigerians are so blessed. We are so intelligent that it is painful that we are where we are. That is why the moment any Nigerian escapes abroad, they hit it big! Unfortunately, not the way they are going about now (japa syndrome). This one is slavery.

“Unfortunately, not the way they are going about now (japa syndrome). This one is slavery”

HITM: Okay, you have some reservations about japa?

Dr. Abayomi Ajayi: No, you cannot go this way. Just like what we did to our Ghanaian brothers (Ghana must go) in those days. It cannot work. All of you cannot just move. If it was that you were chosen because you have a particular skill, you can hit it big out there. But when everybody goes in droves, I am afraid some people will end up in prison because the culture is different. There was a Nigerian doctor in the UK who was seeing a patient and the patient was upset. So he crossed over to pat her (the patient) saying, “don’t worry, it is going to be alright”. Ha! You do not do that in the UK. Of course, he was charged for assault! These are some of the things that our people do not understand. Also, the western world does not respect those who are financial immigrants.

HITM: Because they are a burden on the system?

Dr. Abayomi Ajayi: Yes. One day I was in Spain, so I went to the Valencia Stadium to watch a football match and something happened. One guy was seated and another one was standing up in front of a woman who is also Spanish. So she told the guy to sit down and I told him why can you not sit down. He then looked at me because I am black and said “I am going to call the Police.” I said oh! Before you call the Police, I am going to beat you up so that you have a reason to call the Police. Why did he behave that way? Because he assumed that I was an illegal immigrant.

HITM: Now let us look at success rate of infertility. Nationally, it is known to be about 30%-40%. Based on experience of the past 20 years, what would you say is the success rate for Nordica and what factors would you attribute to whatever rate?

Dr. Abayomi Ajayi: Well, I am not sure because even in the UK, it is not that high. Why I said that is because success rate is age-related. You have to talk about particular age groups. About two years ago, the baby take home rate in the UK was 19%! So when you are talking to patients and you say oh, this treatment, you have a 40% chance that you will be pregnant and they say that is low; I ask them “what are you comparing it with because nature itself offers only 25%” and at best, that is when you are below 25 years of age. So, 40% is probably about the best you can get. Then for donor-recipient cycle, sometimes we get up to 50%. Then when we do PGD (Pre-Genetic Diagnosis), sometimes we get up to 60%-70%. But those are not things that anybody should be blabbing about because you have now chosen or selected the embryos.

What I say about PGD is like Ferrari of IVF. You put a Toyota Camry on the road and you put a Ferrari and you say they are speeding. Of course which one would be faster? So, success rate is individualised. Even with the same age group, Couple A might be different from Couple B. Why? What is the age of the husband of Couple A? What is the age of the husband of Couple B? What are the sperm parameters of Couple A? Couple A, does the woman have endometriosis? There are so many factors that can just change the figures. So it is a little bit difficult. You then have to put it to the individual. But I know why people ask such questions and I tell them that the answer is not verifiable. I do not like saying things that are not verifiable. The number of babies is not verifiable. The success rate is not verifiable.

I still go back to the issue of integrity and those are the things that many people do not look out for in their doctors. The most important attribute of a doctor is his integrity because he sees what you cannot see. So he must be someone who can tell you the way it is. When patients start talking, I ask them, have you seen an egg before? He says no. Have you seen sperm before? He says no. Okay so, how do you go against what I have said? So probably it is not that discussion on success rate that you should be looking out for. What you should look at for is what the doctor’s pedigree is. What kind of person is this guy? What are the things that drive him? These are the issues that should concern the patients.

HITM: Now, let us talk about the affordability of your services…(cuts in)

Dr. Abayomi Ajayi: I do not know about that (laughs). See, healthcare is not cheap anywhere in the world. Quality healthcare can never be cheap. Somebody has to be paying for it. If you want to do IVF properly, it can never be cheap. Not even in the UK, the US or anywhere. Now to compound things, in Nigeria, we do not have power and you have to supply your own power. You know how much an average clinic spends on diesel every month? Apart from that, you must have inverter if you are running a good IVF clinic. So, when people talk about affordability I just laugh. People call and ask, how much is IVF in your clinic? They want to make a choice based on cost, okay e pele (sorry). You get what you are paying for. But I am not saying that it should be over the moon. Take drugs for example, look at how much drugs take out of your cost to the patient. I tell them, well, I do not have to use some particular drugs because they are too expensive if I know that other ones will give me the same result. Just like iPhone, what can it do that another phone cannot do? So why do people buy iPhone? Because it gives them some kind of satisfaction which cannot be measured. That may not be true but is only a mere perception.

HITM: Talking about the rate of infertility, we know that the incidence amongst the population of child bearing age is not low when you look it in absolute terms relative to the general population. So that leaves us with a lot of individuals and couples that need your services. We agree that healthcare is not cheap anywhere in the world. How do we then ensure that a great number of that people have access to fertility services?

Dr. Abayomi Ajayi: That is where health insurance should come in and that is why I said somebody must pay for it. Look, if I am running my cost here now and people are not paying, you will not meet me here tomorrow, no! So somebody must pay if this is going to be sustainable. Now, it can be government that is paying. It can be because they pool funds for you. That health insurance arrangement (for fertility care), for me, should be like yesterday. When you started your introduction of the publication, you said for awareness creation and I was excited because how can a country have 5% coverage? It is too low. We all know what is happening but we need to privatise to get out of the situation.

“If you want to do IVF properly, it can never be cheap. Not even in the UK, the US or anywhere”

HITM: You recently established the Fibroid Care Centre at Lekki in Lagos. Kindly tell us, why a fibroid care facility?

Dr. Abayomi Ajayi: Thank you! Fibroid is a very common disease among women in their reproductive age group. About 50-70% of our women would have fibroid before the age of 50 years. It is very rampant. It affects the quality of life from the symptoms disturbing their menstrual period to pains and sometimes even infertility. The conventional treatment of surgery is also not a picnic. Given a choice, many would not want to have surgery and because of how vascular the uterus as an organ is, most doctors would not want to tamper with it. But unfortunately, since it is a very common condition, doctors have to deal with it a lot most of the time. We do know that many, especially in Africa, because of the fear of surgery; wait until either it becomes so huge and affects their quality of life or when they want to have children.

We then thought that we should have a centre. Really, there was no centre dedicated to this common disorder. We decided that we would have a dedicated fibroid centre where you can take care of every aspects of fibroid care, from the invasive to the minimally invasive and then to the non-invasive. This non-invasive machine that we have happens to be the only one in West Africa. There are only three in the whole of Africa – South Africa, Egypt, and Nigeria. To start with, it is not every patient; not every woman can benefit from it. It is so simple to the point of almost being incredulous. The way it works is that you lie down on the bed with your fibroid and then we do some things (like software) on the computer and it burns the fibroid slice-by-slice. The whole process takes about two hours. Then we observe you for another two hours and then you go home. By that day, before you even leave the clinic, we would have started serving you tea or coffee (whichever is your preference). By the next day, you can eat anything you like. 48 hours later, you can do anything you like. You are back to your normal life. It is that simple!

“The whole process takes about two hours. Then we observe you for another two hours and then you go home”

We thought let us have this technology especially now that we are plagued by many doctors leaving to go abroad. So a single surgeon can do maybe 100 or 150 cases of fibroid in a year. It does not require anaesthesia, no blood transfusion and no form of surgery at all. We think it is going to be a game changer over time in Nigeria. That is what made us to establish the Fibroid Care Centre. 

HITM: Fantastic! Congratulations on this vision and initiative to bring this technology approach to fibroid management to Nigeria. So, the Centre is said to run on the High Intensity Focused Ultrasound (HIFU) technology. What is the value of this technology in the management of fibroid?

Dr. Abayomi Ajayi: One, the technology is non-invasive. Two, it is precise and highly-targeted. It does not affect any other place that we do not want it to affect. Let me try to explain what I mean by this. In those days when children used to play outside of the home, not now the “DSTV age”, we used to do something that we called “magic”. We get a magnifying glass and put on a piece of paper on a table. The paper, at a particular distance from the magnifying glass, catches fire. How that works is that the magnifying glass is a convergence glass. It is able to converge or concentrate rays from the sun on the paper and then at a particular distance, the rays burn the paper. If you raise the glass a little bit or you lower the paper a bit, or you put your hand in between the glass and the paper, the paper does not burn. That is the principle of the HIFU. It converges ultrasound rays on a particular spot and turns them into heat at a particular distance away from the transmitter so that is the only place that it burns. It is only where you want it to burn that it burns. That is why I said it is targeted and specific. It takes a bit of time to burn the fibroid because the machine divides the fibroid into slices and burns it slice-by-slice.

In this environment, it is possible for a single operator to work with nurses. It requires for you to have the machine and be trained. Then you do not necessarily have to have a doctor with you. So a gynaecologist can conveniently do one case per day or between 250 and 300 cases in a year! For the regular surgery, no matter how good you are; as a surgeon, you cannot do that many cases in a year. Also, for the patient, time-to-recovery and time-to-pregnancy is reduced. Then you do not have to be afraid if you have to deliver by caesarean section at your next pregnancy because it is targeted and leaves no scar. So we see it as a big game-changer in this environment. Even there is no fear of whether the patient is HIV positive or not.

Therefore, we see the HIFU technology as having a big role to play over time in Nigeria, in Africa or even the world generally. Since fibroid is more common among black people and tends to get bigger with us, we see it having a big role to play in Africa especially.

HITM: Would you then say HIFU is a conclusive and definitive treatment for fibroid? Are there any reoccurrences or side effects? Does the size of the fibroid matter?

Dr. Abayomi Ajayi: Whether it is definitive treatment or not, it is yes. The fibroid that you have burnt you have burnt and it is gone. But of course you might not be able to burn everything. However, studies have been done to show reoccurrence (rate) between HIFU and myomectomy (surgery for fibroid). The reoccurrence from surgery seems to be more (higher) than that from HIFU. But like I said, it is not the fibroid that you have burnt that reoccurs. It is like killing a fibroid. It is not the one you have killed that comes back.

On whether it has side effects, I will say everything has side effects. That is where training comes in. With HIFU, it is a targeted treatment. Since it is heat that you are using to burn the fibroid, there can be “back scatter” of the heat which is not intended. That is why we do not let our women sleep during the procedure. We let them talk to us. The area where this can happen most is in the abdominal wall where you can have blisters and burns. So when they do not sleep, they tell us when their abdomen is feeling hot. Then we pause and change the direction. We have done about 310 cases and have had only one case of blisters, no burns; and we managed it very well. So I will say it is quite safe. The most important thing is patient selection for this procedure and with experience, you are able to do more patients.

When we just started, if you had an “up and down” abdominal scar (from previous surgery), we would not take you at all. That increases the likelihood of skin burns, the intestines can get occluded or “gummed” to the abdominal wall (adhesion). It increases the chances of intestinal burns also. But now, we have successfully done about 14 patients with scars. Some of them have even had two previous surgeries (before HIFU). We were able to do this because we are getting better with experience. You see, if you have a surgery cut that is transverse, what we call “bikini scar”, it is not a problem because your intestine is likely to be below the umbilicus. The problem usually is when you have the scar that is above the umbilicus but even now, we are beginning to be able to tell the ones that we cannot do by first simulating the treatment. Then if we are able to get a safe passage for the ultrasound rays, we can take on such patients. Also, we prepare the patient bowel to make sure that it is empty before we do this procedure; just like if you are to do colonoscopy (by the way, if you are above 50 years, you should have a colonoscopy done). So we do bowel preparation and once we do that, we are not likely to have any of these complications.

“We prepare the patient bowel to make sure that it is empty before we do this procedure”

HITM: Is someone who has done a previous CS eligible for HIFU?

Dr. Abayomi Ajayi: Yes. The first consideration to note, however, is that there are two possible scars for CS – “up and down” and “sideways” (transverse). If you are transverse, even if you have done four CS, you can have the HIFU. But if it is “up and down”, we have to do a simulation to find out whether your intestine is not going to be in the way (of the rays). The question about fibroid size limit is a very interesting one. People have a misconception about HIFU. They think it is for small fibroids but that is not true. We have actually treated a patient who had a fibroid the size of a seven-month pregnancy with HIFU. So, the size is not a problem. It is more of the location that we are worried about because if the fibroid is inside where the baby should be (uterus), then we are a little bit wary. Sometimes we combine HIFU with hysteroscopy (probing into the uterus) to treat the fibroid. Usually, fibroids are not solitary; they are multiple. So, the one in the endometrium (wall of the uterus), we usually want to treat with hysteroscopy rather than burn the endometrium, especially for somebody who still wants to have a baby.

HITM: Would you like to speak a bit more on the eligibility or inclusion criteria for HIFU?

Dr. Abayomi Ajayi: The major inclusion factor is that the patient is willing to do HIFU. However, the one that excludes a patient is what we call relative and absolute contraindications. The absolute contraindications are, one; if we suspect there might be cancer anywhere. That is why our selection criteria are very tight. We do a colposcopy to be sure there is no cervical cancer. If we suspect, we do curettage for histology. We also conduct some enzyme tests and even MRI scan to establish that there is no cancer. All these we do before taking a patient on board for HIFU. So cancer is the biggest fear that we have. The second criterion is the patient who cannot lie down for over one hour because for someone to be able to do HIFU, she must be able to lie down for about one to two hours. A patient who has problems with her spine or her heart that will not make her lie flat is not a suitable candidate for HIFU. Other than these two, every other factor may be relative contraindications and we can look at them by doing a simulation.

HITM: Considering the number of women in the country who suffer from fibroid and the fact that yours is the only HIFU centre in the country, would you say you have the capacity to deal with the potential high demand?

Dr. Abayomi Ajayi: Yes, we have plans in place to have more machines. You you also need to understand that for any new thing, there is a “siddon and look” (skeptical) approach. We have done this for just about two years (will be two years in July) and we have done about 310 cases already which is not a bad number for two years. Like you said, we expect that the demand will rise and definitely, we are already making plans to have another one because we think it is a worthwhile investment.

“We have done this for just about two years (will be two years in July) and we have done about 310 cases already”

HITM: Can health insurance cover HIFU?

Dr. Abayomi Ajayi: Well, you know it is still a new technology but we are still talking to the health insurance people. I think it is something that they should be able to cover. I think we might make headway with one or two that have shown keen interest. We even have some corporate bodies that are sponsoring some patients because they have seen how valuable it is. For us, we are just taking every day as they come but we think there is an opportunity for health insurance coverage.

“there is an opportunity for health insurance coverage”

HITM: What is the cost of HIFU?

Dr. Abayomi Ajayi: Well, I usually do not like to talk about cost because it is dynamic. If I tell you x now and you publish x, then the patient comes to us and it is already x + y, there will be conflict. What I will say is that it is the cost of doing an open myomectomy (surgical removal of fibroid) or laparoscopic myomectomy in a hospital in Lagos. What we just try to do is to make sure that it is not too expensive. However, anyone who can do laparascopic myomectomy can do HIFU. WE also offer laparascopic myomectomy. We will offer you what you really need and it is not just about the money. For us, it is not a case of oh, it is more profitable to do HIFU. We give you all the options and it is whatever you need that you go for.

“Some think we remove fibroid. No, we cure fibroids”

HITM: What are the challenges of running this Centre?

Dr. Abayomi Ajayi: Well, it is about managing people’s expectations of the treatment. Some think we remove fibroid. No, we cure fibroids. If you do a scan, you are likely to still see them there but they are dead and shrunken. It will take a while for the body to absorb them and for it to reduce drastically in size. That is where you have some people who misinterpret that ha, they have not done anything for me. But we sit them down and tell them
“look at the dimensions before the procedure and look at it now”. Then we follow them up for three months, six months, nine months and one year to see the progress. The good thing is that the symptoms disappear within about a week of the procedure but the fibroid is there because we have not removed but we have killed it. So the patient expectation is the number one challenge that we have. The other one, maybe, is cost. We wish we could offer it to almost everybody who needs it but of course we are talking about technology and there is cost attached to it. So I think, by and large, it has been a wonderful experience even for us as providers. There are lots of our patients who have given very good testimonies about the technology.

 “The patient expectation is the number one challenge that we have”

HITM: Are the skills required to operate the HIFU technology readily available among gynaecologists?

Dr. Abayomi Ajayi: No! You will need special training to operate it.

HITM: Seeing it is the only machine in Nigeria at the moment, we cannot afford prolonged downtime. What technical arrangement do you have in place to ensure all-round availability?

Dr. Ajayi: Of course, I have been doing this business for about 20years. I am aware of what you are saying. We have technical support from the manufacturer. We did not buy from middlemen but directly from the manufacturer who gives us technical support. In the first instance, we have four years technical support arrangement with them and we will renew for another four years. So we have all the support that we need for the machine.

HITM: Let us shift our focus to the state of infertility services in the country. How would you describe it especially from the consumer perspective, the supply and demand?

Dr. Abayomi Ajayi: I think the demand outweighs the supply but accessibility is one problem. That is what some people are preying on. They say IVF, I can do it for N300, 000; I can do it for N400, 000. Anybody who goes to such places is on a long thing! But that is what some people can afford. I went to a clinic outside of the country but I will not mention the country. They invited me to help review their clinic design and advise them. One of my problems is that I must call a spade “a spade” and not “agricultural equipment”. So after looking round, I sat with the owner of the place and he said “what do you think?” So I asked “do people get pregnant here?” and he answered yes. I then told him that people get pregnant here inspite of your treatment and not because of your treatment.

“When you are doing embryo transfer, the embryo should not know that it has left the body”

Why did I say that to him? When you are doing embryo transfer, the embryo should not know that it has left the body. So it must get to the hatch where it is being transferred within the shortest possible time. Most clinics, they even have a hatch between two rooms so that the transfer will be even faster. For this clinic in that country and I am not exaggerating, the distance between where the laboratory is and where you are transferring the embryo is about 100metres! So temperature would have affected the embryo. That was why I told him that anybody who gets pregnant here is not because of what they are doing. The entire embryos they are transferring are dead before they get to where they are going to. I think it was too strong for the man. He did not like it but I wanted it to hit him so that he would know that people are investing their emotions and money. That is what I tell my team too that, look, the work we do is such that people invest their money and emotions. Some, their lives come to a halt. I have had some people who would come here and say they want to commit suicide because the cycle failed. That is the kind of work we do. So we have to be responsible.

“The work we do is such that people invest their money and emotions”

We are not people who just want to make money. If it is because you want to make money, you will not last. You know everything that we do, one day we are going to give account. Some of these women who come to us, their mother in-law are raining abuses on them saying “you are a man.” And then they gather money and come to you. I am not saying that it cannot fail but you must have done your very best. So, what kind of account are you going to give? That you swindle people? Even though I was ready to help them, the people did not call me after that visit (laughs).

HITM: Now to the future, what should the market expect from Nordica in the next 20years?

Dr. Abayomi Ajayi: Well, may be I am not the right person to ask that one because I am not sure I will be here in the next 20 years.

HITM: Okay, the plan for the future?

Dr. Abayomi Ajayi: That is what I intend by God’s grace to be able to build and handover to the person that will succeed me (points at a four-story architectural design/prototype of the proposed headquarters building)

HITM: in Lagos?

Dr. Abayomi Ajayi: Yes! We bought the land and we have started building but it is tough.

HITM: But this Ikoyi location is strategic.

Dr. Abayomi Ajayi: Well, I do not know whether it is strategic. You know we actually started in VGC but the traffic there became something else when some people started building all kinds monstrous things around there. Then we have to move from there for somewhere central. That is how we came here (Ikoyi). But definitely we have also outgrown this place and that proposed headquarters building is what we believe God to help us deliver.

HITM: This proposed headquarters building project is huge. It is like fertility care under one roof. Now the multi location model that you have would appear to be taking care closer to the people. Do you still intend to sustain that?

Dr. Abayomi Ajayi: Of course! In Asaba, we are going to be 14 years. In Abuja, we are going to be 11 years. So we have been in those places for years and we cannot run away from there. We ensure we strategically position ourselves. Lagos covers the South Western zone; Asaba the South South and South East zones; Abuja the North Central and far North zones.

“We ensure we strategically position ourselves”

What works in Lagos will not work in Asaba and what works in Asaba will not work in Abuja. That is one thing we have learnt over the years. We also have this mentorship programme as well to mentor our young ones rather than compete with them or they compete with us. We believe there is always room for the other person to thrive and grow.

HITM: How do you unwind? We see that you love football (paraphernalia of Arsenal FC is displayed in office). How do you combine all of this with demand of your work?

Dr. Abayomi Ajayi: Priority! You prioritise what you want to do. No matter how tight your schedule is, you must have time to relax. For example, I love football. If I can go to the stadium, yes, otherwise I watch it at home. Recently, I have started playing golf also because that is very good for health, especially as one grows older. But football has always been my passion.

HITM: Coming back to something you said about the fertility facility that you were asked to review, it calls to mind the state of facilities even fertility centres in Nigeria. Are there mechanisms in place to monitor the quality of such facilities whether by government even those of you in the private fertility care sub-sector? Is there a self-regulatory system through which you put your colleagues in check so as to prevent a negative backlash on the entire group?

Dr. Abayomi Ajayi: This is Nigeria. We have an association. We have a committee that is supposed to be visiting clinics but they can only visit clinics that are members. We do not have policing powers. So the Government is the only one that has policing power. They can say let us visit all these places but willingness is another thing. That is why it makes me sad when I hear government agencies close hospitals that have been built, that are of international standard; because they made one mistake. Why not punish that mistake? Why not punish that errand doctor? Why do you have to close the entire facility? Meanwhile there are those who really engage in quackery or sharp practices, we leave those and we are destroying the legacies that people have built.

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