When you meet Dr Carnjini Yogeswaran, a consultant urological surgeon, the first thing that strikes you about her is her name—uncommon, intriguing.
Then her calmness. She speaks softly, yet so eloquently as she explains why she chose a career in male reproductive organs. Dr Carnjini isn't just Kenya's first female urologist, she was also the only female urology consultant in North Wales, UK—a title she carries with pride.
I got into urology first before I developed an interest in prostate cancer. It wasn't by mistake though. I knew I wanted to be a surgeon when I decided to do medicine.
Growing up, I envisioned a future in law, inspired by my mother who is a lawyer and by her tenacity and dedication to helping people solve problems.
But life has a way of guiding us toward our true calling. My older sister was in law school as I was preparing for university and I recall being just mortified looking at all the reading she had to.
English wasn’t my forte. So, I got cold feet about becoming a lawyer and thought maybe becoming a doctor wasn't such a bad thing. I was fascinated by the idea of being a surgeon and using my hands to help people.
What did you study?
For my undergraduate, I did a Bachelor in Medicine and Surgery at the University of Melbourne, Australia for six years. I then worked as a general doctor for three years before doing my Master's in General Surgery at the Aga Khan University for four years.
I wanted to specialise in urology and had to look for training outside the country, so I proceeded to the UK where I spent six years pursuing my subspecialty in urology training.
Back then, I worked very closely with a prostate cancer surgeon and developed a strong interest in prostate cancer. That was then, currently, we are training urologists locally, and if one wants to be a urology specialist, you first have to do your basic medical training which takes about five to six years then you can specialise and this takes five years.
What drew you to urology?
During my general surgery training at Aga Khan University, I found urology to be a field rich with challenges and opportunities to make a tangible difference in people's lives.
In addition, many surgeries performed by the urologists were minimally invasive. This means that one isn’t required to make big incisions for complex surgeries like endoscopic and laser surgery, which is done using small cameras. Also, in urology one could have a fairly reasonable work-life balance.
I was also drawn to this field because of two problems. One, many patients have prostate-related problems or prostate cancer, both globally and in Kenya.
Secondly, there's so much that you can do to prevent someone from dying from prostate cancer. One may not be able to prevent men from getting the disease, but you can prevent them from dying.
Therefore, I feel that I can make an impact by encouraging patients to get tested and being part of their journey in making a diagnosis and treating their cancer.
As the first woman in urology in Kenya, and perhaps in urology classes, what hurdles did you face?
As the first female to qualify as a consultant urologist in Kenya, and I must add that currently, there are many, including more in training at the University of Nairobi and Kenyatta National Hospital, I faced numerous hurdles: societal expectations, gender biases, and the weight of being a pioneer in a predominantly male-dominated field.
But my colleagues and I have proved that women could not only enter but thrive in urology, regardless of tradition.
I am fortunate to have very supportive senior male colleagues. This is evident especially in the support and recognition that they continue to provide us within the Kenya Association of Urologists and at the Kenyatta National Hospital where I work and participate in the training of urologists.
My experience at Kenyatta has been so rewarding that it would overcome any discouragement that I may have felt. There is nothing that beats a mzee (old man) saying 'asante sana.'
Male mentors have not only opened doors but also shared their invaluable knowledge. Equally important has been the support from the nurses with whom I work daily.
Do patients get shocked when they walk into your clinic and find a female urologist?
Yes. Most walk in, see me, and I can see the shock. A number of my colleagues often ask me, what's it like? 'Do men really want to come and see you?' But I have also discovered that many men prefer being seen by a female urologist, contrary to what people imagine.
Kenya's first female urologist, Dr Carnjini Yogeswaran.
Photo credit: Pool
Men are more open to sharing some things with me because maybe there's less judgment. So, the journey has been quite filled with adventure. One day I will pen down my experience.
How frequently should men get screened?
Prostate cancer is extremely common. It's the number one cancer affecting men in Kenya. So, if you are of African descent, then you should start screening for prostate cancer from the age of 45.
If, however, you have a family history, meaning you know a parent, an uncle, or a brother who has prostate cancer, then you should start from 40. But if you are not of African descent, then you can start from the age of 50.
The screening involves you doing a blood test called a PSA (prostate-specific antigen) blood test. Sometimes, depending on what the PSA blood test shows, you may need an MRI (magnetic resonance imaging) scan of your prostate.
As you get older, your risk of getting prostate cancer increases such that 80 percent of men at the age of 80 will have prostate cancer.
So, you will need to do PSA Screening every year as long as you are still enjoying good health. The youngest patient I have dealt with was 40 and I've had patients in their 90s. Among the older patients, nine out of 10 men have prostate cancer.
What are the symptoms of prostate cancer?
Prostate cancer in itself, especially if you have it early doesn’t have symptoms. The symptoms that men tend to get with early prostate cancer are more related to enlargement of the prostate and not the cancer itself.
But if you have advanced prostate cancer that has spread, you may have symptoms like pain in your bones, you may lose weight, or in very advanced cases, you may become paralysed and not be able to walk because the cancer has gone into your spinal cord.
How many stages does prostate cancer go to?
Generally, there are four stages. However, in simple terms, urologists usually say there are two; localised or metastatic. If it's localised, it can be cured. The patient can have surgery or radiotherapy to cure the cancer.
If it's metastatic, it cannot be cured, but it can be treated and patients can still live for a long time. Some patients may get chemotherapy, but most patients get what's called hormone therapy. These are in the form of injections and tablets to help castrate you.
In simple terms, testosterone is like a food for prostate cancer so you're trying to starve the cancer by knocking off the testosterone in a man.
But they are not impotent forever, and there are other things that we can give them to help maintain a good sexual life. The main side effects of surgery, radiotherapy, and hormone therapy unfortunately are myriad. These may include fatigue, growth of breasts, erectile dysfunction, impaired ejaculation and the inability to sire children.
What does the future hold for prostate cancer treatment and prevention?
First, I would certainly want to see the shift in the graph from more patients dying of prostate cancer to more patients being diagnosed, but fewer patients dying, which is equivalent to what we're seeing in the West. Screening is key to achieving this.
Secondly, the future in Kenya would be for us to have robotic surgery, which is one of how prostate cancer is treated. The use of artificial intelligence is improving our accuracy of diagnosing prostate cancer; in terms of interpreting MRI scans, biopsy results, etc. will also be a gamechanger.
What is the most difficult thing about your career?
A patient presenting late and losing a patient. This is difficult because you wish you could have done more. It is difficult to break news to his family as it involves the loss of a patient whom you have shared a journey with.
Doctors grieve with family on losing a patient. Fortunately, this is a rare event in the practice of urology.
What are the myths and misconceptions surrounding prostate cancer?
The number one myth that I hear all the time is that you need to have more sex to reduce your risk of having prostate cancer. Diet? There's no scientific evidence that there's anything that you consume that increases your risk or reduces your risk.
Is urology lucrative?
Medicine is a rewarding career in many ways. Financially, the medical profession offers decent rewards. Surgeons often enjoy a comfortable lifestyle, with remuneration that reflects the immense responsibility and skill required in our field.
However, the true richness of my life extends beyond mere monetary gains. The intangible rewards—like the smiles of grateful patients and the camaraderie of my colleagues—are priceless.
In many ways, my career as a surgeon is a testament to the idea that true wealth also comes from the fulfilment that comes from helping others.
Each day presents new challenges, but also new opportunities for growth and learning. The operating room is my canvas, and with every procedure, I strive to create a masterpiece of healing.
