Vasectomy: One Small Snip For Man, One Giant Leap For Humankind(ness)
Columbian-born American award-winning Family and Reproductive Health Specialist, Dr. Esgar Guarín (goo-ah-reen) talks about his journey that led him to becoming a full-time vasectomist. Using a mobile vasectomy clinic as his advocacy vehicle to drive around the US spreading humor and activism, while offering free on-site mobile vasectomies, Dr. G is on a mission to help destigmatize male reproductive responsibility for the love of their partners and the planet.
In this episode, we discuss the simplicity of a non-scalpel out-patient vasectomy procedure, the statistics and stigma surrounding sterlization, and the need to reclaim the procedure for reproductive liberation and responsibility.
MENTIONED IN THIS EPISODE:
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Character Michael Scott from the TV show, The Office 0:00
I said that I wanted to have kids and you said that you wanted me to have a vasectomy. What did I do? When you said that you might want to have kids and I wasn't so sure, who had the vascetomy reversed? And then when you said you definitely didn't want to have kids who had to reverse back? Snip, Snap, Snip, Snap, Snip, Snap.
Alan Ware 0:17
That was a confused and frustrated Michael Scott from the American TV show The Office. To talk all things vasectomies today's guest on this episode of the Overpopulation Podcast will reveal the wisdom in his personal reimagining of a famous saying, ‘one small snip for man, one giant leap for human kindness’.
Nandita Bajaj 0:46
Welcome to the Overpopulation Podcast, where we tirelessly make overshoot and overpopulation common knowledge. That's the first step in right-sizing the scale of our human footprint so that it is in balance with life on Earth, enabling all species to thrive. I'm Nandita Bajaj, co-host and executive director of Population Balance.
Alan Ware 1:09
I'm Alan Ware, co-host of the podcast and researcher with Population Balance, an organization that educates about and offer solutions to address the impacts of human overpopulation and overconsumption on the planet, people, and animals.
Nandita Bajaj 1:25
We are really excited to welcome Dr. Escar Guarin to our podcast today. But before we dive into that conversation, we do have some listener feedback we'd love to share with you.
Alan Ware 1:35
That's right. We've got a letter from K. And he says, ‘You did it again. You added another intelligent and very capable woman to your team. Dr. Phoebe Barnard said it very well. The men should step aside in our critical time in human history, and let women take over the leadership to fix the mess we have created. And here's one from Stephanie. She says ‘I cannot say bravo enough times for all the informative podcasts Population Balance has and is producing. I forward your name and podcast to people constantly. I am a marine biologist and know that the only answer to help save us and every other species on the planet is to face the overpopulation crisis. Of course, we need to still focus on all the other green things we are doing. But those will never be enough and nothing is sustainable unless our human numbers are. Your podcasts give us solid information to educate others on this critical topic.’
Nandita Bajaj 2:32
Well, thank you so much, K. and Stephanie, for your really valuable feedback. We encourage all of our listeners to write to us to share your feedback at podcast at population balance.org or by simply using the contact page on our website, populationbalance.org.
Today's guest Dr. Esgar Guarín is a board-certified Family and Reproductive Health Specialist originally trained in Columbia. He is a fellow of the American Academy of Family Physicians in the US and a member of the Medical Advisory Board at World Vasectomy Day. Now based in Iowa, Dr. Guarín was awarded the family physician of the Year Award from the American Academy of Family Physicians in Iowa in 2017. always interested in the provision of reproductive services, particularly those of minimally invasive nature, Dr. Guarín had the privilege of training in the non-scalpel, no needle vasectomy technique with renowned Dr. Doug Stein in 2012. Since then, Dr. Guarín has been performing his simple vas vasectomy technique, with similar outcomes to those of his mentor. Committed to the promotion of vasectomy as the most effective method of permanent sterilization, he now works as medical director of SimpleVas Vasectomy Clinic in Iowa. Dr. Esgar Guarín, it is so great to have you with us today. Much of our work at Population Balance is about offering education and advocacy for reproductive autonomy and reproductive responsibility. And we're so excited to bring you into this conversation because you've been spearheading the same work, but for men. Which is really fantastic, because traditionally, men have been largely missing from these conversations. And what's even more exciting is the way you are approaching this work. You are bringing in humor, creativity, and lots of determination. So welcome to our podcast.
Dr. Esgar Guarín 04:36
Nandita, thank you very much for having me here. Alan, thank you very much for having me here. I'm really excited. I have had an opportunity to learn about what your organization does, and it's a wonderful opportunity to be here sharing a little bit of what I do and what we do from World Vasectomy Day, which is a nonprofit that I belong to.
Nandita Bajaj 04:54
We can hardly wait to talk to you. And we'll start with our first question which is that you've been practicing medicine for twenty years, and you've moved from general practice to obstetrics to performing vasectomies, which is now your full-time work. What motivated your journey to becoming a surgical vasectomist?
Dr. Esgar Guarín 05:14
I will tell you that from a very early age, I learned the power of the word vasectomy. And the reason for that was because about the time I was ten or eleven years old, I heard that my mother demanded that from my dad. And judging by the facial expression of my father and his immediate behavior following that demand, I questioned the power of that word. And I didn't know clearly what it was. Later on, when I went to medical school, obviously, I understood what this was. And I was amazed about how simple this procedure was in the potential impact from a public health standpoint, this procedure could have. But in medical school, at least in my country in Colombia, the idea of doing vasectomies meant that I had to dedicate myself to the training of urology, which is a very specific specialty dedicated to the genital-urinary system. It made sense. But it seemed that for such a tiny procedure, it was a big undertaking that I really didn't want to take, I didn't want to go that path.
Nandita Bajaj 06:16
Sure.
Dr. Esgar Guarín 06:16
I completed my medical training, and I worked for the government in Colombia, which is required after medical school for you to get your license, in a very small town. Twenty-five hundred people in the town and twenty-five hundred people scattered throughout the mountains in the middle of the Andes in Colombia. And that experience changed my life and changed what I wanted to do with medicine, which had been initially actually, psychiatry. I was really, really interested in the behavior of people. You know, the reason why people do certain things, the reason why people choose certain things - that was very interesting to me. But that experience in Colombia changed my mind. So you know, I was the only physician in that small town, so fresh out of medical school, twenty-three years old, and having to deal with everything in that town. So we ended up delivering about fifty-five pregnancies, took care of children, injuries. I would go to the mountains and take care of people in the mountains every two weeks. I would see sixty, seventy people at a time. It was great. I mean, it was one of those things that really makes you feel like you've made the right decision with your life when I decided to choose that as a profession.
Nandita Bajaj 07:20
Sure.
Dr. Esgar Guarín 07:21
But I felt that I didn't have enough training. I ended up coming to the US because of my wife. She's a microbiologist, and she came to do some training at the University of Maryland. We actually met at that small town. And then when it became a permanent thing, I had to validate, so to speak, my training in the US-
Nandita Bajaj 07:38
Right.
Dr. Esgar Guarín 07:39
So I could continue with my training. And I learned about this thing called family medicine. And I saw that would allow me to reach out to young families, which had been a huge impact for me during my brutal social mandatory service in Colombia. So I decided to do family medicine, but mostly because I wanted to take care of pregnancies and children. Obviously, that allowed me to see a lot of the difficulties that women have to go through in terms of reproduction, and brought up again that interest on vasectomies and what you can do with a vasectomy. Normally, family physicians have rotations through urology, and during my rotation through urology, I asked to be trained on that. I'd say, I mean this is simple procedure. You need to know the anatomy, doesn't have major complications. But the urologist said no, "No, because you're your family doctor." And at that point, I didn't know that the majority of vasectomies in the world are actually performed by GPs - general practitioners and family physicians. 43% of the vasectomies in Canada are performed by family physicians. But it was very disappointed. So when I finished my training in family medicine, I wanted to acquire additional training to get more skills in the care of pregnancies and children and newborns. So I went to Providence in Rhode Island, and I did an additional training - two years in maternal and child health. During that time, I remember approaching my program director and telling her I really want to learn how to do vasectomies, and she's like, "Well, you're doing an obstetric and newborn fellowship." And I said, "Yeah, but it's just, this is maternity care if I can reduce unintended pregnancy.
Nandita Bajaj 09:15
Sure.
Dr. Esgar Guarín 09:15
I am reducing, in a certain way, maternal mortality.
Nandita Bajaj 09:19
Yeah.
Dr. Esgar Guarín 09:19
So why would I?" And she said, "Oh, okay, go and talk to the neurologist to train." And I said, "No, they're not going to do it." And sure enough, they wouldn't do it. And I needed her leverage, and it never happened. It wasn't until I was done. So I stay there two years, and I and I stayed up there for an additional year as a faculty at Brown University. And then I decided to leave to a place where my skills could be better used. So I ended up in the Midwest for that reason. But it wasn't until after I had left the academic arena, that I was able to find somebody who would train me, and then I got that training. So that's how I went from, you know, being crazy, no pun intended about psychiatry in medical school all the way to do and vasectomies. So I learned how to do them. But it was one more thing that I did. It was not the main thing I was doing.
Nandita Bajaj 10:10
Sure.
Dr. Esgar Guarín 10:10
It was important to me to offer it. Because of my work with pregnant women. I was more interested in doing of a vasectomy than doing a tubal ligation on a patient, and I will try to offer it. But there is resistance. People are expecting women to make that decision. And that is not right. So I went through several years of practice, I got my fair share of sleep deprivation with the practice of obstetrics. And finally after seeing from the front row, everything that women go through, and how the burden of contraception has been unfairly placed on the shoulders of women, and some experiences I had along the way that I said, I just don't feel that I'm having enough social projection beyond the patient and the family that I have in front of me. And I felt that it was doing something good, but it just didn't feel like it was enough.
Nandita Bajaj 10:58
Sure, still, like at an individual level, right? You're helping individual families and individual children but not changing behaviors at a large scale.
Dr. Esgar Guarín 11:08
And I was already having kind of a taste of that bigger social projection, because I had started going, since 2015, I became associated somehow with World Vasectomy Day, because of the person I trained with. So I just felt that I needed to spend more time doing that. And that in every single time I was going overseas for a training mission and teaching how to do vasectomies and talking about vasectomies, I just felt so re-energized. You know, I will be wiped out completely from endless sleep-deprived nights-
Nandita Bajaj 11:43
Yeah.
Dr. Esgar Guarín 11:43
Doing obstetrics, with the satisfaction of obstetrics, helping these families navigate through the whole process. But I would be wiped out, completely exhausted. And all of a sudden, without being a vacation, because whenever we've gone to Haiti or we've gone to South America, you know, we get there. And the very same day we start working. It's like doing vasectomy, teaching, doing vasectomies. I mean, we don't stop.
Nandita Bajaj 12:05
Yeah.
Dr. Esgar Guarín 12:05
But I will feel so re-energized coming back, that my wife, I mean, she got to spend time with me while I was doing all that. And then she said, "I understand why. It's that you come back so crazy excited-
Nandita Bajaj 12:18
Yes.
Dr. Esgar Guarín 12:19
Every time you go to these things." Because it's a group. It's a big group of like-minded people who want to do something good.
Nandita Bajaj 12:26
Yes.
Dr. Esgar Guarín 12:27
And it's different. You know, I felt like I was caught in their routine of the medical practice in the US. And I was just trying to be an isolated silo where I would do things my way in terms of that social projection, but it was very limited. So about a little over a year ago, I said no more, that's it. And it was a difficult decision for several reasons. Because are you going to just do vasectomies? Yeah, well, you have to pay the bills with that, that's one thing. Two, I had to leave something that I had trained myself for.
Nandita Bajaj 12:57
Yeah, yeah.
Dr. Esgar Guarín 12:58
To take care of pregnancies, and to take care of young families. And basically, I'm going to put that on the side. Initially, it was difficult, because the thought process was, I'm going to waste everything I did. And that couldn't have been any more wrong than that.
Nandita Bajaj 13:11
Right.
Dr. Esgar Guarín 13:12
Because it was not wasting it. It was what I needed to understand even more what I'm doing now. The whole experience of going through the entire medical practice, just gave me enough material to understand, and not only understand, but also to have enough arguments to promote what I'm doing right now.
Nandita Bajaj 13:32
Yes. Oh, I love that story. I'm so glad you went into the details of how it came about, because it shines through basically, when you're speaking and in the work that you're doing that everything that you've been doing in the last twenty years was leading up to this moment and preparing you to this work, which you are such a wonderful advocate for. You took it even a step further into your advocacy. You started a mobile vasectomy trailer-
Dr. Esgar Guarín 14:02
Yes.
Nandita Bajaj 14:02
To help us normalize and make vasectomies more accessible. We'd love to hear what that journey was like.
Dr. Esgar Guarín 14:11
I've always realized in the practice of medicine, whenever you do something that people are not expecting, you create a higher impact. And I'm not trying to write anything in psychology. I mean, everybody understands that. I mean, if you are disruptive, that is going to create a bigger imprint in the mind of people. So, but in my own personal practice of medicine, I always did that. If I say well, I'm gonna go and see you at home. It's like the doctors gonna come and see me at my house, right? Or if I answer the phone and I call the patient myself, which sometimes is what should be done.
Nandita Bajaj 14:46
Yes.
Dr. Esgar Guarín 14:46
But it is not necessarily expected in environment like in the United States. People will be like, "Oh, this guy call me." So I understood very early that whenever you're doing something unexpected, you really create that commotion that would lead to perhaps behavioral changes, or at least would leave the idea lingering of what you want to accomplish. That's why, when in 2017, when we went to World Vasectomy Day in Mexico City, the Secretary of Health allowed us to operate in mobile units. And these are mobile, primary care units. That mean this is not a novel idea. It's been used in other countries as well, for placement of Nexplanon, or implants, IUDs, and regular visits and checkups. It was a great opportunity. So we had four of these trucks parked alongside the Monumento de la Revolución, which is like the National Mall in Washington, DC, but in Mexico City, so this is very representative area in the core of the city. We did a hundred and thirty vasectomies that day. People come in off the street, we had a process it up, they'd come and talk to a social worker, they will come and then talk to a general physician, and then come and get a vasectomy with us. And I thought it was fantastic. Because one of the things that is so wonderful about vasectomies is is the mobility of vasectomies. And what I mean by the mobility is that you can put it anywhere without requiring a lot of infrastructure, which is what doesn't happen with a tubal ligation.
Nandita Bajaj 16:15
Right.
Dr. Esgar Guarín 16:16
Right? A tubal ligation requires an operating room. And even though there are countries like in Bolivia, and India, where there there are programs to do tubal ligations under local anesthesia, which is, if you ask me, I think it's barbaric. It doesn't still have the same mobility, because you have to have a different kind of setup for that. So vasectomies have this wonderful mobility, that using a vehicle, a medical vehicle, where you can just transport the surgeon to places. But in countries like in Mexico, or in Indonesia, where World Vasectomy Day actually had an opportunity to do a similar thing. And also in Nepal, which has been described in the literature, that whenever you use those units, the uptake of reproductive services increases. It's done in those places, because they don't have the surgeons in remote areas, and they want to travel with the surgeon. Doing it in the US didn't seem like that was going to be the reason for it. So I saw that, I thought it was brilliant, I was I thought it was genius. I said, "This is ridiculous. This is a great way to talk about vasectomies." And we can do it in the States, we have better roads.
Nandita Bajaj 16:32
Yeah.
Dr. Esgar Guarín 16:33
I mean, it's flat land in many areas, so we can just drive without the worry of just having to drive around the Andes, like in my country, Colombia. So it's much better. But we don't do it there because there are not enough vasectomy surgeons, but because people are not talking enough about that.
Nandita Bajaj 17:43
Sure.
Dr. Esgar Guarín 17:43
So I came back with that crazy idea. And I had that idea in my head for three years. Three years. And I said if I do that here, nobody would expect that. We live in a society where medical care is expected to happen at the ivory tower.
Nandita Bajaj 17:57
Yes.
Dr. Esgar Guarín 17:57
Anything outside of the ivory tower is just not good enough. That's a third world thing.
Nandita Bajaj 18:02
Yes, right.
Dr. Esgar Guarín 18:03
Which is inappropriate. That's not good. And that's not true. We do know that if we were to take a lot more procedures and things out of the hospital, then the health care will be less expensive. And we know that only 10% of the diseases actually make it to the hospital, 90% of the diseases can be managed in the outpatient setting.
Nandita Bajaj 18:23
Wow, that's an incredible stat.
Dr. Esgar Guarín 18:26
A lot of prevention would go a long way, you know, freely the patients who end up in the hospital are the ones who make the news, but there's a lot of stuff that happens outside. So because people are expecting that red carpet treatment, coming up with something so unexpected, like a mobile unit doing vasectomies, when this perception exists of this major surgery, which is going to be disruptive - either is going to be culturally disruptive, or is going to be financially disruptive for me if I do it, because I'm just going to waste my effort and my finances doing something like this. So I toyed around with the idea. And finally, in 2020, that was my transition from doing obstetrics. I was doing it, I say that's when I really got itchy for me to leave and start doing something at a bigger scale. I told my wife and said, "This is the idea. You know I've been thinking about this a long time." And thank goodness she bought into that, because otherwise I wouldn't have been able to do it. Because it came out of our own resources to do that. World Vasectomy Day has been very instrumental in in supporting us, but it's been a lot of moral support to put it that way. But most of the finances have come out of what we have.
Nandita Bajaj 19:41
Sure.
Dr. Esgar Guarín 19:42
And it was a huge gamble. And to be honest with you, we never did it thinking we were gonna get financial return out of that. And we don't actually. The bulk of my vasectomies, the vasectomies that I do that pay the bills happen in the two offices that I have.
Nandita Bajaj 19:55
Right.
Dr. Esgar Guarín 19:55
The mobile vasectomy clinic has been literally the vehicle of my activism. And every month I travel around the state. This mobile vasectomy clinic, it's a medical office on wheels that has a bunch of very suggestive messages around it. And a lot of sperm, and somehow, when people see sperm, they giggle-
Nandita Bajaj 20:18
Totally!
Dr. Esgar Guarín 20:19
And that gets their attention.
Nandita Bajaj 20:20
Yes.
Dr. Esgar Guarín 20:21
So we travel around and do that. And it's purely for the frivolitism of it, you know, just for the activism.
Nandita Bajaj 20:28
Yes.
Dr. Esgar Guarín 20:28
To talk more about this.
Nandita Bajaj 20:29
Right.
Dr. Esgar Guarín 20:30
And generate that controversy that elicits conversations.
Nandita Bajaj 20:33
Yeah, it certainly did.
Dr. Esgar Guarín 20:35
But that's what it said, you should say crazy, because it was crazy. It was a, it was a crazy idea.
Alan Ware 20:40
Do you get covered by media in Iowa newspapers and radio?
Dr. Esgar Guarín 20:44
We did. So the mobile unit is nothing but a big box, right? And it was black. And when we got it, what we did was we put some wrapping around it with some messages, because the idea is just to generate the discussion. We didn't want to be discreet. Let me put it that way. I didn't want to just this black thing that looked like an office driving around. No, no. We-
Nandita Bajaj 21:05
Create even more taboos.
Dr. Esgar Guarín 21:07
That's right. It's like, oh, no, the secrecy of vasectomies. Just make it, get it out of the closet, so to speak.
Nandita Bajaj 21:14
Yes.
Dr. Esgar Guarín 21:14
We got this wrapping, and it was it was eye catching, it was kind of yellow with black, kind of go in a little bit with the colors of the state, because people here is like the Hawkeyes and Iowa State University. So anything that has those red, yellow, and black colors just gets people attention, because people are very, very fanatics of the college sports. And put the messages you know, "Time to be responsible," "Love with respect." And then the very back of the trailer, it says, "Honk if you got a vasectomy." And people would just do that. And we started seeing that coming up in social media. I was really not following social media enough to see how much was happening. But then for World Vasectomy Day, this year, when we decided to make a trip to New York City with a trailer, we changed the entire wrapping, and we changed the words that we put there, and we changed the color - made it black and white, and wrote the word vasectomy really big in both sides, and put a ton of sperm. So it has a meaning to it, because it's just this sperm going towards the front of the trailer. And then the word vasectomy, and after the word vasectomy, there's nothing.
Nandita Bajaj 22:24
Right.
Dr. Esgar Guarín 22:24
It's a black void. So it's just this idea that, you know, the vasectomy stops them. And then that actually created more interest. You know, perhaps the graphics were more eye catching this time. And one of the local news channel caught it and they put it in online. And there was a lot of people making comments. Obviously there were, you know, good comments, there were people making jokes, which I absolutely adore. I just love the fact that people get excited about it, because they talk about it.
Nandita Bajaj 22:51
Sure.
Dr. Esgar Guarín 22:52
And there was a lot of people complaining, it's like, "Oh, I wouldn't get into one of those things. That's not sanitary." Obviously, no one is going to do something that doesn't meet certain standards for patients. But there was so many of them that the Secretary of State came public and said, actually, this is real.
Nandita Bajaj 23:10
Wow!
Dr. Esgar Guarín 23:10
This guy is registered with the Secretary of State's office, his business is registered, as in people were questioning - is this true? Is this real? And the Secretary of State himself came out and made a comment about that, which was hilarious. And it was a great, great starter for our trip to New York.
Nandita Bajaj 23:28
Wow. That is an incredible, incredible story.
Dr. Esgar Guarín 23:32
It was really interesting.
Alan Ware 23:33
Yeah. As far as the surgery itself, you perform a no scalpel, no needle form of surgery, right?
Dr. Esgar Guarín 23:40
Yes.
Alan Ware 23:40
So it's not a cut cut, snip snip - the way men might imagine something painful, or can you give us a sense of how the procedure works?
Dr. Esgar Guarín 23:50
Yes, it's not that I came up with anything. I mean, there's way smarter people than me who have come up with that. In the 1960s, Dr. Li Shunqiang, a urologist from China, he was very interested on contraception. And if you remember, back then in China, there was this one child policy and they were trying to control natality there. And the use of a scalpel seemed relatable to the idea of castration for men.
Nandita Bajaj 24:18
Wow.
Dr. Esgar Guarín 24:18
In order to make it simpler, he started thinking about what to do, and he was trialing some chemical catheterization, so to speak, of the vas deferens. And then he came up with the idea of sharpening a forceps, an instrument, it made it very, very sharp and pointy. And he came up with the idea of, instead of cutting the skin, to puncture the skin, and then take advantage of the elasticity, the elastic fibers of the skin. So you poke a hole and then spread the skin. It's very different than cutting the skin because when you cut the skin, you are cutting the fibers so you have to put them back together. So if you spreading this skin, then you don't have to put it back together. And what happens when you put it back together, that means when you put a suture again to try to close the wound, is you cause more trauma.
Nandita Bajaj 25:03
Sure.
Dr. Esgar Guarín 25:04
So he came up with that. And that was a success because, not only it was more appealing to men, but also the recovery time improved considerably. So in the mid eighties, actually, there was an organization now that is called EngenderHealth that took a group of physicians to China to learn with Dr. Shunqiang and they learn how to do vasectomies this way, and they brought it back to the US. So it really started taking off by the mid-nineties. But still, by the end of the nineties, 29% of the vasectomies that were done were just non-scalpel and that is the non-scalpel technique. So we do it that way. Basically, with a regular vasectomy or classical vasectomy, you have one incision in each side of the scrotum. And you use those incisions to take the vas deferens out, you cut the communication of the vas deferens, you cut the vas deferens and then you do certain things to occlude the vas deferens to avoid that they get together again. Because of the cutting that happens with a scalpel approach, you have to put a suture, the trauma's higher. With the no scalpel, you use a single opening, so you puncture the skin in the center of the scrotum, and using the same opening, you get each individual vas deferens one at a time, and cut it, and do the procedures that you need to do in order to occlude it. The difference is ridiculous. The potential risk of a hematoma, which is the biggest concern with a vasectomy, if it were to happen, was reduced considerably. So the chance of a hematoma with a classical technique with scalpel is about 3.1%. Whereas the chance of a hematoma in the hands of an experienced surgeon is is less than 0.4% with a non-scalpel technique. It's much better.
Nandita Bajaj 26:49
Sure.
Alan Ware 26:49
And this is a fifteen minute procedure?
Dr. Esgar Guarín 26:52
Yeah, ten to fifteen minute procedure.
Alan Ware 26:54
Wow.
Dr. Esgar Guarín 26:54
That's right. I know some people, if they're not doing it often enough, then it can take them thirty minutes. But still, considering the fact that the patient comes in walking and leaves walking after that and doesn't have to stay for recovery and doesn't have to go through the general anesthetic that a woman has to go through for tubal ligation, then it makes it absolutely much better.
Nandita Bajaj 26:56
And a perfect candidate for a mobile clinic.
Dr. Esgar Guarín 27:03
Exactly! That's my point. You just park anywhere and just do it, right? If you think about that, in terms of going back to the mobile clinic, there are a lot of other things that could be done that way.
Nandita Bajaj 27:30
Sure.
Dr. Esgar Guarín 27:31
But we are so stuck in this ivory tower mentality in terms of the provision of health care, that it's difficult for people to accept that.
Nandita Bajaj 27:40
Yeah.
Dr. Esgar Guarín 27:40
Reproductive health services, as I said, in other countries have been better accepted, and have had increased use because of the mobility that our unit like that will provide. So why wouldn't we do something like that? Can't we just go to a town and then have a mobile reproductive service unit where you can provide, you know, implants, IUDs, STD screening, and do vasectomies on top of everything? I think that'd be fantastic.
Nandita Bajaj 28:07
When you speak about it, it seems like a no brainer.
Dr. Esgar Guarín 28:09
That's right.
Nandita Bajaj 28:10
Especially given how many contraceptive deserts there are, even in, you know, a lot of states within the US. And given the high rates of unwanted pregnancies. So many of them are because of lack of access-
Dr. Esgar Guarín 28:25
That is correct.
Nandita Bajaj 28:26
Not always lack of information. A lot of people just aren't able to get to reproductive care services.
Dr. Esgar Guarín 28:33
That's right. And doing it that way, I mean, we carry four instruments, that's all I need. Four instruments. And the procedure is really quick. And the way I do it, which is the way many of the surgeons from the from World Vasectomy Day do it, is just me. I really don't even have an assistant because that's exactly what we go and teach overseas. That all you need is a very well experienced surgeon to do it.
Nandita Bajaj 28:59
Yeah.
Dr. Esgar Guarín 28:59
You know, compared to tubal ligation, you need the surgeon, you need an assistant, which is the scrub tech usually, you need a circulating nurse, you need the OR, you need the anesthesiologist, the infrastructure - the human infrastructure, and the fiscal infrastructure is much bigger, which makes it much more expensive, which is part of the pitch that I have every time we go to another country that doesn't have the promotion of vasectomies as much as they should have it. It's like, why are you doing this many tubal ligations? If you do as many vasectomies it's way cheaper.
Nandita Bajaj 29:31
Sure.
Dr. Esgar Guarín 29:31
It just doesn't make any sense, even from the economic standpoint.
Nandita Bajaj 29:36
And isn't the number something ridiculous? Like there are six times as many tubal ligations worldwide?
Dr. Esgar Guarín 29:42
Yes. And that's one of my personal concerns and my personal missions. There's a big gap in between the utilization of tubal ligations and vasectomies. Worldwide, approximately there are thirty-three million vasectomies done. Out of those thirty-three million, twenty million alone are done between China and India, but the population is somewhere about 1.3 and 1.4 billion, which just makes sense that that many happens there, just by pure difference of population. I don't know about the numbers recently, because in China it has been very difficult to get vasectomies lately-
Nandita Bajaj 29:42
Yeah.
Dr. Esgar Guarín 29:52
Because of the change in the policy of the government.
Nandita Bajaj 29:52
Yeah.
Dr. Esgar Guarín 29:52
And now they want more people.
Nandita Bajaj 29:52
Exactly.
Dr. Esgar Guarín 29:54
They're limiting the access to vasectomies, which is a shame. But thirty-three million vasectomies done a year give or take, versus two-hundred and twenty-five million tubal ligations in the world.
Alan Ware 30:34
Wow.
Dr. Esgar Guarín 30:35
The discrepancy is huge.
Alan Ware 30:36
Well, it's interesting. You've mentioned on another podcast that we listen to that the ratio of ligations to vasectomies varies by culture and place-
Dr. Esgar Guarín 30:45
Correct.
Alan Ware 30:46
Where you said the US was two to three times?
Dr. Esgar Guarín 30:48
For every vasectomy that happens in the US, it's about two to three, depends on where you are, tubal ligations.
Alan Ware 30:54
Okay.
Dr. Esgar Guarín 30:55
So it's about twice as many tubal ligations, you can argue that that's not that bad, particularly considering that about 49% of the tubal ligations happen after pregnancy within forty-eight hours of birth, which means they either get it in a cesarean section, or it happens after the patient has given birth.
Nandita Bajaj 31:13
Sure.
Dr. Esgar Guarín 31:13
And actual surgery on top of the birth, you know, the C-section, it makes total sense, the patient has her abdomen open already. And the tubes are readily accessible for the surgeon to do the procedure.
Nandita Bajaj 31:24
Makes sense.
Dr. Esgar Guarín 31:25
But the rest of them are what we call interval tubal ligations, which means the patient is not pregnant, you know, and she has chosen to be sterilized, which is half of what happens in the US - the US give or take about 700,000 tubal ligations per year, about 345-350,000 are interval tubal ligations. So to me, those are 345,000 opportunities to do vasectomies.
Nandita Bajaj 31:54
Yeah.
Dr. Esgar Guarín 31:54
Right? Because if the other ones are happening, assuming that they all were happening because they occurred within a cesarean section, then you don't count those.
Nandita Bajaj 32:03
Yeah.
Dr. Esgar Guarín 32:04
But not all of those 355,000 happen after a cesarean section, nearly half of those happen at that point. Those are another 120-130,000 plus opportunities to more vasectomies.
Nandita Bajaj 32:17
Yeah.
Dr. Esgar Guarín 32:18
It seems like oh, it might not be that bad, because you have to consider those factors when you see the ratio, especially if you compare it to other countries. You know, you look at Bolivia, or you look at Ecuador. In Ecuador, for every vasectomy that you do, there are thirty tubal ligations done.
Nandita Bajaj 32:33
Wow.
Dr. Esgar Guarín 32:34
I mean, that's the huge gap. When we see the difference between the number of tubal ligations and vasectomies that happen worldwide, all I can see when I see those numbers is that men are absent. Men are not participating in reproductive health matters as much as we could. Because continuously we think that this is a thing of individuals with female parts.
Nandita Bajaj 32:57
Sure.
Dr. Esgar Guarín 32:57
That's what we think.
Nandita Bajaj 32:58
Yeah.
Dr. Esgar Guarín 32:59
And that's in part because men have had the idea that getting a vasectomy might take something away from them, right? Not just their ability to get their partners pregnant, which is the intended effect, but something else goes away.
Nandita Bajaj 33:13
What are those misconceptions?
Dr. Esgar Guarín 33:15
Well, the misconception is that's going to affect my erection, it's going to affect my libido, my sexual drive is going to be different. And they cannot be more wrong than that, because none of those things are affected. But because of that fear in the collective mind of men, we don't talk about that.
Alan Ware 33:31
You mentioned in Quebec, eight or nine times as many vasectomies versus-
Dr. Esgar Guarín 33:36
Yes! So overall in Canada, the ratio is totally inverted. So in Canada, for every tubal ligation that is done that are two to three vasectomies done-
Nandita Bajaj 33:47
Really!
Dr. Esgar Guarín 33:47
In the entirety of Canada. Yes. So in Quebec City, it's higher. Is it because of the people who are doing vasectomies there, which one of them is Dr. Michel Labrecque, a really good friend of mine who perhaps one of the people who knows the most about vasectomies in the world. He's published ridiculously on that, and he is responsible for a lot of those vasectomies in Quebec City. I mean, his practice, they do, I think about three-thousand vasectomies per year, so it's a really big practice. So that could have something to do with that, but also is the acceptance. You know, anecdotally I tell you that talking with Michel, it tells me that many of the gynecologist actually tell their patients, "Hey, tell your husband to get a vasectomy instead."
Nandita Bajaj 34:27
Yes.
Dr. Esgar Guarín 34:28
"Well, why are you gonna get a tubal ligation?"
Nandita 34:30
Yeah.
Dr. Esgar Guarín 34:30
And they could be doing that tubal ligations.
Nandita Bajaj 34:32
Yeah.
Dr. Esgar Guarín 34:32
Right? Let's just put it plain, simple at the financial level. It's more interventions for them, it's more revenue for the gynecologist, but if the gynecologist says, "This is not the right thing for you, just tell your husband."
Nandita Bajaj 34:43
Yeah.
Dr. Esgar Guarín 34:43
"Why are you gonna go through that?" And then, I think behind that, there's a lot of empowerment. Empowerment of women, perhaps also empowerment of men, you know, feeling like they can do something about that. So I personally hold very close to my heart the idea, the mission of flipping that relationship in the United States, because we're not too bad. I mean, men are participating. But I can flip that relationship and make it look more like Canada. And that is exactly the same reason why I'm so passionate about going to other countries, because I see that the participation is not there. Colombia, my own country, similar thing. There's about twenty tubal ligations per vasectomy done in Colombia. That's not okay.
Nandita Bajaj 35:25
Yeah.
Dr. Esgar Guarín 35:26
That means men are not participating enough. And granted, we don't have a whole lot to do in terms of contraception. I mean, it's condoms and vasectomies.
Nandita Bajaj 35:35
Yeah. And World Vasectomy Day was actually founded in 2012, right, by Jonathan Stack and Douglas Stein?
Dr. Esgar Guarín 35:42
Correct. Yes. Jonathan Stack is a filmmaker, very accomplished one. He's gotten a couple of Emmy Awards and has been nominated for documentaries to the Academy Award. And Douglas Stein, who's a urologist and based out of Tampa, Florida - they both created World Vasectomy Day. It all started after Jonathan Stack had his own experience about his vasectomy. He got to that point in his life when he thought about making that decision. And as a good filmmaker, he wanted to document everything about his decision. So he started visiting different people within the community of urologists and vasectomists, and one urologist in New York City where Jonathan is from, told him, "You should meet Doug Stein." He said, "Who's that guy?" "Oh, this urologist. Does a ton of vasectomies down in Florida. That's all he does. He travels around the peninsula doing vasectomies." So he went to meet him, and Doug had been working with a now retired urologist. He's originally from the Philippines, who created an organization, a nonprofit called Non-Scalpel Vasectomy International. The Philippines is overly populated.
Nandita Bajaj 36:52
Yeah.
Dr. Esgar Guarín 36:52
And he wanted to provide services for free. And Doug, they knew each other and Doug was working with him. And they they started going to Haiti as well. So Jonathan saw that work, and he got very interested. Jonathan is, as a filmmaker, he was very accomplished doing documentaries, but all these documentaries have been in areas, as he would say it, where men are doing wrong things, things that didn't help society. It was war documentaries.
Nandita Bajaj 37:20
Sure.
Dr. Esgar Guarín 37:20
You know, documentaries in jails. You know, he's very well known at Angola prison down in Louisiana, because he's gone there many times and done several documentaries in that prison. He says that he was at a point in his life when he felt that he just couldn't see anything good in men, you know, in people. And when he started going around with Doug Stein, he wanted initially just to talk about his own vasectomy, and he saw what he was doing. He started following him. And he started asking every guy who was getting a vasectomy why they did it.
Nandita Bajaj 37:53
Yeah.
Dr. Esgar Guarín 37:53
And he started seeing that every single person, all of a sudden, was talking about love when they were doing it.
Nandita Bajaj 38:01
Wow.
Dr. Esgar Guarín 38:02
And, "I'm doing it because my wife has gone through enough. And I think I should do this for her." So he saw that men were doing it for the love of their partners. "I'm doing it because I have three children already. And I cannot afford any more children. You know, I want to be able to give to my three children what they need when they need it." And so he saw that men were doing it for the love of their children. And even men without any children would come and get a vasectomy and say, "Well, I'm doing it because it's too many of us on this planet. And I really don't have an interest in having children." And so he saw that men were doing it for the love of the environment as well. So it just changed completely his mind.
Nandita Bajaj 38:41
Yeah.
Dr. Esgar Guarín 38:42
He said men are capable of doing good.
Nandita Bajaj 38:44
Yes, right.
Dr. Esgar Guarín 38:45
And then it just changed completely. So he stopped doing the whole film that he was doing about himself getting a vasectomy and made an entire documentary on Doug Stein. It was on Netflix for a while. It's called The Vasectomist, and talk about him and what he was doing. And with those trips, they decided to go to Adelaide, Australia in 2012 and do this big event where they thought they could do live, televised vasectomies and cameras will be rolling. And they were just put them in on TV and people were volunteers and they were signing waivers, so they did live vasectomies. And that was the very first World Vasectomy Day. That was in November in 2012, in Adelaide, Australia. Jonathan says that he thought, well, this is a one time thing. It's been nine years and every year we're doing this. And some of us got into that along the way. I got involved with them in 2015. It is really exciting every time we have an activity like this. So every year it's been a different country. We've been to Kenya, Indonesia, Rwanda, Haiti, Colombia, we've been to Ecuador. And in every single experience, it's just fascinating. So this is going to be our tenth anniversary, and we're planning on doing something even more meaningful this year.
Nandita Bajaj 40:03
Wow. Yeah, when you look at the degree of impact that you can have with different types of actions, this is one tiny little action that has probably the most impact environmentally, in terms of human rights, in terms of animals, in terms of how our planet is being dominated by so many of us.
Dr. Esgar Guarín 40:27
It is absolutely fascinating to me.
Nandita Bajaj 40:30
Yeah.
Dr. Esgar Guarín 40:30
And that's why we can talk and talk about this for days. It is fascinating to me the potential impact and so many aspects, as you just said, Nandita, that a vasectomy can have.
Nandita Bajaj 40:40
Yeah.
Dr. Esgar Guarín 40:40
One of the things that I've always said is that man who comes in and gets his vasectomy, he could be a wonderful man who's had, you know, two or three children who's doing this because he realizes that he has to play a role in reproduction.
Nandita Bajaj 40:55
Yeah.
Dr. Esgar Guarín 40:55
And he wants to show that he cares for his family, and he's making a responsible decision. During those ten minutes, you know, he's getting his vasectomy, he's a wonderful, wonderful person.
Nandita Bajaj 41:07
Yeah.
Dr. Esgar Guarín 41:07
He's showing that he cares, right? Or you can be a really bad person who has four children with three different women and pays no child support whatsoever, and doesn't care about the environment.
Nandita Bajaj 41:21
Yeah.
Dr. Esgar Guarín 41:21
But during those ten minutes, because of what he does, because of that decision he's made, he's a wonderful man as well. So it's just mind blowing to me what you can do with a vasectomy, because the awareness you can bring to people about so many different things during that moment-
Nandita Bajaj 41:40
Yes.
Dr. Esgar Guarín 41:41
It's so big. I mean, I've had people in the office who have gone to the psychiatrist after coming to see me. Not because they had a terrible experience, but because the conversation led them to realize that they've been having issues. Not to be graphic, but when an individual allows you to touch his genitals, when you're a total stranger, and you're holding in one hand sharp instrument. I mean, that person is being so vulnerable in front of you, you should be smart enough to take advantage of the opportunity and do much more good-
Nandita Bajaj 42:17
Yes.
Dr. Esgar Guarín 42:17
Than the good that you do by just doing a sterilization procedure. I asked many of these men that come to the office, what might seem an obvious question - they come with their partner and I usually tell them, "So why are you getting this vasectomy?" And many times you get the usual answer, "Oh, well, we don't want to have any more children." I said, "Well, that's the practical reason for it, obviously, that's the desired outcome. But why are you doing this?" "What do you mean?" "Sure, well, she could have gotten a tubal ligation, right?" I'm not trying to talk him out of it.
Nandita Bajaj 42:47
Yes.
Dr. Esgar Guarín 42:47
I just, I want them to think more about why they make that decision. And they said, "Well, cuz it's easier for me, you know, she has to go through all that stuff in the OR." And I said, "Do you understand what that means?" And they look at me like I'm speaking in a different language. And I said, "What that means is that you care about her."
Nandita Bajaj 43:06
Right.
Dr. Esgar Guarín 43:06
"How else are you showing that you care about her and about your children?" Sometimes they say, "Well, it's because of my children. You know, we have plenty, I love them. But I don't want to have any more." "How else do you show that you care?"
Nandita Bajaj 43:22
Yeah.
Dr. Esgar Guarín 43:22
And deep inside, I don't know if I'm too naive, that I want to believe that taking advantage of that vulnerable moment, when I say things like that. I just make something come up in their brains, or at least they leave thinking, "Yeah, I care about her." Or the gentlemen who come and say, "I never wanted to have children." Good. "Because I want to be able to experience the world in a different way." So that means you care about yourself.
Nandita Bajaj 43:49
Yes. And so much of it is the validation of good deeds, right?
Dr. Esgar Guarín 43:54
That's right.
Nandita Bajaj 43:54
You're validating good actions so that, not only are they proud of what they're doing for their partner, but in the process, you're also normalizing it.
Dr. Esgar Guarín 44:03
Yes. But I'm very careful with something, Nandita, and it's that, when it comes to to have a more equal balance in terms of reproductive interventions, we don't want men to think that this is it. Right?
Nandita Bajaj 44:16
Right.
Dr. Esgar Guarín 44:17
It will be a wrong assumption for men to think that hey, I did my vasectomy. That's it. I don't need to do any more. No, no, it's a wonderful thing for men to be active participants in reproduction by getting a vasectomy, but that's not enough. How else are we participating? How else are we showing those individuals with female parts that we care, right? That individuals with male parts care for the other?
Nandita Bajaj 44:44
Yeah.
Dr. Esgar Guarín 44:45
Right? We are in the middle of a situation where rights of women to make decisions about their own bodies are at this moment at risk.
Nandita Bajaj 44:54
Yeah.
Dr. Esgar Guarín 44:54
And what are we doing? Right? So yeah, you can get a vasectomy, but that's not it, that's not enough.
Nandita Bajaj 45:00
It'd be a good start.
Dr. Esgar Guarín 45:02
That's right. It's a great display of interest. It's a good display of commitment. But that's not it.
Nandita Bajaj 45:07
Yeah.
Dr. Esgar Guarín 45:08
If you get married, yeah you get married, but that's not it. I mean, it's just the beginning.
Nandita Bajaj 45:12
Yes.
Dr. Esgar Guarín 45:13
You go and take your vows, however you want to do it, you go to the front of a judge, in front of a priest or whatever ceremony you want to do. Yeah, you're just publicly saying, "Hey, I care." But that's not it. Same thing here, right? I try to do that, World Vasectomy Day tries to convey that, because we don't want men to think, "Alright, well, I did my duty already, had my vasectomy. Don't ask anything else from me." Oh, it turns out, we're pretty behind.
Nandita Bajaj 45:39
Right.
Dr. Esgar Guarín 45:40
It turns out, we have a lot to catch up.
Nandita Bajaj 45:42
It's good work that you're doing, Esgar. It's incredible, and especially the philosophical approach that you're lodging into people's minds to think beyond just that one action. And even for some people, I'm sure they're having existential questions about life and what does it mean to bring new life into-
Dr. Esgar Guarín 46:02
Correct.
Nandita Bajaj 46:03
The planet? What does it mean for you to use your own body to create that kind of impact? Whether it's good, you know, for you, for your child, for the planet? I think what you're doing with these conversations sounds like it's having a domino effect in making people think beyond just this one surgical procedure.
Dr. Esgar Guarín 46:21
That's right. I've said it before, this has been my excuse to talk about more things.
Nandita Bajaj 46:26
Yeah.
Dr. Esgar Guarín 46:27
The participation of men and reproduction, definitely an excuse for me to talk about family dynamics, that is the family doctor within speaking. It is important that people understand that it's coming to the decision of having this procedure requires so many things that they might take for granted, it's important that they go back and think a little bit about those. I mean, there are people who come here and just a wonderful discussion, they have thought about this so much, that I learned from them a lot. I had this patient, and I actually got to take care of their pregnancy. And this patient comes after the very first child they had, the first and only child, and comes and gets a vasectomy. Obviously, I am not anyone to try to make people change their minds, because I have to be respectful, and I am, about reproductive decisions. But I have to put things in perspective. So I talked with him and I said, "Look, there's some potential risk of regret. And I need you to understand that. I want you to think that if you follow through with this decision, at least in the back of your memory, you know, that we have had this conversation and that things were put in perspective for you in case you change your mind in the future." And he says, "Yes, I need to tell you this Doc. I'm a janitor at a school. I make enough for me to live fairly well with my wife the way we live. And I think that my job, which I have no intentions to improve, will give me enough to take care of our child. So I understand that another child would not allow me to provide to my children, what I need or what I can provide to this only child."
Nandita Bajaj 48:00
Wow.
Dr. Esgar Guarín 48:00
It was just this deep, deep conversation about why he wanted to do that. And it was, yeah, sure, you know, he didn't want his wife to go through the whole thing, he felt like he needed to participate. But those deep conversations just are so enriching and so wonderful. Same thing with this gentleman, twenty-three year old gentleman in Mexico, who comes in and gets a vasectomy, no children, the only child in his family. And before doing the vasectomy, after going through a whole process of counseling that the Mexican authorities had for him, I asked him about his decision and tried to put things in perspective. I said, "Well, it seems like you've talked to everybody about this. So let me just remind you that a sterilization procedure is a permanent decision." Just to close my discussion with him, you know, my talk with him. And he grabbed my arm looked at me in the eye and he said, "Thank you, Doc, I understand that. But it turns out having children is also a permanent decision."
Nandita Bajaj 49:00
Love that.
Dr. Esgar Guarín 49:02
It blows your mind, because he's like, you see that those people have thought so thoroughly about that.
Nandita Bajaj 49:09
Yes.
Dr. Esgar Guarín 49:09
And it's so enriching for me. I enjoy every single one of my vasectomies for that reason, because it's stories like that.
Nandita Bajaj 49:18
Yes, that is a really beautiful story. And you know, so many of the conversations that we're having in our work in shining a light on pronatalism, which is, you know, a set of these pressures that are placed on people, that parenthood is a default option. Instead of allowing a whole set of options on the table for people to choose from and decide, is this the right path for me, etc. We're having similar conversations with people because these are some of the most sacred decisions people make. Finding a partner, having a biological child - and that's, as you say, is a permanent decision that has an impact-
Dr. Esgar Guarín 49:57
Correct.
Nandita Bajaj 49:58
On the rest of your life and on the rest of the child's life. And I think it's just incredible that you also have this educational opportunity when you're having these conversations with people to help them understand both sides of the coin in terms of shared reproductive responsibility with their partners, but also reproductive responsibility in the biggest possible way.
Dr. Esgar Guarín 50:22
It is wonderful. I mean, I really like it. I enjoy it so much, because of what I think I can accomplish with this.
Nandita Bajaj 50:29
Yeah.
Dr. Esgar Guarín 50:29
You know, changing that mentality, and I guess, is my two cents. You know, I put those two cents and I hope those become fifty cents and a dollar later in their minds.
Alan Ware 50:38
Yeah, it shows how much you care. You know, you could just turn this, have an assembly line vasectomy operation, that's obviously not what you're doing.
Dr. Esgar Guarín 50:47
No, I can't do that, I wouldn't be able to do that. We have a little bit of everything. I mean, there are some of our colleagues, they have a huge, ridiculous volume of vasectomies, and I respect what they're doing. I just, my approach, and the approach that we try to suggest from World Vasectomy Day is one that has this holistic view of what we are trying to accomplish with the individual. Because I think, I couldn't have said it any better, Nandita, when you were talking about the transcendental aspect of this decisions. You know, we cannot just talk about contraception or sterilization specifically, in this situation lightly and say, "Well, yeah, no, we sterilize people, we just reduce the population like this and then reduce the tubal ligations period." Because it's not that simple - sterilization, because it's affecting this important function, it has a huge social-emotional impact.
Nandita Bajaj 50:48
Yeah.
Dr. Esgar Guarín 51:06
You know, in communities, that you have to approach it in a different way. You know, people historically have used and misused sterilization-
Nandita Bajaj 51:53
That's right.
Dr. Esgar Guarín 51:54
In a coercive way, that we cannot just talk, you know, lightly about what this means. We have to see the good behind this. And we have to own it.
Nandita Bajaj 52:05
Yes.
Dr. Esgar Guarín 52:05
You know, before it was imposed, during the early twentieth century, when we saw the tragic history of eugenics in the United States.
Nandita Bajaj 52:15
Yes.
Dr. Esgar Guarín 52:15
Up to thirty-two states by 1930 had involuntary sterilization laws.
Nandita Bajaj 52:21
Yes, right.
Dr. Esgar Guarín 52:21
That was a terrible thing. Now, we are claiming the power of being able to make that decision for permanent sterilization, and we need to make it clear that it's a matter of empowerment for men, so that we can say that we can be active participants in reproduction. It's a matter of empowerment for women, because women can say I am not the only one carrying this burden.
Nandita Bajaj 52:43
Yes.
Dr. Esgar Guarín 52:44
You know, I have a partner, even if it's not my physical, actual partner, but but those individuals with male parts are partners in reproduction with me, it's a matter of empowerment for families, because we're saying that with a procedure like this, families can then allocate their resources in a more appropriate way for their members to use them whenever they need to. And we're not talking about only financial resources, but emotional resources, social resources. And it's a matter of empowerment for the environment itself. Because when we care about the number of people that exist on Earth, and how we provide for us, if we put a limit, when we make a decision about a permanent sterilization procedure, we will be able to care better for our own species and the environment. So it's regaining that and feel empowered with that procedure.
Nandita Bajaj 53:35
That was amazing.
Dr. Esgar Guarín 53:38
I could just talk and talk about this. I love it, it has changed my life in ways that I did not expect. All the experiences that I've gone through, I wouldn't have thought that I would have ended doing this. But it's so satisfying. And one of the reasons why there's also satisfying is because I always said that I'm biased, because I have two daughters. So I want to leave behind a world that, in terms of reproductive equity and equality, it's a little more fair. And when I see that they see the passion that I have about this, and they actually share it, that makes it more satisfying.
Nandita Bajaj 54:12
Incredible.
Dr. Esgar Guarín 54:13
It's not just because I have children. And it's also other people that I've seen, I've had patients that I used to take care of who were adolescents and they saw me doing what I was doing and they get super interested, it's generating that passion in others that also makes it very fulfilling.
Nandita Bajaj 54:29
Absolutely. Yes, we can relate to so much of the work that you're doing. So much of the messaging that we're using with our work at Population Balance is philosophically oriented. We're really asking people to ask themselves the bigger questions about the fundamental drivers for how we relate to the planet, how we relate to each other, how we relate to nonhuman beings. Where does the desire for biological children come from? To what degree is it authentic? To what degree is it pressured? To what degree are we ready and able to bring a child into this world? And when you start getting down to the real questions like these, it generates some of the most incredible conversations. Because we're not used to, in our society, having deep conversations with one another. So much of it is just surface level stuff. We wish we could have another hour with you.
Dr. Esgar Guarín 55:34
I have had a terrific time with you both. I really would love to continue the conversation about what I could learn more about your organization and be part of that effort to bring more awareness of what we're doing. We're not just surviving. Yeah, sometimes it might seem for many that we are surviving, because we are caught in this rat race of just going to work and making a living. One of the things that the pandemic itself has done for many, and that's why we're having this issue with many people leaving the workplace is that it has put things in perspective. We have to think about what we're doing in the environment we are in, we have to think about what we're doing with the people that we have around.
Nandita Bajaj 56:15
Yeah.
Dr. Esgar Guarín 56:16
With our family, understanding that there's a plurality in the definition of family nowadays, you know.
Nandita Bajaj 56:22
Yes.
Dr. Esgar Guarín 56:23
Are we just using wisely our time here? Irrespective of the moral opinion, or religious beliefs of many, we cannot get stuck on the idea of hoping for a better life later, when we have this wonderful, wonderful gift in front of us. You know, whoever or however, we ended up with this gift, we have a beautiful world, we have human beings and other species that we should be delighted with. We shouldn't be wasting our time.
Nandita Bajaj 56:53
Yeah, well said.
Alan Ware 56:55
That's a great example of you extending beyond the vasectomy, and to the whole life of caring for other people and in the planet. But in this case, your loved ones, your partners.
Nandita Bajaj 57:06
Yes.
Alan Ware 57:07
Yeah, it's great that you're a passionate promulgator proselytizer of this, of vasectomies, and to have somebody with such caring and compassion, and it has the big picture in mind, but it's also able to work on a very psychological, personal level with people. It's a rare combination.
Dr. Esgar Guarín 57:25
Wow. Thank you. Thank you very much for those words, Alan. I, once again, I appreciate it very much. And thank you, thank you for having me here. And hopefully this is not going to be the last time we talk.
Alan Ware 57:35
Wow, that was great. I could listen to Esgar talk about virtually anything for hours. He's so informed and entertain. And he's got this combined interest in psychology and an obvious deep care for his patients. That was reflected in him winning the 2017 Iowa Family Physician of the Year, and it gives him this unique abilities to make those men feel heard and cared for. And he's doing that at a time where they're often feeling quite vulnerable in his hands.
Nandita Bajaj 58:04
Yes. And I love how Esgar is helping to gently and carefully dismantle these pervasive pronatalist pressures that men experience to have children and large families and to take a more intentional role in shared reproductive responsibility.
