It's not all fun and games...

Okay, so I’m reading over my blog thus far and apparently I’ve given off the vibe that we’ve flown halfway across the planet for vacation. So let me talk a bit about what we do with the majority of our day….

We all wake up around 6am to get ready for breakfast, which is served at 7am in the dining hall/ballroom. The food is pretty good for a hostel, with a decent amount of variety from day to day….we get really excited when they put out the beef sausage. The best part about the meal is that it’s prepared and served by some of the nicest folks you’ll ever meet. After breakfast, we head back to the hostel and finish getting ready for the work day.

After the 15 minute hike up the up the hill to the hospital, we all split up and go our separate ways. (Actually, whoever is rotating through orthopedics gets a break from the hill since the rehab center and ortho operating rooms are just next door to the hostel…currently, that’s Nancy). I’m still in Maternity/Pediatrics, and will be switching on Monday to either the Eye Unit or Orthopedics. I spend the morning rounding with a team of residents and an attending on women currently in labor or being induced, post-partum mothers and their newborns, gynecologic/surgical patients, and pediatric patients below the age of 5 years old. It’s definitely more of a primary care field than what we practice in the states. In the US, we basically catch the babies and pass them off, sometimes literally, to the pediatricians. From that point on, unless a boy is getting circumcised, we don’t have anything to do with the newborn.

Pretty much every morning after rounds there has been a c-section that needed to be done, either for failure to progress leading to fetal distress or as an elective procedure to reduce the chance of mother-to-baby transmission of HIV. What I’ve observed during those surgeries has both horrified and amazed me, sometimes at the same time. I’ve included some pictures from the operating room (or “theater” as they call it) so you get an idea, first and foremost, of the environment they work in. I’ve learned that sterilization is a relative state that probably exists somewhere between the reusable and rewashable hand scrubbers, surgical gowns, and patient drapes I see here and the completely disposable and ultra-wasteful use of surgical supplies in the U.S.

The next thing that blew me away was the speed at which they perform the c-sections. First off, the mothers are all put under general anesthesia here. It was explained to me that culturally women here do not particularly enjoy the idea of being awake with just spinal anesthesia. Apparently, they prefer to simply go to sleep and wake up and find the baby out and the wound sewn up as opposed to experiencing all the pulling and commotion associated with the operation. With that being said, the general anesthesia they use, primarily nitrous oxide and halothane, works its way quickly into the mother’s circulation and, ultimately, into the placenta and the baby’s circulation. Therefore, in order to avoid a floppy baby or possibly respiratory distress upon delivery, the baby needs to be extracted quickly. So far, I have seen an average time of about 6-7 minutes from the time mom goes under and the knife hits the skin to when the baby is pulled out; No bovies to cauterize any bleeders and no extra care to create a bladder flap. No fuss, no muss.

Oh, and did I mention that those performing the surgeries were an intern (for one intern, it was his 5th ever…for another, it was her first) and the scrub nurse, who is the senior surgeon in the room. The attending wanders in and out from his spot in the lounge periodically to check the clock and to see if there are any complications arising. Otherwise, it’s trial by fire for the intern. And thus far, I have been utterly amazed at the skill and incredible poise they’ve shown. When I first learned that it was my intern’s 5th c-section ever, my jaw hit the ground. I had to make sure he didn’t say “50th”. All the babies have come out happy and healthy and most mothers are discharged in 2-3 days barring any complications, of which there is only one that seems to be brewing at the moment involving possible bladder trauma and potential fistula formation. Of course, given the spotty follow up and return rate, it’s hard to quantify the true post-operative complication rates for such things as infection, infertility, incontinence, and fistulas.

This post is long enough, so I’ll save my story about the 19 year old girl and her “criminal abortion” for my next post. It’s a sad story, but with the way things are going in the US with our current administration and its Supreme Court, it’s a story that could become pretty relevant once again in our neck of the woods.

I hope I’ve given those of you who thought I was just frolicking out in the sun, working on my tan, and sipping mango juice all day a bit more perspective on why I’m out here. It’s hard work, I tell you.

Now, I’ve got to go the store and pick up a few things for our safari this weekend. More pictures to follow!

Cheers!