After an incredible month, I’m headed back to Colorado
now. I finished by squeezing in a twin
C-section the morning I left (and running from the OR to catch my car to the
airport).
I certainly saw a lot of unforgettable things this past
month, met several doctors who quickly became role models, and gained a
valuable experience in adapting to a very different obstetrics
environment! Babies really do come out
the same general ways regardless of where you are. But the amount of antenatal care is
drastically less. First trimester scans
are rare and dates are generally uncertain.
The way people communicate about labor progress is different – I learned
to judge effacement by centimeters instead of percentage and station by feeling
the pelvis, not by cervical exam. In
fact, I gained valuable examination skills in so many areas – with little
advanced testing available, physical exam is critical to making good clinical
decisions. Breech babies don’t always
come out by C-section here. In fact,
transverse lie babies sometimes come out vaginally too if they’re small IUFDs
(shoulder first?). Eclamptic seizures
happen. Sometimes a patient comes in
with an IV from some village clinic with who knows what prior treatment. The
partograph system for plotting labor curves that I’d only witnessed in action a
few times before is used in every labor here – figuring out the advantage of
this system, its pitfalls, and how to use it clinically was really
important! I’m still working out the
nuances of this, but as the partograph is used worldwide, I know this will be a
very useful skill. C-sections are
basically the same…just with different clamps and different needles in a
different operating room. I’m certainly a better surgeon after this month for
having learned to be flexible with equipment.
And there are the more general skills – learning to work
with a new team that involves various levels of doctors & midwives,
changing my personal patient organization system to fit the quantity and
constant movement between beds, figuring out a successful communication style
with my limited Bangla. And learning to
emotionally cope with tragic outcomes and higher rate of IUFDs than we would
typically see in the US with all of the monitoring and testing that is able to
be done.
So again – I can’t say thanks enough to the amazing LAMB
team who took me in and taught me so much!
I’d certainly love to go back someday to LAMB or a similar setting, and
despite the challenges, feel that my interest in going long-term to a hospital
in a low-resource area overseas has been confirmed this month. I’m looking forward to sharing more details
& stories when I get back to Colorado!
