Bangladesh Update #4

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!