OB Clinical, v. 2.0

Yesterday was FANTASTIC.

In the afternoon I shadowed one of the volunteer doctors in the hospitalito and saw several patients with her. One was a teenage boy with dehydration and abdominal pain (and I heart murmur which I was able to listen to!), and the rest were pregnant women, there for regular prenatal visits. It was really interesting to be able to listen to the visits. Two of the patients needed a translator from tz'utujil to Spanish, and it was great to see the interaction between doctor and patient/family with the language barrier. I thought the doctor was great at still talking directly to the patient and making him or her feel comfortable. During the prenatal visits I got to hear everything I learned in OB clinical this year... the doctor determined how far along the woman was, which tests she had already and which she needed, if she was having any problems like headaches or blurry vision. She did some education with the women, including how to time contractions, when to come into the hospital, the importance of a support person and more. I measured fundal height with her and did Leopold's maneuvers (for non-nurses: fundal height measures how far up the uterus is to determine if the baby is growing sufficiently, and Leopold's maneuvers involves feeling the woman's abdomen to determine the position of the baby). After I left the hospitalito, I went over to the centro de salud, where there was even more obstetric excitement.

At first there was one patient in the centro, a woman who had delivered at home with a comadrona (midwife) and had extensive vaginal tears so came in to the centro for repairs. Right away the doctor and nurses had me helping out... I took her vitals (took a manual blood pressure for the first time on an actual patient, and got pretty confident with it by the end of the night), pushed an IV med, and took out her IV. Then, a patient came in with contractions, and after her water broke moved along pretty quickly. Within a few hours she was ready to deliver! The centro de salud was obviously much different from what I was used to on the maternity floor at HUP. Here they have one tiny delivery room, sterilize equipment themselves, often run out of supplies and have to send famiy members to the pharmacy to get more, don´t generally give pain meds, use newspapers on the floor to soak up blood, and in general just have the most basic necessities (they did just receive an ultrasound machine, though, and are very excited to start using it!). If a woman needs a c-section or has a complicated pregnancy, they have to send her to the hospital 2 hours away. I was so glad I got to see this delivery. One difference from what I had seen in school: the woman made almost no sounds the entire time. I could tell she was in pain from her face but she did not scream or cry out, and I'm not sure how much was the woman's personality and how much was expectations of pain tolerance in this culture. All I know is it was very different from the birth I saw at HUP with no pain medication! After the baby was born the nurse washed him in the sink and wrapped him in blankets, including a red cloth on his head which I learned is to protect the baby from the the mal de ojo, or evil eye. Throughout the evening I was also observing the interactions between the nurses/doctor and patient/family, and there was not the same level of patient education or privacy that I am used to.

While this was going on, there was also another patient who came in in labor, and the doctor determined that her baby was breech, or feet down, and the centro de salud does not have necessary equipment to deliver the baby (I got to do a vaginal exam after the doctor and feel the baby's foot. By the way, sorry if this is way too much information for those of you who are not medical or are squeamish... but I love this stuff!). So, they were ready to send her to the hospital in an ambulance, when her husband arrived and would not let her go. Apparently that is not uncommon here, and even after the staff explained that if she does not go to the hospital she and the baby could die, he still did not want her to go. In the end, they took a tuk tuk to the hospitalito, but even there they may not be able to care for her and successfully deliver her baby.

Overall, my experience at the hospitalito and centro de salud was great. It was both a refresher course in things I had learned from OB already, as well as a crash course in new skills! It helped me start to get an idea of the differences in health care between here and US, which is what I really hope to get out of this whole experience to complete my reflective practice project.