Learn, Grow and Give Back

I have to admit that I have been putting off blogging about my hospital experience here.  This is mostly because I’m personally still trying to process everything as it has been quite the emotional and educational roller coaster. That being said, I would like to add a disclaimer that some of my thoughts I’m going to blog about here are very raw, honest and I am very aware that I am by no means an expert on medical training or health care systems.   

Anyway, back to my roller coaster, on my overnight shift last night I delivered twins!!! I was by myself, with minimal supervision and the second twin was actually breech (feet first). It was an incredible experience and truly one of the coolest things I have done in my life. However, this amazing experience for me also highlights the health disparities at play between our two countries and systems. In the US, a twin pregnancy would be highly supervised, would most likely result in cesarean section, and no matter what happened, would definitely NOT be handled by a lone 4^th year med student. Additionally, as I was delivering twins, the woman in labor next to me was at risk of rupturing her uterus (and thus most likely losing her own life and her baby’s life) because no operating room was available for her to have a cesarean section due to the water being out and linens not being clean. While I have some guilt over the fact that I was basically alone while delivering these twins, I also think it is sad how much we are shielding our young doctors from experiences like this. We have come so far from trying to do things as naturally as possible, and instead have added a large amount of technology to the process and slowly chipped away at a hands on learning experience when dealing with rare complications. Don’t get me wrong, I am so happy our maternal mortality is much improved due to this technology, but a lot of times I feel the use is driven by litigation and defensive medicine than it is by true patient safety. We have very under served populations in the United States and I feel that adequate, comprehensive training to deal with their complications and events is harder to come by in the US than sometimes it should be.

This one hour of my experience pulls in so many things that I have been struggling with and growing from, but also have been really enjoying throughout my rotation here. Yes, resources are low. Yes, patients come to the hospital quite sicker and later than they should. Yes, sometimes things don’t go as efficiently as they should. However, the doctors, nurses and staff I have met are wicked smart, they are amazing diagnosticians and have skills that most physicians in developed countries have never even thought of having. For example, my first day on OB I was astonished to find that the fetal heart monitoring system was not electronic cords and dopplers surrounding and ensnaring the patient, but was a wooden “fetoscope” which looks more like it belongs in the kitchen than in the OB ward. The first few days I couldn't hear anything, but after a few dozen tries I finally am able to find most heart beats with the fetoscope. Just getting used to using this rudimentary tool developed my diagnostic sense and awareness within a few days.

 Additionally, I have also noticed how well adapted clinicians are to giving the best care they possibly can to patients day in and day out. The acuity and the amount of patients these physicians deal with is incredible. Often times when I am on the ward for merely 2 hours I feel is I have worked a 12 hour shift in the States. For example, I was working in OB triage checking a woman’s cervix when I turned around and saw two feet sticking out of a woman’s vagina. My intern (who is amazingly talented) luckily came in seconds later and delivered the very blue baby in the middle of triage without breaking a sweat (literally, he was completely calm and I was sweating my gazankers off). Afterwards, with nothing more than a drying blanket and a half functioning bag mask, the intern and I worked to resuscitate the baby. I, in no way, possessed the qualifications to be one of two people resuscitating that baby. I am not a pediatrician, I am not even a pediatric resident and I haven’t even taken by pediatric life support course yet. Thankfully, my intern is much more experienced than I and together we did succeed in resuscitating the babe and overall turned a terrifying situation into a really happy one.  Even though this situation turned out well, I have to stress how incredible it is that it was managed by the intern as well as it was. To give you perspective, a third year OBGYN resident from the United States told me she had never seen a breech vaginal delivery (she by the way is amazing to be on a rotation with and I feel so lucky to have her there too!). In the United States we scan and scan and scan and if the baby ever turns breech we try to turn it or we move immediately to Cesarean section. Very, VERY few physicians or midwives will attempt a breech vaginal delivery, and in my two weeks of being here I have been a part of 2.

Another refreshing thing is that patients take a lot of ownership over their health. This might mean that they frustratingly refuse treatment because they feel that it is just evil spirits that will take their disease away, but this also might mean bringing something up in their chart that I completely would have missed had they not pointed it out to me. Patients are incredibly strong, resilient and patient (no pun intended) as well. Women sit for hours in labor on the cold, dirty concrete floor as they wait for a cot to open up. Once they get a bed, they lay a plastic sheet or garbage bag down, labor and deliver with absolutely no anesthesia and minimal supervision. I’ve also seen episiotomies and vaginal laceration repairs done without ANY (not even local) anesthesia, and sometimes the woman doesn't even flinch. At the end of the day, no matter how much they scream, they always end up saying “Thank you so much musawo” (Musawo means doctor). I felt terrible that I was the only one at my patient’s twin delivery, however, judging by the gratitude coming from the patient and her husband, you would have thought I bought them a new house.

I can’t pretend all my thoughts and ideas are processed through rose colored glasses though. A lot of times I sit around with other international students at lunch and just debrief about how inefficient and sometimes just how plain wrong things go. There are many patients dying from preventable mistakes that could have been caught by a number of people (which also happens in our health care system). There is sometimes an incredibly frustrating lack of urgency. Often times, I just want to clean the C section OR myself because there are so many women on the list who needed a C section 1 week ago, but probably won’t be able to get in until the next day. Most frustrating though, is that even though this is exactly the type of patients and the severity of conditions I have a passion for treating, I have little to no say in what happens here. I feel like there are all these things that could be improved but again, I can do little to nothing about it. Furthermore, on the flip side, I feel like it is going to be really hard for me to bring the same empathy to developed patients as I once did. Suddenly a housewife from the suburbs whining about not vaccinating her children against very preventable diseases makes me even more angry as I’m watching children die every day but just not having basic resources available to them. Again, I apologize if this is too harsh, these are merely my knee jerk reactions and might especially be more blunt as I’m writing this after being up for 36 hours J.

While the above paragraph is probably my most negative and harshest critiques of both situations, what it comes down to is that we just come from such different worlds, backgrounds, resources and cultures. However, I do not think this is an excuse to allow one world to suffer so incredibly, while another has ample resources that could easily be shared. I’ve struggled a lot with exactly how to deal with these emotions and frustrations and I have to say the only answer I’ve really been able to come up with is that learning from each other and working with each other can hopefully bring our two worlds closer together. As my very wise global health professor e-mailed me “learn, grown and give back” and right now that is all I think we all can do to start solving these problems.