Tuesday, February 4, 2014

Obstetrics

I showed up at the clinic today trying to find Dr. Jorge to change services.  I had very good luck and found him in the first few minutes.  I asked for medicina, since that would allow me to work with a doctor for a while.  I want to understand exactly what doctors do here.  But, somehow, that didn’t end up happening.  Instead I was moved to Obstetrics.  I’ll be honest with you, that is one rotation that I was fully planning on avoiding during my time here.  I have almost 0 interest in that field as a career, and it doesn’t seem like the most fun place to be if I’m given the choice.  Of course I was not, so here we are.  I quickly figured out that there are several rooms which serve different functions.  First is hospitalization, which is split into 2 rooms with a total of 13 beds.  Hospitalization serves the dual purpose of allowing expectant mothers to rest if they need sleep before the baby pops out or a place of recuperation and basic tests after birth.  Of course there’s no privacy whatsoever between beds, but perhaps the mothers appreciate the support group.  The odd thing is that family (including husbands) aren’t allowed in these rooms at all unless they are handing food to their wife or something.  Next was the dilation room, for when the time of birth has almost arrived.  There are 4 beds, and all of them were filled today.  This is typically not a happy place, since woman aren’t given pain meds and they frequently gasp or groan in pain.  When the woman is about to give birth, she must get across the hall to the labor room.  That’s a basic run-down of the system here. 

My first few minutes were spent doing rounds with a doctor for all the newborn babies.  After that I sat down with a couple of med students I tried to understand the paperwork in the dilation room.  The radio was playing Love Shack.  Hollywood doesn’t write scripts this good.  The handwriting was too poor, I had no hope of understanding the written documentation.  As I was sitting there chatting a nurse came over and said “Can you keep this baby for a few minutes for me?  Thanks,” as she rested the newborn in my arms.  This kid must have been an hour or 2 old.  I’ve definitely never held any children that young before.  Adorable little thing.  After she helped the mom into a wheelchair to go back to hospitalization she came over and took the baby back.  I went through introductions with several of the staff in the department, and they generally went as follows: “What’s your name?”  “Michael.”  “Michael Jackson?!?”

Anyway, one of these staff members gave me a task.  She showed me a device and asked me if I  knew how to use it, and I of course did not.  It looked similar to an ultrasound machine, but it had no video display and instead allowed you to hear the heartbeats of the baby.  Of course the automatic counter was unreliable so you had to manually count the number of beats while looking at your watch.  My task was to make rounds to each of the women and measure the heart rates of their babies.  As uncomfortable as I was about this, it may be the most important duty I’ve been given during my time at Belenpampa.  The most awkward part (the whole thing was kind of awkward to me) was trying to find the little heart.  I wasn’t instructed on how to do that, so I was just moving the little probe around women’s’ bellies until I could find it.  This took a horrifically long time for several patients.  Eventually a med student came and showed me a little bit of how to touch the belly and feel approximately where the heart should be.  I didn’t understand all of his Spanish but it was good enough for now.  At one point I very distinctly felt the head of a little kid still in the womb.  Not what I expected to be doing today, but I did enjoy that part.  At one point a woman was rushed to the other room to give birth.  I wasn’t sure if I wanted to watch, but I ended up standing by the viewing window during preparation nonetheless.  The husband was brought in and it sounded pretty dramatic in there.  I suppose that makes sense given that childbirth is the most common excruciating pain experienced by mankind (ok, womankind).  One of the nurses told me to run measure the heartbeats again, so I went back and made another round instead of watching the actual birth take place. 

In a strange transition, after the birth, myself, the equivalent of a resident, and 2 med students went out to second breakfast.  I figured it would be fun to hang out with them even if I wasn’t immensely hungry at 11:00.  It only cost 4 soles for a drink and a decent plate of food so I wasn’t going to complain.  I didn’t understand everything they said, but I was able to get general ideas.  Some of the time they talked about soccer.  We talked about the US and our health system for a little while.  It was a fun group, and one med student spoke a little English so I was thankful for that.  I also finally have a male med student friend, although the girl is the one who knows a little English. 

Once we returned to the hospital, I didn’t do much else clinically.  We found a computer and looked at something I found very interesting.  This excel document was the first time I have personally been involved in any way with a computer here.  It had the names, grades, test scores, place of origin, etc. for all the med students who had graduated in 2013.  That’s crazy, everyone could literally know everything about everyone else.  I could see doing the general stats for schools and such, but names and individual scores was just crazy to me.  Cuzco didn’t fair too bad in it all.  Some schools were higher, some were lower, but Cuzco was very respectable. 

That finished my day in the clinic.  Carlos and I met up for lunch at this little restaurant not too far from my house.  A little salad, big soup bowl, delicious main dish, gelatin for dessert, and a beverage for 5 soles.  That’s less than $2.  And remember that you don’t have to tip in Peru.  I simply don’t understand how that can possibly be profitable.  We had a fun chat, he is helping me learn a lot of the Peruvian slang. 

In the afternoon I attempted to use ProWorld internet which was down the whole time.  Spanish class was fine but uneventful.  I went home to use the public internet shop nearby so I could catch up a bit from the weekend despite the dysfunctional ProWorld Internet.  The rest of the night was nothing special; editing pics and helping Joaquin with math.  I would like to note that I don’t like how they teach multiplication here.  If I remember correctly, when I learned to multiply 2-digit numbers (for example 12 X 59) I had to multiply each digit together and keep track of zeroes.  When this was 2 numbers with a tens place, I would have 4 numbers that I would then add.  In Peru they only use 2 lines, so if a number carries over you write it above like you carry numbers in addition.  The problem is that it can be easy for kids to want to add this number in places where it shouldn’t be.  They’re skipping a step that I think really helps understanding.  It’s too hard to teach a new technique so we’re working with what he’s got at the moment. 



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