So I am officially finally recoverd from our hike on Saturday... and it only took 4 days! This week has been pretty uneventful so far. Labor ward has picked up a bit, which is nice. Yesterday I delivered three babies, and today I did one and a C-section. I've turned into a pretty good little scrub tech/1st assist if you ask me. He even let me close the skin today using subcuticular stitches (ones that don't show at all so it looks much prettier when you're done). I really wish I could be there when she compares her scar to other people's C/S scars and I could be like... well, you're welcome.
There is a local orphanage that people from Work the World regularly go visit while we're here (not the one Caroline's mom is working at, but a smaller one) and the kids from there are coming for a barbeque at our house tonight. It should be very interesting. We went one afternoon last week to play with them and they are just the cutest things ever. The younger ones don't speak a whole lot of english, but the older ones are pretty good. They still all knew games like duck duck goose though, I assume from so many western visitors. It's very sad how poor they are though. You can sponsor a child (food, clothes, school, everything) for about $700 a year. The four oldest are old enough to go to secondary school, but only three go because the fourth isn't sponsored and so they can't afford the school fees. It's a little different to see those adds on TV for sponsoring an African child than it is to actually see where they live and to meet them face to face. Anway, tonight should be fun. I can't quite picture them outside of their little muddy house roaming around our big beautiful Work the World house.
We are also planning to have more fun with orphans this weekend. We are taking the kids from the orphanage Caroline's mom works at (22 kids) to Arusha National Park this Sunday. It's sort of like a mini safari. One of the safari companies around here is taking the kids for free and giving us a discount since we're taking them. Three teachers from the orphanage are coming too (thank goodness! They seem well behaved, but it's a little tough to discipline when you don't speak the same language). Sadly, Caroline's mom has been sick since she got here (seems like the flu, but pretty bad) so I'm really hoping she gets better soon.
Lastly, since I'm thinking of this as I hear rain pouring down outside, I think it is officially rainy season here. Online I read it's not supposed to start until sometime in March, but it has rained every day since Sunday. Not all day, but those pop up thunder storms that pour down rain for a little bit and then clear up. So not terrible, but not quite the perfect weather we had our first three weeks here. I just hope it doesn't get too much worse since we are going on our safari starting in a week and a half. And then with our last four days we are going back to Zanzibar (pretty much can't afford/have time for anything else) and rain there would be even worse. As I'm now peaking out the window though it looks as though the rain has stopped just in time for my walk home! Lovely!
Wednesday, February 25, 2009
Sunday, February 22, 2009
This is not what I signed up for... I need some culture, STAT!
Yesterday we went on what was supposed to be a "cultural tourism program tour". It was TOTALLY not what we expected. When they guy came and told us about it he said "We'll see some traditional villages, then we'll walk to the top of a hill that has a nice view of Arusha, then we'll go to a waterfall and some lunch." Sounds lovely for a lazy Saturday. We also went out to karaoke the night before, so none of us had really gotten a whole lot of sleep. Anyway, "walking to the top of a hill" really consisted of about a 1500 meter assent up to the top of one of the foothills of Mount Meru. Then he insisted that the waterfall was just on the other side of the "hill" (I'd call it more of a small mountain... ) in the valley. We then walked for another hour or so until we came to a gorge. He said the waterfall was just down the gorge. We'd come too far at this point to turn back, so we descended down into the gorge I don't even know how many feet (a LOT) on a very tiny STEEP winding path that was really slippery cause it was just loose dirt. By the time we finally got the bottom we found a little stream, but not waterfall. Again, the guy insisted we only had a little farther, but again he majorly underestimated and we walked along/through the rocky river, periodically scaling rocks as tall as me for at least another half an hour before we finally made it to the waterfall. It was really pretty and worth the hike, just definitely NOT what we were expecting. When we left in the morning the guide told us we would be back in the village at 1 pm for lunch, but it was almost 1 pm by the time we made it the waterfall. (We left at about 10:30 am, so a two and half hour hike to just get there.) He then insisted on the way back that it would only take about an hour... (yeah, right!)... it took nearly that long to complete the hike back down the river and out of the gorge. To add to the fun of it, we had all worn flip flops because we thought we would just be walking around a village and wading in a waterfall. On the way back up the gorge I had to go barefoot because I kept slipping out of my flipflops. (Did I mention it was really steep? I spent most of the time on all fours using my hands to help climb up and having to rest about every 50 feet from exhaustion.) We didn't end up making it back to the village until about 4:30 pm (6 hours after we set out) and hadn't eaten anything since breakfast!
In the end I'm glad we did it because it was a super pretty hike and waterfall and we got to pass through a lot of traditional villages. Little kids would come out to the trail just to watch us go by, and a few would join our trek for a little bit before turning back to home. It was VERY exhausting though! And we certainly would not have work flip flops it we had know what we were getting ourselves into! The guide at the end said we hiked a total of 18 kilometers. It also made us feel really good that he had hiked Kilimanjaro, and he told us that last day's hike of Kili is not any harder than the hike we had just done. So basically, I'm going to start telling people that I basically climbed to the summit of Kili in flipflops!
Only other news, Caroline's mom arrived last night and is very excited to start seeing Arusha. We are doing some shopping today at the market which should be fun.
In the end I'm glad we did it because it was a super pretty hike and waterfall and we got to pass through a lot of traditional villages. Little kids would come out to the trail just to watch us go by, and a few would join our trek for a little bit before turning back to home. It was VERY exhausting though! And we certainly would not have work flip flops it we had know what we were getting ourselves into! The guide at the end said we hiked a total of 18 kilometers. It also made us feel really good that he had hiked Kilimanjaro, and he told us that last day's hike of Kili is not any harder than the hike we had just done. So basically, I'm going to start telling people that I basically climbed to the summit of Kili in flipflops!
Only other news, Caroline's mom arrived last night and is very excited to start seeing Arusha. We are doing some shopping today at the market which should be fun.
Thursday, February 19, 2009
First night in Africa
Alright, so finally a post for all you non-medical folks! (Ok ok except to say that I did deliver two babies on my own today back to back, both with cords wrapped around their necks, and scrubbed in at the end of a C-section to close skin also on my own- guess the doctor must trust my suturing skills to leave the OR... it's almost like I'm an intern already!) Let's start at the beginning and talk about my first nigth in Africa. Our flights here were uneventful. It was snowing in Amsterdam when we landed so I was worried about delays, but everything went very smoothly. We hardly slept at all so when we landed in Dar Es Salaam at about 11 pm Africa time after about 30 hours of traveling, we were definitely ready to pass out at our hotel. I had booked a room ahead of time and they were also supposed to pick us up at the airport. Of course, no one was there to meet us. We got a cab to the hotel for what the hotel said they were going to charge us (probably more than the going rate really but we didn't really care at that point), and the cab driver was actually very friendly and taught us our first Swahili words (Asante sana - thank you very much). Arriving at the hotel was a little nerve wracking, I wasn't expecting anything near a five star hotel, but the reviews online at least said it was clean and a good value for the money ($30 a night for a double with air conditioning)... I'm not sure clean really would have been a word I would use to describe it, but then again I was new to Africa... maybe this WAS clean by their standards. It was a tiny entrance with big metal bars and a gate securing the "lobby"... really just a tiny square space with an awning and a tiny bench, and on one side a dark narrow staircase leading up to the rooms.
We attempted to check in, where they promptly informed us that they had no rooms, and absolutely no record of our reservation (even though I had a copy of the e-mail correspondence, they didn't really seem phased). But then even though they told us no rooms, the man who seemed to be in charge said, "give me five minutes" (or at least we're pretty sure that's what he said), made a brief call on his cell phone, and less than five minutes later we were being ushered up to our double room with air conditioning. (Don't think about it too much... I shudder to think why he could clear a room out so quickly... ) The room was tiny, not really the cleanest, but at least it had a bed for each of us with a mosquito net, and a bathroom with a western style toilet and shower. And air conditioning! If I haven't mentioned it already, it is REALLY hot in Dar. We cranked the air conditioning as much as we could (which really means turning it on since all the nobs were broken off so couldn't be moved), and nestled in under our mosquito nets. After about an hour of drifting in and out of fitful sleep I finally awoke denched in sweat and decided that the mosquito net would just have to go. What little cold air the air conditioning was pumping out was not making it under the net at all, and at that moment I decided risking malaria and cancer from all the Deet I then sprayed on myself was a small price to pay for being able to get some sleep. I even hauled the mattress onto the floor next to the bed so as to be more directly in line of the coolish air that the windown unit was blowing. After that I actually slept pretty soundly until 5 am when the loud-speaker from the mosque woke me by blasting prayers in Arabic. I also realized that the air conditioned was off for some reason. When I tried to turn it back on I realized the power had gone off at some point during the night. We sweltered in the heat a bit longer trying to sleep, until we started to hear rain outside. We opened the windows to an absolute downpoor. We were supposed to take the ferry to Zanzibar that morning, and when I pictured the boat trip to our island paradise in my head before we left it definitely did NOT include a thunder storm. We couldn't sleep anymore from the heat, so we managed to shower in the dark, and make our way down to our included breakfast. We were extremely relieved to find that the rain had completely stopped by this point and the sky was starting to look considerable lighter.
In my zeal to not forget my Doxycyclin (malaria medicine... especially after not having slept in my mosquito net, although honestly I had net to see a mosquito), I took it first thing in the morning, forgetting that the label explicitely says to take with food. While we were still attempting to get the waiter downstairs to acknowledge us (at least a ten minute endevor), I began to feel extremely sick to my stomach. "Oooh... noooooo... not already! " was the only thing I was thinking, forgetting completely about the doxy, and thinking that the water had gotten to me already, even though I had been meticulous about not getting any in my mouth in the shower and had yet to even have a meal in the country. I managed to stuff down too bites of granola bar before urgently asking for the bathroom, which apparently are only in the rooms. I tried to make it back up to our third floor room but didn't quite make it and settled for the bathroom of an unlocked room on the second floor right off the stairwell that had already been checked out of (I hope, anyway... ). As I vomited up the entire contents of my stomach (not much) in some poor unsuspecting tourists toilet, I couldn't help but wonder what I had gotten myself into. I sheepishly made it back down to breakfast, which I couldn't force myself to eat any of (I wasn't missing much since I declined the egg and what I assume was supposed to be two pieces of toast had the power not still been out was just two pieces of plain white bread). The only thing I could stomach was two dramamine (for motion sickness) at the thought of getting on a two hour boat ride to Zanzibar. After another trip to my favorite bathroom on the second floor, we set out for the docks.
I'm happy to report that the entire trip has been uphill since that first night! I'm taking my doxy at night after a full dinner now, Zanzibar really was the island paradise I had pictured, and Arusha is ten times better than Dar es Salaam (and LOLS cooler!). If that is the worse experience I have while here I must say I've done pretty well. Stay tuned for our adventures on Zanzibar, whenever I get the chance to write again (Saturday we are taking a day trip to a Massai village, then Caroline's mom comes Saturday night, and then Sunday is Caroline's b-day, so it might be a little while). Miss you all and hope all is well back home!
And good morning, Mom!
We attempted to check in, where they promptly informed us that they had no rooms, and absolutely no record of our reservation (even though I had a copy of the e-mail correspondence, they didn't really seem phased). But then even though they told us no rooms, the man who seemed to be in charge said, "give me five minutes" (or at least we're pretty sure that's what he said), made a brief call on his cell phone, and less than five minutes later we were being ushered up to our double room with air conditioning. (Don't think about it too much... I shudder to think why he could clear a room out so quickly... ) The room was tiny, not really the cleanest, but at least it had a bed for each of us with a mosquito net, and a bathroom with a western style toilet and shower. And air conditioning! If I haven't mentioned it already, it is REALLY hot in Dar. We cranked the air conditioning as much as we could (which really means turning it on since all the nobs were broken off so couldn't be moved), and nestled in under our mosquito nets. After about an hour of drifting in and out of fitful sleep I finally awoke denched in sweat and decided that the mosquito net would just have to go. What little cold air the air conditioning was pumping out was not making it under the net at all, and at that moment I decided risking malaria and cancer from all the Deet I then sprayed on myself was a small price to pay for being able to get some sleep. I even hauled the mattress onto the floor next to the bed so as to be more directly in line of the coolish air that the windown unit was blowing. After that I actually slept pretty soundly until 5 am when the loud-speaker from the mosque woke me by blasting prayers in Arabic. I also realized that the air conditioned was off for some reason. When I tried to turn it back on I realized the power had gone off at some point during the night. We sweltered in the heat a bit longer trying to sleep, until we started to hear rain outside. We opened the windows to an absolute downpoor. We were supposed to take the ferry to Zanzibar that morning, and when I pictured the boat trip to our island paradise in my head before we left it definitely did NOT include a thunder storm. We couldn't sleep anymore from the heat, so we managed to shower in the dark, and make our way down to our included breakfast. We were extremely relieved to find that the rain had completely stopped by this point and the sky was starting to look considerable lighter.
In my zeal to not forget my Doxycyclin (malaria medicine... especially after not having slept in my mosquito net, although honestly I had net to see a mosquito), I took it first thing in the morning, forgetting that the label explicitely says to take with food. While we were still attempting to get the waiter downstairs to acknowledge us (at least a ten minute endevor), I began to feel extremely sick to my stomach. "Oooh... noooooo... not already! " was the only thing I was thinking, forgetting completely about the doxy, and thinking that the water had gotten to me already, even though I had been meticulous about not getting any in my mouth in the shower and had yet to even have a meal in the country. I managed to stuff down too bites of granola bar before urgently asking for the bathroom, which apparently are only in the rooms. I tried to make it back up to our third floor room but didn't quite make it and settled for the bathroom of an unlocked room on the second floor right off the stairwell that had already been checked out of (I hope, anyway... ). As I vomited up the entire contents of my stomach (not much) in some poor unsuspecting tourists toilet, I couldn't help but wonder what I had gotten myself into. I sheepishly made it back down to breakfast, which I couldn't force myself to eat any of (I wasn't missing much since I declined the egg and what I assume was supposed to be two pieces of toast had the power not still been out was just two pieces of plain white bread). The only thing I could stomach was two dramamine (for motion sickness) at the thought of getting on a two hour boat ride to Zanzibar. After another trip to my favorite bathroom on the second floor, we set out for the docks.
I'm happy to report that the entire trip has been uphill since that first night! I'm taking my doxy at night after a full dinner now, Zanzibar really was the island paradise I had pictured, and Arusha is ten times better than Dar es Salaam (and LOLS cooler!). If that is the worse experience I have while here I must say I've done pretty well. Stay tuned for our adventures on Zanzibar, whenever I get the chance to write again (Saturday we are taking a day trip to a Massai village, then Caroline's mom comes Saturday night, and then Sunday is Caroline's b-day, so it might be a little while). Miss you all and hope all is well back home!
And good morning, Mom!
Monday, February 16, 2009
Monday... Monday. Back to work today. Very sleepy because I have to get up at 6 to make the hour commute to get there on time. Today was pretty slow. Only two deliveries, sadly I didn't get to do either of them. No one really warns me when a mom is about to deliver so inevitable it seems like I'm running over after the baby has already popped out. I did repair a perineal laceration though, quite interesting. I did it with a visiting midwife from Germany who is volunteering there a few days a week. In general it was really nice to have her there because she speaks English infinitely better than the local nurses/midwives and she has been there for about 6 months so she can explain to me how things work and answered a lot of my questions. Thank goodness the laceration wasn't bad or through the sphincter (sorry non-medical folks... ) because I had NO idea what I was doing. The midwife asked if I wanted to do it and I said sure, as long as she could show me where and how to put the stiches. She said she didn't really know herself and had never even been taught to suture, so figured I was a better bet since at least I had been taught that much. I did the best I could from what I've seen back home, with a less than ideal set-up (sitting on the side of a bed in a dark corner wearing a very dim headlight and extremely questionable sterile technique) and it didn't end up looking half bad. The only other laceration repair I've seen done by a local nurse was at least at haphazard, if not more so. Then I taught the midwife how to do an instrument tie, which she was very impressed by. Also, apparently they do have lidocaine for local anesthesia, which we did use this time, thank goodness. I'm not sure I could have done it without. I asked the midwife about that and she said the local nurses just don't use it, it's available and they just don't, she doesn't know why. It's awful, she said she's heard a lot of the mothers are more afraid of that part than the actual birth (which doesn't surprise me based on how much pain the lady last week seemed to be in).
It's a little frustating to watch them practice medicine here. Last week I saw a completely botched neonatal resuscitation (the baby finally started breathing on it's own, but wasn't breathing for WAY too long without appropriate ventilation), the C/S I saw didn't exactly obey evidence based medicine (among other things, they close the rectus muscles which has clearly to have no benefit and cause lots more post-op pain), and I've seen some instances of quite excessive use of oxytocin (a drug to speed along labor, but can be dangerous if not used correctly). I know they are doing the best they can, but it is hard to watch sometimes.
Now I will stop boring most of you with medical details, as Mom wants me to talk more about Tanzania itself. So here goes, Mom, in answer to your questions:
- Is it pretty, bleak, flat, mountainous?
It is very pretty and mountaious in Arusha.
Is Arusha a city like we think of a city, or very different?
- Like a city kind of... except for the guy next to me in the internet cafe dressed in traditional Masaii clothing (they are the tribe that stretched out their ears and everything)
- What are the people like?
Very friendly
- How is the food?
Delicious
- Have you had a chance to take any pictures?
Yes
- Do you have weekends off?
Yes
Hehe... ok, just kidding Mom, I'll write more later but I'm running out of time as usual. Hope everything is going well at home (if a bit colder than here... :-) )
It's a little frustating to watch them practice medicine here. Last week I saw a completely botched neonatal resuscitation (the baby finally started breathing on it's own, but wasn't breathing for WAY too long without appropriate ventilation), the C/S I saw didn't exactly obey evidence based medicine (among other things, they close the rectus muscles which has clearly to have no benefit and cause lots more post-op pain), and I've seen some instances of quite excessive use of oxytocin (a drug to speed along labor, but can be dangerous if not used correctly). I know they are doing the best they can, but it is hard to watch sometimes.
Now I will stop boring most of you with medical details, as Mom wants me to talk more about Tanzania itself. So here goes, Mom, in answer to your questions:
- Is it pretty, bleak, flat, mountainous?
It is very pretty and mountaious in Arusha.
Is Arusha a city like we think of a city, or very different?
- Like a city kind of... except for the guy next to me in the internet cafe dressed in traditional Masaii clothing (they are the tribe that stretched out their ears and everything)
- What are the people like?
Very friendly
- How is the food?
Delicious
- Have you had a chance to take any pictures?
Yes
- Do you have weekends off?
Yes
Hehe... ok, just kidding Mom, I'll write more later but I'm running out of time as usual. Hope everything is going well at home (if a bit colder than here... :-) )
Monday... Monday. Back to work today. Very sleepy because I have to get up at 6 to make the hour commute to get there on time. Today was pretty slow. Only two deliveries, sadly I didn't get to do either of them. No one really warns me when a mom is about to deliver so inevitable it seems like I'm running over after the baby has already popped out. I did repair a perineal laceration though, quite interesting. I did it with a visiting midwife from Germany who is volunteering there a few days a week. In general it was really nice to have her there because she speaks English infinitely better than the local nurses/midwives and she has been there for about 6 months so she can explain to me how things work and answered a lot of my questions. Thank goodness the laceration wasn't bad or through the sphincter (sorry non-medical folks... ) because I had NO idea what I was doing. The midwife asked if I wanted to do it and I said sure, as long as she could show me where and how to put the stiches. She said she didn't really know herself and had never even been taught to suture, so figured I was a better bet since at least I had been taught that much. I did the best I could from what I've seen back home, with a less than ideal set-up (sitting on the side of a bed in a dark corner wearing a very dim headlight and extremely questionable sterile technique) and it didn't end up looking half bad. The only other laceration repair I've seen done by a local nurse was at least at haphazard, if not more so. Also, apparently they do have lidocaine for local anesthesia, which we did use this time, thank goodness. I'm not sure I could have done it without. I asked the midwife about that and she said the local nurses just don't use it, it's available and they just don't, she doesn't know why. It's awful, she said she's heard a lot of the mothers are more afraid of that part than the actual birth (which doesn't surprise me based on how much pain the lady last week seemed to be in).
It's a little frustating to watch them practice medicine here. Last week I saw a completely botched neonatal resuscitation (the baby finally started breathing on it's own, but wasn't breathing for WAY too long without appropriate ventilation), the C/S I saw didn't exactly obey evidence based medicine (among other things, they close the rectus muscles which has clearly to have no benefit and cause lots more post-op pain), and I've seen some instances of quite excessive use of oxytocin (a drug to speed along labor, but can be dangerous if not used correctly). I know they are doing the best they can, but it is hard to watch sometimes.
Now I will stop boring most of you with medical details, as Mom wants me to talk more about Tanzania itself. So here goes, Mom, in answer to your questions:
- Is it pretty, bleak, flat, mountainous?
It is very pretty and mountaious in Arusha.
Is Arusha a city like we think of a city, or very different?
- Like a city kind of... except for the guy next to me in the internet cafe dressed in traditional Masaii clothing (they are the tribe that stretched out their ears and everything)
- What are the people like?
Very friendly
- How is the food?
Delicious
- Have you had a chance to take any pictures?
Yes
- Do you have weekends off?
Yes
Hehe... ok, just kidding Mom, I'll write more later but I'm running out of time as usual. Hope everything is going well at home (if a bit colder than here... :-) )
It's a little frustating to watch them practice medicine here. Last week I saw a completely botched neonatal resuscitation (the baby finally started breathing on it's own, but wasn't breathing for WAY too long without appropriate ventilation), the C/S I saw didn't exactly obey evidence based medicine (among other things, they close the rectus muscles which has clearly to have no benefit and cause lots more post-op pain), and I've seen some instances of quite excessive use of oxytocin (a drug to speed along labor, but can be dangerous if not used correctly). I know they are doing the best they can, but it is hard to watch sometimes.
Now I will stop boring most of you with medical details, as Mom wants me to talk more about Tanzania itself. So here goes, Mom, in answer to your questions:
- Is it pretty, bleak, flat, mountainous?
It is very pretty and mountaious in Arusha.
Is Arusha a city like we think of a city, or very different?
- Like a city kind of... except for the guy next to me in the internet cafe dressed in traditional Masaii clothing (they are the tribe that stretched out their ears and everything)
- What are the people like?
Very friendly
- How is the food?
Delicious
- Have you had a chance to take any pictures?
Yes
- Do you have weekends off?
Yes
Hehe... ok, just kidding Mom, I'll write more later but I'm running out of time as usual. Hope everything is going well at home (if a bit colder than here... :-) )
Friday, February 13, 2009
Just the facts, ma'am.
Whew... Katie gave me permission to cut out the wit as long as I convey the facts, so here you go! (What a relief!) Work has been going well. On my second day I delivered a baby. Pretty much on my own, although the nurse was right there next to me. The word "deliver" doesn't apply quite as much here, "catch baby" would really be a more accurate term from what I've seen so far. The women pretty much do it all on their own too. There's no coaching like at home with "ok now push for 10 seconds..." or "good job, almost there!"... it's just the women doing their own thing and then when a head pops out, you pull a little bit if needed and cut the cord. Like I said before there aren't any family allowed in the deliver room either, so they really are totally alone. I really wish I knew more Swahili so I could be more supportive, so far I've learned "push", "almost there", "sorry", and "beautiful baby".
There are definitely lots of expected differences/surprising similarities that I've noticed so far: (sorry if some of them are technical, but at least Dad and Hilary will appreciate it!)
- Difference: I knew the women wouldn't have any epidurals, but I'm really impressed by how well they deal with the pain. You can tell they are feeling it by their facial expressions, but there is a minimum of screaming and complaining. I've definitely seen women back home with an epidural make more a fuss than most of the women here.
- Difference: No local anesthesia for repair of tears. Yikes... it seems like that might be worse than the birth itself.
- Difference: I also got to scrub two elective C-sections yesterday, and by scrub I mean 1st assist/scrub nurse. For each case they only have two sterile gowns, so no more than that can fully scrub in. There was a nurse that put sterile gloves on and helped a little bit, but mostly it was just the two of us. Figuring out what in the world the doctor wanted me to hand him with his super thick accent and limited English was quick challenging, but I was pretty good by the end of the second case. Next time I see a surgeon freak out when the scrub nurse doesn't anticipate his every more, I want to say "There are surgeons in Africa who operate without a scrub nurse at all!" (he hem... Dad..... :-) Ok, ok so they aren't doing any open hearts I suppose)
- Similarity: I am surprised at the basic things they do have. I brought a lot of my own gloves/hats/masks because I was told they might not have them, but at least at my hospital they have plenty of gloves, including sterile ones. For the OR they have everything you need, the only difference is everything is cloth instead of paper disposible. So I was fully decked out in scrubs, white rubber boots you're required to wear, a platic apron, cloth hat, mask, and sterile gown and gloves for the OR.
Ok, I'm running out of internet time and my thoughts are rambling (I totally forgot what else I was going to write about, I think I need to start making notes of what I want to say) so I'll bid farewell.
Hope to write again soon!
There are definitely lots of expected differences/surprising similarities that I've noticed so far: (sorry if some of them are technical, but at least Dad and Hilary will appreciate it!)
- Difference: I knew the women wouldn't have any epidurals, but I'm really impressed by how well they deal with the pain. You can tell they are feeling it by their facial expressions, but there is a minimum of screaming and complaining. I've definitely seen women back home with an epidural make more a fuss than most of the women here.
- Difference: No local anesthesia for repair of tears. Yikes... it seems like that might be worse than the birth itself.
- Difference: I also got to scrub two elective C-sections yesterday, and by scrub I mean 1st assist/scrub nurse. For each case they only have two sterile gowns, so no more than that can fully scrub in. There was a nurse that put sterile gloves on and helped a little bit, but mostly it was just the two of us. Figuring out what in the world the doctor wanted me to hand him with his super thick accent and limited English was quick challenging, but I was pretty good by the end of the second case. Next time I see a surgeon freak out when the scrub nurse doesn't anticipate his every more, I want to say "There are surgeons in Africa who operate without a scrub nurse at all!" (he hem... Dad..... :-) Ok, ok so they aren't doing any open hearts I suppose)
- Similarity: I am surprised at the basic things they do have. I brought a lot of my own gloves/hats/masks because I was told they might not have them, but at least at my hospital they have plenty of gloves, including sterile ones. For the OR they have everything you need, the only difference is everything is cloth instead of paper disposible. So I was fully decked out in scrubs, white rubber boots you're required to wear, a platic apron, cloth hat, mask, and sterile gown and gloves for the OR.
Ok, I'm running out of internet time and my thoughts are rambling (I totally forgot what else I was going to write about, I think I need to start making notes of what I want to say) so I'll bid farewell.
Hope to write again soon!
Tuesday, February 10, 2009
First day of work
So sorry to all that it has taken me so long to update this (most of all Katie, although I must say I'm pretty sure I have a better excuse... :-) ), but internet access was limited until we arrived in Arusha and it is still a bit of a trek into town to get to the internet cafe. We've been here over a week now so there is lots to tell, but since I started work today I figured I would start with the hospital.
I'm placed at a different hospital than the other girls, which I thought I wouldn't mind, but it is quite the trek out to the one I'm working at. It's about a 40 min (brisk!) walk and then a 20 min dala dala (think a big crowded full size van... all for the bargain price of 500 tanzanian shillings, about 40cents). It wasn't as terrible as I was anticipating, there was a decent breeze though the windows so I wasn't suffocating and at least today I didn't sit next to anyone too smelly (as I realized quite quickly they haven't discovered deodorant in Africa. Not entirely surprising as the majority of Europe hasn't really either, but it's a bit more evident here. It's not just if you're packed into a crowded space with someone like in France, but you can't really walk down the steet without getting a whif of BO as people walk by. I'm trying to be open to their culture and whatnot... but if there is one thing I could change so far, it wouldn't be being able to drink the water, or less dust, or airconditioning everywhere, or toilet paper, it would be giving everyone a stick of their very own deodorant. I'm thinking of taking up donations.
Anyway, I got way off track there on my little rampage about smelly people (you KNOW how sensative I am to smells!) , but the point is it takes just over an hour to get the hospital. We are technically supposed to be there at 7:30 for morning report, but I've heard from some of the other students that you don't really need to go every day. Which is nice, because although that is still late on American labor and deliver standards, it's pretty early on fourth year time.
The hospital itself is made up of lots of separate buildings. I got a very extensive tour today, I think I saw pretty much every room/office there was to see and was introduced to just about everyone who works in the hospital (including the laundry lady and the lady who makes Chi tea for break time). It struck me as odd that they would barge into the various exam rooms to introduce me to the clinicians while the patients were sitting right there. No one seemed to mind though and everyone was very friendly. There were lots of awkward moments, however, as everyone insisted on trying to speak Swahili to me, so I kept having to decide which of my limited Swahili works (Shikamoo - formal hello, Asante - thank you, Nzuri - good) was the most appropriate reponse to whatever they said. I must have said asante about a billion times for lack of anything more substantial to say.
There are separate buildings (all one floor and not very big) for the women's ward, the men's ward, the labor ward, the pediatric ward (which only goes up to 5 years old, after that you're considered an adult), and then various outpatient clinics (dentistry, peds, a special HIV clinic) which are less buildings and more just small rooms around a covered courtyard where people wait. The wards are just what you might picture, one long room lined with about 16-20 beds. The pediatric and mens wards have the option to have a private room on one side of the ward for 10,000 shillings a night (about $8), but most people can't afford that (the regular ward is only 500 shillings a night... again, about 40 cents). You don't get a whole lot extra for that either, other than three walls and sliding door because the rooms are TINY and don't have anything more special than the regular part. Although I guess you are guaranteed your own bed, as they double up the beds in the regular ward when they run out of room. It's different than at home though where the patients spend most of their day in bed. The majority of the patients I saw where just lounging about the buildings, sort of roaming willy nilly. I can't really see that flying so well at Barnes...
The labor ward itself is a long skinny building, one end is the antenatal side, where the women in labor come and hang out until they are ready to deliver. It has about 16 beds, and there were more than that number of pregnant women there. They were all surprisingly calm, only grimacing silently occasionally with a contraction, but for the most part it felt more like a sleep over than anything else. From the antenatal side, it leeds into a smaller room in the middle with three guernees (hmmm... NO idea how to spell that) for deliveries or private exams. There are curtains separating the beds from where everyone is walking though, but no curtains between the beds. The head nurse was telling me today that fathers are not allowed for the births because there could easily be another one taking place in the next bed. From there you walk though to the postpartum ward, which is identical to the antenatal ward, just usually less crowded.
I didn't get to do a whole lot today because the orientation took so long. There was one C-section but it had already started by the time I was finished. Other than that no deliveries today. I did get to listen to lots of fetal heart tones through a fetoscope, which is basically a small plastic trumpet device that you put on the women's belly and the other end pressed against your ear. They couldn't really understand when I tried to explain continuous fetal heart tone monitoring to them. They listen to heart tones about twice a day, unless the women complains of some problem. Today there was the head nurse and two other nurses who were all very nice. One of the nurses is actually named Dina! It was quite the awkward moment as we introduced ourselves because her English isn't the best and we both kept saying "Dena", thinking the other person was just repeating our name to see if they had it right until we realized we had the same name! She didn't seem quite as excited about it as I was, though. I have yet to see a doctor on the labor ward, although I'm not sure what there would have been for them to do today.
I'm running low on internet time, so I guess I'll leave it at that for today. I hope I didn't bore anyone to death, it is indeed quite hard to be witty in these things. Especially when your time is limited, so it's turned into more of a stream of consciousness thing really. So that's what I was up to today. Don't know when I'll make it back to write more, but I miss you all very much and I'm having a great time.
I'm placed at a different hospital than the other girls, which I thought I wouldn't mind, but it is quite the trek out to the one I'm working at. It's about a 40 min (brisk!) walk and then a 20 min dala dala (think a big crowded full size van... all for the bargain price of 500 tanzanian shillings, about 40cents). It wasn't as terrible as I was anticipating, there was a decent breeze though the windows so I wasn't suffocating and at least today I didn't sit next to anyone too smelly (as I realized quite quickly they haven't discovered deodorant in Africa. Not entirely surprising as the majority of Europe hasn't really either, but it's a bit more evident here. It's not just if you're packed into a crowded space with someone like in France, but you can't really walk down the steet without getting a whif of BO as people walk by. I'm trying to be open to their culture and whatnot... but if there is one thing I could change so far, it wouldn't be being able to drink the water, or less dust, or airconditioning everywhere, or toilet paper, it would be giving everyone a stick of their very own deodorant. I'm thinking of taking up donations.
Anyway, I got way off track there on my little rampage about smelly people (you KNOW how sensative I am to smells!) , but the point is it takes just over an hour to get the hospital. We are technically supposed to be there at 7:30 for morning report, but I've heard from some of the other students that you don't really need to go every day. Which is nice, because although that is still late on American labor and deliver standards, it's pretty early on fourth year time.
The hospital itself is made up of lots of separate buildings. I got a very extensive tour today, I think I saw pretty much every room/office there was to see and was introduced to just about everyone who works in the hospital (including the laundry lady and the lady who makes Chi tea for break time). It struck me as odd that they would barge into the various exam rooms to introduce me to the clinicians while the patients were sitting right there. No one seemed to mind though and everyone was very friendly. There were lots of awkward moments, however, as everyone insisted on trying to speak Swahili to me, so I kept having to decide which of my limited Swahili works (Shikamoo - formal hello, Asante - thank you, Nzuri - good) was the most appropriate reponse to whatever they said. I must have said asante about a billion times for lack of anything more substantial to say.
There are separate buildings (all one floor and not very big) for the women's ward, the men's ward, the labor ward, the pediatric ward (which only goes up to 5 years old, after that you're considered an adult), and then various outpatient clinics (dentistry, peds, a special HIV clinic) which are less buildings and more just small rooms around a covered courtyard where people wait. The wards are just what you might picture, one long room lined with about 16-20 beds. The pediatric and mens wards have the option to have a private room on one side of the ward for 10,000 shillings a night (about $8), but most people can't afford that (the regular ward is only 500 shillings a night... again, about 40 cents). You don't get a whole lot extra for that either, other than three walls and sliding door because the rooms are TINY and don't have anything more special than the regular part. Although I guess you are guaranteed your own bed, as they double up the beds in the regular ward when they run out of room. It's different than at home though where the patients spend most of their day in bed. The majority of the patients I saw where just lounging about the buildings, sort of roaming willy nilly. I can't really see that flying so well at Barnes...
The labor ward itself is a long skinny building, one end is the antenatal side, where the women in labor come and hang out until they are ready to deliver. It has about 16 beds, and there were more than that number of pregnant women there. They were all surprisingly calm, only grimacing silently occasionally with a contraction, but for the most part it felt more like a sleep over than anything else. From the antenatal side, it leeds into a smaller room in the middle with three guernees (hmmm... NO idea how to spell that) for deliveries or private exams. There are curtains separating the beds from where everyone is walking though, but no curtains between the beds. The head nurse was telling me today that fathers are not allowed for the births because there could easily be another one taking place in the next bed. From there you walk though to the postpartum ward, which is identical to the antenatal ward, just usually less crowded.
I didn't get to do a whole lot today because the orientation took so long. There was one C-section but it had already started by the time I was finished. Other than that no deliveries today. I did get to listen to lots of fetal heart tones through a fetoscope, which is basically a small plastic trumpet device that you put on the women's belly and the other end pressed against your ear. They couldn't really understand when I tried to explain continuous fetal heart tone monitoring to them. They listen to heart tones about twice a day, unless the women complains of some problem. Today there was the head nurse and two other nurses who were all very nice. One of the nurses is actually named Dina! It was quite the awkward moment as we introduced ourselves because her English isn't the best and we both kept saying "Dena", thinking the other person was just repeating our name to see if they had it right until we realized we had the same name! She didn't seem quite as excited about it as I was, though. I have yet to see a doctor on the labor ward, although I'm not sure what there would have been for them to do today.
I'm running low on internet time, so I guess I'll leave it at that for today. I hope I didn't bore anyone to death, it is indeed quite hard to be witty in these things. Especially when your time is limited, so it's turned into more of a stream of consciousness thing really. So that's what I was up to today. Don't know when I'll make it back to write more, but I miss you all very much and I'm having a great time.
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