Payton’s Blog

50 pregnant ladies, a late night c-section, and absolutely no ID docs

So yesterday was antepartum day.  Basically all of the pregnant ladies due for checkup come around 7am and take a number then wait all day to be seen by me and a midwife, who is the cutiest old lady that everyone calls Auntie.  The visits are completely different than any patient encounter I have ever experienced.  I am behind a partial curtain with a table; the lady comes in and pulls up her dress, sits on the table and I measure her fundal height, feel for fetal position, and check for fetal heart tones (present or not, no heart rates!).  Then she leaves to wait outside for 1-3 more hours to get called in to be counseled by Auntie.  The next lady comes in and pulls her dress up to sit on the same sheet and use the same fetal monitor as the previous lady; no clean sheet, no spray sanitizer, just toilet paper to wipe the goo off.  And no one uses hand sanitizer (there really is none) or washes their hands between patients unless something really nasty happens or it’s lunch time.  Sounds gross but this is the only opportunity for pre-natal care these women have so no one complains, in fact they don’t say anything!  No questions, they don’t ask what or why I am doing something, just go with it and trust that what we are doing is right (huge difference from the TMC population!).

 So, in this herd of women there was one that required an ‘emergent’ c-section (emergent takes ~9hrs to happen).  She was a new onset pre-eclamptic with anasarca (swelling everywhere).  At first she did not want it, and Auntie finally convinced her by saying (in Ga) that they brought over a special white doctor just for her, then they looked at me and laughed and told me what they said.  So she stayed, I went home to change into scrubs while the anesthesthitist came in.  When I came back to the hospital it was around 5, the anesthesthitist arrived around 7 and the surgeon at 8.  Anyhow we proceded in a fashion that would make every ID doc go nuts, if the absence of handwashing didn’t do it!  I put on the shoe covers which were made of cloth, and would later act as a great mop for amniotic fluid and blood, then I ’scrubbed’ by washing my hands with iodine soap, no brush, then had to turn off the faucet with my elbow.  The nurse put a sterilized reuseable gown on me that was kind of like windbreaker/raincoat material (that made me sweat profusely!) then gloves.  They are so short on supplies that they only had 3 sizes of surgical gloves, so I chose a size too big on bottom with a size too small on top.  At the table I realized that I did not have eye protection, and neither didi anyone else!  So I asked a nurse if she could put some on me, and everyone thought I was crazy because they do not use it, but I asked nicely and they finally found me a scratche up pair of glasses in a cabinet.   Although the technique was not what I am used to the surgery went relatively well and mom and baby are doing fine today.

 Today was another usual day in clinic, but I started seeing a few on my own.  There are 2 major problems with this: 1 they will act like they know what I am saying but really have no idea, and 2 they use the British system of drugs so I am totally unfamiliar with about half of the trade names and doses.  This makes it hard on the resident that I check out patients to but she is very nice and understanding that I am trying to learn.  I have only been seeing patients for 3 days here but I have come to appreciate the art of physical exam.  There are no stat CTs (there are only 3 CT machines in all of Ghana!!), no radiologists (we read our own plain films), and no way to get electrolytes here.  The lab does CBC (no dif), UA, blood smear for malaria and sickle cell, pregnancy test, and that’s about it.  The doctors have to rely on history and physical exam which is a dying art in modern technology.  Anyway I have enjoyed my time so far and can’t wait to learn more.

 I am very excited that I am going to a Ghanian wedding tomorrow!!  As some of you know I love weddings and I am missing Adam’s brother’s wedding this weekend so I was really excited to be invited to Dr. Ablorh’s brother’s wedding.  I will surely write about that soon!