Maternal/fetal mortality and the wonders of modern medicine

I got called in at 2:56am for another c-section for a dead baby with a ruptured uterus which ended up needing a hysterectomy. I have lost count of how many of those I've assisted on in the 6 weeks I've been here. I bet most OB-GYNs in the developed world have never even seen one. (Feel free to correct me if I'm wrong).

I read somewhere recently that late fetal/newborn death rates were around 40% in the 1800s, and only with the advent of modern medicine, pre-natal care, ultrasound, etc., has it decreased as much as it did (to something like 4% globally-- I can't find the article now). According to Unicef data: "The lifetime risk of maternal death in high-income countries is 1 in 3,300, compared to 1 in 41 in low-income." http://data.unicef.org/topic/maternal-health/maternal-mortality/

Well, you might remember from an earlier post, that I said Chad was stuck in a way of life from 2000 years ago. And that means, maternal/fetal/newborn death is still ridiculously high. Unacceptably high.

Call me a wimp, call me a weakling, call me whatever you want, but it's been really hard for me, dealing with it all. Last week I only went to the OR one day, and dedicated myself to teaching at the nursing school. This is my last week, and honestly, I'm glad it is. 

Since I have been trying to push it all down and not think about it, I guess my brain decided to make me deal with it at night, in my dreams. So I've been having terrible dreams, waking up crying, and sleeping badly. Consequently, I'm tired all the time.

I'm glad and always in awe of people  like Dr. Danae, Dr. Olen (her husband), Dr. Bland (her dad), but I don't have what it takes to be a full-time doctor in a place like Chad. I'd last a month, maybe two, run away screaming and move to an island in the middle of the pacific, preferably populated by only nuns and cats (therefore no ruptured uteruses, dead babies, ectopic pregnancies, etc., etc., etc.).

So for those of you who might be wondering if I intend to be a full-time doctor in Africa someday, the answer is no. I couldn't handle it. I'm not strong enough. And that's ok. 

(That's a ruptured uterus, so badly ruptured that it was impossible to save. I think this is the one we gave 5 bags of blood cuz she just kept bleeding)

An Ode to Nurses

An ode to nurses

For the past 2 weeks, I've been giving Anatomy and Physiology classes for the nursing school attached to the hospital. It's just 2hrs a day, before I go to the OR. 

I love it. It has helped take my mind off things for a little while, and preparing the classes has been a great way to review stuff. 

But today, at the end of class, I stopped everything, turned off the powerpoint, and told them to pay very close attention because I was going to tell them the most important thing they need to learn about nursing: 

The doctors see a patient at rounds, for maybe 5 minutes a day. The doctor is the detective, that discovers what is wrong, and decides the treatment. But the nurses are the ones who actually treat the patients. The nurses are the ones who realize if something is wrong, and the patient is getting worse. Or if the treatment is working or not. 

If something goes wrong, the nurse is the first one to notice, and it is their responsibility to tell the doctor. The doctor can't guess or devine what is going on. The nurse is the eyes, the ears and the hands of the doctor. 

Nurses: don't underestimate the importance of your work. The doctors could never treat patients without you. 

Doctors: never forget that. Treat your nurses well, because the quality of patient care depends on your interactions with them.