Warning: graphic pictures at the bottom, view at own risk!
Sorry it's been forever, life has been busy! I went back to the UK for 10 days because I had a job interview for the 7 year obs & gynae training program. Everyone keeps asking how it went - who knows! I can think of lots of things I could have said/done better, but overall I think it was OK. It's pretty competitive though, so we'll have to wait and see!
It was a major effort, but was so great being home, seeing everyone and eating all the food! At the beginning of the week I was feeling a bit unenthusiastic about coming back. We were really busy in the period leading up to me going away as our 2 O&G registrars from Lusaka had left and their replacements took about 4 weeks to turn up. But they're here now so we've gone from doing 1 in 2 on calls to 1 in 5, which is SO much more manageable. It really felt like coming home, returning to Katete, even if it is a fairly stressful place to live! All the nurses and even some of the patients were asking me where I was/had I had a good trip, which was really sweet.
The Dopplers have gone down very well. Thank you all SOOO much for such incredible generosity. There was an almost overwhelming response, to the point were I could have bought about 20 dopplers with the number of people who offered. It's was so kind of you and it will make such a difference. In the end I bought/received 2 dopplers, rechargable batteries, a battery charger, a HUGE thing of ultrasound jelly, some urinalysis sticks and some pregnancy tests. I've taken in one doppler, the charger, jelly and half the urine sticks/pregnancy tests and kept the others at home for the minute to see how we get on with the first lot. The doppler has been used a lot already. It's fairly straight forward, but James said he'd do a teaching session for the midwives with me to make sure they know how to use it properly.
It's SO much better than using the pinard stethoscopes. During my on call on Sunday I picked up a patient with fetal distress who was having decelerations after each contraction. I should be able to pick that up with a pinard too, but it's SO much clearer with the Doppler, so less likely to miss things, and it means you can listen for an extended period of time without getting back ache from bending down for so long (with pinards you have your head about 10cm away from the patient's belly).
On Friday we had a manic morning - me and James were on labour ward and we had a lady having eclamptic seizures and uncontrollable high blood pressure, then another lady had a bleed in labour (APH). It was difficult to decide who to section first as they were both at risk of dying if left untreated for too long. We took the bleeder first while the eclamptic lady's BP was hopefully coming down on medication - she wasn't able to have a spinal anaesthetic as she was too confused/agitated and a general anaesthetic makes your BP even higher so risks giving them a stroke. So you treat the BP first and then do a section under GA.
It turned out the APH was caused by a large placental abruption (blood collecting behind the placenta, causing it to separate from the womb). We managed to stop the bleeding in theatre, but unfortunately post-op she had a large PPH (bleed post-delivery). We tried the usual methods to get it to stop (rubbing the uterus to encourage contractions and giving medication - oxytocin and misoprostol) but these were unsuccessful, so James did a balloon tamponade. You get a catheter and tie a condom on the end and put it inside the uterus, vaginally, and then fill the condom balloon up with water and the pressure (hopefully!) stops the bleeding.
While he was doing that I went to check on the eclamptic lady who was waiting in the theatre corridor for her section. She was being seen by Dr Makukula, our consultant. Whilst waiting for the theatre to be free she had become fully dilated so could be delivered vaginally, with assistance. Much to the amusement of the general surgeons, we took her into what's essentially a broom cupboard off the corridor and attempted a kiwi suction delivery. Unfortunately things went from bad to worse as she then had a shoulder dystocia - the head came out but the body was stuck because the shoulder was impacted behind the pubic bone. After a lot of pulling and pushing eventually the baby came out, not in a very good condition. I took him through to the main theatre where we have a resuscitaire, and after about 20mins of resuscitation we got him to breath (like I said doing the newborn life support course really was the best thing ever!) Then on top of everything, while the baby was being resuscitated the mother had a PPH! She was rushed into theatre in case we needed to do a balloon tamponade on her too, but luckily this one did stop with the medication.
So we managed to see about half of all possible obstetric emergencies in two patients in one morning! As my housemates back home will tell you I actually really love working with these kinds of emergencies, as long as there's good senior support. Perhaps it's a little strange, but what I actually find stressful about being here is that often I'm left doing mundane things, like the ward round, on my own. Whilst there are rarely emergencies on the ward round, there are a lot of complex patients and often I don't feel comfortable making decisions for them (generally I write a LONG list of questions and then find James).
Then after all the madness settled down we got on with the elective surgery and I assisted Dr Makukula and Dr Kiniyki in removing the BIGGEST fibroid uterus I have ever seen. Here come the gross pictures!!
See how small my pen looks next to it - that's a regular biro!!
Sorry this blog has got quite medical lately! I'll put some pictures of chickens or sunsets or something next time!!
Sorry it's been forever, life has been busy! I went back to the UK for 10 days because I had a job interview for the 7 year obs & gynae training program. Everyone keeps asking how it went - who knows! I can think of lots of things I could have said/done better, but overall I think it was OK. It's pretty competitive though, so we'll have to wait and see!
It was a major effort, but was so great being home, seeing everyone and eating all the food! At the beginning of the week I was feeling a bit unenthusiastic about coming back. We were really busy in the period leading up to me going away as our 2 O&G registrars from Lusaka had left and their replacements took about 4 weeks to turn up. But they're here now so we've gone from doing 1 in 2 on calls to 1 in 5, which is SO much more manageable. It really felt like coming home, returning to Katete, even if it is a fairly stressful place to live! All the nurses and even some of the patients were asking me where I was/had I had a good trip, which was really sweet.
The Dopplers have gone down very well. Thank you all SOOO much for such incredible generosity. There was an almost overwhelming response, to the point were I could have bought about 20 dopplers with the number of people who offered. It's was so kind of you and it will make such a difference. In the end I bought/received 2 dopplers, rechargable batteries, a battery charger, a HUGE thing of ultrasound jelly, some urinalysis sticks and some pregnancy tests. I've taken in one doppler, the charger, jelly and half the urine sticks/pregnancy tests and kept the others at home for the minute to see how we get on with the first lot. The doppler has been used a lot already. It's fairly straight forward, but James said he'd do a teaching session for the midwives with me to make sure they know how to use it properly.
When I took this picture I was really careful to not get the lady's face (confidentiality) but it didn't occur to me that it's probably not appropriate to have her boobs in the picture until I'd uploaded it! Our patients spend most of their time naked or at least topless so I've got a bit desensitised!
On Friday we had a manic morning - me and James were on labour ward and we had a lady having eclamptic seizures and uncontrollable high blood pressure, then another lady had a bleed in labour (APH). It was difficult to decide who to section first as they were both at risk of dying if left untreated for too long. We took the bleeder first while the eclamptic lady's BP was hopefully coming down on medication - she wasn't able to have a spinal anaesthetic as she was too confused/agitated and a general anaesthetic makes your BP even higher so risks giving them a stroke. So you treat the BP first and then do a section under GA.
It turned out the APH was caused by a large placental abruption (blood collecting behind the placenta, causing it to separate from the womb). We managed to stop the bleeding in theatre, but unfortunately post-op she had a large PPH (bleed post-delivery). We tried the usual methods to get it to stop (rubbing the uterus to encourage contractions and giving medication - oxytocin and misoprostol) but these were unsuccessful, so James did a balloon tamponade. You get a catheter and tie a condom on the end and put it inside the uterus, vaginally, and then fill the condom balloon up with water and the pressure (hopefully!) stops the bleeding.
So we managed to see about half of all possible obstetric emergencies in two patients in one morning! As my housemates back home will tell you I actually really love working with these kinds of emergencies, as long as there's good senior support. Perhaps it's a little strange, but what I actually find stressful about being here is that often I'm left doing mundane things, like the ward round, on my own. Whilst there are rarely emergencies on the ward round, there are a lot of complex patients and often I don't feel comfortable making decisions for them (generally I write a LONG list of questions and then find James).
Then after all the madness settled down we got on with the elective surgery and I assisted Dr Makukula and Dr Kiniyki in removing the BIGGEST fibroid uterus I have ever seen. Here come the gross pictures!!
Sorry this blog has got quite medical lately! I'll put some pictures of chickens or sunsets or something next time!!
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