25.02.2020 Full days

All our current patients (yes we have 3 children in one bed)

Tuesday morning began like it has most Tuesdays for me that means doing ultrasounds to date pregnancies.  I’ve had a senior midwife I’ve been teaching abdominal scans for biometrics later on in pregnancy but have now started showing her vaginal ultrasound technique.  I’m still very impressed with the ability of many here to pick up quickly on skills.  Today we had some challenging cases.  The first was a patient with missed abortion coming tomorrow to begin treatment, using the QM which I just finished modifying to meet the standards I know from my training back home.  My next patient was one with a suspected molar pregnancy.  Since last week I have been trying to organize some form of lab tests because we don’t have any possibility to do lab tests here on site.  I visited the lab of another hospital and found out the details of what I would need to do. The blood tubes arrived just this past Friday and today I was actually able to take the very first blood sample here!  The results of my beta-HCG are still pending but the blood got delivered. 

First set of blood collection tubes :) These were not so easy to find! And for those familiar with those vacuum systems like for Quantiferon test - well here all blood is taken this way....not my favorite!

Another case today was a young lady whose husband recently left her as the family informed me due to some problem down there. The reason sadly I soon discovered during the vaginal exam for which I was only able to insert my finger tip.  Upon further questioning I was given a report from a doctor she had seen already.  No uterus visible.  There was a recommendation for a vaginal reconstruction.  However, there is no way the family could afford it so they came here to seek advice.  Its not a surgery I am capable of doing so we spoke about the options and what expectations she can have.  Those were some tough cases for the morning.  Meanwhile operations for hernias and club feet were well on their way with the team of German doctors.

Patients waiting on operations

Volunteers managing and tending to patients during the busy week in our ward.  Meanwhile labor and delivery was continuing on normal schedule.  The moms that just delivered had to stay in the labor and delivery room (of which there are 2)  so we were hoping that not too many would deliver these days!

In the evening it was another patient that had my attention.  Last baby born had neonatal asphyxia due to prolonged birth and shoulder dystocia.  This baby was even larger and the chance of a repeat are about 13 percent.  We spoke to her about the risks and the possibilities as contractions were slowly starting. She opted for a c-section.  As preparations were made her water broke, very green, and the baby began showing signs of fetal distress.  The delivery via c-section went quick, but the baby was quite weak so the team went straight to work stimulating it and giving oxygen.  Meanwhile I was quite busy tending to the deep cervical tear that resulted.  I was nervous as it was difficult to see but I remembered what I had learned in my training and went step by step with my heartrate a bit higher than usual.  All went well in the end but this was a challenging case for me.  So thankful to have had a very experienced anesthesiologist, Michael, from our team of German doctors there this night.  That was a blessing.

Surgical preparations with Anna (surgical nurse), Ando (midwife) and Dr. Michael (Anesthesia)

#7 C-section: Baby Henintsoa