Tuesday, March 25, 2014

Taking it all in - obstetrics and gynecology in Senegal

This is my first time in Senegal and my first time providing clinical care outside of the United States.  I have made a fair number of rather long journeys to similar locals, but never in a clinical capacity.  In the past I had generally embarked on the journey expecting that I had an idea as to what my role would be, either in a school, a clinic, a public health project, but without an explicit job description. I had been comfortable with that. Coming fresh from a month of nights on a busy labor floor, I stepped off the plane in Senegal and I felt like I should enter back into constant movement and flurry of activities.  The first day at the hospital, I was relieved to find an awaiting cesarean section – I felt immediately useful.  And when down time followed, I found myself anxious about how I would maximize my time –how should I integrate into the resident team?  what should I do in my free time? should I join in a research project?  which presentations should I prepare for my colleagues? I was searching for ways to find the affirmation as an individual that I was accustomed to in residency. 

But I did not come to Senegal to simply be my American resident self, I was here to begin to learn how to be a doctor in a place where I don’t have every amenity and test at my fingertips.  I shifted my outlook over those first few days and paid attention, observed, listened, and asked questions, so that I could begin to understand the system I was going to be working in.  This is a glimpse of what I found.

The labor room.  Only for women ready to push.  As opposed to Boston’s spacious, private rooms with epidurals overflowing, there are three gynecology beds in a row, for three women to labor side-by-side, each to her own rhythm.  The only pain relief is delivery. 

The nursery.  You may have noticed the “nursery” in the picture above.  After birth the babes are cleaned, swaddled and placed in a row on an open table, under regular lamps to keep them warm.  Spooning babies is surprisingly effective soothing while mom is recovering after her delivery.  

The Pinard.  My co-resident pictured above is expert and I am always wishing that I had smuggled a bedside Doppler into my luggage to find each babies’ heartbeat. 

The operating room.  No bells and whistles, but with everything we need.  After scrubbing and prior to opening the sterile box of instruments, it is always a mystery as to which instruments you will find.  It is typically no more than 15 instruments, many of which are different from the last kit used.   We return to surgical basics and make instruments work for us.

Anesthesia.  General is rarely needed though available with manual ventilation as pictured below.  Nearly all gynecologic procedures are performed under regional anesthesia.  Fortunately, both the gynecologists and general surgeons do extremely challenging surgeries within the time constraints of regional anesthesia.  

Indications for surgery.  Fibroids were by far the most common reason for gynecologic surgeries.  These are typical specimens from one patient - every last one comes out.  

Operating with general surgeons.  I have not assisted a general surgeon, let alone had a male patient on the operating table since my third year of medical school. Yet the general surgeons here do a fair amount of gynecologic surgery and thus are incredibly valuable teachers. 

Fortunately, despite some of the contrasts highlighted here, the human body and gynecologic pathology are fairly constant whether you are in Boston or Senegal.  That keeps me breathing easy while I continue on this incredible and humbling journey.

Rebecca Luckett MD MPH

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