Today was our first day in the hospital. We met with Cristin the dietitian, who is our contact here. Although she wasn’t expecting us until Wednesday, she was super accommodating and took time out to tour us around the hospital and introduce us to various doctors and nurses. She then sent me to do rounds in the paediatrics ward with her colleague Caryn.
Caryn was also absolutely wonderful. She’s in the middle of her community service year (after completing medical school, all South African health professionals must perform a year of community service in one of the state hospitals) and wants to stay on for another few years. We went through the ward and spoke with all the mothers about their children’s nutrition. Most of the patients were infants, but there was one almost-four-year-old. All of the children were malnourished, but some were much worse off than others. One of the babies was only at about half of her proper weight. I just wanted to hold and play with them, but before I knew it we were off to maternity.
Ward 9 is the maternity ward here, and it is busy. First I joined the doctors on their rounds. The women who were in the ward overnight were those that had been admitted the day before because they were starting to go into labor (or “labour,” since we’re in South Africa). The group of doctors and interns went through palpating abdomens and performing pelvic exams. Two women were given a stack of paperwork to fill out in preparation for their C-sections (the hospital hasn’t been computerized so everything is on paper).
From there two of the doctors and I moved into admissions, where a long line of patients was waiting. The admissions room had one desk which the doctors shared and three beds for exams. Some of the women who came in were given pelvic exams to determine how close to term they were and whether or not they were in labor. Very few ultrasounds are done here–gestation is determined the old-fashioned way, by the size of the uterus. The doctors here have done this long enough to know how large the fetus is by feel, but they explained that one can use a tape measure as well (the measurement in centimeters of the external distance from the fundus to the pubic symphysis is equivalent to the number of weeks of gestation towards the end of the pregnancy, assuming the fetus is developing correctly). Palpation is also used to determine the positioning of the fetus. Generally, ultrasounds are reserved for abnormal cases, like when the fetal heartbeat is absent or when the weeks of gestation as determined by palpation don’t match up with the weeks of gestation as determined by dates (counting from the woman’s last period).
The doctors totally expected me to jump in hands first and as soon as they realized I knew nothing, they set about remedying the situation. I’ve already learned how to decide if a woman is going into labor and been given lessons on how to draw blood and how to palpate a pregnant uterus (definitely don’t feel comfortable with the latter two yet). As much as I love that I’m being allowed to get involved right off the bat, I must admit I’m a little uncomfortable with it. This whole experience is giving me a ton of respect for the degree of patient involvement at Feminist. I’m not sure the women I’m being instructed over have any idea who I am, and they’re certainly not being asked if they’re ok with my presence (and incompetence). This is definitely sitting very uncomfortably with me.