Tuesday, August 18, 2009

I'm Here!

 I am contributing to this blog a bit later than I wanted to as I have already been here for four days, but it should be fairly easy to catch you up on what has been going on so far!

Day One

 I arrived on Sunday morning feeling a little disoriented since I had been on various planes from Seattle for approximately twenty hours and Vanuatu is 18 hours ahead of PST. Arriving in Port Vila (the main city on Efate, which is the island I am staying on in Vanuatu) at 10AM on a Sunday makes one feel as though Vanuatu is a quiet and desolate place. Not so. It is just that barely anything is open on Sunday!  Here are three things that I wish other students had told me right away, and that I think will be helpful for those following me:

  1. Don’t take a taxi from international arrivals! The cost is 2000 Vatu, which equates to about $20 USD and if you just go outside and walk to the right you will find yourself in the domestic arrival area and can take a bus. This is half the price and you can chat with a few of the locals, who are very friendly.
  2. If you are traveling alone I recommend the Coconut Palms Resort. They offer a great deal to those who are booking for a month or greater, are a two-minute walk from the hospital, and they get most of the ‘Baby Docs’. Okay, so let me tell you  about the term ‘Baby Doc’: I thought that this term meant obstetrician or midwife, but that is not true. What is means is that you are a baby doctor, i.e. not a doctor quite yet because you are a baby who is still learning. That is why you are still training at the hospital, after all—because you are a doctor who is not grown up just yet! Anyway, there are lots of ‘Baby Docs’ that I have met at this resort. Two are from Australia, one from New Zealand, and a couple from France who have just left. All of these med students are doing various rotations at the hospital. There is another New Zealand midwife who I have met as well who is finishing her training. She and I are delivering babies together. What is also great about this resort is that there is a ‘Baby Doc’ lounge/common room with a kitchen and a computer with internet access (albeit sometimes very slow).
  3. As previously stated, internet is not the best here and wireless connection can be rather expensive to buy ($5 USD per hour in my room!). That being said, there is a lovely place on the water called NAMBAWAN CAFÉ (and yes, this is pronounced ‘Number One’ Cafe) that has free and very fast wireless (you will meet many lovely tourists and they make a mean latte or anything else you might want).

So these are all the great things I learned on day one (not bad!), the day before I started at Port Vila Central Hospital (VCH).


Day Two

On Monday I showed up at the hospital at 9:15AM since I knew that was when morning rounds finished. The sisters in the maternity ward had no idea that I was coming since calling them from the states can be a bit hit or miss. This was not a problem as Sister Leitangi (the midwife in charge) welcomed me with a big smile (though she may have been welcoming my gift of chocolate) and had me shown around right away. It should be no surprise that things are very different here. The hospital is old, the equipment is ancient, and supplies are short. For those coming to work in the maternity ward, I recommend bringing these supplies if you are wanting to donate to the hospital:

  • Gloves (sterile and non-sterile)
  • Amnihooks
  • Sterile lubrication!!!!!!!
  • Chucks
  • Overnight pads (or any other maxi-pad)
  • Hand sanitizer
  • Hospital grade liquid soap
  • Short needles for IM injections on babies
  • Office supplies (pens, a hole punch, etc.)

I was told that I should bring white fabric since the maternity ward is short on sheets, but I have to tell you that I don’t think they’ll use them unless the material is extremely thin and light material. That is the quality of the sheets that they use in the delivery rooms because they are extremely easy to wash and so better quality sheets are put elsewhere.

 My first day was very good and I assisted on my first birth and then jumped right in and delivered the second baby who was born. There is a definite routine in regards to birth here. Mamas don’t generally want to see their babies right away so as soon as the baby is born he/she is dried off and taken to the warmer. The mother is given a shot of syntocin immediately upon delivery to prevent hemorrhage. The placenta is delivered and then the mother’s blood pressure is taken. As long as it is 120/80 or less she is then given a shot of ergometrine; if it is higher, you give her another shot of syntocin. I realize that to those of us in the states this may seem like some serious overkill, especially to those of us who don’t even follow an active management protocol of giving pitocin at delivery. That being said, this hospital has only had two postpartum hemorrhages in two hundred births. These women come to VCH from the 80 or so other islands that make up Vanuatu and they leave two days after they have delivered and go back to the island that they call home. There is almost no follow-up and so it is better to manage as conservatively as possible; birth is much more dangerous here than in the states.

Perineum inspection is done right after placental delivery and suturing done, if needed, at that time. The baby is weighed and given two shots almost immediately: one is Vitamin K and the other is a Hepatitis B vaccination. Although I am not used to giving this vaccination (and actually tend to advise against it in the states until a child is an adolescent at least) the Hepatitis B infection rate is very high here (I have heard 60% but need to check that out) and so it is fairly easy to understand why it is done at birth (babies are also given their BCG vaccination for prevention of Tuberculosis before they are discharged from the hospital). It is after all of this that the mama finally breastfeeds and bonds with her baby a bit.  Mothers are moved to the postpartum area about an hour after birth and her baby is given a bath. The two are then with all the other mamas and new babies and the doctors check on them the next day and discharge them by day two.


Day Three

Yesterday I finally felt like I was getting the hang of how deliveries are done here. When I arrived at 7am, one mama had just arrived after having had her baby unattended at home. She was stable and well and her baby was healthy so, thankfully, not much to report on there. Two other ladies were in labor as well, but only at four or so centimeters, so they still had a bit of time to go. They were neck and neck for much of the afternoon, even rubbing each other’s backs when their labors got very intense (I wish I had gotten a picture!), and then had their babies about a half hour apart. On the whole, the labors I have been at were fairly uncomplicated, which is definitely the way to start when you are in a new place!


Day Four

I woke up this morning to a cloudless and beautiful day. I took my shower, had some tea, and put on my scrubs, walking as far as the front door of the hotel. I stopped for a moment, turned around, and went back to my room and changed. I decided to take the day off! I realize how irresponsible this may sound after only two days at the hospital, but have decided not to feel guilty about it (and to not feel guilty is very difficult for someone with a work ethic like mine). My day, then, has consisted of a fantastic and slow breakfast with a couple lattes and lying in the sun at the pool. Not too shabby!

Will write more tomorrow....

xoxox Carrie

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