Thursday, October 1, 2009

Not my first day, but the subsequent two

2/10/2009 10:37 AM, Port Vila, Vanuatu. I am hard boiling eggs. The eggs are small, maybe 70% the size of the regular egg in the US. We got them last night at the open market, 30 eggs for 700 vatus, so probably around US$8. If you buy eggs singly they can be as many as 50 vatus apiece. The day before yesterday there were no eggs at the market. We stopped by last night on our grand survey of stores and markets last night and found them, and little bananas which had little black bugs which prompted me to put them down on the pavement and suffer the hilarity of the American guy afraid of the bugs, but if you had read the chapter in Getting Stoned with Savages about the centipede you would have been afraid too!)

I'm hard boiling eggs because the sisters at the hospital sent me home because there was nothing going on. We had already discharged the 3 post-partum patients available to be discharged. Then another sister commanded me along on her mission to do nursery rounds. The nursery babies were actually with their mothers in the "extension" ward, another room across the breezeway. All the wards are open. Each woman has a bed and a little basket on wheels for the baby, which is covered with mosquito netting. Most of the women have a relative staying with them also. This is indicated on the big board by "+ relative x 2." They cook for themselves. There is a shower and bathroom in our ward for them to use.

At some point I will get over my resistance to taking photos of relevant things and actually take photos of the ward.

So, today I discharged people, which involves writing things in 3 books, and did nursery rounds, which involves taking temps and doing pulse oximetry and asking the mom a few questions. Temps are done with a body temperature sensor (pressed against the baby's chest). The sequence for using it appears to be: press on. Press on a bunch more times until it displays "Er 3." Then it counts down and says "Ready." Then it's pressed against the baby's chest and displays the temp in Fahrenheit, which is noted on a piece of scrap paper until it can be compared against a chart of Celsius conversions. Pulse ox is done with an adult-size pulse-ox on babies who are decidedly not adult-sized. In fact, these babies being held are under 2.5 kg or premature or both. They have tiny toes. It usually gives a reading anyway though, and these are noted on the paper as well. Then we ask "titi good? piss-piss? sit-sit?" and note that they are breastfeeing well, urinating, and stooling.

When we get back to the nursery (a small room with a sign "Incubator Room") these notes are transferred to stacks of paper on clipboards, which constitute the inpatient records of the babies. None of the babies are referred to by name, just "B/O Marie" which is to say, their mother. The midwife set me to the paperwork, then gave me a little book on Ob/Gyn protocols for the country and told me to sit and read it so I can learn how they do things there. I did.

There is a small tea room with a TV, a hot water dispenser, and today's newspaper, which features a photo of Barack and Michele Obama with the PM of Vanuatu and his wife at a museum in New York. Many people have asked me about Obama, if he is good. "First black?" a sister (Annie, I think) asked me today. (I'm terrible with names.) I really want to bring home a copy of the paper. It's a mix of English and Bislama and includes a gossip column, government job postings (in English and French), and on the front page was the continuing saga of Little Sharon who has a tooth abscess and needs surgery in Australia but the Australian government won't give her a visa and so they might need to go to New Caledonia instead (continued on page 3).

Yesterday was quiet on the ward as well, so Sister Annie took me to the Antenatal Clinic. It was quiet there too, but soon a woman came for her prenatal appointment. The visits are scheduled for a general time of day, and the women wait in a waiting room with a TV playing educational DVDs. All the charts are in big binders on a table at the front of the room. There is a teenager sitting out front, checking people in, reading a novel otherwise. The sister handed me the woman's chart and indicated I should begin. I balked and asked if I could watch her do a visit first, which I did, but then she expected me to do the next visit on my own, which I did, in a halting mix of Bislama and English and confusion over what to ask, even. (I've grown reliant on the checklists we use at our clinic.) Every visit needs the basics of blood pressure, weight, how the woman is feeling, if the baby is moving well, but then I started drawing blanks. That was deemed sufficient, and the woman climbed onto the table and I did Leopold's, feeling the baby's position, and tried to estimate how far down into the pelvis the baby had descended (which they note as a score out of 5). Then I used a fascinatingly old and large Doppler to check the baby's heart rate (using KY from a tube instead of ultrasound gel). This woman was almost 35 weeks, so we decided she should come back in 2 weeks (noted as "2/52") in the morning, which I wrote on her appointment card (the back of a piece of cardboard on which all the appointments were noted and subsequently crossed off). This card is also used as a convenient ID -- it looked like she presented the card at the door, which enabled the nurse to get her chart. Then we all moved back into the midwife's office, where she was dispensed prenatal vitamins (iron and folic acid) and chloroquine (for malaria prevention) for 2 weeks (the tablets are assembled into little baggies in advance and stored in cylinders marked "1 week" "2 week" etc indicating how many weeks' worth of medications each baggie contained.

The sister (midwife) and I sat and talked for a bit, about different protocols, the services they offer in Antenatal (including family planning, cervical cancer screening, and PMTCT, which she repeatedly referred to in its acronym form until I finally asked -- Prevention of Maternal to Child Transmission of HIV). She was well-read on all the latest MTCT research, and while I read a journal on international sexual health, she flipped through a new comic book (produced by AusAid) breastfeeding, which she gave me a copy of and while I will prize as my Bislama tutorial book. (It's a very relevant story about a mother who goes back to work, so the grandmother starts feeding baby a tea from orange leaves, and the baby wastes away. At the end she learns how to hand-express her milk, how long breastmilk can stand on the counter, and how to feed baby by cup.)

There was still nothing going on in Maternity, so I headed back to our studio, and Molly and I went out to faire le shopping! I had read about a Chinatown, and we were in sore need of cheap food, so we made a big ring (including a stop at the ATM -- WestPac is in affiliation with Bank of America, which works well for me) and found all the cheap Chinese stores, most of which were still pretty expensive on the canned food front, and none of whom had dry beans. We found a little Au Bon Marche (upscale grocery store) where they had soy milk (but I didn't remember why I wanted it). We did not find a place with a sunglasses string (which I was hoping to use to keep my glasses up -- my sweat is proving an amazing lubricant to my new plastic glasses) but we did find meat (my Eat to Live sensibilities are being put on hold while legumes prove difficult to find) and cheaper cans of beans at the closest store (French-speaking Chinese-run). Bean and beef chili for dinner!

So, basically, two days without babies. But! On my first day! 3 babies! I went with Molly so I could have a little intro/transitional day before she went to a different shift, and Sister Leigtagni asked if I was ready to start, and I said "sloslo" but then we had all these babies quickquick! And oh, the paperwork! Oh, the books to write in!

The hard-boiled eggs are ready, so I'm going to pack up some lunch and head somewhere on the water. I'll try to blog more often and hope to dig up the details of those births (and my first suture job) because they're replaced by more.

(The wireless is really terrible at our place, so I haven't been able to upload photos. Maybe tonight I'll go to Nambawan Cafe to re-re-attempt.)

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