Monday, 19 September 2011

Episiotomy repair by nokia flashlight!

Episiotomy repair by nokia flashlight!

Today was mostly spent with just one woman who was in labour when we arrived in maternity after the morning meeting. We were told by the midwife she was probably about an hour away from delivering and so decided to stick around rather than going on morning ward round (or in Aj's case instead of going to get an x-ray of a potentially broken foot - injured by jumping off a meteorite for a picture. True story. I failed to get the picture...).

Turned out to be more like 5-6 hours in the end but oh well! For the best in the end as the midwives kept wandering out for literally hours at a time, leaving just me and Aj with this lady who was fully dilated and could theoretically give birth at any time. Not too big a problem if it was a straightforward birth as at least we know how to deal with these now but ideally would have liked to know where help was if we needed it. It was a complicated birth in the end as the woman needed an episiotomy so it’s a good thing the midwives had reappeared. Other than that I delivered the baby, a healthy baby girl.

By the time the repair of the episiotomy was carried out the electricity had gone on one of its frequent disappearing acts and no functioning torches were in the labour room so the suturing ended up being done by the light of my mobiles tiny flashlight! Quite a surreal experience and not one I anticipated when I bought the phone!

Later we heard about a c section that had occurred that morning from one of the other students. The baby had been born with a low Apgar score and required CPR. Having not initially responded to the first few minutes of this the baby had been injected (via the umbilical vein) with adrenaline. This is good… but also odd. We have seen a number of babies during the our 3 weeks here so far that would probably have had a better end outcome if they had received adrenaline as per the resuscitation guidelines but they did not get any. When we have in the past asked why not, we have been told it is because they do not have a large enough supply of adrenaline. However today’s baby did receive adrenaline and the other medics were told that this was because that baby was “a very special baby”. Don’t get me wrong, I’m glad that the baby got adrenaline and apparently he improved a lot immediately after that, but aren’t all babies special and important?? How can they choose one baby over another like that if both babies had equal need of the adrenaline? Well it turned out that this baby was the grandchild of one of the senior doctors and that his mum was 40 years old - so exceptionally old in Tanzania to be having a first child. I guess that explains the preferential treatment of this baby, not sure it would be the correct answer to one of those interview ethics questions about “Who should get the treatment?” though.. But at least someone got it rather than the adrenaline just sitting in a cupboard forevermore.

Aj's foot? Possibly a v. small fracture but some debate - radiologist says yes, senior doctor says no. Management is same either way - RICE, however ice isn't exactly easy to get here and rest/ elevation would involve missing compression will have to do! Moral of the story? Don’t jump off meteorites in flip flops. Wellll not all morals are universally useful ones :P.

1 comment:

  1. great experience . best way to study and remember facts in medical field is practice and practice , practice