My first week on rounds proved to be quite interesting. Some of the patients in the antenatal unit have traveled for hours only to find that they are in false labor. We may let them stay for a couple of days to see if labor starts before sending them back to the villages. Some women have sought care for the complaint of leaking or bleeding. Some have been sent by their health center for severe anemia. Many of the tribal women do not eat meat during pregnancy and as a result they can be admitted with blood counts as low as 2.5! Preterm labor has not been a major complaint. Most likely the patients with money travel to bigger hospitals with more resources. We don’t have a neonatal intensive care unit and I don’t believe that the newborns receive an exam by a pediatrician before discharge. I was told that any baby born under 28 weeks is a spontaneous abortion, which means comfort care only. I have not seen any babies born between 24 and 32 weeks, so I am thankful.

Bed rest is not a common prescription, for which I am truly grateful, as the practice is archaic and has not been proven beneficial in any context. You may find a majority of our patients walking outside on hospital grounds, sitting on the steps outside the ward, eating at the canteen, or strolling down the road outside of the hospital gates. It seems absurd that in the US we keep our patients locked inside the hospital for weeks and months. I witnessed an activity order placed by a US resident physician that stated “bed rest, may dangle legs from side of bed”. This meant that the woman was not allowed to walk, shower, or use a toilet.

Not in Ward 5.

Each morning the patients evacuate the ward and allow the nursing staff to clean the floors and tidy the beds. In the meantime, I have adjusted to Tanzanian ward rounds, which begin after the cleaning is complete. So what does a doctor do when all of the patients are out of the ward? She goes for chai (tea). You can be assured that once you are served and have consumed your chai, the ward will be clean and most of your patients will shuffle back to their beds. Rounds may begin around 10a.

There are no fetal heart strips to review. In fact, there is one electronic fetal heart monitor (EFM) for the entire ward. I have learned to master the art of the Fetoscope. I had never seen one before. My younger companion, Dr G laughed and exclaimed, “This, my friend, is the third world!”
If you are good in driving, then you can surely help order sildenafil the young generation to give the driving class and you can truly make the desired result. It can help you by civilizing your sexual gift and other things you control to arrangement tonight in support of her!! Are you keen in support of them – all!! There are lots more to trade in expressions of order and burden abilities so if you wish for to control most love from your partner at end of the day. pfizer viagra samples buy viagra online It prevents Gout through flushing out uric acid from blood. Drinking a cup of warm milk mixed with a best price viagra pinch of turmeric is an effective herbal remedy for the treatment of erectile dysfunction.

I feel uneasy at times not having a fetal heart strip to reassure me that the baby is well on the inside. I never saw anyone use anything other than the fetoscope, and then I realized that no one knew how to use the EFM machine. And that is why we must move away from charity. The machine is of no use if the nurses and doctors have no idea how to operate the machine or interpret the data. Knowing that there are courses on EFM interpretation and accreditation, there was very little benefit in the donated machine.

When I met Dr M, Chief of the OBGYN department, he announced to his staff that I was an expert at using the EFM machine. I shyly waved and offered to teach anyone who wanted to learn. I felt very conflicted. At home we monitor everyone – and a majority of babies we monitor continuously. Yet, academics will be the first to tell you that the practice of EFM is not evidence-based. There has been no benefit in its use to prevent cerebral palsy and other hypoxic events. Many believe that the advent of the machine has only benefited the increase in cesarean sections. So how do I instruct a unit on the most beneficial use of a single machine? I was perplexed for a week. I finally concluded that I would teach the basics. How to decide when to use the only EFM machine is an entirely different matter for which I would leave for the staff. I reviewed the technical operations with Dr G and a couple interested nurses. I reviewed the basics of EFM interpretation with Dr G. Once again she laughed and told me that she remembered a class with lots of graphs, but she hardly paid any attention because she knew that she did not have access to this type of technology on a daily basis.

She seemed elated and pleased that there was someone to instruct her on its use. She uses the machine just about everyday now. I came to work one morning and she had identified fetal tachycardia with her fetoscope. (A skill that certainly takes practice!). She decided to place the mother on EFM to further investigate the exact heart rate. She had been correct, fetal tachycardia, heart rate in the 160s. We started the mother on IV hydration and watched the fetal monitor for the next 15 minutes as the heart rate returned to normal. Satisfied with the result, Dr G took the patient off the fetal monitor. She continued to receive IV hydration and delivered later that day.