Saturday, April 7, 2012

Ob/Gyn (Feb. 17 - 24)

After finishing my two weeks in Emergency Medicine, I spent the weekend in Bangalore. A few of my German friends who had been spending the last several weeks traveling were going to stick around for a weekend in Bangalore. Unmotivated to go traveling somewhere by myself, I opted to stay in Bangalore as well. On Friday evening, I went out with my friends Kim and Ruby and we met up with one of our Indian friends Prash and several of his international friends out at the Skyye Bar (Skye Bar is spelled with two k's, y's, or e's but I can never remember which letter they double...). The bar is really cool and like most of bars/clubs I visited while in Bangalore, was really upscale and per usual, I felt terribly underdressed. The bar is located on the top floor (14th I think) in UB City - a shopping center with all designer label stores. The best part is that the bar is partially on the rooftop and outside with a really cool view of Bangalore below. I think this is the best view of Bangalore I saw while in India and from the rooftop of the bar, it doesn't look like such a dirty, crowded city like it does from the streets. We had a great time that night with old and new friends and at 11:30 when the bar closed, went back to the Annex 3 satisfied with our evening and all of us looking forward to not having to get up the next morning.

Saturday I slept in then spent some of the afternoon shopping on Commercial Street with Kim. Commercial Street is one of the major shopping areas of Bangalore and is nothing more than a main street and several side streets with a variety of stores including some Western-style stores and Western brands of clothing and shoes as well as stands along the sidewalks of the streets selling all sorts of clothing, shoes, jewelry, and bags. After returning from shopping, Kim, Michael, and I went out again with Prash, this time to the Ice Bar. This bar was of course upscale as well and was built up by a hotel and surrounding a swimming pool. A group of Swedish students who arrived during my last week of emergency medicine and were doing their pathology course at St. John's also met up with us at the bar. We had a good time although I think both Kim and I agreed that the previous night at the Skyye Bar was more fun. Sunday was again spent relaxing and gearing up for the week ahead.

For the start of my second half of my time at St. John's, I decided to spend a week on Ob/Gyn. I decided to only post myself there for a week and see how it was and if I liked it, I would stay for another week, otherwise I would switch to a different service. I brought my posting letter to the department office and was instructed to wait in the labor and delivery room for the head of the department. I introduced myself to the interns on labor and delivery and asked if they could tell me when the head of the department arrived. The only problem was that they had all just started on the service and none of them knew who the head of the department was. Within the first hour of sitting in the labor and delivery room, I saw my first vaginal delivery in India. It was fairly traumatic for me as an observer which means that for the pregnant woman delivering, it was probably even more traumatic. The non-private labor room had about 10 beds for pregnant women. When a woman seems ready to deliver, she is brought back to the delivery room where she is transferred to a delivery bed and her feet placed in stirrups. The first traumatic thing I learned was that in India it is common practice to cut episiotomies on all women. I was told that this is because the pelvis of Indian women is typically unfavorable for delivery even though Indian babies tend to weigh less than American babies. Regardless, this was the first episiotomy I have seen cut and although I have nothing to compare it to, it seemed to be quite a large episiotomy. After the episiotomy, one of the consultants and one of the residents both climbed up on the bed with the patient and started pushing down on her abdomen. It didn't seem like they gave her much of a chance to push at all before they decided to help physically push the baby out from up above. Again - I don't know the history of this patient and it may very well be that they had a good reason to start pushing so hard down on her abdomen, but I have never seen anything like this either. The baby was delivered successfully and seemed to be a healthy newborn. I floated between watching the pediatricians do their newborn exam and watching the resident deliver the placenta. Not long after the placenta was delivered and the baby was cleaned up, the baby was brought to the mother and placed on her breast to try and start breast latching to facilitate breastfeeding immediately. This seems to be a common practice as well.

Unfortunately the excitement of this first hour was the highlight of the day. I had high hopes for this posting after such an exciting start but found the rotation to be overall disappointing. Sometime during the delivery, the head of the department had shown up but I missed her. After the delivery, I was told to go look for her on rounds and I searched all of the obstetrics wards as well as the gynecology wards. I found only one group of consultants and residents that were doing rounds and the head of the department was not among them. I did finally find her after all the rounds were done and the first thing she said to me was that she wished I would have found her earlier so that I could have joined her rounding team that morning. I explained that I had been waiting in the labor and delivery room and saw the delivery which is why I hadn't found her sooner. She then told me to go observe in the labor and delivery room and then left. That was the first and only time I saw her during my time on Ob/Gyn. I got very little other instruction as to what I was supposed to do during that week - where I should report, what clinic I should observe - actually, I got no instruction for what I should spend my week doing. After spending the morning on a search mission, I returned to the labor room and read for a while. After nearly 2 hours of reading and only 1 patient in the labor room in latent labor, I decided my time would be better spend outside the hospital and I left.

I returned Tuesday morning to the labor and delivery room and started my day of waiting. I rounded with the Ob docs on labor rounds and after they were through, I went to the operating room and saw a cesarean section for a patient with pre-eclampsia. The C-section was very similar to ones I have seen in the US. After the C-section, I stuck around in the OR and watched part of a hysterectomy and then left after about an hour of not really being able to see much of anything of the procedure. I went back to labor and delivery and again there were no patients in active labor so I decided to go get some lunch and do some independent learning outside of the hospital.

On Wednesday I reported to labor and delivery and found out that it was the clinic day for the labor rounding team. I spent the day in clinic with one of the senior residents. Her clinic was a little slower paced than that of the consultants. I didn't see as many patients as I would have seen with the consultants, but the major bonus to being with the resident is that there was time to talk about the patients between their visits and this was by far the best learning day I had on the whole rotation. I learned that the Ob/Gyn residency is only 3 years long and there is not any sub-specialization within the field after residency. I learned that at least at St. John's, the consultants will not perform speculum exams or bimanual exams in unmarried women. If a patient comes in with a complaint of a white vaginal discharge, she is treated with a cocktail of medications to treat any of the possible causes - Chlamydia, Gonorrhea, Candida, and bacterial vaginosis - without having any cultures or lab tests to find the cause. In clinic, I did see my first patient with leprosy. She was in the Ob/Gyn clinic for other reasons, but as this was my first time ever seeing leprosy, I found that to be the most interesting part of her history. One of the more disturbing patients that came into clinic was a first time pregnant woman who was married to an HIV positive man. There have been a few HIV negative women married to HIV positive men that I have seen in the hospital. The disturbing question that I have is since arranged marriage is very common in India, are any of these women knowingly married off to HIV positive men? I really hope that this is not the case...

Thursday I saw my second vaginal delivery on the rotation. An episiotomy was again cut but at least no one jumped on the bed to push the baby out for this delivery. There was a large audience for the delivery, however. A group of 8-10 medical students on their Ob/Gyn course stood around and watched the delivery of the baby and the placenta and the suturing of the tear and episiotomy. The rest of my time that day I spend looking through the large birth registry that they keep at the hospital. Every delivery is recorded with detailed information about the mother and father including age of the mother, occupation, level of education achieved, literacy, number of previous children, and number of years the couple has been married. These logs were really interesting to look through. The majority of women had "housewife" listed for their occupation and those that were not most often had the same occupation as their husbands. Also, I noticed that many of the women were quite young (18-21) when married and when having their first children.

Overall, my week on Ob/Gyn was not the greatest. It seemed pretty disorganized, and I very much felt like absolutely no one cared that I was there and wanted to learn. I saw a couple of vaginal deliveries and felt that the experience I had that week were enough to get a sense of Ob/Gyn in India. I decided the rotation was not a high enough yield learning experience to spend more than one week posted there and made the decision to spend the next two weeks with pediatrics.

Location:Bangalore, India

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