Thursday, April 7, 2016

Finding my niche

I am a volunteer for 4 weeks with Project HOPE. All opinions expressed are my own and do not represent the positions, strategies, or opinions or Project HOPE.

This past weekend, my fiancé Michael came to visit me from Germany. It was his first time in Kosovo. Unfortunately, he started not feeling well the day he left and continued to not feel well the whole weekend. Despite having to take it easy and not being as ambitious in our plans as we had hoped, we still had a great weekend!

Stone Bridge of Prizren
On Saturday, we took the bus to the city of Prizren. Prizren was the original capital city of the region in the era of the Ottoman Turks. It is strategically placed along a river and within a valley of beautiful mountains. In Kosovo, it is one of the areas where Turkish heritage is best preserved - Turkish is still taught in a lot of the schools and the local cuisine tends to have more Turkish influence than in other parts of Kosovo. The bus ride took approximately two hours and en route, Michael slept and I read about the city and formulated a plan for the day of things we may want to try and see while there. We took a walking tour along the river up to a fortress dating back as early as the 6th century overlooking the city. En route up the steep hill to the fortress, we passed by the ruins of a Serbian Orthodox Church - St. Savior. It is completely enclosed within a metal gate topped with barbed wire and is watched over by a caretaker. This Church was destroyed during riots in March 2004 and is in process of restoration. The church itself was built in the 1300s and some of the frescoes on the wall can still be made out - those that weren’t destroyed in 2004. While wandering through the inside of the now open air church, one can imagine the beauty of it when it was complete. Continuing up the steep hill, we reached the fortress and the view was spectacular. We could see the entire city below and the surrounding mountains. Standing on top, we stood quietly and listened as the call to prayer rang out across the mosques in the city below. We grabbed lunch at a place along the river specializing in Albanian cuisine and happened to be present when a large entourage of political figures came to dine at the same restaurant. The roads were blocked off by police cars. After lunch, we continued our walk through the city. We walked past many of the city’s highlights including the League of Prizren which is considered the original group advocating a nationalist movement for Albanians in Kosovo since the middle ages. We saw multiple mosques and another Serbian Orthodox church destroyed in 2004 and now in process of restoration. Sunday, we took a walking tour of Pristina before Michael headed back to Germany.

Serbian Orthodox Church - St. Savior. Destroyed in 2004.
I feel as though I am getting into my niche at the hospital. I have had multiple students, residents, and specialists ask me if I have done any deliveries/episiotomies/c-sections and I said, no, but that wasn’t really my primary focus for being here. This is true, and I really do feel like I have an alternate purpose in being at the University Hospital. As I mentioned in a previous post, I am working towards providing educational resources for the faculty (residents, students, midwives, nurses, specialists - whomever!) to have on hand on labor and delivery so that when there is some down time, they can look at evidence-based guidelines and try to make the University Hospital up to international standards of care. I have emailed some PDF files to one of the residents and provided the residents with a brief textbook of Ob/Gyn so that there is at least something to start from.

Kids playing outside in a public fountain on a warm spring day in downtown Pristina
I have discovered two additional roles for myself that have certainly provided me with a sense of purpose, and I hope have contributed positively to the experience of the others I am with on a daily basis. There are many medical students that rotate through labor and delivery. Medical education is difficult. There are many more students than there are positions available to them after the finish their studies. If you are not at the top of the class, the chances you will find a residency program and especially a program that will pay is limited. After completing 6 years of medical studies (this is a bachelors/masters degree), they do a 6 month internship. Afterwards, they must work for 1-2 years as a general practitioner and then can apply to residency. The number of spots are limited within specialties so there is a chance that the specialty one is interested in may not have an available spot at the time you are ready to start residency. A choice is made to start residency in another specialty or to wait. Residency positions within the university or public hospital system are paid but not a living wage (I’ve hear anywhere between 500-700 euros per year) and private residency training is not only unpaid, but requires the resident to pay for the job and training. For Ob/Gyn, residency is 5 years. After that, many physicians do not make a living wage working in the public hospital system and so have private practices on the side. Because of these limited opportunities in training, many students and residents will leave to complete or do further training abroad, many with plans to not return to Kosovo given the limited opportunities here for work. If such highly educated people are not paid a living wage for their work, I worry that an educational drain will exist in Kosovo whereby everyone who can leave, will leave. 

Medical students very much take on the role of observer when doing their practical part of training (during medical school and during the internship). They are sometimes engaged by the specialists but there is not a lot of teaching that happens at the bedside. Some of the this is the hierarchical culture of the training system but some is just a lack of time - with 10,000-12,000 deliveries per year, there is not a lot of down time on labor and delivery for teaching. I have tried to personally fill in this gap by engaging the medical students and trying to teach things that are applicable to the clinical situation they are observing or to answer any other Ob/Gyn related questions. This is one role I have been trained to do as both a medical student and a resident and I am happy to be able to fill the role of a teacher while I am here.

The other role I have made for myself is being the support person for the woman in labor. Since family members are not allowed on labor and delivery, the first time moms seem the most nervous and unsure. Although I do not speak Albanian, the effect of holding a hand or rubbing someone’s shoulder, head or back when they are in pain gives the support I am unable to provide with words. In my normal day-to-day residency work, I often have too much to do to be able to provide this one-on-one support for the patient in labor. In the US, many of them have family members or friends who come to support them and also have awesome labor nurses who are their support people. It has been nice to take that place for the women who deliver at the University Hospital in Kosovo. For me, this role as part of the care of the patient has been invaluable, and I think more meaningful for the patient than if I were the one sitting on the other side delivering the baby. 

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