அம்மாவாசை

Hi all. I apologize for not posting a blog yesterday - I had some stuff to share, but not that much so I decided to wait! So I will include all of that on this post with today's information... I took six pages of notes today, so I'm going to try to make this all work without being a jumbled mess! So here goes nothing!

So to begin our day yesterday, we had a little bit of a let down. The girls and I woke up promptly at 5 am so we could head to the kidney transplant surgery at 5:30 am. When we arrived at the hospital, we were a bit scared. There was barely anyone there and from the outside it seems less than ideal. When we found out that no one at the hospital was able to understand us, and we were asked several times if we needed surgical opinions, we decided to call our driver Raja to come pick us up and head home. So on the downside, we didn't get to see the kidney transplant. On the plus side, we did get to sleep for an extra two hours after our return! 

After a much-needed nap, I headed to Janet for the afternoon shift. I've decided one of my favorite parts about Dr. Victoria's crowded office is the children that come in with their mothers. Their are usually three types of children: shocked and happy to see me, terrified because I might be an alien, or curious but too nervous to come talk to me or say hi unless coaxed. Yesterday there were two little girls who came in that clearly had personalities of their own. One was about three and decided she needed to weigh herself and figured out how to make it work easier than most of the patients. The other was a bit older, but was so interested in what Dr. Victoria was saying that she seemed to be paying more attention than even her mother. But on the way out, both of the little girls waved good bye to me, which always leaves a smile on my face

The most interesting thing that happened yesterday was an unmarried pregnant girl came in. For us in America, premarital pregnancies hardly get a second glance. But here in India, this girl who is 21 years old is looked down upon by almost the entirety of society as someone who has cheated her family and is a disgrace to the family. When she came in for abdomen pain, after a routine scan, they discovered she was four months pregnant. Because she was still within the 18-weeks limit, termination of the pregnancy is still legal, which is exactly what her parents wanted. They also didn't want to know who the boy was, even though the daughter claimed no contact with a boy and Dr. Victoria advised them to find out since it's often a relative or an acquaintance. However, after the girl went to get the termination medications from another doctor at the clinic, she informed them that she did not want to take the medication and intended to keep the baby and runaway with the boy. I was told that this is not uncommon, but that all contact with the family would be cut off and the family would be expected to support themselves entirely. 

After we got home that evening and Maddie and I were headed to dinner while Morgan was at the private clinic, we ran into Dr. Rohini headed right towards our hostel. I'm not sure if I mentioned this before, but Dr.Rohini and Dr. Ravi already gave me three pairs of earrings and gave the three of us two loaves of delicious whole grain bread. Well yesterday when Dr. Rohini came towards us, she was holding a bag with a strand of jasmine flowers for each of us as well as a bookmark for each of us. On the bookmarks, she had written a special note such as "Rissa, It was a joy having you at our clinic... God's plan. Love, Stephens." Now let me just say, the Stephens are really the sweetest people in the entire world. I seriously cannot express my gratitude to them for everything they have done for us since we've been in India. It was very nice to get to see Dr. Rohini one last time since I didn't get to see her when I told Dr. Ravi goodbye the other day after surgery!

Anyways, onto today! Many women in India are either very underweight or very overweight. Either way there are risks, especially when it comes to pregnant women. Based on their pre-pregnancy BMI, the women are advised to gain a certain amount of weight. For instance, women who are obese (BMI 30+) are advised to gain only 7 kg. Those of normal BMI (20-25) are advised to gain 10 kg. Those with BMIs lower than 20, or underweight, are advised to even gain 15 kg to support the fetus and themselves during child-bearing. Women who are underweight often have uterine growth restriction which then causes the demise of the fetus. 

Since Maddie came to Janet with me today (the Stephens went out of town for a wedding for the next two days), we were able to watch two surgeries. The first surgery was a laparoscopic tubectomy (or tying of the fallopian tubes). Doing this laparoscopically means clamping each tube and sliding a clamp over the area. If this same procedure is done during open surgery, the tubes are instead cut and then tied. As I mentioned in an earlier post, sometimes women wish to undo the family planning surgery. Obviously, cutting a simple loop would be a lot easier than cutting the tubes back apart and then freshening them so they are then able to be placed back together. So for many women, the laparoscopic tubectomy is ideal, but because the surgery is often performed during a C-section, not always the most plausible option. The second surgery we saw was a laparoscopic exploration to determine the cause of infertility. Nothing out of the ordinary was discovered except for polycystic ovaries. Polycystic ovaries are the most common cause for irregular menstrual periods and infertility at Janet. In order to temporarily relieve the ovaries of the cysts, each ovary is punctured three or four times and drained. However, the fluid usually builds back up during each cycle, so the hope is that conception will occur within the same month as the draining.

We also got to see a couple procedures in the labour room today - one to help conception and one to hinder! The first was an intrauterine insemination. The woman was being injected with donor sperm directly into the cervix to lead to better chances of conception. The family had decided to go with donor sperm since the husband was HIV-positive and the couple had no sexual contact but still wanted children, so this was the best option for them as a family! The second procedure was a temporary intrauterine contraceptive. The contraceptive lasts for three years and has a nylon string attached for easy removal. Every year the string is checked to insure that is is still in place and accessible. This contraceptive method is ideal between a first and second child, but can also cause menstrual problems.

Something that definitely varied with my previous thinking was the "ideal age" of pregnancy. I know there is a time that is best for pregnancy (22 - 25 years) but I was also told today that a pregnancy over the age of 30 is considered elderly in India. In the US, the age is 40, so that was quite different! Dr. Victoria informed me that after 30 years of age, there is an increase in risk for diabetes, hypertension, fibroids, endometriosis, and polycystic ovary disorder. So the ideal age here is 22-25 and the latest Dr. Victoria likes to advise is 29! Crazy since my mom had all three of her children after the age of 30!

Today was also a special day in two ways: 1) the beginning of Ramadan in the Muslim religion and 2) an ominous day due to the lack of a moon. Ramadan is a 30-day fast in which those of Muslim religion are not permitted to eat or drink anything, including water, during daylight hours. They eat a large meal around 4 am before sunrise and a large meal around 7 pm after sunset. Today is also called Amavasai (அம்மாவாசை) which is an ominous day. Due to that reason, the day was much slower than any day I have seen at Janet thus far! We only saw 50 patients, most of which were infertility cases and very few pregnancies. We also didn't see any deliveries because it is considered bad luck to deliver on these days. Tomorrow is also part of Amavasai, but since it's my last day I hope we are able to see a few more interesting cases and I'm especially hoping for a delivery to end my journey on a high note!

I think the rest of my day can probably be explained via photos, so here you are!

During Dr. Victoria's lunch period today, I worked on my Tamil! So my name is the part at the top. The best one is the one that says V. Near next to it! The others are Saranya, Rahila, and Jennifer's names first written by them and then by me. Personally, I'm pretty impressed with my Tamil writing skills!

I went to pick up Morgan and Maddie from the clinic and, of course, because I wasn't there they saw lots of adorable babies. This little guy (shout out to Rocky cause you guys share a name) was there when I got there! 

He was also a little squirmy-worm!

Excuse the editing, it made this photo worthwhile. But Yoges (left) and Reo (right) have helped us so much while we've been here. They are technically attendants to the hostel, but they have been so friendly and have made sure that our time here has been great! 

And finally... tomorrow is my last full day in India! Can you believe it... I've been in India for one full month. The time here has flown by. Sometimes I feel as if I've been here for only a few days and then sometimes I feel as though I've been here for a year! I've learned so much in my time here and I will be forever grateful for this opportunity. I cannot wait to continue my journey in Europe after I leave India, but leaving will definitely be bittersweet.

Until tomorrow, my last day in India,
Rissa