So I know all of my posts are pretty long, but prepare yourself... I have four pages of notes from two days and I don't feel like writing two blog posts, so it's all going into this one!
Yesterday was my first official day at Janet Nursing Home and it is definitely a different world than at Stephen Nursing Home! I went on rounds with Dr. Victoria at 10:15 and it's actually really strange to see, but pretty much everyone is either scared of, intimidated by, or just knows that Dr. Victoria's not a person to mess with. As she comes walking down the hallway, all the people will back up to get out of her way. And when the nurses see that she is on their hall, they run ahead to make sure the first room is ready to be seen. Though it's really weird to see, it's actually pretty entertaining. I do understand where they are coming from since Dr. Victoria definitely can kick butt and take names and get stuff done, but she's a wonderful doctor and that's how she's going to do it! During rounds Dr. Victoria basically makes sure that the women are healing well from whatever method of birth and that they are lactating. She also tells all of the women who have had cesareans to apply Arnica gel to the healing site. I thought this was pretty interesting since that is a common gel that dancers use to sooth sore muscles! I also saw a baby in the NICU that was only 1.3 kg (2.86 lbs) and a baby that had had surgery for a bowel obstruction. In contrast, I also saw a baby that was 4 kg (8.8 lbs) which apparently qualifies for a cesarean since he was so big. So, uhm, yeah mom, I'm so sorry... For those of you who don't know, I was 9 lbs and born at home. So mom, you're a trooper. Love you lots!
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| Saw this on our way to the clinics. Note: Pure Honey; in case you want some honey with your copies. |
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| Ultrasounds are performed behind that curtain. This room is NEVER empty like this. |
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| Dr. Victoria's office, empty for once. |
Speaking of patients, to come see Dr. Victoria, they initial visit is 200 Rs ($3.30 USD) and any follow-up visits are 100 Rs ($1.66). Obviously, delivery and stays overnight are more expensive, but simple appointments are very affordable by American standards! A laparoscopic surgery on the other hand is 30,000 Rs ($497) + the cost of a three nights stay. Even so, this is much cheaper than in America.
I got to see an ultrasound yesterday and it was amazing! I was able to see the heartbeat, the head, the spine, and all four limbs! I'd never seen an ultrasound before, only pictures, so I thought that was pretty cool. Legally, the doctors in India are not allowed to tell the mothers the sex of their baby and the patients are not supposed to ask. If they did ask, the doctors are still not allowed to tell. This is due to the high rates of female infanticide in India. In other words, if the family finds out they are having a girl and not a boy, they will want the pregnancy terminated and if the doctor refuses, they might find other (more unsafe) ways of terminating the pregnancy. So they government's way around this infanticide is to not tell the parents the sex of the baby pre-birth.
One thing I've been very impressed with here is the ease at which all of the women know the date of their last menstrual period (LMP). None of them even hesitate with the date, which I think is amazing because I always know I will be asked but I still always struggle with a date and end up estimating. The people here are great with keeping up with things, such as their LMP dates, their immunization records (yep, they keep those on paper from birth forward), and their scripts for medicine which they faithfully bring to every appointment.
Many of the patients who come to see Dr. Victoria come because she's also a infertility specialist. So today I got to meet a woman who had had an ectopic pregnancy (pregnancy in the fallopian tubes - no bueno) and then had a spontaneous abortion. So Dr. Victoria gave her a fertility drug called clomiphene and Intrauterine Insemination (IUI) and now she has conceived! Follicle monitoring is something that is also often performed on women who are infertile. This basically lets the doctors know if all of the egg-producing follicles are functioning correctly and if not, what they should do to best deal with it.
Around 3:00 pm, Dr. Victoria takes her lunch break and everyone leaves her office. So I went to sit at the front desk and talked with two of the nursing students, Reemu and Priyanka Gandhi. Both are 20 and both have boyfriends. When they found out I didn't have a boyfriend, they were shocked - that's like a sin here. It's funny though because having a boyfriend doesn't mean they are dating. They told me that "dating" meant your parents didn't care about you! So they don't date their boyfriends, they only talk with them. And if they are lucky, 5 years from now, the boyfriend will propose marriage to the family and the family will approve. But the family has every right not to approve and if they don't, they will arrange a marriage with another man they approve of. This is so crazy to me - they can "talk/date" for 5+ years and then when they want to get married, they could be told no, that they have to marry someone else that they don't love...
On a totally different note, one of my wishes came true yesterday: WE WERE GIVEN FRENCH TOAST FOR BREAKFAST (two days in a row)!!! It was amazing. But, we also had a super weird dinner. Everything was pretty typical, except we had a lime green egg on the side. I'm not sure why the cooks decided to make it bright green, but hey, it made the meal more colorful!
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| Green eggs and no ham! |
Onto today (Tuesday): I went on rounds with Dr. Victoria again. This time I saw a few different things:
-A woman who had given birth to her third boy, but still did not want to have the family planning surgery
-A woman who had hyperemesis, which is excessive vomiting during pregnancy
-In the ICU I saw a woman who had depression and had had a cesarean because they weren't sure if she could mentally handle vaginal birth (I thought that was interesting) and a woman whose baby had been in fetal distress. The fetal distress was caused the baby having a bowel movement (which isn't supposed to happen) in the amniotic fluid, which is the baby's source of nutrition. So when the impure amniotic fluid goes into the baby's lungs, they can aspirate and it causes fetal distress
-A woman who was anemic and was treated aggressively since her hemoglobin was at 9, but she ended up delivering six weeks early with a hemoglobin level of 7. The childbirth lowers the levels even more and now she is not lactating, so they are hoping to settle that! I was told he will be fine as he gradually grows!
I got to see another ultrasound and this time it was twins! I was able to see both the babies' heartbeats and both were moving, so that's always good news! I was also able to see the membrane separating the two gestational sacs. Apparently if there is no membrane, it is called a monoamniotic pregnancy and it has lots of associated complications. I also found out that extramarital pregnancies are very rare in India. Sometimes the girls will "cheat" their families and have unprotected extramarital sex, but sometimes they also don't know what they are doing or they are raped, so that's sad. I thought it was also interesting that Dr. Victoria used the word cheat to describe their deception of their parents. She told me about one girl who was pregnant and hid it from her parents for 8 months. Though she was Hindu, she wore the traditional Muslim dress (a black burqa) to hide the pregnancy. After the 8th month, she delivered and the baby was adopted out because the family didn't want him/her. The families have a lot of power here, especially over the women. It's really sad to see what happens because of that sometimes. I know that is the culture and that it is slowly getting easier for women, but it is still hard to see and hear about.
For the last half of the day I was in the operating theatre where I saw 2.5 surgeries. The first surgery I saw was a cervical tightening which lowers the likelihood of the spontaneous abortion of twins. The second (half) surgery I saw was the suturing of a woman's breast after she had a small benign tumor removed. Lastly, I saw the removal of a fibroid tumor on a woman's uterus. I was told the tumor was large and benign, but I wasn't told that her ENTIRE uterus would be removed! So when the whole thing was taken out, I was a little shocked. But since she was older and had completed her family, there was no reason to do an extensive surgery in order to leave the uterus intact. And the tumor really was about the size of the entire uterus once it was opened up - scary, actually. I also figured out that surgery really isn't for me. I think it's really cool to watch and it's amazing what they can do, but I think I would rather work with people who can look at me and talk to me, and not just their insides with blood and fat.
More fun facts:
-Minutes abbreviation is MTS, not Min.
-If it is a woman's first pregnancy, she is called a primi.
-To calculate the estimated delivery date: LMP + 7 days - 3 months
-The shirt that goes with a saree is a blouse, NOT a saree top (they thought that was hilarious)
-It's also a "switchbox" not an outlet or plug
Just to give you an idea of all of the people who work at Janet, here are all of the names I have learned in two days (and I haven't even gotten half of the other peoples' names yet): Saranya, Rahila, Vijaya, Reemu, Priyanka Gandhi (no, I haven't yet asked if she is related to Ghandi), Jennifer, Dalakshmi, Bona, Ajumunnisha, Jonisha, and Jones. So... that's a lot to remember! I wrote them all down so I am able to cheat sometimes! I also learned a new Tamil phrase: "Unna enaku pedicheku." Apparently that means I like you, but I feel like that's much too long to mean something so small!
Anyways, that's it for tonight! We might head out to get some ice cream in a bit, so that will be very nice! Also, I apologize for how jumpy this post was, I feel like I just had logorrhea, or word vomit, on here, sorry!
-Marissa
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