Monday morning we loaded up in a large van to go to our hospital for the week. We first went to a different hospital to hear a Grand Rounds type presentation from two groups of medical students. They talked about meth rehab programs and gestational diabetes and shoulder dystocia. We were fed lunch at the hospital, given a tour (where we got massages in their alternative medicine building), then to our hospital where we’ll work. We got another tour then went to dinner at a restaurant with some of the doctors.
The hospitals here are open to the free air. You go from the halls that are open to the outside into the wards. No AC, just fans. There are beds lining the walls of the rooms, so no private rooms. They still use glass bottles for IV fluids and meds. Paper charts, even for labs. X-rays are printed on films still too. It’s probably like it was in the 70’s. Their beds and equipment look like they were newly bought, but dated. Does that make sense? They have the knowledge and the meds, just not American standard up-to-date equipment and supplies. Labor and delivery are in separate rooms. The labor room is like the wards, a lot of beds in one room. Families don’t come in during labor or delivery.
Today was the first day to see patients. We had breakfast at the hospital then went our separate ways with our Thai staff. I was with the OB. We did post-partum rounds first. Women stay two days after vaginal delivery. They don’t have epidurals, because they don’t have a trained anesthesiologist. That’s common for these hospitals (which aren’t at all third world- it’s just how it is here). Everyone, even women who have had more than one baby, get episiotomies. I’ve done those in America, but we cut them down the middle. Here the go to the side at ~7:00. After rounds we went to OB clinic. There is only one OB, so she only gets the complicated patients. The nurses do all the routine OB visits (same with well- child checks; nurses here do a lot more than nurses in America b/c of the doctor shortage). We did a sono on every patient. I got to do a few. They have awesome prenatal books that show them exercises and diet tips and keeps their prenatal vitals & labs. It is for the baby too. It has developmental milestones and a growth chart for the baby. I loved those books!
After lunch I scrubbed into the OR with the OB to do a post-partum tubal ligation. For the OR, first you take off your shoes at the entrance and put on rubber flip flops (like the cheap ones you buy at walmart) then go to your dressing room. Women wear a green dress like thing (see my picture on facebook). In the OR they have very little throw away stuff. Most of it is washed and autoclaved. The gown is green and made of the same stuff as the dress thing. The patient is draped with drapes made out of the same green material. The patient got Ketamine for her sedation for surgery. The set up reminded me of how we set up for the OR at the vet clinic I worked at (I’m not at all saying these people are like animals, don’t get me wrong). But Dr. K had his OR gown that we washed and autoclaved (he only wore it for ortho surgeries) and we draped the animals the same way- with four square drapes held together at all the intersections by the exact same clips, then covered with a drape with a hole over that. The doctor was really nice. She let me make the skin incision and do one of the tubes. I didn’t know how much she’d let me do on the first day.
We did home visits to do post-partum and newborn exams this afternoon too. We went to two homes. The nurses do these, but they let us tag along.
Doctors do 6 years of combined college and med school here. Med school is free, so to pay back the government, they work for 3 years after med school. They do residency after that. Most residencies are 3 years. But the doctors here are very intelligent. They have higher expectations during their senior year of medical school than we do in America. They are expected to be interns their senior year.
I’ll post more often now that we’re in the meat of things. Stay tuned.