The people here are so nice.  I can’t get over it.  They over feed us with so much more food than they’d eat themselves, they give us water and juice every few hours, they are so attentive and if they think we want or need anything they’ll get it without us asking, they clean our rooms every day and give us fresh bedding and towels (whether we used them or not).  I really just cannot get over it.

We had breakfast at the hospital again.  The hospital cooks are such good cooks (or at least we don’t know it if they’re not).  I only saw one patient on postpartum rounds.  We sent her in from clinic yesterday to deliver.  She ended up having a failed forceps delivery and getting a c-section, but since it was at night we weren’t there.  They stay 4-5 days after c-section.  There was only one surgery today, a c-section with a tubal ligation.  Jackson and the med student scrubbed in for it.  Richardson was doing a delivery with a midwife during the start of the surgery.  They get general anesthesia for c-sections.

We looked through their OR book and they do mostly tubal ligations (called tubal resections there).  If I had to have babies with no anesthesia and had to get an episiotomy I’d want my tubes tied too!!  Right after babies are born, while the mom is getting her unnecessary episiotomy repaired, the nurses bring the baby and hold him/her to mom’s breast to breastfeed to help her uterus contract to help the bleeding slow down.  This patient was checked by the OB and was 8 cm dilated.  Less than 30 minutes later she had a baby.  Apparently most women here progress and delivery quickly.  The labor nurses do intermittent auscultation during labor (there is usually only 1-3 patients laboring at a time with 2 nurses).  They check heart tones right after a contraction.  They have a continuous monitor in the clinics for BPPs.

The other med student was in the ER and acute care clinic.  The other residents went between the ER, chronic care clinic, and the alternative medicine clinic.

We had lunch at the hospital then headed out for our community medicine experience.  We went to a subdistrict hospital/ community health clinic and met their employees- a MD, a RN, three community health workers, and a dental hygenist.  They have a room for acute care procedures like abscesses, sutures, etc.  They have an observation room with 4 beds where people can get IV fluids.  They see about 50 patients a day, mostly in the morning.  They also do some home visits.  Once a month they have diabetes clinic and once a week they have vaccination clinic.  The building was very very very nice!  The doctor said that they are about 50/50 on patients who aren’t and are compliant with their treatments for their chronic illnesses.  He also said that in that community the young parents go work out of town or even in other countries and the kids are left to be raised by the grandparents, who can’t take care of them.  So the kids are dropping out of school and getting into drugs an alcohol.  Sounds like this clinic has its hands full–lots of things in their job description.

This afternoon we did to a trip to a fish pond downtown where you can feed the fish–tons of hungry catfish.  Then we went to see some of the rice fields.

Dinner was at a restaurant.  The restaurants are open on all four sides and the weather is so nice at night that it doesn’t matter.  We did karaoke to American music for like two hours.  I bet the other people at the restaurant were annoyed, but we had fun.