Sign here, please

Surgical Consent:

"I explained the procedure to the patient, and I hope she understood."

Then, the patient's signature and the physician's signature.

This was documented in the medical record for one of the mother's who was going to the theater for her Cesarean Section. I don't remember if I've shared that with you all. The medical records here are kept in these small blue books (much like the blue books that we would use to take written college exams) and then everything is documented in the booklet. They are not clearly labeled with each patient's name, so when there are many patients on a ward, there is much confusion as to which patient belongs to which booklet. I am certain that this causes additional problems to the system. I should also add a note about the surgeons here...they attend medical school here, and then have one year of an internship, where they learn everything from general adult care to pediatrics, to specialized surgery such as Cesarean Sections. I was not in the theater today, but I have heard additional stories about what happened there today. One mother who was to have a Cesarean Section after failure to progress (for several days) went under "general" anesthesia and then they proceeded with the surgery. I should add that the surgical instruments were just cleaned from the previous surgery, and they did not have a sterile drape for her, so they used the used surgical scrubs from previous surgeries to drape her abdomen with (with blood and stains on them). There is no catheterization here either, so she apparently peed during the surgery (peed? did the doctor knick the bladder? who knows...I was not there) and then after he removed the baby from the uterus, he was lining up the used gauze on her abdomen and then proceeded to pull out the abdominal organs from her to show to the students (much to their horror). Then, he wrung out the used gauze (with blood, amniotic fluid, etc.) back into her abdominal cavity before he closed up. My stomach just turns at the thought of this. I should also add that they do not have a ventilator or any type of assistive device for her to breathe with during surgery, so I am not sure if this general anesthesia is really more like conscious sedation?? The baby, after being stuck in the birth canal for days, had a horribly molded head, and when I saw him, no reaction to stimulation. How awful.

Other students witnessed a stillbirth this morning in Labor and Delivery-again, the "herbs" were to blame. I also found that there is a blood bank at this hospital, and sometimes, if the doctors or nurses try to get blood to use for the patients, they are informed that there is no blood. However, if the family members go to pay, then there is blood-they charge 40,000 schillings, which is about $20. For a free hospital, I am not sure how this can occur? It seems that like much of what happens, just gets swept under a rug and forgotten.

I did find out the salary of the nurses though-when they are "new graduates" they will expect to earn about 380,000 schillings per month (about $190) which is more than teachers earn. I am not sure what other professions here earn-there seems to be a language barrier between the students from BU and the US students, even though we all speak English.

I also tried to ask about comfort measures for the infants-there is a surplus of sugar cane that grows here, so naturally I wanted to know if they were using sucrose for pain management. I got the typical "crazy girl" looks that I have gotten many times this week. When we go back next week, I will try to pursue this teaching further.

Tomorrow is the visit to the witch doctors in the area. We will be gone all day, so another early morning for us. I don't think we have any days that are "off" days for R & R for at least another week. I think for my mental health though, I need to find a way to get a break. Today was an especially discouraging day for me. I feel that even though I have been able to bring some comfort here, there is so much that needs to be done. And where to start? One at a time, I suppose. Certainly I do not have worlds of knowledge to share, but I think that there are other ways to provide care here that would be better than how it currently works...

I love all of the comments and emails from everyone. It is especially nice today. Thank you all for your support, and I can't wait to see everyone again!

PS I am more and more thankful every day to have been born in America.