Today on the way to morning report, there was a strange crowd of about 30 people standing around the door. Diomede was also there and what stood out was many of these people were white (naturally this is an odd thing to see in Africa). I rushed into the room and mouthed to Diomede “What’s going on?” He shook his head and smiled. Diomede walked into morning report about 30 minutes later. It wasn’t until later that I found out this was a group of belgium students who started today ! They’re rotating on all specialities but we have two! Astrid and Maxim. They’re very cool. They’re 6th year Med students and will be choosing specialties in the upcoming 2 weeks (this is their last year before residency). So now, all 3 of us were in the labor ward with poor Emery to keep us entertained. To keep them busy I showed them around and taught them all the tips and tricks I’ve learned over the last week and a half (I.e bring your own toilet paper because there is none anywhere! Etc), you know, the essentials. I told them of my stalkerish tendencies and how I find the residents once they disappear. I’ve even gotten my hands on the daily resident schedule for the month so I know which resident to look out for each day! Next we went back to the labor ward. There wasn’t anything too crazy going on but there was an IOL for gestational hypertension who was getting ready to deliver, the same IUFD from yesterday who was maxed out on cytotec and needed a Foley balloon, and a IOL for oligihydramnios.
So we stared with the Foley balloon placement which is very different from how I do it at home. They do it with a speculum and everyone gets cleaned with clorohexadine (internally and externally) before anything is done. I always think to myself, but the vagina is so dirty… Whatever it’s Africa, guess it can’t help to be a little extra clean. So I assist Emery in his venture. The Foley gets placed and it’s attached to a Foley bag, filled with normal saline, and placed on gravity- interesting. We usually just tape it to the thigh back home. I like this way better. That way I KNOW it’s on tension instead of crossing my fingers and hoping that the nurse is tugging every few hours.
Next while Emery did paper work- me, Maxim, and Astrid talked about bread and butter obstetrics. We talked cervical exams, methods of induction of labor, and hypertensive disorders in pregnancy. I sent them a practice bulletin on fetal heart rate monitoring which were going to review tomorrow. I told them to take advantage of this, they will never again have a chief resident in their back pocket like they way they do this week. They are great though and they pick up on things very quickly. When we were finishing up, one of the inductions was delivering. So maxim went in to watch, next thing I know I am summoned by Emery to partake. I’m down. The delivery ended up being quite dramatic. The baby was bradycardia so she ended up with an episiotomy. Ehhhhh. I watched Emery do the repair and then went to lunch with Astrid and Maxim. I met the other Belgium students and even met 3 Internal Medicine Residents from Yale! One even went to stony brook for medical school and undergrad! For lunch I ate Safrinas left overs from last night that I couldn’t touch because I was so full. Finding creative things to do with all this food is overwhelming.
When I got back to L&D, Emery seemed like he had a lot on his plate. I asked him if I could help… he responded, “YES! I need you to do a c-section with Eugene!! They’ve started, I have so much to do, can you go?” “Sure.” I really wanted to scrub in on the hyst they were doing next door, but this c-section would have to do. I already delivered in my work clothes, white coat, and sandals (they don’t wear scrubs here for deliveries…and I’ve already gotten yelled at for not wearing my white coat) I drew the line at a c-section though. I ran and changed into scrubs and my danskos. I walk into theatre and Eugene looks at me like Jesus walked in. “I AM HERE TO SCRUB!” I proclaim! Naturally as the Rwandans do, he said, “thank you, thank you.” They’re always so polite. They hit a vessel in the OR and begin profusely apologizing. So we scrubbed and did this repeat cesarean section together while singing Enrique Iglesias’ Hero, and struggling to get the baby out. Again, very dramatic experience. That baby was floating in the North Pole. After some serious fundal pressure (that I liken to body slamming the patient while on my tippy toes because the bed was so high) the baby popped out. We closed and then I dismissed myself for the day as no residents were to be found.
Next I went to the tailor to try on the items she made! Everything was beautiful! Some of the items were too big so she will alter them and meet with me tomorrow!