Sunday, February 22, 2009
Sonsanate Hospital (by EDF)
So this week we went to Sonsanate Hospital (an ISSS hospital, for those with ISSS insurance) on Mon, Tues, and Fri, and these were looong days. We would leave the house at 5:25am in the dark- in fact, it was so early that each of the mornings we had to wake up the guard to get him to open the gate to let us out of our neighborhood (interesting side note- the guard is definitely armed, and at night when it is cold out he wears a black knit hood over his face with eye and mouth holes- I was like 'that's a little scary', and Dr. M said, 'he probably just has that left over from the war', which was not that reassuring to me or KRF!). Anyways, we would rendez-vous with Dr. C (chief resident), who drove me and KRF the hour or so to Sonsanate.
The first two days it was interesting to join a team at the hospital and go on rounds- on Monday I went with the Gyn/Obstetrics team and KRF went with Internal Medicine. I enjoyed Gyn/Ob so much that I stuck with that team on Tues and Fri and KRF joined me on those days. Rounds are pretty much exactly the same in El Salvador as in the States. The Gyn/Ob service was fairly busy with a nice variety of patients- pregnant women with problems early in the pregnancy (threatened abortion, bleeding, high BP, placenta previa etc), women in labor, and post-partum women, as well as those getting gyn surgery (ex laps for endometriosis, ovarian tumors).
I liked being on this team, because the attending was extremely calm and relaxed, and liked to explain pathology and plans to us. After rounding on all the women and the pre-surgery area, we would then join the pediatrician and examine all the babies- this was definitely a highlight for me. In the morning the nurses and all the women who were well enough would take their babies to one bed to go over how to clean them off and things (see the photo above)- pretty cute! After having a baby vaginally women stay at least 12 hours, and after a C-section at least 48 hours (in the US it is 24 and 48 hours).
On Monday I observed a C-section- the OR was actually fairly well-equipped, they used a bovie and things- instead of the blue plastic sterile field sheets they used green cloth sheets, which definitely absorbed all the spilt blood, but other than that, things were pretty similar. I wore scrubs, but didn't assist- just observed, and chatted with the pediatrician. It was actually pretty rough once the uterus was open and they were getting the baby out- this was a repeat C-section, which makes it harder- but they got the legs and butt out first, and it took what seemed to me a long time to get the rest of the baby out- the baby was entirely blue and limp at first- but the pediatrician calmly cleaned it off and gave respiratory support- APGAR scores were 6 and 8. When the baby was fine, I got to hold it and show it to the mother- everyone joked that I should be it's godmother.
Friday was rather more of the same, plus we gave our powerpoint to the 2nd year family medicine residents- we added a bunch of slides about the healthcare system in the US, and tried to make it more of a discussion. Overall our days at the hospital were interesting, but extremely long! In general we would get back to the house at 7 or 8pm (so 14 hours or so after leaving), because we would pick up the girls or meet up with family and go to dinner and things before going home. Friday involved a birthday party for one of the cousins who was turning 5- we ended up having some fun, but KRF and I felt gross- the party was at Pizza Hut, and the residents got Pizza Hut for lunch to go with our presentation--- turns out you can have too much of a (sort of) good thing!