From Peds to OB

I finished Peds last week and started OB this week.

Peds was a lot of fun. I enjoyed working with Eric McLaughlin and Alyssa Pfister, two of the Samaritan's Purse Post-Residency Fellows that are here for 2 years, as well as Chuck Bemm, the long-term pediatrician here. I also enjoyed working with and teaching the interns that are training here. There are four interns on each service (Medicine, Peds, OB, and Surgery), for a total of 16. They spend three months on a service, so they will train here for a year. Here I am recently rounding on the Peds ward with the interns.

I just started Obstetrics this week.  I am really enjoying it so far.  There are four interns on the service that have been doing OB for three months now, so they all generally have a pretty good handle on things. Next week a fresh group of interns will start OB for the first time, so it will be an adventure getting them up to speed.

I just finished a c-section on a very sick patient today.  A 28 year-old, gravida 6, para 5, at 38 weeks gestation, with the pregnancy complicated by rheumatic heart disease was admitted a couple days ago with edema and shortness of breath.  She was in congestive heart failure.  She was started on digoxin and lasix.  But this morning her heart rate sped up abnormally (in the 220's).  My concern was that she was in atrial fibrillation.  One of the frustrations of working in a resource-limited setting is that resources are limited!  For example, I had heard that there were a few EKG machines in the hospital, but I don't think I've ever actually seen one.  I've seen a few EKG's so I know they must exist.   Today, however, was not a frustrating day.  We found the EKG machine quickly, which showed p-waves and was regular, so no A-fib, just a vigorous sinus tachycardia.  You could even see her heart tapping out this ultra-fast rhythm on the front of her chest.  I needed to slow down her heart rate.  Her blood pressure was already borderline low, but I decided to give her labetalol (a beta-blocker which slows down the heart, but can also lower blood pressure).  Her heart rate very quickly came down to the low 100's, and her blood pressure remained stable (that is, it didn't get any lower).  Now that she was stable for the moment, and with these risk factors, we rushed her to the theatre for an urgent cesarean.  The baby came out fine, but after the intern manually removed the placenta, there was a lot of bleeding from the posterior wall of the uterus.  It looked like possibly an accreta, but I'm not actually certain.  With a few quick stitches and a lot of pressure, the bleeding stopped.  We were this close to doing a hysterectomy.  Right now, she looks fine.  The baby was small for his age, and had to go to the nursery.  I'm thankful I was here and able to help this mother.  Please remember her and her son in your prayers.  She still has rheumatic heart disease and things could get worse before they get better.  Thank you so much for your prayers while Julie and I are serving here.  We're now over halfway through our time in Africa.  Pray that we'll learn and experience everything God has for us during the rest of our remaining time here.