All is well here, I hope you are all enjoying a nice Spring there is the USA. Here, one day is mostly just like the rest. It continues to rain most every evening and is sunny and nice each day. I have on occasion heard thunder and seen lightening, but not most days. All-in-all, it is rather like paradise.
Thought I would talk a bit about the obstetrical care in Papua New Guinea. Care here is much like it must have been 50-60 years ago in the US. The post partum/anti partum floor, or ward as it is called here, consists of a small nurses station and a large room with 28 cots or beds. Each bed sits approximately 20 inches from the next. The hospital provides the bed with rubber coated mattresses for 50 kina or $17 dollars. The patient must supply the sheets, blankets, pillows and food. Some patients simply sleep on the rubber mattress or sometimes even the floor.
Each patient arrives at the first sign of serious contractions with their watch-merri, or female observer. At the time of arrival, they may be complete or it may be several days prior to delivery. They are worked up and examined by the nurses. If everything is routine, they stick around in this area till hard labor begins. At this point they move to one of 5 delivery bays where, the actual delivery will occur. The nurses screening sometimes detects problems. Hypertension, toxemia, twins, abnormal presentation, premature labor, etc… just to name a few. If anything out of the ordinary is found, then a doctor is called and the patient is evaluated by a physician. Most days, I have several mothers with toxemia or some other problem to evaluate and treat. Nursing supervision is scarce, so I must constantly keep checking to make sure no one falls through the cracks. Several times I have discovered patients with ruptured membranes that sit unattended for days waiting for labor to start.
When a patient moves to the back, they are usually very near time for delivery. All routine deliveries are done by nursing staff, that includes the delivery and any stitching up that needs to be done. I get called for breeches, most twins, arrested labors, or any large stitching up that needs to be done. I have a head-lamp that I use for light. Most deliveries are done on a flat bed without stirrups or foot pegs. Shoulder Dystocia would be tough in this position. Thankfully, most babies are 6-7 pounds and Shoulder Dystocia is not likely. I have had to go in to repair a few "blow-outs". The nurses are reluctant to do episiotomies other than medio-lateral, so you can imagine some of the awful tears I have had to repair.
As far as anesthesia goes, it is pretty much cold turkey! There are no spinals or epidurals for labor or delivery. Once delivery has occurred, a local is usually given for episiotomy repair. On occasion, I have had to use ketamine and valium for a really bad stitch up job.
Most minor obstetrical surgeries are done in delivery. I have done many D&C's, including three molar pregnancies. I like to start an IV and then give ketamine and valium for the procedure. When the surgery is done, the patients lies there until they are alert enough to go home, usually unattended.
Prenatal care is also very sparse. I do see patients in the clinic that are pregnant. I usually treat their medical problem and then take a little time to look their pregnancy over, no one here seems to have any notion of a due date. A quick two minute ultrasound can really give a ton of information. I am making much use of the portable ultrasound that I brought.
Records are very sparse. The hospital record for a labor/delivery/recovery is usually 7-8 pages. when a patient is ready for discharge, a short note is made in their "scale book" about the delivery This book is maintained by the patient and taken to all health events in their lives, i.e. clinic visits, ER visits, hospitalizations, etc. All treatments and medications are recorded in the "scale book" and presented to the pharmacist, doctor, or clinic each time health care is rendered. This does provide a nice record of health events in a patient's life. Unfortunately, not all entries are legible or complete.
Enough for today. Please pray for us and the patients we are seeing. Hope to see you in a couple of months.
God Bless,
Dr. P
p.s. I hope to see you soon/ mi bi lukim yu behain.
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