Late this afternoon I went to a funeral in a village about 20 minutes away (more about that later). When I came back I was showing Heidi my photos and she stopped me on one and said “Wait a minute! I saw that guy this morning at clinic!”
Apparently, she gave him the right medicine because when I saw her patient he was dancing quite a jig at the funeral. Good work, Dr. Heidi!
Most surgical procedures at the BMC are done under either spinal anesthesia or with the use of ketamine (a dissociative anesthetic which blocks the connection between one’s consciousness and the pain). Rarely is a patient put under general anesthesia.
Giving a patient spinal anesthesia is the same basic process as doing a lumbar puncture (aka spinal tap). Instead of taking out a sample of spinal fluid, a local anesthetic such as lidocaine or marcaine is injected into the canal. Read More
This past week, a young first time mom had been laboring for a long time without any progress. She was a small-framed woman and finally it was determined that she had a cephalopelvic disproportion, meaning that the baby’s head was too big to pass through the mom’s pelvis.
I scrubbed in acting as scrub-tech and first assistant with Dr. Faile. He did most of the C-section, but allowed me to pull the baby out of the womb. It was not as easy as I thought it would be. Read More
The maternity ward here is staffed mostly by nurse midwives who assist laboring women in their deliveries. The doctors are called to step in only when there is a problem. Last week, a mother of 7 came in after being in the 2nd stage of labor, pushing for nearly 10 hours. She was exhausted and the baby still was not delivered. The midwives could not find fetal heart tones so they called the doctors. Deepa, one of the family medicine residents who is currently here, took the woman to get an ultrasound, and still could not find a fetal heart beat. Uterine rupture seemed the likely diagnosis. Read More
A 17 year old girl presented to me in clinic 1 week after giving birth to her first born child at home. She complained of fever, abdominal pain, bilateral hip pain and leg swelling. She stated that the pregnancy and delivery were without complications. She stated that there was no hemorrhaging after delivery and the placenta was delivered without a problem. About 2 days later, she began having fever and pain and became very weak. She had no nausea, vomiting, or diarrhea. Denied any vaginal bleeding. No history of trauma to the legs. Read More
A 30-something, 6-month pregnant lady came to clinic the other day with a complaint of having a rash on her abdomen. When she lifted her shirt, I saw three medium sized papillomas in a curved line on the right side of her pregnant belly. They appeared to be in 3 different stages of development, 2 of which had central ulcerations.
I really had no idea what it was. I looked to my translator/ nurse for an idea. She said “it looks like yaws.” “YAWS?” I said, trying to figure out if she was just pronouncing an English word in a funny way. She repeated it. Then Mrs. Faile came into the room and agreed. “That looks like yaws.” I was still confused.
Come to find out, yaws is one of those diseases that I read about a long time ago, probably just once, figuring I would never see it. It is a non-venereal cousin of syphillis. The treatment is Penicillin or Erythromycin, both of which are safe in pregnancy.