Labor and Delivery

I am finally getting use to the whole staring thing that Indian people do. I realized that they are going to stare at me regardless of what I do. I stopped the whole starring contest thing, b/c in the end they usually win and I end up looking away out of uncomfortableness. My new fascination is the way they say yes. In the US, when we say yes we shake our heads up and down. But here when they say yes they do this sort of side-to-side shake. To the average American, it looks like they are saying "Maybe," "I am not sure," or "Kind of." It in no way resembles the standard "yes" head nod. It is hard for me to explain on paper. I wish I could video tape someone doing it and post it on my blog. Anyway, it causes me a lot of problems on a day to day basis b/c I can't figure out if someone is saying yes or no to me. They kind of look like bobble head when they do it.

About two days ago, Erica and I decided to go jogging on the college campus. It was actually a nice jog. The college campus is surrounded by forrest so their was a nice breeze blowing while you jog. We ran across some bats during our jog, which was bit scary at first b/c they move so fast. But don't worry, none of them bit us. The main problem we ran across is after running, I just kept on sweating. The concept of evaporative cooling is lost in a country where most places aren't airconditioned and the only form of circulating air comes in the form of a fan. One of my fellow students saw how bad I was sweating and offered me a moist wipe which helped a lot.

That same day, I was taken to the police station by the bell boy at my hotel b/c as a tourist I have to register with the police department for some odd reason. He took me down there with some other medical student from Germany. This was her first time in a developing country and she was having a hard time adjusting. She said that one day she went to the local park to read a book and she was bombarded by a group of kids from a school close by. They came up to her and started touching her skin and her hair.

When we finally got to the police station, we walked in on some cops beating one of the locals with a big stick. The German girl looked really scared and said, "This is such a crazy country." I wasn't shock since I feel cops are crocked wherever you go. The cops weren't the only ones beating the man, another local person starting hitting the guy on the back. Then they moved the guy into the back room and a bunch of other people followed them into the room. Then they told us to wait outside. That whole incident was very suspect. Poor guy.

Grand Rounds: On Wednesday, I went on Grand Rounds with OG team 2. Here grand rounds just means the team walks around with the attending to each floor to check up on ward patients. This was not a pleasant experience: The team never asked the patient if they could draw back the curtain before they came in. Several times we walked in on patients in the middle of breastfeeding. The residents here talk really soft when they are presenting patients. It is really annoying b/c I can't hear anything they are saying. They stand about 2 feet away from the attending and she can magically hear their whispering. Plus it doesn't help that I am about 4 feet taller than everyone around me so I am constantly bending down and pressing my ear against their backs so I can hear what they are talking about.

When rounds were over, the team dropped me off at Labor & Delivery which was completely dead that day. Only 3 women were in the ward and none of them were in active labor. Then I saw Erica's OG team walk by so I ran to catch up with them to see if they were doing something a bit more interesting. They were also rounding on patients and had just got back from a lime juice/coffee break (NOTE: Indians love to drink freshly squeezed highly sweeten fruit juices here and people take breaks from what they are doing at work to go get some). Her attending was so much better than the one I rounded with earlier that morning. Her name was Dr Verghese and she was really into teaching her residents. She pimped her residents hard but wasn't harsh on them for not knowing the answers to her questions. One of the interesting things she discussed was their management of eclamptic patients: Eclampsia is like a norm here. I have seen lots of preeclamptic patients in SA, but never an eclamptic one. She said when an eclamptic patient is actively seizing they usually just wait for the seizure to end before they intervene. They do not give anything like phenytoin or any other meds to break the seizure. They simply do seizure precautions (turn patient to side to prevent aspirations or give them a tongue dam to prevent tongue biting) and cry for help. Scary!

Labor & Delivery: L & D here is split into two sections: high risk and low risk pregnancies. The room is set up with high risk on one side with the better baby-mommy monitors and low risk births on the other side of the room. Inbetween these two areas is the baby resusitation area where they take the babies to be cleaned and clothed. I couldn't find an ultrasound anywhere in the room and wondered how the doctors knew what position the babies were in. It turns out you can do pretty good Leopold's manuvers on these women b/c they are pretty skinny. They only do ultrasounds if they feel something is really wrong.

The nurses wear the cutest white saris and they call them sisters instead of nurses. While the doctors wear big scratchy scrubs that tie in the back and the pants are very high-water. Each bed is only separated by a flimsy curtain and no men are allowed in the ward. If you want your husband by your side you have to pay a lot of money for a private room. The beds have no stirrups. They just ask the women to hike up her legs and move to the edge of the bed when it is time for them to push. The women are not given epidurals unless they can afford it. So most of these women are giving birth without any form of anesthesia, which is amazing to me. Watching this was a good form of birth control and makes me not want to have a baby anytime soon. You could tell they were in actual pain b/c they would have tears in their eyes and moan but they would not scream and shout like women in the US who get epidurals. Also the women would barely scream during contractions or when they were actively pushing. The OGs do not waste anytime here when a lady is fully dialated. They are quick to pull out the vaccum, forceps, or scissors to give episiotomies. They barely ever protected the perineum when the lady started pushing.

The episiotomies were so painful to watch b/c they just use a little bit of local or a pudendal block and start cutting. The same went for the stitching the OGs did on the lady's perineums once the baby was out. You could tell the patient felt the needle or scissors by the look on there faces. After being in L&D for two days, I was sure that I truly wanted to be a Pediatrician b/c I spent more time playing and holding the babies once they out than watching what the ob/gyn was doing. They did not do much to the babies once they were born. They suctioned their mouths and nose then took them back to the resuscitation room to clean them and cloth them. The babies are also very small here. They are about 2-3kg when they are born which is about 4.4-6.6Ibs. The truth is that we probably just have super fat babies in the US. Plus the women here are pretty small statured so they wouldn't be expected to have huge babies. I also picked up a few words of Tamil while in L&D: "Muca Ma" means "Push Lady." I like saying that.

Most of the time while we were in L&D the only people that spoke to us were the interns and nurses. The upper level residents always seemed too busy to deal with medical students. We met one really sweet intern that asked us tons of questions about the US way of medical school. Here you go straight from high school into medical school which is 5 years. Then you do an intern year rotating through all the specialities. Then after your intern year you specialize in whatever field you want to go into, which usually takes about 3 years. She also asked me about my braids b/c she didn't understand the concept of braiding your hair and wondered how I kept them clean.

Pictures above:

1) Erica and I on the public bus back to our hotel one night.

2) This is a picture that was on the public bus we took. In Vellore, they have two types of public buses: one of them we call the party bus b/c it has pictures everywhere, flashing lights, and music (we were on this one) and the other one is just a regular crowded bus.

3) The whole gang from UTHSCSA. From left to right: Jenn, Kathryn, Erica, Aruna, Collin, Seema, and Nicolete. We were eating at a nearby hotel called Hotel Surabi. We met up with some other international students who were volunteering at the Leprosy Hospital, which is 30minutes outside of Vellore. I want to go there at least once before I leave Vellore.

4) This is a picture of one of the new born babies. He was so cute. Indian babies have the biggest eyes when they are born and open them wide. And they have a full head of hair.

5) This is the baby resusitation room.

6) This a picture of the saris the nurses wear and the ugly scrubs I had to wear in L&D.

7) This is Erica, Nicolette, me, and one of the interns we met in our fabulous scrubs.