medical commentary on the maternity ward

I still can’t get over the blood-drawing differences. In fact, one of the residents commented that she’s never seen a tourniquet. I have trouble tying the glove in the right conformation to form a tourniquet, but they’re experts at it. I’m getting pretty good at phlebotomy, even though drawing up blood into the syringe while holding the needle steady is still something I’m struggling with on occasion. I miss the technology we have in the states.

Speaking of technology, have we ever considered the convenience of the tube system for blood delivery to the lab? And to continue with the general lack of resources, the pleasant use of biohazard bags in which to put the tubes of blood?

Behold the box for blood samples! After drawing up a tube of blood, you fill out the paper slip to order the labs, wrap it around the tube, fold down the ends, and put it in the box. Hope you mixed the preservatives in the tube well with the blood—it could sit there ALL day. If you really want something ‘stat,’ be prepared to walk it to the lab yourself and you still might not get the results in a timely fashion.

The lack of resources extends beyond the lack of tourniquets and tube systems. There are no op-sites to tape down IVs with, but just tape. Even that can be in short supply (in fact, we ran out of tape and purple top tubes for CBCs today!). There is no sharps box, but just a cardboard box. Which then adds to the fun because to put a needle in it, you have to recap it—and that puts you at risk for a needlestick injury. (For those of you who aren't aware, health care workers are NOT supposed to recap needles AT ALL. EVER. It's drilled into you. We still do it. Not so much in America, but situations do arise. Regardless, it's the time you're most likely to stick yourself with a used needle and thus, get a needlestick injury.)

Also lacking is a Pyxis system (the fancy term we have for the computerized system on every floor in every hospital in America, where the meds are locked in drawers and only the med drawer you key in for one particular patient opens when you key in your password and the patient's information), or any kind of secured medicine container. 

We have a cabinet.

It doesn’t even close all the way. It doesn’t really matter too much because there are no narcotics or anything particularly frightening in there, there is a small box with more dangerous medicines locked up (misoprostol is about it, though, no morphine here!).

Here’s another of my favorites.

This could be harder to figure out, but there’s a stack of notebooks on the counter. Those would be the booking diaries. You need a c-section? Open the calendar to the day you want to book it! Someone need to be induced? Check the diary to see if we have room! I went down to the OT (it’s a theatre here, not a room!) today to book someone for an emergency c-section; all I needed was her name, age, registration number, ward, and why we’re doing surgery. No signatures, no phone calls, nothing else. The orderlies came and got her later in the day.

There are no computers on the maternity ward (or anywhere else). You generally ask the patient their name while you’re doing rounds, then you go find their ‘docket,’ or chart. In fact, the patient brings their own supplies—receiving blankets and hats for the baby (West Wing aside--babies apparently do NOT come with hats!), pillows, sheet, rags, clothes, etc. There is a refrigerator where they can come to the nurses to buy juice or soda. Food delivery is common, though they do get food trays—not nearly so well stocked as American hospital trays.

This may be my favorite thing that happened today (besides getting all my blood draws)—finding the fetal heart rate with this thing.

I believe it’s called a pinhole, but I’m not sure. The resident actually handed it to me and I just had to say that I had no idea what to do with it. She kindly demonstrated while shaking her head at the thought of dopplers. (Her reaction when I told her that EVERY hospital has electronic medical records was priceless). I will tell you—it works. It belongs in a museum, to me, but it works.