new start in maternity

New week, new placement—this time on the maternity ward. It’s supposed to be OB/gyn, but there’s a separate ward for gynecology stuff, and I don’t think I’ll really end up there much but we’ll see.

It’s rather awkward here starting a new placement because the culture is different than what I’m used to in America. I’m trying so hard to not offend anyone that it makes me nervous to go somewhere new where I may inadvertently do something wrong, sit in someone’s seat, etc.

So the day didn’t get off to an auspicious start. Going into the hospital, your bags are searched by security guards. Mine are not, because I am clearly not Jamaican and also because I wear a Projects Abroad ID badge protecting me. Some of the guards like to talk to me and ask about America, but most just wave me through. To get to maternity, there were different guards who weren’t as friendly, but I found the ward and told the charge nurse why I was there and was directed to wait. Multiple nurses asked me if I needed help, which is always nice. Overall, these nurses are nicer than the surgical nurses. A lot of what is considering nursing care in the US is doctor-level care here, so I never really saw the surgical nurses doing much business nursing, but the maternity nurses visibly do work. I watched them while I waited around for my doctor for about an hour, which isn’t too bad in Jamaica. In fact, the maternity ward has a TV locked away in its small waiting area, so I was entertained. Even more so entertained considering it was a program on food allergies, something I know a lot about (I have charmed Ingrid with the idea of cooking without eggs—she was exclaiming to her friends in the grocery store about it yesterday!).

Collette, from Projects Abroad, came to check on me this morning and how things were going and she started to agitate more to find me something to do besides waiting around. As she is more au courant with the Jamaican culture, I went along with this. We tracked down the doctor to which I was assigned, who happened to be in clinic that day so it’s a good thing I didn’t wait around, and they sent me back to the wards with the doctor who was on wards today. I ended up being introduced to the residents and from there, things went swimmingly!

First off was watching one of the residents write her progress notes. It was fascinating, not only because OB notes are generally different than the traditional SOAP note, but because they use different abbreviation and phrasing here! NAD in America is no acute distress, a general observation or something put next to respiratory findings. Here is means no abnormality detected and can be written next to any system. For respiratory, we would write “CTAB,” clear to auscultation bilaterally, here there’s commentary on the vesicular air flow and something else I didn’t quite catch.

Ward rounds came next, and they’re not that exciting, although I enjoyed the attending playing a joke on the resident regarding the recently delivered mother—she’s not G2P1 anymore, she’s G2P2. They didn’t think it all the way through. (G=gravida, or pregnant, P=parity, or how many children--so she was pregnant twice and had one child, but now that she delivered she's been pregnant twice and has two children).

Then the going got interesting. I mentioned earlier about how some nursing care in the US is doctor-level care here. As such, I got to play phlebotomist and drew blood on four different patients. Never done on a real patient in America and in fact, I haven’t drawn blood since the lab where we had to learn it during second year, practicing on each other. They also do it differently here—in the US, we have rubber tourniquets, and the needles we place in the vein have a place where you put the blood tubes right onto the catheter drawing up the blood. Here there’s a latex glove tied for a tourniquet, and a beveled needle attached to a 10cc syringe to draw up the blood. I wear gloves, but the residents do not. You wipe the site down with alcohol swabs drawn out a jar that the orderly prepared earlier, and the same swab will be place on the site after you draw the blood—no band-aids here. Also, I’m used to my easily visible veins in my pale white skin, and it’s more difficult to see the veins in some of the very dark skinned Jamaicans. But I was proud of myself, I only struggled on the radial draw on a woman for whom we couldn’t find anything in the antecubital fossa. (in English, wrist...elbow crease)

The main part of the day was preoccupied with general admissions and notes and boring things like that, but then the resident asked me give the post-surgical patients their IV Augmentin. There is no such thing as locked up medicines/Pyxis, but you go over to the cabinet and take out what you need. I had to be shown how to mix up the medicine, but that was interesting. Also, there’s no sterile water like I’m used to, in jars or containers. I was drawing sterile water out of an IV bag, adding it to the powdered Augmentin in the vials, and pulling it back up into syringes and administering it to the patients. No IV flush afterwards, and apparently it burned a lot and I wished I could have flushed the lines.

There were then two emergency c-sections, which was interesting. It’s actually the first time I haven’t scrubbed in on c-sections, and it’s a surgery I had seen five times previously, so one with which I’m rather familiar. They suture the uterus together differently here and I was rather fascinated by the suture technique, which apparently doesn’t really have a name and is one of those things that is passed from surgeon to surgeon.

All in all, it was a long day by Jamaican standards, but a standard American one. I left some of the residents on the 24 hour shift, which I’m so glad we don’t do in America anymore.