Dr. Danny--obstetrician & neonatologist

So here at Mbingo Hospital there are two residency programs—a surgery residency through PAACS (Pan-African Academy of Christian Surgeons), which has been here for a good number of years, and an internal medicine residency, which was started by Dr. David Palmer, the chief medical missionary, only three years ago.  In addition to taking residents into those programs, the hospital also takes on “housemen” who essentially do a year of rotating internship.  Each houseman is assigned to a service for a 2-month block.  There are also 2 other American residents, one pediatrician and one internist, rotating here for the first 4 weeks that I’m here.  Since I’m the only one of the three who’s had obstetrical training, I’ve been assigned as attending on the maternity ward.  Yep, I said “attending.”  That means I’m kinda in charge of the service…scary!  I say kinda because there are nurses and (I think) nurse-midwives who essentially function as mid-level providers on maternity.  So they are a great help and have lots of experience.  We’ve had a number of deliveries since being here, and most of them not too scary.  The more involved ones included a lady who hemorrhaged after delivery down to a hemoglobin of 5, a twin delivery (although she was transferred here from an outside facility after delivery), and a uterine rupture who was taken to emergent C-section at 32 weeks gestation.  The facilities are certainly quite different than those at home, but they certainly make do with what they have.  Interestingly, maternity seems to include the premature babies, so I get to round on the preemies as well.  It’s actually kinda cool as I really enjoyed my time on NICU during second year, but I have to say it’s been nice having Emily, the peds resident (who rounds on the pretty full inpatient peds ward), here to help me out.  Right now we have five pre-36-weekers and two incubators.  Since 3 are in need of the incubators, two of them are roommates!  And yesterday, we found a third roommate in the incubator with the two babies—a large cockroach!  While gross and kinda sad, we had to laugh at the situation...otherwise we would have vomited or cried, I think.

I’m enjoying my time here so far, but it’s kind of hard at the same time.  Things are just so different back home—the wealth of technology available, the ease with which you can have studies done, the lack of concern about cost.  In some ways, it’s actually better as you don’t feel like you’re practicing defensive medicine, doing things just to cover your rear and keep from getting sued, but you also feel like your hands are tied in some situations when you don’t have all the information you feel you should in order to make the choice for the patient’s best interest.  And the attitude of both the patients and the medical staff is quite blasé at times.  They lack a sense of urgency when doing pretty much any kind of patient care.  I think that’s probably one of the most frustrating things for me so far.  In the US, especially in very old or terminally ill patients, the pendulum certainly swings the other way, as we try to keep people alive by any means possible, even if their quality of life or dignity is gone.  But here it seems that even in the salvageable cases—or at least the cases where there is a considerable chance of good outcomes—the lackadaisical attitudes persists.  I guess when you see so many patients die, maybe you get numbed to the idea.  I don’t want to be an ethnocentric westerner who berates anyone who doesn’t do it “our way,” but I also don’t want to neglect the opportunity to teach and improve the patient care to which the people of this area have access.  This is an area where you all can continue to pray for me and my compatriots.  Lord, give us the wisdom to see the proper balance!

Here are a few photo updates:

My room.  They call it the chicken coop, so I was a little concerned at first, but once I arrived I saw it was actually quite nice. 

A view of the hospital compound from atop a hill across the valley

A Falani man was herding his cattle along the trail as we hiked.

View of the ridge along the backside of the hospital land...beautiful!

A family hanging out on the roadside along our hike.  The littlest ones are 5-month-old twins!

The Richie kids (Dad is a general surgeon serving for 6 months) came trick-or-treating to my door tonight.  Good thing I packed some goodies for my trip!