When I am not busy in the office, I scoot off to the wards to try to see some clinical work. I have not really had as much opportunity to do this as I might have liked, but when I do, I get to see quite a bit. A few days ago I shadowed some interns who were working in CO3, the emergency gyn ward. UCSF is unusually focused on patient care along with excellent clinical skill development, and though that is the primary reason that I chose to go to medical school there, now that I have begun my training I find that it is easy to take it for granted that these attitudes are universal or at least persistent to some degree throughout the medical world. Being here has shocked me out of that particular delusion.
At school we invest a huge amount of time learning about how to interview a patient in a way that is respectful and thorough, practicing how to elicit the patient’s personal understanding of sickness and wellness (the “explanatory model of care”), and discussing the subtleties of culture, gender identity, past experience, and all manner of other influences that might come to bear upon the doctor-patient relationship. Here I watched the doctor answer his cell phone and chat for several minutes about his car midway through an interview with a woman in pain who already was being interviewed and then examined in a room with at least eight other people in it. A pregnant woman came in complaining of lower abdominal and upper thigh pain and was told basically, “You’re pregnant, and that’s how it is. Goodbye.” Women brought their own chitenges to use as drapes – they certainly cannot count on there being a clean cloth or paper or anything at all on the examining table. And in the background the whole time are the moans of the women undergoing manual vacuum aspiration abortions, a procedure normally done under general anesthesia, but because the women recovering from the anesthesia would take up too much time and too much space, it is done without anything at all. Abortion is legal here, but from what I gather, this is something of a technicality in this very Christian country. It had to be made legal in order to receive funding from some human rights organization, but most women do not know about this option, and many doctors will not perform the procedure. It is not unusual for them to misinform women that it is not legal. As a result a high proportion of the obstetrical hemorrhage cases that we see in the study are the result of botched home abortions.
I am interning at an interesting time in Lusaka, as the Project Coordinator mantle was officially passed this past week. For the past two weeks the old coordinator (Althea) has been training the new one (Kelly), and I have learned a great deal about the project by listening to their dialogue. The transition was a bit chaotic, and so it is an exciting time to be working here as Kelly gets her feet under her as well. We both have similarly compulsive tendencies with regard to the efficiency of procedures and project organization, so we have had long and multiple conversations about how to give the study a bit of a makeover. I have already started reorganizing the office, and if this is anything like what happened when I got my hands on the Scadden lab, soon there will be aqua blue signs everywhere telling people how not to mess it up again!
At school we invest a huge amount of time learning about how to interview a patient in a way that is respectful and thorough, practicing how to elicit the patient’s personal understanding of sickness and wellness (the “explanatory model of care”), and discussing the subtleties of culture, gender identity, past experience, and all manner of other influences that might come to bear upon the doctor-patient relationship. Here I watched the doctor answer his cell phone and chat for several minutes about his car midway through an interview with a woman in pain who already was being interviewed and then examined in a room with at least eight other people in it. A pregnant woman came in complaining of lower abdominal and upper thigh pain and was told basically, “You’re pregnant, and that’s how it is. Goodbye.” Women brought their own chitenges to use as drapes – they certainly cannot count on there being a clean cloth or paper or anything at all on the examining table. And in the background the whole time are the moans of the women undergoing manual vacuum aspiration abortions, a procedure normally done under general anesthesia, but because the women recovering from the anesthesia would take up too much time and too much space, it is done without anything at all. Abortion is legal here, but from what I gather, this is something of a technicality in this very Christian country. It had to be made legal in order to receive funding from some human rights organization, but most women do not know about this option, and many doctors will not perform the procedure. It is not unusual for them to misinform women that it is not legal. As a result a high proportion of the obstetrical hemorrhage cases that we see in the study are the result of botched home abortions.
I am interning at an interesting time in Lusaka, as the Project Coordinator mantle was officially passed this past week. For the past two weeks the old coordinator (Althea) has been training the new one (Kelly), and I have learned a great deal about the project by listening to their dialogue. The transition was a bit chaotic, and so it is an exciting time to be working here as Kelly gets her feet under her as well. We both have similarly compulsive tendencies with regard to the efficiency of procedures and project organization, so we have had long and multiple conversations about how to give the study a bit of a makeover. I have already started reorganizing the office, and if this is anything like what happened when I got my hands on the Scadden lab, soon there will be aqua blue signs everywhere telling people how not to mess it up again!
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