Today is our final day here at FAME. I've been waiting to be part of a delivery and I finally got my wish :). Unfortunately, all deliveries that present to FAME are usually high-risk given their late presentation. If the delivery was easy, it would be done unassisted at home.
Mom presented after 48 hours of laboring. The baby was difficult to extract and didn't cry immediately. After some help though, the baby is doing fine. Mom is also doing well thankfully. Practicing medicine in Africa while training in the US is really interesting. In residency, you train by repeated exposure. You've seen so many deliveries by the time you're done that it's ingrained in your memory. Prolonged rupture of membrane --> needs rule out sepsis workup --> draw cultures and CBC --> start empiric antibiotics. Those were the string thoughts running through my head after the baby was stabilized.
Then I stopped. Everyone who presents to FAME has prolonged rupture of membranes, because only the most difficult cases come here after driving or even walking for many many miles. We do not have the facilities to perform cultures here so how will we rule out sepsis? CBC and CRP seem like good screening labs, but how do we interpret them in a newborn who's undergone the stress of prolonged labor? All of these questions required much deliberation and together our team came up with a reasonable plan for this newborn.
FAME has been such a challenging and rewarding experience. Practicing medicine without the same supplies you have at home requires creativity and utilizing all the resources you have available. I am grateful for the small corridor in our clinic where we have internet access. It has allowed me to keep in touch with the intelligent individuals I know back home. Many thanks to their help with taking care of the patients here.
This will probably be my last post here in Tanzania as we leave for Arusha tomorrow and then fly home shortly thereafter. Thanks for your interested in my blog. Hope you had as much fun reading it as I had living it...
Mom presented after 48 hours of laboring. The baby was difficult to extract and didn't cry immediately. After some help though, the baby is doing fine. Mom is also doing well thankfully. Practicing medicine in Africa while training in the US is really interesting. In residency, you train by repeated exposure. You've seen so many deliveries by the time you're done that it's ingrained in your memory. Prolonged rupture of membrane --> needs rule out sepsis workup --> draw cultures and CBC --> start empiric antibiotics. Those were the string thoughts running through my head after the baby was stabilized.
Then I stopped. Everyone who presents to FAME has prolonged rupture of membranes, because only the most difficult cases come here after driving or even walking for many many miles. We do not have the facilities to perform cultures here so how will we rule out sepsis? CBC and CRP seem like good screening labs, but how do we interpret them in a newborn who's undergone the stress of prolonged labor? All of these questions required much deliberation and together our team came up with a reasonable plan for this newborn.
FAME has been such a challenging and rewarding experience. Practicing medicine without the same supplies you have at home requires creativity and utilizing all the resources you have available. I am grateful for the small corridor in our clinic where we have internet access. It has allowed me to keep in touch with the intelligent individuals I know back home. Many thanks to their help with taking care of the patients here.
This will probably be my last post here in Tanzania as we leave for Arusha tomorrow and then fly home shortly thereafter. Thanks for your interested in my blog. Hope you had as much fun reading it as I had living it...
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