First Year Going On Third.

Excitement. I’m preparing to present my first patient (and her newborn) during the daily morning report.

In lieu of my research failure, I’ve taken the opportunity to learn as much about Obstetrics and Gynecology as I can on the wards. I’ve watched many surgeries, seen many patients, and read many textbooks.

I’ve been reading the “First Aid for OB/GYN” – the bible for third-year students rotating in the OB/GYN department. I’m attempting to turn my “shadowing” experience into a mini third-year rotation, where I actually get involved. I can’t tell you how gratifying it is for your attending to mention the types of abnormal vaginal bleeding, which you have already studied a few days earlier.

Without formal training, I can’t do most tasks like IVs, blood draws, cleaning wounds, etc. However, two weeks ago I was allowed to scrub in and assist the surgeon with surgery. It was an abdominal hysterectomy and my first time touching a uterus. The entire experience filled me with excitement as I assisted the surgeon clamp, cut, and sew.

Yesterday, I was allowed to assist in a cesarean section for the first time. After observing a few (and years of hearing the story of my own cesarean birth), the speed of the procedure took me by surprise. The cutting didn't elapse as long as the anesthesia. After a few minutes of cutting and some blood-splattered scrubs later we were able to deliver a healthy baby boy amidst a sea of meconium, blood, and amniotic fluid.

It was both amazing and disgusting at the same time. I have joined the club of those who have placed their hands inside the uterus of a woman he or she didn’t know (though I did know her vital signs).

After the delivery, the hard part began. The surgeon delivered the placenta, and we both started the process of cleaning, patching, and sewing. After we finished and both patients were transported to the right places, I got the third-year honor of presenting this patient to the rest of the OB/GYN staff.

Research Failure

When I decided to work at KCMC in the Obs and Gyn department, it was with the expectation that I would assist with an ongoing research project that assesses methods to prevent mother-to-child HIV transmission. In New York, if a new mother is HIV positive, we would just encourage her to avoid breastfeeding her child (which can transmit HIV) and use a formula for her child instead. However, in a developing country like Tanzania, one can’t guarantee a stable, clean water source with which the mother can make formula. Hence, the mother risks transmitting fatal diseases, like cholera, from the potentially-polluted drinking water – especially if the infant’s brand-new immune system lacks the antibodies necessary to ward off these diseases.

To prepare, I’ve read a few studies from Malawi and Botswana that discuss the usage of prophylactic HIV medications to prevent the mother from transmitting HIV to the infant with good rates of success. I was hoping to participate in a similar study at KCMC, but to my dismay, I was informed that no such project exists anymore at KCMC! I must’ve come too late. When I asked about other research projects in the OB/GYN department (including the famous Pre-Eclampsia/Eclampsia project), they either have already been completed or were awaiting approval. I was in shock. My classmates, also hoping to assist with some sort of research project, experienced similar disappointments.

Now, I’m considering the possibility of spending six weeks shadowing physicians, which isn’t unappealing. The staff and faculty of the OB/GYN department have been really helpful. One physician offered to give lectures on important topics in OB/GYN.

I could also use the spare time to conduct research of my own in the library. Giant obstetrics, surgery, medicine, and physiology textbooks await.

Now, I'm updating this blog on real time. I go for a four-day safari tomorrow. Can't wait!

Obs & Gyn

… in Tanzania; Obs and Gyne (pronounced guy-knee) in the UK; and OB/GYN (oh-bee-guy-nn) back home in the US. No matter how you abbreviate it, obstetrics and gynecology is an interesting and interdisciplinary medical field.

Though obstetrics (the medicine of pregnancy and childbirth) and gynecology (the medicine of the female reproductive tract) are two separate fields, they intertwine very closely. Hence, most doctors specialize in both, which gives the OB/GYN field the multifaceted approach I especially enjoy.

In fact, at the age of 13, when I first considered medicine as a career, I wanted to be a gynecologist. I told everyone. The initial interest stemmed from my mother’s explicit descriptions of puberty, birth control, menstruation, childbirth, and pelvic exams; explanations that would have terrorized any pre-teen fascinated me. At 14, I built an anatomical model of the female human body, which still resides in my room back in New York. One could change the breastplate, intestines, and uterus to make the model 7 months pregnant.

The 9 years between those awkward adolescent moments and my first year of medical school have seen multiple changes in both career aspirations and academic interests – including serious time commitments to both HIV/AIDS issues and mental health issues. However, OB/GYN (and women’s health in general) has always held a special place in my heart.

In college, as I developed other medical interests, I’ve looked away from OB/GYN. Mental health is a heavily overlooked issue I desire to pursue, first of all. Also, the medical malpractice insurance for OB doctors is ridiculously expensive in the US (in the range of 150,000 to 300,000 a year), and not many doctors are compensated enough to cover such an egregious expense.

I decided to work in the Obs and Gyn department at KCMC this summer to acknowledge my initial interest – and because it is more difficult to shadow a psychiatrist in a country where everyone speaks Swahili.

Let’s see how it goes!