La Hospìtal Maternidad

This week I am working in La Hospital Marternidad with Dr. Marquez. He´s a really great guy and knows quite a bit of English, which helps me understand. I am also with another student, Jennifer, who just completed her first year of med school at Cornell in NYC. The hospital that is affiliated with the school hosts celebrities like David Letterman! We live aways from each other so I take a taxi and she takes a bus and we just meet at the hospital. It is a public hospital so patients pay very little, if anything. The government covers the costs and this mirrors the care and organization the patients receive. Monday was my first day and after changing into my scrubs, I met Dr. Marquez in the antepartum room. The first patient we saw had pre-eclampsia, as did numerous other mothers. It was hard to concentrate on the diagnosis of each patient, not because of the language barrier but because I could not believe the conditions of the hospital. There are around 10 beds lined up next to each other, each occupied with a pregnant woman. They are using maternity pads as pillows and many of them have IV´s in. They do not give pain medication before hand so many are crying out in pain. In addition many are in labor. I will elaborate on that later. Also, I did not see a sign that said, "No Med Students Allowed" as I have seen on Mother/Baby a few times. Whoever is in the room gets to hear and see everything. That day there were 17 of us looking at the patient along with the other patients in the room. It was more disturbing to see the conditions these women were in and knowing there was nothing I could do.

If one woman complains when I get back to work I am going to show her the picture of this room and say, "You could be here! And without pain medication!" I honestly had to leave the room a few times just because it was disturbing hearing them cry out in pain. I got to see one of the doctors insert Prestol in a woman´s vagina. It looks like a tiny pill and dialtes the cervix further. I also watched Dr. Mejia insert one when I shadowed her on Labor and Delivery back in the states. The doctors tend to talk amongst themselves ABOUT the patient, rather than TO the patient. The fathers do not wait around at the hospital. There are no visiting times or menu to order from. Dr. Marquez told Jen and I that the reasons the fathers aren´t here is because there isn´t room. They could come if they really wanted to, but they don´t. Only to pick up the mother and baby after the delivery. The next room we walked into was smaller with only 2 woman lying under wools blankets. At first, I thought it was more antepartums but then I heard it was the abortion room. Since abortions are ILLEGAL in Ecuador, most woman come in with partial abortions and then the doctors can complete it. Once again, the government pays for these operation. One woman was ten weeks along. When I walked back into the antepartum room, I noticed a new patient and I began speaking with her. I found out she came to Quito last night from Lohan, which is 18 hours away by bus, and she was in labor! There were no births on Monday but I was okay with that because I needed to take in everything else I was seeing.

On Tuesday I arrived at the hospital earlier and immediately heard a woman crying out in pain. I think the med student was trying to break her water. All of a sudden everyone starts screaming,"PARTO! PARTO!" (Which means BIRTH) And they run with the woman on the bed to a birthing room. The doctors frantically scrub in as the woman is moved onto the birthing bed. Usually they do not move the woman here until they can see the head coming out. It´s insane. They asked me if I wanted to help but I was unsure of what that would intail so I said no, I would only watch. Also, I have no idea what I am doing! I did get to do the footprints and Jackie Powers would have been proud. I even showed them the clipboard idea so you get a clearer mark. I also got to take the baby back to the mom. It was a boy and his name is Manella.

Fernando, the resident cutting the cord of the baby in the above picture, told me the mom should name it after him. I asked if they do circumcisions here and they said no, not unless the penis is huge. They don´t get erythromyocin or Vitamin K. After, I met Gabriel the doctor that delivered Manella and he showed me the placenta and the membranes around it. He was showing me how to make sure that he completely removed the placenta by checking to see if it bled when you cut it. I think he was making sure nothing else was left in the mom. For the next 15 minutes or so, I could swear I kept hearing people say, "C-section," but really they were talking about Dr. Cesar. They all laughed at me because I would come rushing out and ask if I could watch. Dr. Cesar also showed me the nursery which is completely seperate from the birthing area/antepartum rooms. Most moms see their baby right after it is born and then when it is time to go home. Also, nurses doctors and myself carry the babies around in our arms, not in cribs. It feels so weird/wrong! I am so used to making sure that babies are in their cribs when they are being transported. I wonder if they even have Code Pink here. A lot of women were in pain on Tuesday and many of them were vomiting. The doctors check the mom´s cervixes a lot here and the more they check the greater risk for infection. I just want to give each patient a pillow, a blanket and some strong pain meds. But with all that comes money. I cried during the birth this morning. I always get teary eyed and I wonder how many I will have to see before I don´t cry anymore. It´s such an amazing sight. I finally saw my first ceasarean section on Tuesday as well!! It was crazy and I thought the baby´s head was going to pop off as they pulled it out. I have learned a lot already and I love working with the doctors here. The picture below is of me and Dr. Gabriel. He delivered Manella. Below is what the crib cards look like. Oh yea, I learned how to upload photos to the computer :)