The Birth of My Research- May 25, 2012

4 06 2012

By Kelly Andrejko

At Duke, I’m always busy. There’s always a club meeting to attend, a homework set to finish, a practice to attend- rarely do I have the time to sit back and collect my thoughts. So when I started my research this week, shadowing in the local public hospital, my natural instinct was to find something to do. Yet as the chief of personnel dropped me off in the “salle d’accouchement” (the birthing suite) I realized, much to the annoyance of the nurses and midwives rushing around me, there was absolutely no way for me to be helpful except to stay out of their way. It was automatically assumed that I was at least a nurse, if not a doctor, and they explained to me that one does not sit in the birthing ward- there are babies to be born! I must have looked pretty pitiful, just following people around wide-eyed. I had never seen a cesarean, let alone a natural birth in person before, and it was all very overwhelming. That wasn’t even considering the broiling heat in all the rooms (except for the operating room- a refuge of air conditioned bliss). I later found out the lack of air conditioning was partially due to the complaints of the patients that the unit made it too cold.

Over the next two days, I gradually found my niche in the suite, vigorously taking notes on the sights, sounds and procedures, and asking questions when the health workers had a precious spare moment of time. My scrubs and American-tainted French served as an all access pass, allowing me to come and watch as I pleased- a rare privilege for someone who hasn’t completed medical school in the US. Watch out med school- after watching at least five cesareans, I think I have the surgery down! Just kidding.

The whole process for a natural birth was quite different from what you would observe at an American hospital. The women were ushered into the suite one at a time by porters, and were responsible for bringing all of the supplies necessary for the birth in little plastic baggies purchased at the adjoining pharmacy. A nurse/midwife who was probably also filling out a birth certificate or a birthing chart, would register the patient by writing their name on a pink booklet, which would be fully completed after the birth. The women were then told to wait in a side room- I counted eight beds and seventeen women at one point- until they or medical personnel deemed their labor as progressing. When their labor was considered advanced enough, they were moved to one of five beds prepared for the birthing process. The only privacy afforded to the women was a collapsible curtain, sometimes left wide open in the rush. No family members or friends were ever present, and the nurses and midwives took no nonsense, allowing minimal noise. Often the births happened quickly, without any apparent complications, and the women were given about fifteen minutes of rest in the bed before they took their newborn to the adjoining vaccination clinic. The average women would have a bed in a communal recovery room for twenty-four hours before she traveled home.
The births in the hospital could be considered expensive, a simple Cesarean running on average at 100,000 FCFA or $200 (to put that in perspective, it was more than the nurse I was working with made in a month). However, the environment is safe and sterilized. Out of the many, many births I witnessed, only one baby was stillborn and all of the mothers survived.

Overall, my shadowing experience has been a great start to my research, providing me with firsthand observations on the biomedical services offered in a public hospital. Hopefully my experiences at the hospital over the next seven weeks will continue to give me a better insight into how patients make their medical decisions, hospital versus traditional treatment.

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