busy-ish day today, 6-1-10

today...it was a somewhat busy day...we had 2 nice pripip births, normal, nice, no big issues. there were also several women there with incomplete abortions...the OB did 3 D & C's in a row (scraping out the rest of the uterine contents). the third one, this woman was just in agony, in so much pain, and people are just standing around...ignoring her...i had to lead a student over to her side, and tell her to comfort her. she was doing some kind of paperwork, and was conflicted about what to do, and i said, what is more important? this woman or the piece of paper?! geez. there was a woman who was "5 months"--maybe 20-24 weeks, who had pre eclampsia, had swelling all over, and delivered a dead baby...i caught her baby, it was very small, the placenta was small, and friable and pale...there was another woman there whose baby had died in utero, she was around "7 months"--an 8/7 (8th pregnancy, 7 previous births). being induced. one of the knees was coming down through the cervix, which was about 3 cm dilated...poor lady. yesterday there was this woman who had been in the earthquake in port au prince, who came in and said that in the earthquake, something had fallen on her head, and that ever since she has had a headache that doesn't go away. it's so hard to know how to help people sometimes...is she just chronically dehydrated and undernourished? is she just traumatized from the quake? PTSD? is something really wrong? there is nowhere to send her for any of the tests that you would do to rule out a real problem, so what do you do? what do you do about people not having enough food and water? i see so many people, kids and adults, who yes, you look at hem and they look like they are starving. you want to help everyone, but you can't, and you know that if they have already come to the hospital here, they're at a dead end...where else are they going to go?
marthonie and i have been talking about trying to do some kind of continuing education for the MW grads who work at the hospital...i think we're going to start with neonatal resusitation, and then do labor monitoring, fetal heart tone patterns, kinds of decelerations and their significance...that would be a good place to start.
there is no one else here to do that for them.
well...just another normal day here. a few ladies with pre eclampsia, a few stillbirths, a few normal births, a few abortions...all in the same room.
it is very interesting. very very interesting.
reina