clinical update

Over the course of the week, I finished my first week on maternity which, due to the maternity doctor's absence in Choma getting his car fixed for three days, has included exactly one day of rounds and one day of OB- and gyn-related outpatient visits. But I've done more cervical exams on women in labor (albeit inaccurate ones, according to the nurse-midwife) here over the past few days (three) than in almost two years of clinical rotations in the US. We do also have rounds tomorrow, and hopefully the doctor will be back.  I've been doing some reading and learning relevant OB-related Tonga in the meantime (baby moving? vaginal bleeding?  contractions?  leaking fluid?  nursing well?  milk?).

I also rounded on women's ward again, seeing some patients I knew as well as some new ones, and did my first paracentesis (for fluid in the abdomen) without ultrasound guidance, of course, and attempted several lumbar punctures (or spinal taps - 1/3 successful). For procedural-related things like those, sometimes it's nice not having residents or interns to allow to go first when there is something to be done. But we'll see how I feel about it when I become an intern in a few months! 

I do think that I am gradually gaining something of a team feel as I work here.  The people with whom I work seem more open to me doing things, although I think I've started asking to do more, too.  I feel my judgment on some things is trusted more than previously.  I remember more often to order HIV tests on practically everyone I see.  I can conduct a very basic interview in Tonga as long as the answers consist of yes (ee-ee), no (pay-pay), today (sunu), a little (ashonto), or a lot (meningee).  That's gratifying, too.  We'll see what the next few weeks bring.