TGIF again!

First off, a shout-out to Dan and Robin for generously donating five hours of their Thursday evening as our proxies for scheduling night. (Scheduling night is when all twevle members of our class sit down to try to figure out the schedule for the coming year, and suffice it to say it can get difficult with people not wanting to work on certain holidays or wanting vacations at certain times.) Amy and I hope our class provided enough fermented beverages to help set aside any recurring thoughts of, "Why did I volunteer to do this again?!?!" We are both extremely pleased with our schedules so muchas gracias! Something funny did happen though while we were discussing the results of the scheduling. The exchange went something like this:

Amy: So were you happy with the scheduling results?

Cindy: Oh yeah! Robin did a great job!!

Amy: Yeah, Dan did a great job, too. I'm sooooo happy to not be working on Christmas or New Year's. God, I would hate to be the person doing Women's Health that block. Can you imagine? Taking call on BOTH Christmas Eve AND New Year's Eve???!?!? How much would that suck?

Cindy: Hmm... yeah. Guess who that person is?

Amy: Oh -- (gulp)

Cindy: Yup, me!

With all due respect, the truth is it's not that bad and I don't mind it. I just thought it was funny. (Seriously, Robin -- I'm thrilled with my schedule. Thanks! :)

*****

After my last bad experience with the delivery, I decided to look up some information on episiotomies to figure out for myself whether they are necessary or not. Coincidentally, Amy did the same independently after our discussion over dinner that night. Separately, we both found that the most recent evidence shows that routine episiotomies are not justified, and in fact, worsens tears, increases postpartum pain, and can cause dyspareunia and anal incontinence (if midline.) I printed out a couple of abstracts of studies (including one specifically focused on the high prevalence of episiotomies in Latin America -- somewhere between 85-95% for primiparous women!) and showed them to my third-year resident. She said she concurred with much of it, but that, however, because she was at a teaching institution, her attendings still expect it to be done. Even in the States it can be difficult to change old ways, and this is even more apparent in the field of obstetrics.

As would be expected, the residents often like to ask me how things are done or not done in the States. The consensus of our discussions is that medicine is a few steps behind in Nicaragua, and the reason is obvious: lack of resources. Last night I was scrubbed into a couple of c-sections with a 2nd-year resident, Juan, who has an 8-year old son. Jokingly, I said, "Let me guess, he was delivered by c-section." Actually, he wasn't, but that was because Juan was only a medical student then. Now that he's been doing OB/GYN for almost two full years, he says his next child will be delivered by c-section because it's a controlled environment. However, he did offer that if they had epidurals and continuous fetal heart monitoring he, he would be more comfortable with a normal vaginal delivery. I can see where he's coming from. When the resources are limited, you're better off being overly cautious and avoiding emergencies and catastrophes because the resources aren't there for an immediate rescue.

One other thing that's kinda funny is that I brought with me my "Essence" OB handbook, made by one of our very own residents. Many of the residents who have seen it have wanted to make a copy. You may have found yourself a market down here in Nicaragua, Jeff!

Here are some pictures from the hospital:

1. The OB delivery room

2. El Quirofono (operating room)

3. Neonatal resuscitation area in the OR

4. C-section for a breech (legs first) baby, me holding the beloved "barba" (bladder blade)

5. Premature baby in the UCIN (intensive neonatal care unit)

6. An albuterol nebulizer machine

7. A baby with neonatal jaundice getting phototherapy

***

I decided to take a trek out to the local beach, Las Penitas, today after a post-call morning nap. (Amy didn't join me because she was sleeping and recovering from a night out in Chinandega with an anesthesiology resident, Roxanna, who was eager to show her around her hometown.) After a somewhat disappointing visit to a local Guatemalan beach a few years ago, I wasn't expecting anything spectacular. I was pleasantly surprised though. The beach was quite clean and had beautiful crashing waves. The best part was that there weren't too many people there, and of those who were there, 95% were native Nicaraguans. Amy and I have both commented that one of the main reasons we have enjoyed Leon so much is because we don't see too many tourists around town. It's refreshing. Both of us have been to Costa Rica and felt repulsed by the ridiculous number of backpacking gringos or recent college grads on an extended, potentially lifetime spring break.

I met a cute little 11-year old girl, Lupe, who was selling little sculptures made of shells. I bought three of them off her on the condition that I could take her picture. Sharply, she snapped back, "Sure, but only if I can take a picture of you, too. I'm good at taking pictures." We exchanged picture taking and I realized I had a packet of Elmo stickers with me (Amy and I had brought stickers in the case we were working with kids in the hospital or clinic). I gave her the two sheets and she asked me if I had more because she has twenty other brothers and sisters. Twenty?!? I said she was lying. She said, "Ok, well I have only eight brothers and sisters but we also live with nine cousins!" She was very cute.

Some pictures:

1. Hotel Suyapa Beach, the "swankiest" place on the beach according to Lonely Planet and locals. I enjoyed a coke and rum (Flor de Cana, Nicaraguan brand) here.

2. Near sunset, the fishermen on lanchas (boats) head out to spear some fish

3. Lupe, savvy saleswoman of 11 years old

4. A satisfied customer!

5. Locals watching the lanchas head out

***
Alright, off to catch some zzzzzs. We're headed to Matagalpa in the Northern Highlands about four hours away this weekend to meet the family of one of the medical assistants with whom we work in our Family Practice clinic. There are supposedly lots of organic coffee farms as well and the weather should be cooler -- thank goodness!

Cindy