Welcome to Shyira Operating Room!!

I'm writing this on my third day at Shyira--also my first time to see a tubal ligation, C-section, and eclamptic seizure (not just to see them, but to assist with them in surgery). Because of the high population density of Rwanda the government is working to educate people on methods of birth control. Today three tubal ligations and one viscectomy were scheduled (and the one scheduled for a vasectomy did not show up: I know what gender is the wimp in this culture!). I watched the second surgery, and then the doctor asked me to assist the third. I figure that this business will seem commonplace sooner or later. But, for now, I am still in awe that I dipped my hand into a woman's belly, found her uterus and plopped it onto her belly. I am completely amazed that I held a woman's ovaries in my hands today. The doctor told me to get started on suturing her up, then left the OR. I got a little shaky when the patient moaned and I realized I was alone--suturing a human abdomen together and not just a pig's foot like I've practiced on.

After lunch I got to see my first C-section. The P1G0 21 yo woman had been given oxytocin to initiate contractions at 9 am. At 1pm, her cervix was still only 3 cm dialated. Because of her active phase arrest, Dr. Kohl did a low segment transverse C-section. I got to be his first assist and close the incisions. It was quite an experience: In his German accent Dr. Kohl explained everything. "Dis is ze sfubcutaneouz fatz," he pointed out as he dug his hands in and ripped it from the fascia. He looked at me and said, "Now youtz. Rrrrip. Watchz carefully: you dzo ze next one." There was blood everywhere, a blue baby screaming, bloody rags being pulled from her peritoneum, and latrine smells wafting in. She had to recieve a transfusion because of the blood loss. I was stunned. I loved it.

An ambulance brought in the next patient. She looked to be at term and was seizing. Her BP was 160/90. The fetal HB could not be found with a fetoscope (old school here) or a doppler. They gave her MgSO4 and brought her into the OR. Three assistants held her down and monitored her BP and O2 saturation. She was unconscious so she was just given a local anethestic and a classical incision was done. I carried the blue baby to her chitange. While Dr. Kohl and I did the matress stitches, I wondered what she would think when she regained consciousness.