day in the hospital

i thought i should make some attempt to describe a day in the hospital, especially to all my medical friends back home who might be following this blog. Typically we start with maternity ward rounds, a long ward , open style, with about 15 beds , mothers and babies share a
standard twin bed, there are some curtains for privacy when necessary, otherwise its an open ward. Family members often sleep on the floor on mats next to their admitted family member.
There is extra cots for the floor for overflow cases. Laboring moms walk about in the ward or just outside the doors. Scarves, nose rings of various types, multiple rings in the ears, and different shades of brown skin , wrinkles or smoothness of youth adorn the faces, most happy and smiling after birth, some sad or just quiet depending on their circumstance. We have had a number of moms come in with deceased babies to deliver, retained placentas following home births, eclampsia and severe preeclampsia, prolapsed arms, breeches of all varieties come in to the hospital, some after quite a few hours on the road. I am always amazed at the strength and resilience of the human body when it is tested to its limits, which occurs almost daily on the maternity ward. There are 3 delivery rooms in the back with old style metal delivery tables and old stirrups with padding , which serves as the delivery area. Each delivery is attended by nurse midwives and other nursing staff, there may be anywhere from 3=6 people in the delivery room shouting encouragement and instructions in Nepali to the women. There is no pain relief in labor, only encouragement and company. Shouts of "boldognos" meaning, PUSH
and lo lo lo lo lo strengthen the about to be mothers to give it their all. There is combinations of touching, encouraging and scolding given out , sort of all in this wonderful noise that preceeds the cry of a newborn. If I help, its been with a few difficult deliveries, breeches, and doing some suturing and helping with decisions about labor managment or taking a decision for a c section. . They call the nepalese docs or myself . There is no fetal monitors, just intermittent auscultation or listening with either bell shaped ear pieces or a few hand held dopplers.
We have oxytocin and misoprostol which is quite useful . The operating room is a concrete ramp and a hallway away, the dash takes about 2 minutes when needed and the operating room staff are pretty quick to get mothers in for c sections when they arrive. We scrub with bar soap and tap water, and put on heavy cloth scrubs and gowns and wear flip flops in the OR. Im usually dripping with sweat by the time a case is over because its so warm in the OR. Babies are swaddled in linens and taken back to maternity to greet their fathers. Babies are in linens every day in bed with moms, there is no diapers or bottles here at all. Only breast feeding, and a daily bath and change of linens for the babies. I wish all the maternity nurses and my physician colleagues and friends from Toppenish could see the sight. Ill have to describe the outpatient clinics another time. We're down to the last 2 weeks here in Tansen, then off to travel a bit , hopefully for some trekking in the Annapurna area out of Pokhara. Will try to get one more blog off before departure. Thanks for reading.