First Rotation: OBGYN

So today was my first full day the the CMC Hospital. Yesterday, we spent most of the day getting signed up for our electives and paying our fees. Things here in India run at a much slower pace and tend to be relatively inefficient. First, we had to visit the medical school campus at Bagayam, which is about a fifteen minute ride by autorickshaw from where we are staying (autorickshaws are the main method of transportation here in Vellore...they look like a three wheeled motorbike with a little open air cab placed on top). The campus there at the medical school is like a small oasis in the middle of this crowded, noisy city. It is wide open with beautiful garden of lush plants. It was a nice temporary respite before returning to the chaos of Vellore.

I chose to do OBGYN as my first elective here in Vellore. Since I plan to go into OBGYN, I thought it would interesting to compare the care here to what I'm used to in the US. Surprisingly, there aren't too many differences. They ask most of the same questions, do the same types of exams, and use the same equipment (including continuous fetal monitoring). It also seems that most of the residents and attendings are female, just like in the US. I had thought because Indian society is more patriarchal and most women stay at home or work menial jobs that more of the OB doctors would be male. But instead, it was very similar to OBGYN programs/hospitals in the US with women predominating the field.

One of the only big differences I could observe was that they don't use anesthesia. Epidurals and narcotics simply aren't available here (I did find out later that private hospitals do offer anesthesia; however, the local people I talked to about it seemed to believed epidurals often caused long term detriment and wouldn't use them anyway). Another thing that was slightly disturbing coming from our germ/infection prevention obsessed culture was that the doctors wear sandals all the time (the same ones they wear when walking around outside). And while the doctors do wear shoe covers in the OR, they do not wear them during deliveries. During mulitple deliveries, I saw both doctors' and nurses' feet covered with blood...very unpleasant to think about.

I was also surprised to realize that operative deliveries (ie forceps) are very common here, although without anesthesia, they are especially brutal for the mother. This afternoon, I watched one forceps delivery on a women with arrest of descent. The forceps they used looked different than the ones used in the US and in order to apply them, they had to cut an episiotomy at least a few inches long. I thought the poor mother (who of course did not have any anesthesia) was going to either die or kill somebody. It all sounded pretty awful, although the baby came out just fine and the mother survived.

All and all it was a very good first day and I am looking forward to seeing more over the next few days.