OBGYN Continued

The end of my first week at CMC is nearing and I will move on to a community health rotation next week. OBGYN has been quite interesting, but mostly, because of its similarity to the practice of obstetrics and gynecology in the US. Granted, the equipment and facilities are not as nice or high tech, but it is essentially very modern and demonstrates an extremely high level of care. I guess I expected that many modern practices would be lagging here in India, but that obviously isn't the case.

One of the most interesting things I got to do during the week was participating in Grand Rounds. In the OB department, Grand Rounds consists of the head of the department (who is a wonderful female physician, Dr. Alice George) going around with all the faculty members and residents and reviewing every inpatient's hospital course. The resident typically presents the case and then Dr. George proceeds to pimp or quiz them about the case. The whole experience is very similar to our system of resident learning and teaching in the US. Most of the cases presented (both OB and GYN) were typical scenarios seen in American hospitals: hysterectomies for excess vaginal bleeding, mothers with severe anemia being monitored after delivery, antenatal montioring of high risk pregnancies etc. Therefore, for me, the most interesting part, aside from the valuable teaching that was done, were the differing social implications resulting the surgeries and interventions done by OBGYNs in India. For example, one woman we saw was a 24 year old female one day post-op from a total abdominal hysterectomy and bilateral salpingoophorectomy (ovary removal). The patient apparently had a history of terrible endometriosis, which had deposited on her ureters and scarred them, causing obstruction of her left ureter which had already lead to permanent kidney failure on that side. In an effort to prevent further complications from her endometriosis, the uterus and ovaries were removed. However, Dr. George belabored the point that this lady would most likely become somewhat of a social pariah due to her infertility. She surmised that her husband would most likely imminently leave her since she is unable to bear children. And without a husband or children, there are very few roles available to women in India (most women in India are housewives and are fully supported by their husbands). Dr. George spoke of past patients whom, under similar circumstances, had be sterilized at a young age only to be subsequently ostracized from society. The whole conversation was a very intesting commentary on Indian society and how it differs from what I am accustomed to.

Which brings me to one final observation about Indian women in relation to their role as childbearers. First, whenever I saw babies born throughout the week, I never saw a single mother display any trace of emotion after giving birth and seeing her baby. I am not sure if this is because emotional displays are unacceptable here in India or because many women are rather indifferent to their primary role as childbearer. I was informed by the OBGYNs that mothers are usually especially disatisfied if they give birth to girl, particularly if they had many female children at home but do not yet have any boys. In fact, a local informed me that dissatifaction with and discrimination against female babies has been so severe in the past that many women would have an abortion if they found out they were having a girl. Consequently, it is now illegal for an OBGYN to inform a woman of the sex of her child during pregnancy. Having a male to carry on the family name is obviously vitally important in this culture.