Here is what I notice as I return to acute care in the US from a clinic in Ethiopia.
First, no, I am not that shocked. Maybe less shocked than I expected to be, but that is primarily because I know Good Sam pretty well, I remember it all from before. Things are much less shocking when they are not brand new, but are more of a way of life you remember.
The fundamental goal is different. You are taking care of the patient in the safest manner possible when you are here, steering clear of any risk what so ever, if at all possible. And there are few surprises- you know most situations ahead of time, with early detection/testing. Over there, you are being as creative and non-standard as you can to try and think of any way to help the patient, who has some sort of huge, previously undetected problem. Over here we are always discussing "what we better do, to be safe.." where there, we are saying, maybe we could try.... would it be worth it to attempt... etc.
The number of interventions and C-sections, and the pace that moves so fast, was different here and took me a few shifts to get used to. Gee, we never, or rarely, had to hurry that much in Ethiopia, even in OB, and we rarely had the luxury of any sort of really quick intervention or outcome (not with a two hour drive to the closest operative facility...) Is that just because Africa is slow? Were we too relaxed?
I figured out the reason: here, we save babies. In Ethiopia, we were usually thinking about maternal mortality and counting on, most likely, a woman that would deliver a baby that had died. No wonder we rush around here, the babies live and have really good outcomes. Responding to uterine rupture here has a radically different outcome here than it will for a woman walking into our clinic.
Women all over the world, people all over the world, grieve. There is no culture where death is anything but death- representing sadness, tears, and loss, especially in young people, children, and babies. Grief over someone here looks different than it does there, but it exists.
But intrapartum and neonate losses are a little different over there. Almost every woman will report in a childbearing history to loosing a child, usually after birth. It is a grief that is expected, I guess. Not so here.
When the community (30 people or so) carried a woman in obstructed labor in to the clinic, we always marveled at their disposition. Cheerful, laughing, wow, you speak our language and you're white, teach me your language, take me to your country, all kinds of banter with her husband joining in, too.
Even in the delivery room, as the baby delivers as is noted to be dead, nobody reacts. Is it stoicism? Or had they resigned themselves to loosing this baby before they were put on the stretcher to carry them to us??
I remember one time, the baby had died and we needed to deliver the placenta. Time was ticking, she was bleeding, we were getting stressed, and Claire was reading up on manual removal. I was giving vigorous uterine massage, and the patient was trying (as usual) to pull my hand off her stomach. I stopped and said to her in Oromo, "I know it hurts, but it is very important!" (Something like, "Si dhukkuba, nan beeka garuu barbacheeseedaa!") At that point, she, her sister, and the midwife all burst out laughing saying, "Oh, you know our language!!" They were genuinely happy I did, and were cheery and warm to me- as her child lays lifeless in the crib next to us...
