Tuesday, March 27, 2018

Been looking forward to sharing my O&G posting experience with y'all reasons being that it has always been my favorite right from Uni days, its straight forward when practicing like you can't miss the diagnosis and most importantly because you get to assist surgeries regularly.
To start off with, the environment was friendly, it had sane people around and the Consultants, Senior Registrars and Registrars were really friendly which made the experience a good one although, Lagos Island Maternity Hospital is popularly referred to as Nigeria's Largest baby making factory so you can imagine the work load and referrals we get from all over. It was founded in 1859 making it about a hundred and fifty nine years and one of the first hospitals in Nigeria.

One of the things I loved about this posting was that all hands were usually on deck. The way emergencies are handled and also the fact that the mortality is usually low unlike in Internal medicine where patients die anyhow and diagnosis keeps changing. Also loved the fact that you could review cases or talk to any Consultant or Registrar irrespective of if they are on call or not.
Obstetrics & Gynecology is the branch of medicine that deals with the care of women from pregnancy until after delivery and with the diagnosis and treatment of disorders of the female reproductive tract.
God really did an amazing job creating women. This posting made me appreciate women more.
So, I worked with two Consultants Dr Ogungbemile and Dr Agbetoba during my stay and initially three Senior Registrars and two junior registrars but along the line, I worked with new Senior Registrars and junior ones because they usually rotate working with different consultants which means they are not permanent in each unit.
My Unit members during this posting actually made it fun and worth it. Shout out to Doctors Thelma, Taj, Lovelyn, Titilade, Azeez, Folarin, Andu and Mahinmi. Laughing out so loud now thinking about so many things that happened.
We were expected to work in four different wards for 12 weeks which means means 3 weeks in a particular ward and we switch.
As house officers, we do our rounds every day very early in the morning and report to our senior Doctors if theres anything we noticed during our rounds the wards were ;
A1- Obstetrics ward: This is the most delicate of the wards because it has to do with the pregnant women. They are monitored closely especially those with some conditions like gestational Diabetes mellitus, severe preeclampsia and eclampsia, threatened miscarriage, etc.. they are given all the necessary attention and make sure nothing is wrong. Taking their vitals and doing the necessary examinations are very important and we also make sure the nurses are carrying out instructions given by the doctors.
A2-Caeserean Section ward: Basically, we make sure they are fine, take vitals, check how their operation site is doing,  make sure the nurses are dressing the site as instructed, check the general condition of the patients and carry out some necessary investigations, etc.
A3- Normal Vaginal Delivery ward: This ward is for those women who had normal vaginal delivery and all we do is make sure they are getting the necessary drugs, observe their general condition, make sure their babies are doing fine and plan to discharge once everything is fine and follow up.
A4- Gynecology ward : All gynecology cases are usually here, we make sure those who had surgeries are doing well, care of the operation site, ensure the necessary drugs are being used. We also have cases like fibroids who have not been operated but being managed conservatively.
Also every morning, theres something called morning review where all Consultants, Senior Registrars, Registrars and house officers gather together to learn, where we discuss the patients admitted overnight. The Registrars on call present the patients and the discussion starts, questions are asked and in general, we learn although, the morning review can be bloody if you know what i mean lol.
We also had the B3 ward also known as the neonatal ward where babies are usually admitted following their delivery immediately or some days after. Some are admitted because they are preterm,  they have Jaundice, birth asphyxia, some congenital anomalies and other conditions. The pediatricians are usually in charge of this ward.
MONDAYS: This was my permanent call day which means I was usually on call Mondays and it meant my unit had to handle the theatre, the Labour ward and the emergency room. Once we resume work usually before 8, we get to see our patients on the ward, listen to their complaints document for them and make sure those for surgery that day already have their lines set, catheters inserted by the nurses, and are well shaved. As house officers, we rotate through the Theatre, Emergency room and Labour ward. For instance, if I work in the ER during my call today the next place i'll work will be the labour ward and subsequently the theatre.
Theatre: We then all move to the theatre after which those working in Labour ward move there then the rest of us stay in the theatre. Most cases done that day usually would have been booked and assessed by the anesthetists to be sure the patients are fit for surgeries. We usually do more of obstetric cases and one or two gynecology cases like Hysterectomy which is the removal of the womb, Myometomy which is the surgical removal of uterine fibroids and it depends on how complex one gyne case would be. For every Caesarean section to be done that day, the Pediatricians are usually on ground just to make sure nothing goes wrong after the delivery of the baby. While working in the theatre, theres every possibility that we get emergency cases that are more important than the cases we already booked and one of the emergency cases includes Ectopic pregnancy which is a situation where the embryo attaches outside the uterus and could be ruptured or unruptured.
The surgery done is called Exploratory Laparotomy: Which is usually to gain access to the pelvis to remove the pregnancy and  is a very serious case because some of them could bleed to death if the surgery is not done asap. But if theres no emergency during the day, we move on with our booked patients for surgery and by 4pm, those working in the Emergency room move there to work overnight and take over from those who worked there since morning.
We also do cervical cerclage which is also known as cervical stitch a treatment for cervical incompetence or insufficiency.
We usually send all samples/ specimen from gynecology cases for histopathology which is the microscopic study of diseased tissue.
Emergency Room: We get to see all pregnant women who present with complaint, those who were in labour and had to be referred to the labour room, emergency cases like Ectopic pregnancy, Obstructed labour especially when the patient started labour at a traditional birth attendant's home, etc. We examine all the pregnant women that present here and make sure their babies are alive because we have cases that mothers present but the fetus is dead also known as Intra Uterine Fetal Death and let them know immediately as no doctor wants to get into trouble. We also see cases of women that delivered somewhere else and still have their placenta retained and lots of other interesting cases I can't mention. As house officers, we calculate the gestational age and estimated date of delivery so we have an idea what we are dealing with and the best line of management. It helps us in cases of those that have post dated pregnancy. The ER also determines patients that would go to labour ward and theatre during our call.
Some of the cases we see in the Emergency room are;
Ectopic pregnancy, Severe pre-eclampsia and Eclampsia, cases of bleeding per vaginum, Anaemia in pregnancy, etc. We also see some gynecological cases which are later referred to the gyne clinic.
We also do some cases like Manual vacuum aspiration which is done to remove uterine contents through the cervix. We usually do this procedure after a miscarriage.
Labour Ward: This is so interesting but is mixed with lots of feelings and emotions. You have the opportunity to see what goes on during labour, the progress of labour, you get to hear the beautiful cry of babies right after they are born, the whole drama associated with delivery.
Most patients that present at the Labour ward are usually registered patients of the hospital and when in labour, most of them just come to the labour room straight without having to go to the ER. We also attend to those that are unregistered and are already in labour. Some of the signs to know a woman is in labour is drainage of liquor, she has abdominal pain that radiates to the back and has also passed show which is blood mixed with mucus. Once any of these has happened, we start to clerk them to know exactly why they presented and we start monitoring them. In labour ward, I gained some skills like doing Episiorrhapy which is the surgical repair of injury to the vulva by suturing and this happens when a woman gets a perineal tear during delivery.
Another skill I learnt was how to do cervical ripening which is one of the ways of inducing labour. From the labour ward, we also send women to the theatre once we notice any form of threat to the mother or baby which could be some cases like obstructed labour, prolonged labour, etc.
There are 3 small but mighty instruments used generally in this department and they are very important. They are: A pinnard Stethoscope, a measuring tape and fetal doppler monitor.
TUESDAYS: We have our Senior Registrars rounds where we go from one ward to the other to see patients in our unit, those we admitted overnight and those who have been on the wards before, to know their condition and make certain decisions. We also move stuff, discuss some topics and so on. After the rounds, we do all our mop ups which involves following instructions given by our SR and then we go home.
WEDNESDAYS: Its the day for gynecology clinic, where we see all gynecology related cases like; Infertility, Genital prolapse, Fibroid which is so common, Cervical carcinoma etc. This clinic brings out the emotional part of me especially the infertility aspect. So many people will do anything to have children and I always feel for them while some are even unable to afford the necessary tests. As house officers, we get to the gyne clinic and start clerking the new cases to be presented to our SR or Consultant. Our SR and JR follow up on the old cases. After reviewing with them, we carry out all the necessary instructions by filling out forms for investigations, etc. Before getting to the clinic, the nurses would have taken their vitals. We are also allowed to examine the patients as house officers in the examination room. The clinic can last for 3-4 hours which depends on the number of cases and some other factors. After the clinic, its our Consultants ward round. This day is usually a long and tiring day. The consultanst usually have an idea about the patients because the SR or JR must have discussed some of the cases with them especially the really bad ones. We call it a day after the rounds.
surgical removal of a fibroid in Nigeria
THURSDAYS: This day is usually mild and not stressful. Its our Junior Registrar's ward rounds, we discuss some topics during the rounds and after, we do our mop ups which involves setting lines and carrying out the necessary investigations as requested by our reg.
FRIDAYS: This is the most busiest of all days because we run our Antenatal (before birth; during or relating to pregnancy) and Post Natal(period after child birth) Clinic. Antenatal clinic is done with the aim to ensure that mother remains in sound health during pregnancy, ensure the birth of a healthy baby, provide general information about pregnancy, childbirth, etc. We get to see those for follow up and those registering/booking for the first time. We see a lot of pregnant women and its usually very noisy with lots of patients.
When they come in, we ask for complaints, check the general well being of mother and fetus by checking their vitals, the fundal height which is done using a measuring tape, the position of the fetus and the presenting part of the fetus. We also  refill routine drugs and request for necessary investigations. During this clinic, we make sure mothers get their Tetanus vaccines and also get their Intermittent Preventive therapy which is aimed at treating and preventing malaria. The part I enjoy is when I listen to the foetal heart rate using the magic stethoscope called Pinard. Depending on the condition of the mother/foetus, the best line of management and delivery is discussed with the mother. While on the other hand in the post natal clinic, we follow up on mothers who gave birth either through vaginal delivery or caesarean section and listen to their complaints. If its through caesarean section, we check wound care and see those who need their stitches removed. Generally, the aim of Antenatal/Post natal care is to make sure both mother and child are fine. During the ANC, some patients are asked to stay back in the hospital for admission which could be due to some factors like postdated pregnancies with some conditions, mothers that are term with other comorbidities be it diabetes or hypertension and those for induction of labour, etc. One or two house officers work at the post Natal Clinic while the rest of us work with the Consultants and Senior Registrars at the antenatal clinic. We also get to rotate so we have experience. I really appreciate the fact that as house officers, we get to examine the patients. Antenatal clinic sometimes ends 3pm or even 4pm. During the clinic, one house officer is in charge of making the surgery list for Monday, to be submitted to the theatre for anesthetists to review patients ahead.
One of the babies I witnessed her delivery  such a cutie.
This posting was stressful, used to have two calls in a week and get one free weekend but we still had to come see patients despite being a free weekend but I enjoyed it so much because I've always had interest in O&G. After I finished the posting, things changed, the new labour room was completed and up to Foreign standard and lots of other amendments were made to the hospital. I really hope everything is maintained. The Medical Director is a very hardworking person and I must commend him.
I hope y'all enjoyed my activities in the Department. This was my favorite posting during my Internship.

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