Thanks Preemie Experiment for the thinking blogger award. I was caught a bit by surprise, as I have just returned from some fieldwork in the town of Leh, Ladakh, smack in the midst of the Indian Himalayas, where I did not spend much time in the cyber cafes, because I was having far too much fun in the labor room and delivery ward of the Leh hospital.
Picture this. The Sonam Norbu Hospital in Leh, Ladakh is the larger of two hospitals that serve an area roughly one and half times the size of Switzerland or Denmark. Although vast geographically, the region is only home to 250,000 people, making it one of the least populated areas in India.
Why so so few people? Did I mention the forbidding landscape? In fact, Ladakh is a desert, with some of the lowest precipitation in India, but where most villages are situated between 10 and 15 thousand feet, many higher than the Alps and the highest peaks in the continental US
Why all this talk about altitude?
Imagine a hospital, where electricity is intermittent and the back-up generator takes about 5-15 minutes to kick in, depending on how cold it is and whether or not the guy manning the generator feels like getting out of bed to start the thing. I asked Dr. Padma, the chief obstetrician what it was like to do cesareans and difficult breech extractions in the operation theater when the electricity went out and she laughed and said, "I now carrry a headlamp."
Imagine a delivery room where the heating is spotty, the mother gets up on the operating table by means of a tiny rusty step-ladder, lies down on a cold rubber surface that has just been scrubbed from antiseptic from the last delivery, and is then asked to put her feet into straps that hang off two poles situated at the end of the table. These odd looking stirrups---combined with the rusty oxygen tank, the little stainless steel vat that is supposedly sterilizing the surgical instruments and gauze unless a nurse forgot to turn it on---lend the room the ambience of a medieval torture chamber as much a birthing room.
Despite the limited aparatus, the obstetric staff are amazing. Tireless, trusty, and professional.
I smile when I think of an American obstetrician attempting a difficult delivery, using only a headlamp. This is where finesse and experience help. Padma does not shy away from doing difficult deliveries vaginally and she does them well, but she is also not loathe to send a primi gravida in for a cesarean if she feels the labor is not progressing. She's also happy to discuss the latest literature on antenatal corticosteriods with me. She graduated from one of Delhi's most prestigious medical colleges and then left a lucrative fellowship to come and work in her home hospital, in one of India's most remote and least developed regions.
There will be more on birthing in Ladakh anon.
The five blogs that I vote for thogger awards are:
Babycatcher: fascinating tales from a midwife in Africa
Midwife with a knife: Great post on a breech extraction
pinwheels: a mother, a writer, a son with downs
Blog,MD: a fascinating blog about oncology, medicine, life
maternal digressions: a blog about motherhood, work, balance. on hiatus, but coming back
Here are the rules for those of you nominated:
1. If, and only if, you get tagged, write a post with links to 5 blogs that make you think,
2. Link to this post so that people can easily find the exact origin of the meme,
3. Optional: Proudly display the 'Thinking Blogger Award' with a link to the post that you wrote