Now that I've gained more trust from the doctors there, I've been fortunate to have the opportunity shadowing surgeons and the team in the operating room. I showed up in my business casual clothes, as I always wear to the hospital, and then changed into a pair of scrubs they lent me in a pretty well-trafficked break room. But again, privacy is defined differently here, in general.
I spent most of the morning with the surgeon's assistant in the smaller, non-sterile operating room for minor surgeries. There, I watched her clean, apply antibiotics, and bandage a number of infections on injured feet or at the sites of previous surgeries - almost all of which were related to trauma. I noticed things that might contribute to patients' risk of secondary infections in the OR, like never changing the sheet on the bed, as well inconveniences experienced in administering treatment.
Earlier, I saw a woman escorted into the sterile OR in a gown to undergo some operation ... but I wasn't sure what. Now, the surgeon's assistant threw on a cap, shoe covers, mask and a gown, telling me to do the same and come into the OR when I'm ready. I was about to see the biggest operation I've ever seen.
I almost immediately realized what the surgeon and team were about to do - this woman would be giving birth to her child by cesarean section, and I would get to see the whole operation, from prep to cleanup. The anesthesiologist sat monitoring the machine, the nurse taking some notes at the table, and the surgeon and assistant perched on either side of the woman. Although soaking in every part of the procedure for my first time, the things that stood out as a potential needs were improved fluid management and regulating patient temperature (even though the room was air conditioned). The surgeon was interrupted a couple of times with a nurse relaying messages or with questions through the open OR door.
The surgeon and assistant proceeded and finished by carefully stitching the uterus and abdominal wall, as the woman was waking up from anesthesia. I wondered why a cesarean section had to be performed, since it poses significantly higher risk than a normal birth and longer recovery time, but I later found out that the baby was of term and the woman had simply elected to have a cesarean birth. After questioning some doctors later, I found out that there could be a few cultural factors that influence this preference; one is that many women believe that if they were to give birth naturally and have the baby pass through the vagina, her female parts wouldn't be desirable by her husband; second, there are some misunderstandings that women will endure less pain and complication with cesarean than they would naturally.
More than half of the births performed at this public hospital, but also characteristic of many other parts of the country, are cesarean ... and the number of them is growing. The growth is very concerning to the health community and sparking a lot of research to better understand this phenomenon, but it could be due in part to some of these cultural beliefs as well as the inability (most often) for a mother who previously had a cesarean birth to be able to give birth vaginally.
It's a complex issue and concern for maternal health, and I hope to better understand some of the drivers during the remaining time I have this summer here in the DR.