Continuity of Care

One thing that Ob/Gyn residency, working as a hospitalist and now working at Tenwek have all had in common is the lack of continuity of care.  I often do surgery on a patient and then never see them again.  It can be nice if the patient is annoying, but some people are very pleasant and I often wonder what happened to them.

Amazingly enough, I have had some "repeat" customers during my missions to Sudan; sometimes previous patients come by just to say hello!  I have discovered that it is actually very nice to have this follow-up and see how peoples' lives have changed one year to another.....

This is a lady that I met last year.  She came to me with complaints of labor pain.  Her two previous deliveries had been stillbirths.  I followed her progress all day and then went to her hut that night (brings a whole new meaning to HOME DELIVERY).  Her labor was very complicated: she had meconium-stained fluid, persistant fetal decelerations and her progress was very slow.  If any operating room had been available, she would have received a C- section.  But that was not an option.  So the entire team sat with her and prayed.  And waited.  And hoped....

When this little guy was finally born - there was never a more happy group!  It was pretty interesting - a bunch of white people and some Sudanese women all cheering together for the same reason. 

And here is the official "newborn" photo with the proud grandma...

Fast forward one year.....

Pretty cute, huh? 



The whole family came back to visit!  Even grandma!  And they decided to name the baby "Richard," after two of  the male doctors on the team.  And check out the little stuffed animal that the lady is holding in the photo above - two of the team members gave the baby that last year!  Mom brought it with her this year, so we would remember her!  Who needs medical records?

Next...

This lady came complaining of labor on the same night as the first patient.  (Welcome to the life of an OB!)  this patient was C R A Z Y!  It was her third baby, but she was not doing well with the whole "pushing" thing.  So, in order to expedite things, I delivered her baby with forceps.

Another healthy boy!



Official "newborn" photo

And here is mom and baby at one year! 

Unfortunately some stories are little more bittersweet...

This is Roda.  The first year I met Roda, she complained that she looked pregnant, but the baby would never come out.  On exam, she had a large (20-22 cm) ovarian mass without any features of malignancy.  I hoped it was a benign tumor, so we took her for surgery in Kenya.  It was benign and she had the tumor removed.

The next year, Roda came to visit me and she was pregnant!  I checked fetal heart tones and talked with her about nutrition.  She was very excited and happy.

This year, Roda returned to see me again.  Her baby was born, but died this past January.  The baby was about 4-5 months old.  I am hoping for a better update next year....

And finally, a story in the making.....

This is a baby that was born during our mission this year.  His mom told me that her last two babies have died within two week of life, despite seeming very healthy at birth.  I took some special precautions with her delivery and made sure she was breastfeeding well, but it's all in God's hand now.  I hope I will see this cute little guy again.....