Fish out of water

So today marks my third day at Victoria Jubilee Hospital. It is in downtown Kingston. To get there I take a taxi to school to catch the 6:30 or 8:00 shuttle (depends on which one is running) that brings us downtown.

Kingston Public Hospital gives free care to the citizens of Kingston. On its complex is Victoria Jubilee which is just a Maternity hospital. The first floor is just administrative, the second floor has teaching rooms and the NICU. The third floor is post-surgery; it is for anyone that has had surgery --gyn or c-sections. The fourth floor is L&D and the Operating theater for c-sections. The fifth floor is post-partum and high risk obstetric cases who need hospitalization. It is a very busy hospital.

Unfortunately, it is poorly funded so the supplies are lacking as well as the facilities. It has a much greater volume and intake than any other hospital I have been to in the States. It is a tough scene too. The staff is pretty intimidating (the charge nurse or sister as they are called here-- is seriously the most formidable women I have ever met. She could eat me alive if she wanted to). The staff is all over worked, calloused, weary and stretched thin. I felt like a fish out of water there. No one is interested in taking me under their wing because, heck, they are too busy to coddle an American exchange student. It has pretty much been sink or swim there. Talk about stepping outside of my comfort zone!

This is Victoria Jubilee Hospital, the maternity hospital. Kingston Public Hospital-- the hospital where all the other specialities treat patients--is directly behind me in the picture.

The labor and delivery floor. Through the doors and to right is L&D and through the doors and to the left is the Operating Theater.

When pregnant women come to Jubilee, they come into this room to wait to be admitted. All patients are admitted whether they are in labor or not. They bring their own night gown, and are instructed to shower and change into the nightgown and wrap the towel they brought around their waist and wait to be seen by nursing.
This is the waiting area. Usually there are 3-4 women waiting at all times. In the triage/admission room there are two exams rooms. The women are examined by the nurse (except vaginal exam) and give a urine sample. They re-use almost everything here so the urine sample goes into an old prescription bottle!

Here is the exam room.

After the patient as been admitted she goes into the waiting room. I was not able to get a picture of this because there were always a lot of women--in various stages of undress and labor--waiting in there. The room is at the very end of the hall on the labor ward and is a medium-large room with roughly 20 or so beds in it. The beds are basically touching each other. There is no air conditioning. The women come in here to wait to be examined by a physician to rule if they are in labor or not. If they are in labor they go back to the room, and labor in the room until they are ready to deliver. If they are not in labor they are discharged. There is no waiting to see if you are in labor for hours on end or admitting people who are 2-3 cm dilated and contracting irregularly. They get sent home. The volume is very high and there is literally no room to have patients hang out for days at a time.

Of note: There are NO support people allowed on the labor ward. Zero. No husbands, boyfriends, mothers, grandmothers, aunts, sisters, or friends. The women are completely on their own for the whole process. Once they walk through the doors they are not seeing family members until they are discharged home. There is also not enough nursing staff to help the patients to do anything. They get up and go to the bathroom by themselves, carry their own IVs, walk to the delivery room, change their own sheets and towels. They also have NO pain control. ZERO. Anyway more on the delivery process later.

The board where everyone's assignments are. Basically there is one attending, one/two residents, and one intern assigned to the ward everyday. The intern is there from 8am-4pm and responsibilities include blood draws, administering medications, securing IV access, and suturing any vaginal lacerations (unsupervised--the intern was not specialized in ob/gyn and admitted to me that she really has no idea how to repair vaginal lacerations--she just tries to stop the bleeding--again, more on this later). The residents essentially manage everything else. They examine and round on all the patients and write the orders for medications and management and do c-sections if they are needed. They do not need to run anything by the attending on duty. The attending on duty comes by for about an hour or so at some point during the day just to check and see how things are going. The residents and interns do not do any deliveries and are only called to the delivery room if something goes wrong. The nursing staff do all the deliveries.
The nurses station and the board.

This is the exam room. The patients wait for a resident to show up to examine them to determine 1.) if they are in labor and should stay or go 2.) if they are in labor, how the labor is progressing. The women come down from the waiting room and sit on a long bench just outside the room and then the resident calls them in one by one. I would say about half the women we examined were in active labor and since they have no pain control they are literally withering, moaning, and sweating on the table or outside on the bench. The first day I was there I did about 20 or so vaginal examinations to determine the station of the baby, the effacement of the cervix, and the dilatation of the cervix. In the states, over the course of 2 years, I was able to talk my way into a cervical check only 3 times.

After the examination if you are staying you go back to the waiting room to labor until you are ready to deliver. The women determine when they are ready to deliver. They decide that they are ready to push and walk over to the delivery room and choose a table to try to climb up on.
I will write a separate blog post about my experiences in the delivery room and my experiences delivering babies.

This is the delivery room. There are five delivery beds that are sectioned off by curtains that can be drawn. On my first day there four deliveries were going at the same time!

This an example of one delivery area. The baby resuscitation in the corner does not work. There is one for the whole room that is on the opposite side.

Ready for deliveries. There is also a delivery bundle that we fetch when a woman comes into be delivered. It has a sterile cloth to drape the patient, a fabric gown for the doctor and sterile gauze.

The medications they have available. The supplies are truly limited here. Once when rounding on the high risk women in labor a nurse brought it to the attending's attention that we had no way to monitor the insulin dependent type I diabetics blood sugar because they had no blood glucometer strips. They had just given her 52 units of insulin, so the doctor said just watch her closely.

I was able to observe a section in the OT. The way we do training and they do training is sort of switched. In the states, I am allowed to scrub into a c-section, even first assist in my final year. However, we are very limited with the amount of vaginal deliveries and examinations due to liability issues. In Jamaica, students do a lot of vaginal deliveries and examinations but do not scrub in to surgeries that often, especially c-sections. It makes sense here at Jubilee. Why waste another set of gloves gowns for someone who is not essential.

I wanted to take more pictures but in contrast to the University Hospital where I was the last two weeks, they are very sensitive about pictures being taken here. So I probably will not have any more to post or the ability to show you the OT rooms or the labor rooms etc.

I think that I will try to do my final week at Jubilee because there is a lot more going on there and a LOT of learning and hands on experiences. It is pretty tough but I think it is worth it!