the doctors who run the HIV program, they want us to watch one so we can see for ourselves.
the woman in the red dress looked no different from all of the other 20 Dominican and Haitian women waiting in the uncovered waiting area of the peripartum outpatient clinic in the poor public hospital in Santiago. she had a small suitcase with her, and we ran into her there by accident.
she was thin, but her belly was big. the social worker for the HIV program kissed her on the cheek and asked how she was doing and was she ready to be admitted to the prepartum ward to await her Cesarean section scheduled for the next morning at 7am. she smiled, nodded and pointed to her bag. good he said, I'll see you tomorrow. we walked off, winding our way through the rest of the crowded disorderly waiting areas.
the director of the vertical transmission program at the hospital, told us to arrive at 7am with our scrubs on, ready to watch the c-section, and we did as we were told. the lady in the red dress was already there sitting upright on her bed which was the last one, against the wall, in a room full of at least 15 beds. the room had no dividers, and no privacy, there were no doors, only open doorways leading into the main peripartum waiting room, the post partum room, and the hallway containing the surgical rooms. the surgical rooms did not have doors either.
almost all of the beds were full. with a thin mattress, most did not have a sheet - patients were responsible for bringing their own sheets. women in various stages of labor occupied each bed. two senior residents and three interns (medical students) staffed the ward. moaning could be heard from several of the women who were obviously in quite a bit of pain. two were laying on their backs, breathing hard in and out. Two had pools of vaginal blood in the bed. no epidurals here, no pain medications... for the sections, only, were epidurals given.
the ward nurse divided her time between mopping the floor and trying to keep up with the paper work.
the women sat in the ward until they were ready to deliver, several minutes before they were about to give birth, they were quickly wheeled or walked to the birthing room a bare, tile floored room along side the surgical rooms. gloves were a hot commodity, and sterile was not a word i would use to describe any part of the process
we watched a 32 year old g5p5 woman give birth quickly to a healthy baby boy, she was wheeled to the birthing room, where the resident, without the attending, clothed in only his scrubs and gloves, assisted the woman onto the table, which would not lower due to broken lever on the side. the pregnant woman had to climb onto the table by standing in the wheelchair they had brought her in. she starts cursing and screaming, refusing to lie on her back for the birth, and saying she is hot. the resident tells her to take off her bra if she is hot which she does and throws over to the side of the room. she is pulled and prodded and finally lies back on the table. not 2 minutes later the baby is out and the cord is cut.
we watch as several women become dilated and labor advances and they are sent to the birthing rooms. several other women are sent to the c-section rooms. our lady in the red dress waits patiently in the same position.
a team of about 20 medical students come onto the ward with an attending for teaching rounds. many vaginal exams are done with the energetic attending teaching the medical students all about obstetrics... barely a word is said to the patients. their existence is acknowledged only for the purpose of having a teaching example.
one vaginal birth is attended by the entire group of 20 medical students. the patients permission is not asked. and she closes her eyes as the attending using the birth to instruct. i imagine she is imagining she is elsewhere, in a room where there are not 20 medical students gaping at her bleeding vagina...
it is 2pm and we need to leave to do house visits. we ask the resident when the c-section for our HIV patient will be. he evasively tells us it could be anywhere from 4-6pm. we leave, we come back at 5pm, we wait until 8pm. more c-sections, more bloody noisy vaginal births and the lady in red is still waiting. patiently sitting up right, on her sheet less bed, in the corner of the room, observing the madness that surrounds her.
we are hungry and tired, and can't imagine how the woman in red must feel, npo all day, still waiting patiently at 7PM for her 7AM scheduled section. we don't want to leave. we suspect that the doctors don't want us to watch the surgery and furthermore, would prefer not to do the surgery at all.
we leave anyway because hunger wins out over sympathy and curiosity.
we come back in the am. the c-section was done at 11pm. after all of the other sections were complete. the lady in red is on the postpartum ward. we visit her to bring her cookies and a magazine. she is happy to receive the cookies and doesn't really know what to do with the magazine. she tells us she has no idea how her baby is because they haven't told her anything yet. we reassure her that he is doing well, and wish there was more we could have would have done to lessen her suffering...
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