I broke one if my rules by agreeing to do births in Tanzania- I agreed to work in an environment where I couldn’t really communicate with the women.

If I cannot communicate, I am very little help. Actually I can be worse than little help because asking questions takes too long, I cannot get good information from the women and if I am in a situation with an immediate need I can’t let those around me know.

It us very American to assume the entire universe speaks English. While I don’t doubt there are English speakers in every country, they will tend to be your wealthy, not those in a public hospital in a poor part if town.

Anyway, for what its worth, take the time to learn the language before you go.

One of the cool things I get to learn about here is post parting IUDs. In the US, you would wait for the checkup to insert at six weeks or later – the US had a fairly high postpartum follow up rate and the expulsion rate for IUDs is higher when done postpartum.

In Tanzania, the postpartum IUD makes sense, and the mother only needs to return to trim the strings.  I had seen one in Honduras, and I could have seen two today if I hadn’t been helping a primpip push (trying to avoid an episiotomy and fundal pressure).

I still have a few days in the hospital, and I’ve had the inservice. So maybe I can do one this week.

One of my learning goals while in Tanzania is the partograph. It is a visual representation of the labor that allows you to identify problems quickly.

The biggest struggle to learning to use this tool is the reality of Tanzsnisn hospital birth. There are too many women and not enough staff, so the partographs don’t always get filled out. Women don’t enter the labor ward until they are 7 cm or more dilated, which doesn’t leave much time for completing a partograph, and nearly impossible without the information that was never written down from previously in the labor.

Despite the real life problems, I am learning about this tool, and learning some new skills to add to my vaginal exams, such as molding, using fifths for descent and when mec means to refer in low resource settings.  All very good diagnostic tools that help get a woman to the right level of care in time.

There is an online guide to using partographs, I can’t do the link from my phone, but when I get home next week I can add it to this post.