With a goal to one day become an OB/GYN, the opportunity to intern at the Mowbray Maternity Hospital (MMH) was something I had my sights set on from the moment I chose to study abroad in Cape Town, South Africa.
I was told I am given the chance to observe and work closely with the newborn children and doctors, but when I visited the hospital to learn what I would be doing, I learned I would be decently far away from the action and my focus would be on research for the hospital. At first I was slightly disappointed, however, the amount of information I acquired over the past couple months was incredibly valuable.
Working for Professor Sue Fawcus and under the supervision for Ms. F Du Toit, I was given the tasks of reporting on the recorded information from birth registries from the Labour Ward and the Theatre ward from September-December of 2014.
The registry documentation will be used to audit the patient population in order to evaluate the areas in which patient referral was increasing or decreasing.
As a referral hospital, Mowbray gets many patients outside their immediate jurisdiction, and with the hospital patient population, increasing, it is important to figure out which areas the patients are coming from. My work involved recording specific information within the birth records, including:
- number of births that month
- date of birth
- age of female
- gestation period
- parity (how many times the mother has given birth)
- PMTCT (Prevention of Mother-To-Child Transmission). In this case I was recording the HIV status of the mother and baby at the time of labour/birth (recorded as Yes or No)
- mode of delivery
- birth weight
- APGAR (Appearance, Pulse, Grimace, Activity, and Respiration- otherwise known as a vital check up for newborns, taken 1, 5, and sometimes 10 minutes after birth)
- blood loss of the mother any complications that occurred, if any.
Although this was not the work I was expecting to do, I was actually very interested to see the dynamics of the hospital in relation to the patients and where they were coming from.
The project reminded be a lot of my high school senior exiting paper, where I researched and wrote about home birth vs. hospital birth, where I stand on the different options, and how the number home births can be raised in Louisiana.
There may not seem like there is much of a connection, but while writing the paper, I was researching and learning all about the different modes of birth, what complications can occur and why they can affect where a women should be during labour, and these exact gynecologic and obstetric complications and facts are exactly what I am looking at when I am going through these registries.
Although my work did not require me to interact with many professionals in the hospital, I was able to develop a further understanding of obstetrics, and enhance my knowledge of obstetric gynecology.
Wanting to enter into this field, I was very interested in learning the lingo, the dialogue, and the inside outs of labour, and having to decipher registries written by busy nurses and doctors certainly allowed me to do so.
In the registries, most everything is written in abbreviations, so in the beginning I was looking up almost every other entry, adding to my long list of terms to define. Being given the opportunity to enhance my terminology is just as important, to me, as learning how to interact with the doctors or other professionals.Many of my friends look to me with questions about gynecology and obstetrics because they know it is something I am passionate about, and this internship allowed me to gain vast amounts of information in order to provide knowledgeable answers to their questions.
The ability to constantly learn new things about labour and all of the complications that may come with it was not only a huge point of interest for me, but it is also what helped with the monotonous nature of this internship.
For four hours every Wednesday and Thursday, I sat a computer with my headphones in and recorded as many births as I could.
I would say hello to people walking in and out, people who worked in administration in the hospital would introduce themselves if they wandered in, or every now and then I would ask Ferida (Ms. F Du Toit) to help me decipher a phrase or word- but for the most part I was just recording information on approximately 150-200 births every day.
It was a challenge to do the work after a tiring week or morning, or to not get distrated by reading up on a new term I looked up, but being able to venture further into the world of obstetrics by simply searching for the definition of shoulder dystocia, polyhydramnios, MSL, or macrosomic, (to name only a few), really kept me interested and excited about the tedious and overall dull task that I had of putting information into an excel sheet.
By recording the addresses of the patients, I learned about areas of Cape Town that I may not have come across during my time here, and I learned the availability to health care that each of these areas have.
Each district and sub-district of Cape Town, there are health clinics and maternity clinics that are open for the public. If further assistance is needed, patients are directed to bigger hospitals, such as Mowbray formaternity needs.
The ability to go to a local clinic provides care for people who may not have direct access to a hospital all the way across town, and it also allows them to stay up to date on the health of themselves and their families.
One thing that working in the hospital introduced me to was the importance of acknowledging and providing HIV testing and care. Although HIV can be transmitted from mother to child during birth is possible, it is more possible to have a completely healthy child.
Normally, the newborn of an HIV positive mother is tested right after birth, and because they still carry their mother’s antibodies, there chances of testing positive are extremely high.
However, this does not mean that the child will develop the condition, and the baby is required to come back for additional testing.
What was eye opening to me was the stigma around HIV/AIDS in South Africa.Yes there isstill a stigma, but through my time in Cape Town, I have come to understand that HIV/AIDS is something, especially within the health care system, that is not looked down upon, but simply an aspect of some patients that is important to health care providers to take care of.
Being in this internship has also showed me how difficult it is to provide health care to such a large country, but that doctors do what they can to reach whoever they can. doctors and nurses at Mowbray visit different townships on different days of the week and check on the clinics and provide extra care for women in need. I was able to travel with my supervisor Sue Fawcus, and observe appointments with women of all ages, complications, and stages of pregnancy.
Another part of the culture working at the hospital has introduced me to is the normalcy of multiparity and/or grand multiparity, or in other words the normality of women having 5+ pregnancies.
The trend of multiple children, sometimes going up to and past 7 or 8 births, was something I noticed within the first few weeks of recording, as well as the vast range of expecting mothers.
Not only are there many young mothers, but it seemed to me that in the South African culture, (which differs from area to area and race to race), it is also very normal to continue having kids into a women’s forties. However, fr health purposes, both young teenage pregnancies and older women pregnancies, from above 35 and over, were especially noted within the registries.
The experience that I gained provided me with knowledge about the culture of health care, but also left me with questions that may not yet have answers. It made me wonder how health care can continue to be efficiently provided to everyone in a young and growing country? And, concerning HIV/AIDS, is there enough knowledge being spread to the public on the importance of knowing your status, and is there enough care for HIV positive patients available?
Unfortunately, alongside the happy and amazing miracle that is birth, there is many moments of grief, such as stillbirths or miscarriages that occur.
Every time I had to record “SB” or “MISC” in the mode of delivery or complications, and write 0, 0, 0 for the apgar, a little part of my heart was such filled with sadness for the woman who lost their little one that day.
One moment that still really sticks out to me was one specific birth I was recording in October of the Labour Ward.
It was a natural vaginal delivery, but the first number of the Apgar was 1. Within the next couple minutes, minute 5 recorded the newborn as a 4, and minute 10 recorded the child as a healthy 10.
Although it was a quick 3 clicks of the keyboard to insert those numbers into the excel sheet, I could only imagine the feeling of relief and happiness of everyone surrounding the child that went from a 1 to a 10 in 10 minutes. Now I’m sure that happens more than I know, but for me it truly stuck out as a miracle.
Because of my time at the hospital, and my learning experience through the information I was recording, I understood the importance of being thorough in checking for everything that could possibly be wrong during clinical exams.
Although I have a long way to go, and a lot more to learn in the medical field, this experience truly opened my eyes to how simple, yet complex, diagnosing and providing care for patients can be.