Tuesday, January 29, 2013

Starting my clinical fellowship

I'm in the fourth week of the semester and 4 weeks in to my clinical fellowship.  My first semester is spent learning about primary care and basic gynecology, so my hours of clinical are spent in an outpatient clinic.  This clinic is set in downtown Cincinnati and provides care to urban and under-served areas of the city.  While it is overwhelming at the moment, it occurs to me how lucky I am to have this opportunity.

I'm learning from 8 nurse midwives.  My main preceptor has been doing this for nearly 25 years.  She has practiced all over the country and seen pretty much everything.  They have taken me under their wings in an attempt to teach me everything they know.  Right now, it feels as though I will never learn it all, but I imagine this will come in time.  Although one of the midwives said something that stood out to me yesterday.  During a tense moment in which I was frantically trying to answer my main preceptor's question about which oral contraceptive I would give a patient, she leaned over to me and said, "the minute you have all the answers, you need to leave this field."  Which I'm sure is true for every line of work, but especially so in the uncertain world of midwifery. 

This week also happens to be the week we are beginning to study women's health care and midwifery around the world.  Reading about midwives from other countries and how they practice is fascinating.  Especially reading about African midwives who have been trained as surgeons because the maternal death rate is high and there are only 3 doctors per 100,000 people living there.  Can you imagine?  These midwives practice from trunks and work on mud floors of huts.  They are 100+ miles from the nearest city or running water.  Still.  In this century.  While expected, reading their stories astounded me.  I was particularly moved by the book Monique and the Mango Rains.  About a young midwife from Mali who had women from a day away walking to get prenatal care from her clinic.  Her birthing house was without a roof or bed.  Straw mats with buckets to catch placentas were really the only equipment available to her.  She herself died while giving birth and the book was written by a member of the Peace Corps who spent several years under Monique's wing.

Reading this and seeing many documentaries about the current practice of midwives from around the world, makes me want to help in some way.  Maybe after my kids are grown and I have been practicing awhile, I can go volunteer in some of these places.  Although I'm hopeful by then, problems will be fixed, but doubtful.

All in all, the semester is going fine so far.  But I will admit to hanging on to small shreds of my sanity at times.  When my to-do list surpasses the amount of hours I have available, I get stressed.  The work continues to pile on and the boys are continuing to get bigger and into more things.  I still need to work to pay the sitter so that I can go to clinicals.  But I'm still grateful for the opportunity.  Eventually, all this will be worth it. 

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