Clinical Trials

*Warning: If you don’t like to see gross medical pictures, this post is not for you.

If you know anything about the relationship between Duke and KCMC, you know that research is the name of the game around here. There are all sorts of clinical trials going on covering a range of topics including HIV, trauma, tropical infections, mental health, cervix cancer, and obstetrics.

It is also appropriate to say that working on the wards here is a trial in the other sense of the word. I have been overseas many times before, but it has always been in a “learner” capacity. Now, I am a “specialist” and would like to think that I have learned a thing or two about the practice of Obstetrics and Gynecology over the last 5 years. The truth is, I’ve learned a lot about practicing medicine in the States, but the environment here is so different, all but the fundamentals are called into question.

The picture above is a uterus that ruptured. The woman was laboring for 3 days and started bleeding at another hospital. When she arrived, the residents did an ultrasound and quickly recognized the problem. Typically, you don’t see a uterine rupture unless someone has had a cesarean delivery and thus created a weak point in their uterine muscle. This lady had never had any uterine surgery. In America, we say the risk of a uterine rupture, for someone in labor who has had a previous cesarean delivery, is 3–5 per 1,000 attempts. Here a woman is transferred in weekly with such a complication. Like in this case, the complication typically results in a loss of the baby and a complicated hysterectomy (removal of the uterus). I saw zero uterine ruptures in residency and did two cesarean hysterectomies for other reasons. I’ve been a part of three since I have been in 3 weeks of clinical activity.

It is simply a case where everything you thought you knew is called into question. The “limit of viability” is 28 weeks here as opposed to 23–24 weeks in the US. Even then, a 28–32 week delivery is a difficult journey for that child, mother, and family. Surgery is much different without many of the modern conveniences that spoil American surgeons. The thoughts of “Wow, what should I do about that here?” are endless, but that is part of the joy of it. I am not necessarily complaining that things are different, but it is very apparent on a daily basis that I am not in North Carolina anymore. The beauty of OB/GYN is that the fundamentals are the same all over the world. Anatomy doesn’t change. In the end, people are just trying to build families, and women are just trying to get on with their lives in a healthy fashion. It may be a trial, but I hope it shows promising results.

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