■ 1:35 PM
I run back to check on the delivery. The mother has progressed well, and the baby is about to be born. The midwives and I developed a system whereby we each use our medical strengths in the delivery room. The midwives care for the mother, and I care for the baby. I start suction as soon as the head is out. The delivery is complete, and the cord is cut. I evaluate Apgars and determine if any emergency intervention is necessary. This baby is robust, so I dress him, wrap him in the traditional binding cloths, give him an injection of vitamin K, and place tetracycline ointment in his eyes.
■ 2:05 PM
Every Tuesday I hold a special pediatric clinic for children under 5 years. These children are referred by our clinic's vaccinator. In an effort to improve the services to children, I added growth monitoring, vitamin A supplementation, and deworming to the clinic's routine vaccination services. If the vaccinator discovers that a child is so underweight that he or she has not reached the lowest percentile for age, the child is referred to me. Today, there are five patients. These are long visits because a very thorough history and physical exam are necessary. I also always need a translator for these complex situations.
One child has an unidentifiable congenital abnormality and recurrent pneumonia. I want to admit the child in to the hospital, but the parents adamantly refuse. They are extremely poor and cannot even afford to buy food. I am able to give them free food and medicines, but I am quite sure the child is going home to die. The next patient has cerebral palsy. I refer him
to physical therapy and to an organization that provides free support equipment. Another child reports persistent diarrhea;
I treat the child, educate the parents about hygiene and diet, and request a follow-up. The last two patients are twins. They were born prematurely and developed pneumonia shortly after birth. The first time the twins came to my clinic, they were very tiny and mildly dehydrated but had no other significant problems. I focused on proper breastfeeding technique, maternal nutrition, and hygiene. Today, they are here for a
follow-up visit. I am thrilled as I hold these now chunky babies. I congratulate the mother and grandmother for their excellent care, and I grab my camera! The mother confesses that she has not had a menstrual period since delivery about 5 months ago. I am not alarmed, but I send her for a pregnancy test anyway. Sure enough, it is positive. I hug and congratulate her a second time. This will be her fifth child, but she is still under the national fertility rate of 7.1 births.
■ 3:30 PM
There are still patients waiting for care at the OB/GYN clinic. The midwives have been able to see all the prenatal patients, but the gynecologic patients are waiting for me. Normally, when teaming up with a midwife, I see 40 to 50 patients a day, but today is Tuesday so the receptionist stopped the patients early. However, some women always choose to wait, even when they know they have to wait until I'm finished in the pediatric clinic before I can see them.
■ 5:45 PM
Every patient has now been seen and my driver is waiting to escort me home. As we drive home, I think about the patients I saw today. Their lives are beyond my comprehension; 100% of them have been through traumatic experiences. Many had family members murdered, kidnapped, or maimed. As women, they are granted no independence and little respect. Almost none can read. Lies and corruption permeate all levels of society, and poverty is profound. Yet these women want to improve their lives. Complaints are rarely heard, and most patients deny depression. I feel very small next to the enormity of their problems; I sincerely hope I improve their lives just a tiny bit and spread a little kindness over a lot of hurt. JAAPA
Gina Brown is Assistant Professor at Wichita State University, Department of Physician Assistant, Wichita, Kansas. She has indicated no relationships to disclose relating to the content of this article.