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Tumour of Fat Origin - A Lipoma. . .   Tuberculous Neck Swelling. . .   Anatomical Provocativeness. . .  Al Capone.


April 13th

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Ordinary Day Today

April 17th

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A pt with PIH released the same day?!!!! I am flabberwhelmed and overgasted. Do they really do that? In America, if anything happens to her, she would own your hospital!!

kathyekiti:

A pt with PIH released the same day?!!!! I am flabberwhelmed and overgasted. Do they really do that? In America, if anything happens to her, she would own your hospital!!

@kathyekiti

What can I say? My lips, for now, are sealed. . . .

More comments are welcome.



The archived entries continue below . . . .

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@kathyekiti
I guess the lady can leave if she so chooses.
In Naija, I doubt if you can hold someone against their will even if she is of unsound mind.
I am guessing they did not refuse treatment.
Or blogger, are we mistaken?

@ Kongi

She was leaving because she was told to pay more money. Her condition is a medical emergency. This was not an issue of a difficult patient who just wanted to leave.

Kongi:

@kathyekiti
I guess the lady can leave if she so chooses.
In Naija, I doubt if you can hold someone against their will even if she is of unsound mind.
I am guessing they did not refuse treatment.
Or blogger, are we mistaken?

@Kongi, no you are not exactly mistaken in the exact sense of your statement. However you are not exactly correct too. We did refuse to treat the patient unconditionally. We were willing to treat, yes, but only on the condition that she paid us cash.

@kathyekiti's observations were accurate, including the fact that Pregnancy Induced Hypertention(P.I.H.) is a medical emergency.


Interwoven situation. Very much controversial.

A Mid-Wife's Very Own First Child Birth

April 26th

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Out-Patients Cinic. .   No Circumcision

April 28th

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H.I.V. Status Discrimination . .   Bad Obstetric History . .   Elective Caesarean Section

April 29th

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Whenever I come to Nigeria, I would love to volunteer to work at your hospital. I am amazed. Unknowing HIV tests? Unbelievable. However, I am jealous of the diversity in your cases. Do you repair the uterus in one or two layers? Do you do pfannestiel incisions?

@kathyekiti

I feel flattered by your words

Your desire to visit us, is it born of the need to ply us towards the right path concerning international best practice?

If this is the case, I for one would welcome you with open arms. We would both then need to take in deep breaths. . .

My favourite and mostly used incision is the pfannenstiel. However, a lower mid-line is sometimes used by us for specific, particular cases.

We repair the uterus in two layers. Interesting that you ask though, because recently, our former Consultant Obstetrician started leaving the repair at just one layer. I was assisting that first time he did this so I inquired. He said these days one layer can suffice so long as it is deemed that this adequately has maintained good apposition and haemostasis.

Re: H.I.V. Discrimination . .   Circumcision


April 30th

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Krrush
I'm sorry if I offended you. That was not my intention and I hope you believe me. I only want to see how your approach to ob might be different from mine. Your colleague is right and wrong. Another study has recently reversed the thinking that one layer is equivalent in patients who want to VBAC (vaginal birth after c/section) The thing is many hospitals here in America are reverting to a " once a c/sec, always a c/sec" philosophy due to liability issues. So the one layer trend continues. Which situations due you use vertical?

@kathyekiti

I'm suprised you thought that I may have taken offence. I didn't feel this way the least bit. Not at all.

Matter of fact I think you managed to win my admiration in the way you mildly, humorously, registered your surprise at our abusive ways where individuals' consent for HIV screening is concerned. I who had been cringing and expecting a justifiable lambastment.

We have done a vertical incision, when due to a huge fibroid occupying the lower uterine segment, a [i]classical [/i]incision was planned on the uterus, hence the vertical skin incision made electively.

Also used a vertical for the obvious reason that same skin incision had previously been used for a past surgery such as a Myomectomy. We go through the same scar as it were, and this agrees well with the possibility of encountering extensive adhesions for which the pfannentiel approach may prove not too roomy.

Kudos. A lot of obs in America are not exposed to vertical skin incision so end up making what I call "christians" of their patients i.e. doing a pfannestiel in the presence of a preexisting vertical scar. However, I have also seen a few Naija docs who insist on verticals. Doesn't make any sense to me As for the hiv tests, I have a few family members who are still in Nigeria and are practicing physicians. After I heard of delayed c/sections in the presence of fetal distress pending payment of fees, I realized it is impossible to take the behavior out of the location and be fair.

kathyekiti:

Kudos. A lot of obs in America are not exposed to vertical skin incision so end up making what I call "christians" of their patients i.e. doing a pfannestiel in the presence of a preexisting vertical scar. However, I have also seen a few Naija docs who insist on verticals. Doesn't make any sense to me As for the hiv tests, I have a few family members who are still in Nigeria and are practicing physicians. After I heard of delayed c/sections in the presence of fetal distress pending payment of fees, I realized it is impossible to take the behavior out of the location and be fair.

Hmm. . . .

I think Healthcare Policy at the government levels as well as the general lack of civility in Nigeria, are to blame.

Doctors are meant to be civil and part of the highly educated in society, and so with this view in mind, they share the blame for "tolerating" the awful situation, in a sense. The matter is never mentioned really. Just like many other uncivil health issues that go on that we are now numb to, such as sanitary issues in our biggest cities, etc. . .

The patients just get sucked-in and many times hit by unexpected emergency expenditure.

In a civil society, a persons life should not hang in the balance merely based on not being able to raise sizeable sums at moments notice.

The case is worse when good samaritans rush in an unconscious person, say an RTA hit-and-run case, to a private hospital. Most would simply send such a case away to the nearest government hospital, precious seconds ticking away. I know that private hospitals are what they are - Private, hence cash-based. But the consciences of private hospital doctors in civil societies abroad are intact because they are part and parcel of policy that have provided para-medics, ambulances, police patrol and the like, that would aid the critically injured to nearby designated public hospitals at moments notice, many times already being life-supported (by the para-medics) before arrival.

No para-medical services in Nigeria - A gagantuan shame to every doctor in Nigeria who proclaims to be, by virtue of the profession, pro-life.

Me, I'm practically a zombie many times on the job



PS @kathyekiti, I'd like to request something of you, I think. Could you mail me so i'd get your addy? Mine's[i] . . . at yahoo dot com[/i]

Just say kathyekiti, then I'll mail my request to you.
Thanks

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interesting thread!

most touching story the lost twin baby !

ikamefa:


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interesting thread!

most touching story the lost twin baby !

I'm encouraged by this post. Thanks.

That lost twin yet unborn. Was sad, yes.


Will post-on tomorrow. Promise.

. . .

Today On The Out-Patient Clinic Consultations

May 2nd

Today on the campaign trail . . . . .Oops!

Don't mind me. It is not as if I follow Barrack Obama everywhere he goes campaigning. I follow his campaign on the web most nights, though. I like the guy.

Today on my out-patient clinic consultations. . . . . Patients take turns coming in. They sit down as I begin to decipher what manner of ailment they have, quite often a daunting task for lack of adequate communication skills on their part. Eventually they leave me when they are done with me, only for the next patient to resume the challenge.

I wish sometimes I was on [i]any [/i]presidential campaign trail, for want of a little excitement on the job.

@ topic what is your area of specialization?

ob - gyn? or a general practitioner

Tetanus At Deadly Stage. . .    And A Nurse Is Happy
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Death In Advanced Tetanus . .   Intra-Uterine Foetal Death . .    Emergency Caesarean Section

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