On the eve of my departure

I'm posting the abstract of the study that I'm about to try and accomplish. It's in rather boring and scientific terminology - but enjoy if you're interested.

Post partum hemorrhage (PPH) is the leading cause of maternal mortality in Zambia and around the world. Active management of third stage labor (AMTSL) can reduce PPH by 60%. The Zambian government supports this practice and has invested in nursing and midwifery training programs. Prior research and anecdotal reports from the field, however, suggest that AMTSL may be practiced in less than 30% of births attended by SBA. The proposed triangulated study uses quantitative and qualitative methodologies to answer these questions: (1) Are skilled birth attendants (SBAs) in Zambia practicing AMTSL? (2) What is the lived practice experience of a skilled birth attendant with the third stage of labor? Data will be collected in two Zambian sites, the Central Ndola Hospital (Copperbelt Province) and the Chilenge Health Center in Lusaka. The quantitative component involves observation of 52 births (26 births at each site) conducted by SBAs and completion of a standardized tool to record utilization of the components of AMTSL. The qualitative component involves interviewing eight SBAs (four from each site) about their knowledge, attitudes, practices, and perceived barriers encountered when managing the third stage of labor. This study aims to describe current adherence to AMTSL guidelines, and will generate hypothesis regarding barriers to routine use of AMTSL. Knowledge of current practices and information regarding the experiences of SBAs will be useful in the development of future programs to promote AMTSL and other safe motherhood interventions. This study will add to the growing body of literature on the pragmatic implementation of routine use of AMTSL.

my new haven

A pile of discarded childrens clothes on the bridge. They've been there for weeks. There is a story behind that pile that has not yet been told.  Did something happen to the person carrying theme home from the laundry matt? Did they never make it? Did they get to lazy to make it to the salvation army? How did they get there?

No dumping at the dump. Figures.

Green water beneath the boardwalk.  Today they we re selling lobsters from the water below. $7.99 for any lobster. Any size. Delicious.

The walking path of the bridge.

I have been meaning to photograph some of the sights I see each day on my bike to school from my house in Fair Haven. Now that finals are done, I finally brought my camera as I walked to school.

The juxtaposition of wealth and poverty in New Haven is it's most interesting feature - in my humble opinion. It's also what makes living here hard.  There is no way to forget the stark fact that in this world - there are 'haves' and 'have-nots'.  The recent earth quake and cyclone remind us that we 'haves' can soon have not as well.  Those labels are not with us for a life time - and can shift and change with the economy, our emotions, and what life serves up on a plate.  

New Haven serves up some interesting city scapes at least - here is a fraction of what I pass each morning near the bridge into New Haven.  

On my ride this morning I wanted to bottle up the pungent smells that accompany the photos above - rotting fish, a dusty texture from recent construction, and a sweet toxic odor from the scrap metal yard.  

Strawberry Cervix

Trich - see the ovid shaped protozoa in the center of the slide? That's the bugger trich.... what we see under the microscope.

I saw one last Friday at clinical. It was so obviously infected, and it's owner, a teenage girl, had been suffering with it for weeks. It was one of my first experiences in this new skill set that I'm developing where I just KNEW something major was up with her. I followed my instinct, and the advice and assurance of my preceptor, and treated her for a whole gamut of STIs even without the return of test results.

Results came back yesterday. Trich and chlamydia indeed. She took her medication, and is feeling much better... it's nice to know that sometimes, I have a small semblance of confidence and actually know what I'm looking at.

Then, to remind me that I'm really still quite clueless, my professor asked me yesterday during a skill-set check off: "Is English your second language?" My mushy brain forgot the word laryngiscope and instead said "The tube that we intubate with." Yikes - at least I could have said "With which we intubate!" I passed, thank goodness.

I am ready for finals to be finally done and move on to the next big adventure in Zambia, where things more exciting than a strawberry cervix will certainly occur.