Get to know each other

The supervisor of the Maternity is a Congolese midwife, Fruraha. Even before I met her, I was told that she is very experienced and smart in management; as a doctor I am supposed to give her enough space for her to work. Well, there must be a history of some conflict between her and doctors, but I did not ask. Whatever the history was, I just need to take care of my job and stay away from hers. On my first day, Fruraha questioned my diagnosis of seizure since the patient was not typical eclampsia. I had to explain to her that the seizure was clearly seen by me and other medical officers and nurses, yet the cause of seizure could be something else other than eclampsia, like hypoglycemia, malaria, meningitis. She should at least trust our eyes and knowledge of definition of seizure. The final diagnosis would need further investigation. Three days later, she questioned my decision of a CS case as she thought the patient was making progress in labor. I had to run back to Maternity from OT, explained to her the patient’s bone pelvis was too narrow to deliver the baby, although with good contraction the cervix can be dilated. No matter how hard she tried, her bone would not change. The indication for her CS was absolute. After convincing her, I asked her opinion to show my respect. She said since you are a doctor you already made the decision, I should not say no. O~K~, that was the answer I needed. To make this kind of decision is MY job and please let me do it. Afterward, I asked our expatriate midwife about the protocols in this mission. She told me that in order to avoid over-diagnosis of narrow pelvis; every woman has to try until the labor arrests. So Fruraha was just trying to follow the protocols. I can accept this and will give more explanation in the future. The other day, when Fruraha and I were handle an emergent case side by side, both of us were asking the exact same questions to the patient and in the same thought to rule out cholera. For the first time, we look at each other and smiled. The ice is broken. After one week, Fruraha told me that she likes the way I make ward round since I was giving bedside training by asking questions and getting everyone involved in patient management. The medical education and training for the national staff is limited because of the decades of wars. We can come to this country to help for a while but the national staff has to be the key persons to maintain and improve the quality of medical care in the long run. Fruraha and I are able to share some ideas and find things in common when we are drinking tea under the mongo tree.