It felt a lot like the first day of school… nervous energy, irrational fears, excitement, and a lot of hypotheticals. What if I suddenly forgot how to work-up amenorrhea? Or couldn’t auscultate a fetal heart rate with a stethoscope? Or perform fetal biometry? Or couldn’t find the cervix (like intern year)? On top of that, meeting an unfamiliar culture, hospital, and in Spanish. Luckily, I had Jenna, a one-year volunteer by my side to translate and a generous nursing staff fluent in both Spanis and Tz’utujil (the Mayan language).
When I arrived, they had a full OB/GYN clinic scheduled for me. The patients varied from annual exams (a testament to the success of the public health initiatives promoting Pap smears) to routine prenatal visits and sonograms. I learned a few lessons:
1. How to perform a Pap smear – training in an era of ThinPrep cytology with its fancy high risk HPV DNA probes (etc etc), I had never performed a traditional Pap smear. I now know why it has fallen out of favor because it’s hard not to fumble with the steps of prepping, collecting, and fixing all while trying hold a speculum in place.
2. How to perform a full physical exam on a fully dressed patient – it is an incredibly conservative culture here and many women do not feel comfortable removing their traje (traditional dress), even in front of a female physician. Auscultating the heart was easy… the pelvic exam, much more difficult (see lesson #1).
3. How to appreciate the cross-cultural beauty of seeing the first ultrasound – in the overwhelmingly busy day to day of residency, I often miss the opportunity to revel in the emotions of hearing the first heart beat and seeing the first ultrasound. A saw a (terrified) 16-year old for her first visit and her very professional husband and stoic mother (abuela) quietly guided her with reassuring nods and grunts through her whole visit. At the end, when I performed her ultrasound, she couldn’t help but glance at the screen and giggle, while her husband eagerly scanned the fuzzy white and black images with his eyes 5 inches from the screen, hoping to decipher a gender. All the while, the abuela-to-be smiled and pretended not to marvel at the novelty of ultrasound.