Assume the Position: Memoirs of an Obstetrician Gynecologist Read Free

and was far from being in perfect working order. So we spent time getting the equipment cleaned, sterilized, and in working order while instructing him and the operating room nurses how to use it. 
     
         The problems we saw on the first and every day thereafter ranged the gamut in gynecology.  Infertility was huge and a major issue for the women because if they weren’t able to procreate they couldn’t eat.  For many of these women who thought they were infertile, they weren’t infertile at all.  They might have had 3 or 4 children but if the other wives had produced more, in their minds by comparison they were infertile.  Scarring and painful difficult labor and deliveries were the result of poor or no maternity care and mutilating female circumcisions.  There were massive vesicovaginal fistulas, a complication of bad obstetrics that produced a communicating hole between the bladder and vagina so that urine constantly leaked into the vagina.  Many of these women were cast out of their homes to reside in the corner of the villages since the smell was overwhelming and their husbands wouldn’t come near them. Pelvic abscesses were rampant as was HIV.  If a woman’s husband died, his brother would become husband to them.  Thus everyone was more or less having sex with everyone else with all the problems that come along with that.
     
         Unlike medicine in the United States where prior authorization and paper work to perform surgery was required on every patient by the insurance company before taking anyone to the operating room, in The Gambia the resident just pointed and told the patient when to show up in the operating room.  There were no charts or dictating machines, no insurance or related paperwork, and no malpractice worries.  There was also little properly functioning equipment.  In the US, when a surgical instrument or clamp malfunctioned or was bent and wouldn’t work properly, it was discarded.  I never gave a moment’s thought when I tossed it off the operating table as to where it wound up.  But now I know.  They all found their way to the Gambia. When I put my hand out for an instrument it was sure to malfunction, which presented interesting challenges at the operating table.
     
         My first day in the operating room was an eye opener.  There was a sign on the operating room door that anesthetics were in short supply and there was a visiting ‘Professor’ in town. All the elective surgeries other than our cases and emergencies were cancelled for the month so there would be enough anesthetic gases for our patient use.
     
     

     
    We had lined up a full day of cases.  Everyone miraculously was there hours ahead of time waiting patiently for surgery.  As I stood at the scrub sink with the resident for the first case of the day and went to turn on the water to begin my typical five -minute routine surgical scrub, there was no water that came out of the sink!  I looked at him and asked:  “What do we do now?”  The response was that this was common. We just put on our sterile gloves and performed the surgery.  Sterile scrubbing was out.
     

     
    (A waterless scrub sink)
     
         He had chosen a laparoscopy as the first case and everyone was excited to see how the equipment worked.
     

     
     
    (Preparing for our first laparoscopic procedure in the Gambia.)
     
     
      The operating room was windowless without air conditioning.  It was boiling hot and sweat dripped.  We wore heavy cloth gowns rather than the light disposable paper ones I was used to.  We managed to get the laparoscope into the abdomen with the fiber optics working, identified the pathology, and were ready to begin the rest of the procedure to correct the problem when the power went out and left us in the pitch black.  “What do we do now?” I asked again.  This was turning into as much of a learning experience for me as it was for him.  He said: “We wait, the generators will come