IN MEMORY OF DR MAPELA

 The other day one of my colleagues sent me an interesting photo from 2017. It is me in Chris Hani Baragwanath with my senior unit registrars. The image is captured as we are walking in one of the wards, and we accidentally happen to be wearing matching blue scrubs. I was thrilled to be working in Bara. Being exposed to a lot of different cases and growing well in my clinical and surgical skills.

A specific registrar who is standing in the front was Dr Mapela. We rotated together for a major part of our registrar training. I learned a lot from him. He was much older than the other registrars I had worked with. He had a lot of knowledge and skill. He would often challenge the other seniors and consultants in the ward round, pull out the latest piece of evidence, and win the arguments.

I remember he was on call for gynae and I was cutting caesarean sections. I had offered to do any gynae emergency cases so I would get more experience in that field. The one ectopic case I started doing happened to be in the isthmus part of the fallopian tube I called him for help and he showed me how to do a wedge resection and achieve haemostasis.

We later rotated in Rahima Moosa Hospital together and had a good time in late Dr Bera’s obstetric unit. I ended up in a different gynaecology rotation from Dr Mapela but still kept in touch, I knew that his gynae theatre list was on Mondays. After a Sunday shift if the night had not been busy I would usually join him for the second gynaecology case. We would do a hysterectomy together. He would do his side with the ligature and I would do my side the old-fashioned way trying to master the art of tying knots.

There came 2020, the covid pandemic, and everything went upside down. I was in my second year of registrar training and Dr Mapela was doing his last year. he stayed in Potchefstroom, and had requested to finish his time with the Klerksdorp rotation in December 2020. when he was busy with a difficult Caesar in a Covid-positive patient he got infected, was admitted to ICU, and passed away in January 2021. We were all devastated. He will always have a special place in my heart. I am where I am today because of him. 

 

 

 

 

 

 

 

 

SEX AFTER PREGNANCY

 Seeing the post-partum women with their happy and healthy bundles of joy in the consulting rooms is the most rewarding thing. They are glad to be out of the house, most of them bring the little one and some leave them with the grandparents or a caregiver. The dads usually accompany the moms, if it is their first baby they often look exhausted and overwhelmed. Some dads ask the eager question of whether it is safe to have sex again!

Pregnancy and childbirth are transformative experiences that affect every aspect of a person’s life, including sexual well-being. Despite this fact, most clinicians ignore sexual well-being. All we address in the six-week visit is emphasizing the importance of breastfeeding, pap smears, and contraception. Sexual health does not only affect individual well-being; it is an important part of relationship satisfaction. It is common that in the post-partum period the frequency of sexual engagement and desire declines. A lot of women report changes in arousal, orgasm, and sexual pleasure and sex is associated with pain most of the time.

Many factors can contribute to post-partum sexual issues, including hormonal changes, body image concerns, and mental health conditions. Women who are breastfeeding experience amenorrhea which benefits them with post-partum blood loss, but it also causes vaginal dryness and reduced sexual arousal due to hormonal shifts.

The health care providers need to understand the importance of this topic and try to create a safe environment for the patients to start the conversation about sex. Using simple and non-judgemental statements such as saying “Many people notice changes in their sexual desire or pleasure after childbirth. Has anything like this happened to you or your partner?” can encourage women to share their concerns.

Assessing the importance of sexual problems can help direct the need for any intervention. Following up on these concerns and offering support, through counseling, pelvic floor physical therapy, or referral to a sexual medicine specialist or a sex therapist can be some of our interventions. Our women need to know that it is not Ok to feel pain during intercourse in the post-partum period. We are the first caregiver whom they encounter and we need to look for potential problems.

 

 

 

 

 

 

 

FIRST DAY OF PLAY SCHOOL

 As parents, we experience various milestones with our babies from birth. The most delightful milestone of my baby was when she was about two months and she smiled at me for the first time! It was very rewarding after weeks of feeding, changing nappies, and sleepless nights she smiled at me and all the post-partum fatigue went away. Around four months she started crawling and I put her on the couch and she fell within 5 minutes, luckily she did not sustain any injuries, but I knew that she could crawl and move around and I needed to watch her.

She has grown up so much, she can run around and climb and play. The other day I caught her standing on the table in the balcony and bending over the railing. Luckily I saved her and put the table away. Her favourite activity is watching Coco Melon, running outside, dancing to music, and playing with water. We had a short trip to Suncity and she slipped and fell in one of the shallow kiddie pools. She was very scared that day and had a fright. She is afraid to go inside the pool, but I often take her to the poolside to play with her toys. I either swim myself or relax and listen to music. Toddlers get bored very easily, so to have them busy with some activity is a blessing.

I made the decision to put my little one in school, at the end of last year. We stay in a good area and most of the schools look fancy. The other criterion was to have the closest school to our house, so we could cope with the drop-offs and the pick-ups in the peak traffic hours. I had a lot of stress in December before she started school. She is very attached to me and had a bit of separation anxiety when I used to drop her off by the grandparents on weekends. Even if I have to go to the bathroom she follows me and I sleep with her during the night. I have read things about sleep training in toddlers. I feel like everyone is different and I will give her time to understand and be able to sleep alone.

The first week of school went well. The teachers and my work colleagues were very supportive. She was able to settle, eat, play, nap, etc. There is an application where all the daily activities are updated from the nappy changes and the things the children have eaten during their meal and snack time. I am happy to see her sitting with other kids and having food. We are lucky it is currently summer in the southern hemisphere, so hopefully there will be fewer viral illnesses making kids sick in school. The mornings are also nice and bright, which makes the days less sad.