Christine Le, Week 3: OB/GYN, Day 4

Today is my last day in OB/GYN because tomorrow we will be leaving for Guanshan in Taitung county to spend Friday-Sunday at the Tzu Chi Hospital. In the morning, we observed Dr. Cao in the OPD. As usual, there were over 20 patient visits and over half were for Pap smears or follow-up visits for previously done Pap smears. Other cases included irregular menstrual cycles, both excessive and infrequent. One case that stood out to me was a 43 year old female with developmental disability who came in with her mother. The patient had had no menstrual cycle (amenorrhea) for years and this may have been due to the psychiatric drug she was prescribed. However, she had been experiencing vaginal bleeding in recent months probably due to her stopping the use of the drug. The ultrasound showed a right ovarian mass about 3.7 cm. During the discussion with the doctor, the patient’s mother asked if it was possible to get a hysterectomy for her daughter because it was tiring to care for the patient every time she got a menstrual cycle. Dr. Cao immediately told the mother no, because there were no criteria for performing the procedure. Beyond the fact that there were no indications for doing the procedure, the mother’s question prompted me to think about sterilization. According to the Human Rights Watch (http://www.hrw.org/news/2011/11/10/sterilization-women-and-girls-disabilities):

Forced sterilization occurs when a person is sterilized after expressly refusing the procedure, without her knowledge or is not given an opportunity to provide consent…Women with disabilities are particularly vulnerable to forced sterilizations performed under the auspices of legitimate medical care or the consent of others in their name…Across the globe, forced sterilization is performed on young girls and women with disabilities for various purposes, including eugenics-based practices of population control, menstrual management and personal care, and pregnancy prevention (including pregnancy that results from sexual abuse)… The difficulty some women with disabilities may have in understanding or communicating what was done to them increases their vulnerability to forced sterilization. A further aggravating factor is the widespread practice of legal guardians or others making life-altering decisions for persons with disabilities, including consenting to sterilization on their behalf.

In many countries, the practice of forced sterilization continues to be debated and justified by governments, legal, medical and other professionals, and family members and carers as being in the “best interests” of women and girls with disabilities. However, arguments for their “best interests” often have little to do with the rights of women and girls with disabilities and more to do with social factors, such as avoiding inconvenience to caregivers, the lack of adequate measures to protect against the sexual abuse and exploitation of women and girls with disabilities, and the lack of adequate and appropriate services to support women with disabilities in their decision to become parents.

The mother’s inquiry about hysterectomy took me by surprise, and it led me to consider a few things:

1.     How are the developmentally disabled viewed/treated in Taiwanese society?

2.     How are the developmentally disabled cared for and what are their treatment goals in Taiwan?

3.     What education/training is available for families/caretakers who care for developmentally disabled children and adults?

In the afternoon, we observed Dr. Tung in the OPD. Many visits were for Pap smears or follow ups for Pap smears. Other cases included prenatal care visits (2 patients, one was about 14 weeks and the other was about 37 weeks), myoma in the uterus, prolonged menstrual cycle, vaginal discharge, and another HSG (hysterosalpingogram) test to visualize the uterus and fallopian tube (tubal infertility test).

This week in the OB/GYN department has been a great learning experience. During the week, we were able to see many common gynecological disorders, as well as surgical and imaging procedures. In addition, I have become more familiar with interpreting abdominal ultrasounds and have gained more knowledge regarding clinical practice of obstetrics and gynecology. I would like to thank Dr. Cao and Dr. Tung for taking the time to teach us by explaining about gynecological diseases and procedures (especially since we have not learned much about the subject), discussing each patient case with us, and explaining their thoughts about the field of OB/GYN in Taiwan.