Outreach

Kate and I agreed to do outreach with Mary and Simon, two Motswana (i.e. people from Botswana) staff members at Baylor. The premise behind the outreach is that we travel to more remote areas of Botswana to test kids for HIV using rapid antigen tests. If their parents want to come along then they are welcome to be tested as well but the focus is on testing children. When we signed up all we knew was that we should bring our stethoscopes (just in case anyone might want a quick physical exam) and we would bring lunch as we "might be gone for awhile"since the place was outside of Molepolole this town about an hour or so from Gabs.

Mary had talked to this sweet woman, a retired teacher of community development at the University of Botswana, who is on a mission to help people in smaller villages outside of Gabs. Basically she would like to improve their health, help get them jobs and improve their overall educations and quality of life. Sounds easy, no?

The town she first suggested we go to was "Ditshegwane."  Ditshegwane (which when pronounced sounds like: Deets-ha-wa-nay) actually has a local clinic, which is staffed by two nurses. No doctors. The nearest doctor is about 15km away in another town. Keep in mind most of the people there lived in huts and had no garages, much less cars.  

After a long drive in our Nissan SUV, we arrive at Dishegwane and there are about 150 people gathered in the kgotla with the cheif, most of them are elderly and there were very few kids. The majority of them had been waiting since the crack of dawn to come see us!!! We found out that there was a misunderstanding and they thought we were going to do physical assessments for them.  They thought we were actual doctors.  To resolve this misunderstanding we met with the chief in his office to come up with a solution.   We held a town meeting where we were formally introduced by the chief and he gave a long speech in Setswana about how he appreciated that the community had waited so patiently for our arrival.  Some of the community members spoke up, including one toothless man, hobbling around on a cane who declared that he wanted his eyedrops!!! They decided that we could come back next Thursday at 8:30 to do physical exams. Once we saved face we decided that we would head to the smaller town Kgare.  I was struck by how important it was for this community to feel like they were being listened to and how important their health was.  One disabled man had even been pushed by his neighbors in a wheelbarrow to come and see us.  

Kgare was 5km along a road. And by road I mean tracks in sand. And by town again I mean huts and water tanks. They told us that their town was not recognized by the Botswana government in terms of social services because there were less than 500 people in the town.  However, that did not prevent the politicians from campaigning there before elections.  They also commented on how interesting it was that roads were suddenly built right around election time, presumably so that the politicians could actually drive to these areas, in order to continue making promises to these people that they inevitably did not keep.  Needless to say the people of Kgare were tired of being forgotten.  Apparently, focusing campaigns towards the under served and then immediately forgetting them after the election is over is something that is not just inherent to American politics.  Enough of my political commentary :)

As Kgare was even more remote (pictures to follow at some point) we brought them 10 loaves of brown bread, peanut butter and jelly, and drinks.  Before we knew it, the food was gone.  However the people stuck around for their physical assessments.  There were about 50 or so people mainly complaints of cough and chest pain who wanted to be seen.  Hardly any children showed up.  It seemed as though the elderly were first priority in line and everyone deferred to them.

One lady over 60 was complaining of shortness of breath and cough.  In fact, she could hardly complete a sentence and left sided weakness.  She may have had a history of diabetes although she was untreated and may have had a stroke in the past although again her health cards were difficult to read and she was not the best historian.  We were fairly concerned, since she obviously could not make the 4km hike in the heat and sand to the local clinic in her condition.  Naturally we drove her there under the premise that they would take her to the hospital.  They gave her a bronchodilator, said that their truck had broken down and she would have to spend the night and be taken to the hospital the next day.  

The next day we went back to Kgare to complete our exams and we checked in on my friend.  She had indeed gone to the hospital, however they did not comment on her cough and treated her left sided weakness with a vitamin, assuming it was due to vitamin deficiency.  Of course she is probably vitamin deficient, but how could they not notice that she couldn't even state her chief complaint without gasping for air?  It was frustrating to see that her most obvious symptom was blatantly ignored.  Our entire Motswana/American outreach team found this to be an infuriating example of medical neglect.  More from Kate....

Mokolodi Game Reserve!

Yeah!! Animals!!! This reserve is pretty small, so it's easy to see the animals roaming around, even on a hot morning like this one! We were in a big bus/truck think without walls/windows so we could see (& smell) everything!
How many legs does a rhino have?
Peek-a-boo!

A kuru...apparantly thier horns grown 2.5 years per twist...this guys not too old yet!

The inside of our lovely little house...

Kitchen and laundry room. :O)
Kate's bedroom...with a made bed & all!
Annabelle's bedroom, also nicely made beds!

Home Sweet Home

The outside of our lovely, little house in Gaborone. The street is called Phiri Crescent. The house and yard is surrounded by a large, high fence with wires that threaten electricity that is actually not really electrified.

Flora & fauna!

A beautiful looking flowering tree that grows all over here! Your guess is as good as ours as to its name. We'll let you know if we find a local plant expert. So far, no one else seems to have any clue either.

A historic car from the Botswana railway, built by Cecil Rhodes to connect Rhodesia to the coast of South Africa. Unfortunatley, but not surprisingly, Rhodes made no considerations to the people of Botswana and built the shortest connection through the south of the country where few Botswana lived at the time.

PICS FROM THE MUSEUM IN GABORONE:
A view of a traditional "kgale," the Botswana version of a town square. In a traditional village, the chief sits here & is available to hear the opinions or concerns of any village member. They also hold court here. Typically there is a Boabab tree in the kgale.







We think these are traditional huts, although they don't have anything much to describe them. Hopefully we can see a real village before we leave to confirm...

Where has the week gone!?!

I'm shocked that it's already Thursday!
Our week has been centered in the clinic working with pediatricians from the US who care for kids here on anti-retrovirals. There's also one med-peds doc who sees families together for care, so we've both been able to get some adult exposure too. It's been a more familiar clinic setting to what we're used to in the U.S. at least in the structure of how things run. NOT in the types of things we see. For me, there's been the fun, happy, healthy kids doing well on their ARV meds. That's been a great chance to play and tease with the kids. Then there's been some really, really sick kids. I saw an 8 year old who weighs just 31 pounds because HIV is causing "wasting,"or weight loss that cannot be stopped. Unfortunately he also had diarrhea and pneumonia that had to be controlled before we started him on ARVs. Later that same day, I saw an 8 mo. old baby that weighed less than 9 pounds! He had these huge eyes and his skin was sagging everywhere. It's not clear if he has HIV or some kind of other genetic or metabolic problem. Despite their severe issues, they were not admitted because they were stable relative to their serve illness and there is such risk admitting them since the pediatric wards here are open air with 8-15 kids per hallway and the risk of transmitting infections, especially TB, between the patients is very large.
We also met some of the medical students and residents from the U. of Pennsylvania here working in the adult medicine wards. Unlike in the US, where many procedures like drawing blood and placing IVs are done by nurses or techs, here the docs do it all. The med. students are doing lumbar punctures, blood draws, IV placements, thoracentesis (lung tap), and more! Needless to say, we started slow, but did learn how to do some blood draws, and Annabelle successfully placed an IV! Don't worry...we wore gloves and were careful not to stick ourselves. The severity of illness on the adult wards is stunning, largely due to AIDS. Some incredibly shocking and sick people. Despite all the experience they're getting, I'm happy with our balance between in patient and out patient care.
Our evenings this week have been running errands at the local mall, the only place to get groceries, books, and hit up a pharmacy. We also had a nice, cold beer one night at the Gaborone Sun, a hotel across from our house. Annabelle has also been working hard on a power point presentation that she did today for a group of doctors, residents, and scholars. She did awesome and taught us all about comparing the immunologic profile of breast milk from HIV + and HIV - mothers and the outcomes of the breastfed children of HIV + and HIV - women. It's a hot topic here whether or not it's best to breast feed, which can cause an HIV - baby to convert to HIV +, or to formula feed, which is associated with increased risk of diarrheal illness and early death. Interestingly enough, if you mix formula and breast feeding, outcomes are the worst with the thought being that the formula causes small tears in the babys' GI tract and then the virus DNA present in the breast milk can enter the baby's blood stream causing HIV infection. Lots to learn here & many issues I've just never thought of.
We're working on posting pics...hope you enjoy!

Thought soup

Kudos to Kate for updating the blog! In response to popular request, we have added pictures to our blog. This was qutie a feat for me as I have very limited skills when it comes to doing anything on the computer. Kate and I have been reading a lot about the statistics behind HIV/AIDs so I will share a little bit with you: about 2/3 of all people with HIV are living in Sub-Saharan Africa. 2.1 million AIDs deaths in sub-Saharan represent 72% of all AIDs deaths worldwide. I also learned that if you combine the number of children with HIV in the U.S. and Europe (about 15,000) that that is equal to the amount of children that Baylor sees at their clinics. According to WHO there are over 4 million children with HIV in Africa. Crazy!

It is definitely great to see some of these kids in clinic. I saw this girl today who started crying when she was told that her adherence to her antiretroviral medications was less than 100% (I think it was around 97%)... She was sad that she would get in trouble at home. I was so impressed that at 8 years old she was able to remember all her meds and able to take them on her own...

On another unrelated note... Believe it or not tonight we are going to eat Mexican food at one of the pediatrician's houses. The other night Kate and I even saw a Cuban film at one of the local schools. And I ran into someone on the walk to work who was from Botswana who had done her dentistry training in Pittsburgh, and had actually heard of Latrobe! No, I did not make her recite all the famous things from my charming hometown :)

Beginning to get adjusted...

So, Sunday Kate and I called Elliott, our friendly cab driver and had him drive us out to Mokolodi Game Preserve. It is this huge reserve where they organize game drives and cheetah petting- okay so it is kind of like a cross between a zoo and a national park... Anyways we went out in this crowded jeep type vehicle and saw some giraffes, zebras, rhinos, warthogs, impala and kuru free in the park. They were also herding some elephants and there were a couple cheetahs behind a cage. Sadly, the cheetah's mom had been killed by a farmer and they never learned how to hunt so they had to be fed by the preserve...
Afterwards Kate and I stopped at the Game City mall which is HUGE and looks a lot like any mall in the U.S. with tacky stores etc. The funny thing is that there are babboons only about several kms away from the mall hanging out on the side of the road eating trash and picking fleas out from their hair (or whatever it is they do to kill time). Our cabdriver told us he sees them all the time near Kgale hill.
After our adventure Kate and I went to church at the local Catholic church where the singing was amazing! The nuns there still wear a full habit etc. But they gave the best rendition of Amazing Grace that I have ever heard. Off to the adult clinic for the day!!!

A weekend in Botswana

Hello to all!
So we've survived our first weekend in Botswana with a few adventures to speak of...
Friday night we walked down to the "main mall" which is what we suspect to be the downtown area of Gaborone. It's interesting...more supermarkets, fast food joints, and random stores but interspersed with taller buildings some of which look pretty modern. For readers of the Ladies No. 1 Detective Agency, this area holds the famous President's Hotel where the Mma. often has tea. It's where we catch safe cabs home. There are some outdoor vendors which were told is the closest to a market that Gaborone has. Bummer since I was really looking forward to shopping at an African market. Maybe in South Africa...
Saturday we woke early to hunt down a cell phone after revealing the mysteriously disappearing phone that should be at our guest house. We figured if we wanted to communicate with anyone--here or at home--we'd better take matters into our own hands. We then visited the national museum of Botswana and learned some about the geological and political history of the area as well as the environment and animals. Not the most high tech. place, but cool anyway. We also learned about the main square model, or the kgola, of the villages here where the chiefs sit and hold court and hear complaints or input from local village members. Our Saturday night began well...with a bbq birthday party at one of the Baylor doctors families. The end got a bit more adventuresome as we got locked out of our house. Not cool. Several cups of tea and a scrabble game later (at the home of a kind supporter) we finally got back into our house.

More on our Sunday activities...
I'm off to Setswana classes.
-Kate

Millimole vs Megaheadache?

After a morning of rounding on my patient with cryptococcal meningitis, we sat down to calculate his electrolyte status, which we hadn't checked in a couple days since he didn't have an IV. Needless to say, his electrolytes were all off, he had low sodium, calcium and low potassium, which in the U.S. probably would have gotten him stat runs of potassium and fast replenishment of his electrolytes. We spent the afternoon trying to convert the measurements of his potassium and calcium to the measurements we use in the U.S. I was reminded of high school chemistry class as we were converting millimoles to milliequivalents and milliequivalents to milligrams and mililiters... I had a headache by the end and after everything we determined that his calcium was actually normal. His potassium was still off with our calculations and we decided to replete it slowly since we won't be able to check labs consistently this weekend. All our calculations seemed somewhat futile at that point! It was heartbreaking because I feel like his problems are so much larger than his electrolytes and that we really are just scratching at the surface.
Keep watching...Kate and I were going to try and check out the game preserve this weekend, to familiarize ourselves with the local flora and fauna.

End of the week update...

Dumela everyone! (Hello/greetings in Setswana)
We've survived until Friday of our first week here. The biggest challenge, so far, has been getting over the jet lag and culture shock and trying to get into the swing of things around here. So last night we ventured out to the "Riverwalk"--a local mall that has no association with a river whatsoever. It is quite the place complete with a movie theater, many clothing stores, and two grocery stores as well as lots of restaurants. We grabbed a few treats at the "fancy" grocery store located behind the clothing at Woolworth's. They have sort of gourmet type foods including jars of sauces, frozen pizzas, and fun biscotti. We enjoyed dinner at the Apache Spur, a South African chain of tex-mex burger joints that resembles Applebees or TGIFridays in the U.S.. The entire place was decorated in the tackiest American Indian style tribal patterns and they even had a fake stained glass window depicting an indian chief. The food was, surprisingly, very mediocre, but we got our fill of grease for the week!
Yesterday, we got to work a bit early for an informal prayer service held by the staff of the clinic every morning. It was an amazing display of song in four-part harmony and prayers that sounded beautiful, although we couldn't understand what they were saying. I was struck by such a display of deep faith by a waiting room packed full of mothers and their children all suffering from HIV.
Today has brought forth some of the challenges of being here...a few tough spots. Nothing that won't improve with time.
More to come soon...hope all is well with you!

Our trip to the grocery store...

After Kate and I began rounding in the hospital which was crowded with kids and their parents who were trying to feed them, I started to feel lightheaded. My differential diagnosis for my lightheadedness included lack of sleep, lack of food, and lack of water. Seeing that I looked out of it and was leaning to one side, the attending suggested that I go get lunch. Which would be easy if Kate and I actually had money. So we went to the grocery store with our friend Ernest who drove us to this large store which also had an ATM. The grocery store looked a lot like any American store with fresh fruits, veggies, peanut butter, and Nuthella of course. After picking out food that looked safe (i.e. rice and cereal) Kate and I also picked up a bottle of wine. The hummus there was great as well! After replenishing our food and water we headed back to the clinic where we finished rounding and spent 2 hours learning some Setswana. We now know roughly 3 or 4 phrases and will learn some more tomorrow. Go siame- good bye!

Arrived!

After 19 or so hours (more for Annabelle who came from Portland) we finally arrived in Gaborone (pronounced by the locals as Hab-or-on-ay). The Johannesburg airport was ritzy and fancy and had lots of very modern shops and restaurants. The Gaborone airport is a bit more simple with a few runways and mostly small planes. Our flight was on a two propeller plane from Johannesburg.
After a second's hesitation, we accompanied Ernest who greeted us at the airport only with a sign saying "Baylor Botswana" to his pick-up. He kindly stopped at the local "Chickin Lickin" which seems to be a local rendition of KFC. It'd been a while since we'd had Chicken nuggets, but hey, food was food at that point. Then on to our little house, known as "Baylor 1."
Our house is a cute little rambler with a living and dining room and kitchen, 3 bedrooms, and a bathroom with shower/tub and a separate room for the toilet. They claim you can drink tap water...after my days in Mexico...I'm a bit skeptical. I'm going to get a few confirmations before I start imbibing. We share the house with Sam, an undergrad @ Harvard who's taking some time off to hang out in Botswana and work on an education outreach project. He seems cool and laid back so far and has been generous with his pula (local money) as we've yet to exchange any! Really, what more can you ask! :o)
The morning began at 7:30 am "Botswana time" which today meant 7:45, but apparently can be up to several hours later. I think I'll feel right at home! :o) We went over to the "Centre for Excellence" which seems to serve as both a clinic and administrative center...or centre. Talk about first impressions...after never having knowingly laid eyes on a child with HIV/AIDS, it's a bit of a shock to walk into a waiting room filled with around 50 people and to know that all those adorable little smiley kids have HIV or AIDS as do most of their parents/guardians.
We jumped right in and started rounding on the pediatrics ward. Sick kids here means something a bit different than back in Rochester...While some kids here have simple issues, most have complex infections from being immunocompromised. We saw a 12 year old who weighs 18kg because she has "wasting" from HIV. Another 8 yr. old has been here for weeks with cryptococcal meningitis and has to have daily increased cerebrospinal pressure. So sad. It is reassuring to see attentive, caring parents at the bedside of all the kids, although often it's an older sister and not the mother, who stays home to take care of the other kids and/or to work. Quite a reality check, and it's only been a few hours! More to come soon...

Intro.

Hi everyone! Annabelle & I embark on our great African adventure this Monday, 10/8, at 5:20pm. We'll finally be in Botswana at 6:20pm on Tuesday, 10/9! Check out this site for updates about our trip. :O)