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!