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....
