It seems that the more we go along in our life in Botswana, the more polarized things become. For every positive, a negative seems to crop up. To better explain this hopelessly vague introduction, I've divided the experience into "yins" and "yangs" in historical order. It also adds a pseudo-sophisticated angle to what can only otherwise be described as "good stuff" and "bad stuff."
Yin 1:
Our jobs here are fantastic. It's many of the great things about medicine without as much of the pain and paperwork. Matt spends 1-2 days/week attending at the main tertiary care referral hospital in Gaborone. The other 3-4 days/week are spent on community outreach, during which time he travels to district hospitals to teach, learn, and see patients with medical officers. The PEPFAR mandate that he works under is concerned with building local capacity to take care of complicated patients with HIV, TB, HIV/TB coinfection, and other chronic diseases. So most of the time, he rounds and sees patients with medical officers in both inpatient and outpatient settings. The work is exceedingly gratifying - as one colleague Dr. MH likes to say, "it's nice to be in a place where the goal is to work yourself out of a job."
Premal spends most days seeing adult HIV patients at the Botswana-Baylor Center of Excellence (COE for short). It's a sweet gig - she takes care of the primary care needs of adult HIV patients while simultaneously learning about how to manage complicated HIV cases.
Yang 1:
So this actually is a good thing. We just put it in this section because our friends Amy YANG and Shivani came to visit us a few weeks ago. Good times, game drives, and lots of great food - it was great to see them and reminded us about how much we miss our good friends back home!
Yin 2:
Our accomodations are great - we have a three bedroom, 2.5 bath place with a small backyard and a garage (with no car in it - see yang 3). A few of the other Baylor folks live in this complex, making for a nice community. We're also a short hop to one of the main shopping centers, replete with bars, restaurants, and supermarkets.
Yang 2:
There have been 4 burglaries in the past two months here (not including us...yet). Apparently the 24 hour security was sometimes dozing off at night after disabling the electric fences because "they went off too much." Guess we're all targets since we're foreigners, but I just wish someone could translate our collective amount of debt into local currency so they could understand that we don't exactly budget for another laptop computer!
Yin 3:
We bought a great car about a month ago. 1997 blue Honda CR-V with all-wheel drive for those muddy game drives, low mileage, and only a mild hint of the cigarette stench that pervades most Japanese imports here. It drove great (note past tense and see yang 3).
Yang 3:
We went to Johannesburg a few weeks ago to see one of Matt's jazz idols, Abdullah Ibrahim, in concert. He and Matt had been in touch over email and had recommended we come down to "meet." So down we drove on a Friday afternoon, only to find out that he actually had wanted us to join him at a concert. Well, Premal developed a nasty migraine and Matt barely made the end of the first half of the concert (maaaany hijinks trying to find the venue, let me tell you). The following day, we were enjoying ourselves in a nice Jo'burg suburb, commenting to each other that "Jo'burg really gets a bad rap" and that "it really isn't so bad after all - why do people freak out so much about coming here?"
That evening we went to eat supper around 8pm in a very busy, well-populated and lit area. At 8:45 we returned to the car only to find an empty parking space. Apparently going to Jo'burg without eight levels of security on your vehicle and with Botswana registration is "a bad idea." Stolen in front of a bar with a bunch of people eating and drinking outside - what balls! These guys are real pros. Mafioso types - not poor 'youts from the townships. And what a trip it was to drive down and fly back. Jo'burg: 1, Matt and Premal: 0.
Yin 4:
Matt has started to play with a local jazz guru called Socca Moruakgomo. He's a trumpet maestro who also sings his own tunes. Great horn parts, fantastic band, and amazing Afro-jazz energy. He's played three gigs with Socca's group now with many more to come. He's also been able to meet some of the other local musicians and is really starting to get known in the scene (for better or for worse!). It's really a musical renaissance, playing music in a style to which he has always felt a deep connection. (Don't worry - photos to be posted on picasa soon if you haven't seen them on Matt's FB page!).
Yang 4 (unrelated):
Of course after our car was stolen we had to start looking for another one. After looking at 10 to the 6th sub-standard 1997 Honda CR-Vs, we started to think about changing our expectations. Maybe since we do so much driving we should get one with airbags and safety features, right? So we started looking at vehicles with airbags. Shit if we weren't test driving an SUV on Wednesday and got into a SUPER nasty car accident.
We were behind a large 18-wheeler and couldn't see oncoming traffic. Premal was driving. We slowed to see if anyone was coming. She signalled to turn onto a dirt road. No sooner had she begun to turn the wheel to see around the truck when a guy doing about 90 Km/hr blindsided us on the passenger (left) front side. Airbags deployed in P's face. Apparently his crew was fleeing after having stolen a guy's laptop, who was giving chase behind them. He ended up getting his laptop back, but then served as our ambulance so we could get a bruised, confused, and bleeding Premal to the hospital ASAP. In the end, it was an excessively frightening experience that left Premal with a concussion,a pair of nice shiners, and a night in the hospital for obs, but no major intracranial problems or fractures.
On the yin side of that story, everyone here has been nothing but amazing during this weird and awkward post-accident time. We are thankful for our friends and colleagues - we could ask for no better people to be around in a time of weakness and need. Everyone supports each other when it hits the fan - for that we are forever thankful.
So for now, the yins have it 5-3 (I counted Amy and Shivani's visit as a yin!). Stay tuned and we'll try to stay away from cliches for the next posting. Emails and facebookmails are of course welcome.
Matt and Premal
Friday, October 30, 2009
Sunday, October 4, 2009
We're baaaaack!
Wow. Last blog entry September 27th, 2008. How young we were then...
Honestly, though. Has it really been this long?
The great thing about having a blog is that you can assume that everyone who reads it is uber-fascinated with your life. To that end, I guess we've left most people in the dark as to what we've been up to this past month. It shouldn’t surprise you. I mean, living in Africa is totally crazy. We get up each morning early so that we can hunt food for the day. Our jobs take place in thatch huts with no electricity and no running water. We have to hitchhike with child soldiers driving ATVs through 80 kms of bush to get to the one electric outlet that happens to have a computer (an Apple IIE no less) with dial-up internet access. We are really “out there.”
Or are we?
If you believe the above then please keep reading.
We live in Botswana, which at last count was about the size of the state of Texas (let me just tell you how the Batswana looooove hearing that, by the way). There are about 1.9 million nationals in the country, and anywhere from 40,000 to 100,000 Zimbabweans (depending on who you read) living here, most of whom are undocumented. 3% of the population is white and another 1% is South Asian. There are about 5 of 6 thousand Chinese. The GDP per capita is almost $15,000, which puts it in the neighborhood of Mexico, Venezuela, Grenada, and Bulgaria.
Thank you Wikipedia and CIA Factbook.
The point is this: Botswana is a fascinating place. People are generally friendly. It is safe – there are no guns on the streets (even police don’t carry guns). The government is democratic, responsive, and non-corrupt. There was a non-violent transition from British colonialism in 1966, since which time there have been 3 peaceful transitions of power. The government provides health care to nationals, including comprehensive HIV care.
People in the burgeoning middle class here in the capital drive BMWs and Mercedes to work while chatting on iPhones, but go back to their respective villages during any national holiday. For the population of 1.9 million, there are 1.42 million mobile phones. English is an official language, but you get much farther with a little bit of Setswana. It is a country that has benefited from its natural resources and invested heavily in health and education. 80% of the population is literate, and 8.7% of GDP is spent on education (10th in the world). Most people are Christian, and prayer through song is a part of morning rounds in most all hospitals.
The modernity that Botswana enjoys is countered by real health problems. Ours is a sick country. The HIV prevalence is anywhere from 12-60% in some areas (second highest per capita in the world). The rural-urban gap of health resources is widening, despite a well-designed decentralized health care system. Most doctors are not Batswana – the brain drain problem is a real one here. Until this year, if you were from Botswana and wanted to go to medical school, you had to get sponsored to go study in South Africa, Ireland, Australia, or Russia. Not surprisingly, many students end up training and then staying in those countries. But it’s an interesting time now - the health institutions of the country are expecting great things from its first medical school, which just opened its doors in August (but have yet to build an actual building to house the classes).
So that’s our context.
To catch you up on what we’ve been doing since our arrival, we’ll do it in stream-of-consciousness top-10 list form:
1) We finished the draft of the book we were working on
2) Our place is nice, quiet, and safe. We have potable tap water, hot water 24/7, and high-speed internet – it’s a hard-knock life.
3) We got a car – blue 1996 Honda CR-V (every doc in Premal’s group has one so why should we be any different, right?)
4) Matt turned 30
5) We bought a grill because BBQ is tasty and it’s a man’s right.
6) Cuban rum is num nums
7) Our colleagues are becoming good friends – they are fantastic people
8) Setswana is a hard language to learn, but we’re doing our best
9) Work is proving to be both challenging and gratifying – we are working on strengthening partnerships with local health institutions to build health care capacity in HIV, TB, and primary care
10) In minutes you can be out of town and on a game reserve where giraffes, rhinos, monkeys, cheetahs, and zebras roam
Disclaimers:
1) This will not be a play-by-play of our lives. As this experience demonstrates, Premal and I can hardly be relied upon to actually keep everyone current. We want to include the good stuff and exclude the mundane.
2) We feel privileged to be here at this stage of our careers, working with passionate and interested people.
3) Facts and opinions disclosed in this blog do not represent our employers, our country, or our respective tribes. For that matter, they may not even be facts or opinions - just a bunch of bullshit.
For the next entry, we promise fewer factoids and more thoughts/insights about our lives and work. We hope that this site becomes a place for our friends, family, and colleagues to take part in our experiences (for better or for worse!).
Oh yeah, and come visit!
Honestly, though. Has it really been this long?
The great thing about having a blog is that you can assume that everyone who reads it is uber-fascinated with your life. To that end, I guess we've left most people in the dark as to what we've been up to this past month. It shouldn’t surprise you. I mean, living in Africa is totally crazy. We get up each morning early so that we can hunt food for the day. Our jobs take place in thatch huts with no electricity and no running water. We have to hitchhike with child soldiers driving ATVs through 80 kms of bush to get to the one electric outlet that happens to have a computer (an Apple IIE no less) with dial-up internet access. We are really “out there.”
Or are we?
If you believe the above then please keep reading.
We live in Botswana, which at last count was about the size of the state of Texas (let me just tell you how the Batswana looooove hearing that, by the way). There are about 1.9 million nationals in the country, and anywhere from 40,000 to 100,000 Zimbabweans (depending on who you read) living here, most of whom are undocumented. 3% of the population is white and another 1% is South Asian. There are about 5 of 6 thousand Chinese. The GDP per capita is almost $15,000, which puts it in the neighborhood of Mexico, Venezuela, Grenada, and Bulgaria.
Thank you Wikipedia and CIA Factbook.
The point is this: Botswana is a fascinating place. People are generally friendly. It is safe – there are no guns on the streets (even police don’t carry guns). The government is democratic, responsive, and non-corrupt. There was a non-violent transition from British colonialism in 1966, since which time there have been 3 peaceful transitions of power. The government provides health care to nationals, including comprehensive HIV care.
People in the burgeoning middle class here in the capital drive BMWs and Mercedes to work while chatting on iPhones, but go back to their respective villages during any national holiday. For the population of 1.9 million, there are 1.42 million mobile phones. English is an official language, but you get much farther with a little bit of Setswana. It is a country that has benefited from its natural resources and invested heavily in health and education. 80% of the population is literate, and 8.7% of GDP is spent on education (10th in the world). Most people are Christian, and prayer through song is a part of morning rounds in most all hospitals.
The modernity that Botswana enjoys is countered by real health problems. Ours is a sick country. The HIV prevalence is anywhere from 12-60% in some areas (second highest per capita in the world). The rural-urban gap of health resources is widening, despite a well-designed decentralized health care system. Most doctors are not Batswana – the brain drain problem is a real one here. Until this year, if you were from Botswana and wanted to go to medical school, you had to get sponsored to go study in South Africa, Ireland, Australia, or Russia. Not surprisingly, many students end up training and then staying in those countries. But it’s an interesting time now - the health institutions of the country are expecting great things from its first medical school, which just opened its doors in August (but have yet to build an actual building to house the classes).
So that’s our context.
To catch you up on what we’ve been doing since our arrival, we’ll do it in stream-of-consciousness top-10 list form:
1) We finished the draft of the book we were working on
2) Our place is nice, quiet, and safe. We have potable tap water, hot water 24/7, and high-speed internet – it’s a hard-knock life.
3) We got a car – blue 1996 Honda CR-V (every doc in Premal’s group has one so why should we be any different, right?)
4) Matt turned 30
5) We bought a grill because BBQ is tasty and it’s a man’s right.
6) Cuban rum is num nums
7) Our colleagues are becoming good friends – they are fantastic people
8) Setswana is a hard language to learn, but we’re doing our best
9) Work is proving to be both challenging and gratifying – we are working on strengthening partnerships with local health institutions to build health care capacity in HIV, TB, and primary care
10) In minutes you can be out of town and on a game reserve where giraffes, rhinos, monkeys, cheetahs, and zebras roam
Disclaimers:
1) This will not be a play-by-play of our lives. As this experience demonstrates, Premal and I can hardly be relied upon to actually keep everyone current. We want to include the good stuff and exclude the mundane.
2) We feel privileged to be here at this stage of our careers, working with passionate and interested people.
3) Facts and opinions disclosed in this blog do not represent our employers, our country, or our respective tribes. For that matter, they may not even be facts or opinions - just a bunch of bullshit.
For the next entry, we promise fewer factoids and more thoughts/insights about our lives and work. We hope that this site becomes a place for our friends, family, and colleagues to take part in our experiences (for better or for worse!).
Oh yeah, and come visit!
Friday, September 26, 2008
Illegal for 10 minutes
So last weekend, we splurged on a 5-star game lodge called Tau in the Madikwe game reserve, about 1.5 hours from Gabs. It's in South Africa, which requires not one, but two border crossings each way. That detail was not made clear to us. Driving through the poorly signed border, we came to the South African side, where the border guards seemed to be more curious about our iPod than the stamps in our passports. Coming back, we passed through the RSA customs without a problem, then promptly drove across the Botswana side via the truck lane (got confused). No guard was there--just an empty chair, so we figured that we'd have no problems. I guess our driving through must have woken the guard up, because our friends in the car behind us got turned around and had to go through the "proper channels."
Long story short, we were on Botswana turf for about 10 minutes waiting on the road for our friends before we realized that we may have done something wrong. We turned around and went back to the Botswana border station. We were told by one guy that we'd have to go inside and pay something like $130 for crossing the border illegally. In the most apologetic and deferential of manners, we told him that it was not my responsibility to wake up the border guards and that we had made a simple mistake that we were now trying to rectify. He sent me to the "entry" side where, after berating us for "making things complicated," another guard with sores on his lips told us that we could pass through the "exit" lane and re-enter Botswana legally.
More from Jo'burg tomorrow before we return...
Long story short, we were on Botswana turf for about 10 minutes waiting on the road for our friends before we realized that we may have done something wrong. We turned around and went back to the Botswana border station. We were told by one guy that we'd have to go inside and pay something like $130 for crossing the border illegally. In the most apologetic and deferential of manners, we told him that it was not my responsibility to wake up the border guards and that we had made a simple mistake that we were now trying to rectify. He sent me to the "entry" side where, after berating us for "making things complicated," another guard with sores on his lips told us that we could pass through the "exit" lane and re-enter Botswana legally.
More from Jo'burg tomorrow before we return...
Monday, September 22, 2008
More Pics
http://picasaweb.google.com/dacsocles/MokolodiGameReserveBotswana?pli=1#
http://picasaweb.google.com/dacsocles/MadikweSafariSouthAfrica?pli=1#
To view new pics, cut and paste the links above to your browser- there are older pics in the previous blog.
http://picasaweb.google.com/dacsocles/MadikweSafariSouthAfrica?pli=1#
To view new pics, cut and paste the links above to your browser- there are older pics in the previous blog.
Saturday, September 13, 2008
Photos
So we're over halfway through the rotation and definitely getting into the swing of things at the hospital--getting better at IVs, blood draws, and which transport folks to schmooze to get patients transported to x-ray (otherwise it's me or a med student!). In exchange for getting one of my patients with "pneumonia r/o TB" (probably our most common admitting diagnosis) to the X-ray department, one transport lady wanted me to prescribe her some pills, but didn't know the names. Then she asked me to push other patients around with her. Or that's what I thought she asked--it was an awkward Setswana/English mixed conversation. Now every time she passes me in the hallways she laughs at me. As I always say, I'm just doin' my job...
As for P, she's doing great. For the past week, the doc running the adult HIV clinic has been away so she has had a taste of what it would be like to work there. She sees the adult family members of the child patients since those children serve as the entry point into the ARV (anti-retroviral) system. I nearly did a double-take when I heard P utter the words, "I think I really like primary care here."
But enough about work. Gaborone is an interesting city. It's spread out like Houston, but has about 1/100000th the number of restaurants. Not a "walking friendly" place at all. We call our buddy T the Zim taxi man to take us around to most places. He's great--plays reggae in his 1983 Toyota Cressida and always has good chat for us. There's definitely a large ex-pat community here--mostly Brits and South Africans. They tend to congregate at a couple of pubs and at the yacht club (that's right, we're in the desert--see photos) on Fridays.
We went to this place that was billed as a "jazz club" two weekends ago called Satchmo's. Every website I found said that this was the place to hear music. So like idiots we showed up at like 8:15. They were still stocking beer in the fridges when we showed up. So we went to the pub next door and met a scrawny guy named V who offered to sell us a house, then a car, then to be our personal security guy. We took that as a message to go back to the club. In the end, the band showed up around 1 am, but we were too tired to stay. On the up-side, the DJ was playing amazing Afro-pop the whole time and we thoroughly enjoyed the evening.
Then there was the Kalahari last weekend--we'll let the photos speak for themselves.
All in all, Botswana is a unique place. It is mostly rural (3 people per square mile) but has a growing urban population with upper and middle classes. It is a stable democracy but is bordered by a country with the most unstable of governments. Members of rural tribes find themselves confronted by the harsh realities of development and industrialization (see the case of the San in the Central Kalahari Game Reserve). Zimbabweans are here in great numbers--they seek refuge here but find themselves working for little to no pay and without access to basic services. In the hospital, Zim patients must pay 80 pula per night (about $12) and for all medications (needless to say, most abscond without settling the tab).
To whet your whistles, our first round of photos are up for viewing. You may see photos of folks you don't know, but the point is that we've met great people here who enjoy a good "braai" (BBQ).
http://picasaweb.google.com/dacsocles/BotswanaRoughingIt#
http://picasaweb.google.com/dacsocles/WorkHardPlayHardGabs#
http://picasaweb.google.com/dacsocles/TheKalahari#
To all those in Houston/Galveston, we hope that "Dwight David" (as my father calls the hurricane) spared you, your families, and your property any harm or damage.
Until next time...
As for P, she's doing great. For the past week, the doc running the adult HIV clinic has been away so she has had a taste of what it would be like to work there. She sees the adult family members of the child patients since those children serve as the entry point into the ARV (anti-retroviral) system. I nearly did a double-take when I heard P utter the words, "I think I really like primary care here."
But enough about work. Gaborone is an interesting city. It's spread out like Houston, but has about 1/100000th the number of restaurants. Not a "walking friendly" place at all. We call our buddy T the Zim taxi man to take us around to most places. He's great--plays reggae in his 1983 Toyota Cressida and always has good chat for us. There's definitely a large ex-pat community here--mostly Brits and South Africans. They tend to congregate at a couple of pubs and at the yacht club (that's right, we're in the desert--see photos) on Fridays.
We went to this place that was billed as a "jazz club" two weekends ago called Satchmo's. Every website I found said that this was the place to hear music. So like idiots we showed up at like 8:15. They were still stocking beer in the fridges when we showed up. So we went to the pub next door and met a scrawny guy named V who offered to sell us a house, then a car, then to be our personal security guy. We took that as a message to go back to the club. In the end, the band showed up around 1 am, but we were too tired to stay. On the up-side, the DJ was playing amazing Afro-pop the whole time and we thoroughly enjoyed the evening.
Then there was the Kalahari last weekend--we'll let the photos speak for themselves.
All in all, Botswana is a unique place. It is mostly rural (3 people per square mile) but has a growing urban population with upper and middle classes. It is a stable democracy but is bordered by a country with the most unstable of governments. Members of rural tribes find themselves confronted by the harsh realities of development and industrialization (see the case of the San in the Central Kalahari Game Reserve). Zimbabweans are here in great numbers--they seek refuge here but find themselves working for little to no pay and without access to basic services. In the hospital, Zim patients must pay 80 pula per night (about $12) and for all medications (needless to say, most abscond without settling the tab).
To whet your whistles, our first round of photos are up for viewing. You may see photos of folks you don't know, but the point is that we've met great people here who enjoy a good "braai" (BBQ).
http://picasaweb.google.com/dacsocles/BotswanaRoughingIt#
http://picasaweb.google.com/dacsocles/WorkHardPlayHardGabs#
http://picasaweb.google.com/dacsocles/TheKalahari#
To all those in Houston/Galveston, we hope that "Dwight David" (as my father calls the hurricane) spared you, your families, and your property any harm or damage.
Until next time...
Friday, August 29, 2008
1 Week In...
And no needle sticks!
With a near 40% HIV prevalence in the country, and with probably 95% of our patients (or more) infected with something we don't want to take home as a souvenir, this is no small sigh of relief. So we survived the first week. Yeah, it sure sucks being in a 3 bed/2 bath apartment that is in a complex with an electric gate/electrified fence with a pool, 24h security, and a BBQ pit. We really are living the tough life here. I mean, the wireless signal in the apartment is either "low" or "very low" - can you even imagine?
So I will back up to last weekend to describe our luggage saga. As you might imagine, our shit did not make it from Johannesburg to here. Why, you ask? Well, there were a couple of cancelled flights because, as one South African Airways representative told me, "that plane broke." Then there's the relatively lax handling of luggage in the Jo'burg airport (I hear they really like coffee breaks). Despite those slight frustrations, we did make it safely to Gaborone in the end and were very relieved to find our driver there waiting to take us to our flat where we'd be "roughing it" for weeks
After 4 days in narsty clothes we decided that it would be appropriate to appropriate (how do you like that!) some new duds. Anyone who knows Premal knows that she balks at any shirt that costs over $2, shoes over $5, and underwear that isn't second hand. So no one should be surprised that after passing through several reputable (albeit expensive) clothing stores, she found the PEP store. Yeah, you heard me--PEP. You might know its apparel lines from such fine stores as "Dollarama" and "Pick 'n Save." While I was a bit embarassed shopping for underwear next to the "luggage" section, I must say that I was very satisfied with some $4 track pants, a $1.50 tank top, and a $4 shirt. While it may come as a shock to many of you, Premal even bought some clean clothes. I mean, at those prices, how could she resist?
So a brief word about the working environment. Let's see. The days are not short and we do work. I work in a hospital that U. Penn is doing extroardinary work in to introduce academic medicine to a country that very much needs Batswana physicians (key - 1 person = Motswana, 2 people = Batswana, country we're in = Botswana). It is different from most hospitals we've seen in the developing world in that orders are placed in charts and may be followed, and medicines/supplies are not fee-for-service (as in the DR, where families had to buy the ET tube for patients that needed intubations). However, resources are still limited. Some patients still have beds on the floor. Housestaff (namely, medical officers, med students [Penn], and interns) do all procedures, from blood draws/IVs to foleys, to LPs and thoracentesis. IVs, foleys, and central lines are not dressed--they're held on with tape. Daily notes are in sheafs of paper held together by shoestring (not kidding). Mortality is high, and young people may die--all things that are difficult to get used to, but better than they have been in the past (and improving).
Premal works in an air-conditioned office and drinks Fiji water all day. OK, it's not quite that stark. [Premal writing]. Matt is exaggerating- but not by much (I do however prefer tap water). My elective is through Baylor at one of their BIPAI clinics (Baylor International Pediatric AIDS Initiative). These are a global network of clinical centers focusing on treating the Pediatric HIV population. So, what am I as an internist doing here? The BIPAI clinics work on a family model whereby the child serves as the point of entry into the health system--so once they are hooked, the clinic makes every effort to bring in the adults (parents, aunts, uncles, etc) for testing, treatment and primary care as they are likely infected as well. Thus, these patients need a medicine trained doctor (me!). The facilities are very modern and high tech with very knowledgable staff and readily available services (translating, nutrition, adherence conseling, social work, psychology, etc). I don't think the patients could get better care elsewhere! The way the clinic works is interesting: patients start forming a line outside the clinic at 6am, then around 7-7:30, the doors open, patients get "registered" (meaning they write their names down). Then the entire waiting room has morning prayers and erupts in traditional inspirational singing. At 8, the singing stops and the clinic begins. It is a first come, first serve system- there are no set appointment times. Some patients may have to wait 8 hours to be seen and have traveled all night to get there! As the clinic was formulated by western doctors, it works like a clinic in the states. We type our notes which are very thorough, write for meds which they can get filled at the pharmacy in the same building, and order labs which are drawn a few doors down. Some patients are very sick with opportunitstic infections and are referred to the ER for hospitalization. Others are stable and are like any patient in the states with an undetectable viral load/good CD4 count and need better BP control. In all, it is an amazing experience!
In the end, we can't complain about much at all (and you know that we as medicine residents love to complain). We've ended up with spectacular flat-mates who are wonderful and exciting people (one of whom we have discovered I went to high school with!). Premal's experience in the HIV clinic and my experience in the hospital are rapidly proving to be amazing learning experiences. The folks in charge of our programs are passionate, intelligent, and compassionate people. The food is good. There is an Indian restaurant up the road. Pub trivia happens at an ex-pat pub on the last Thursday of the month. People hang out and do grocery shopping in malls (a little weird), but it's easy enough to get used to. There is supposedly a jazz club or two around town. We've worked out for free at a hotel gym (but don't tell them). They sell Havana Club rum here. We're 5 km from the South African border and thus, South African wine. We plan to go on a "game drive" or two to experience wildlife. This is truly an incredible country and we will certainly have more to say as time goes on.
More to come soon (especially about the city!), especially photos...
With a near 40% HIV prevalence in the country, and with probably 95% of our patients (or more) infected with something we don't want to take home as a souvenir, this is no small sigh of relief. So we survived the first week. Yeah, it sure sucks being in a 3 bed/2 bath apartment that is in a complex with an electric gate/electrified fence with a pool, 24h security, and a BBQ pit. We really are living the tough life here. I mean, the wireless signal in the apartment is either "low" or "very low" - can you even imagine?
So I will back up to last weekend to describe our luggage saga. As you might imagine, our shit did not make it from Johannesburg to here. Why, you ask? Well, there were a couple of cancelled flights because, as one South African Airways representative told me, "that plane broke." Then there's the relatively lax handling of luggage in the Jo'burg airport (I hear they really like coffee breaks). Despite those slight frustrations, we did make it safely to Gaborone in the end and were very relieved to find our driver there waiting to take us to our flat where we'd be "roughing it" for weeks
After 4 days in narsty clothes we decided that it would be appropriate to appropriate (how do you like that!) some new duds. Anyone who knows Premal knows that she balks at any shirt that costs over $2, shoes over $5, and underwear that isn't second hand. So no one should be surprised that after passing through several reputable (albeit expensive) clothing stores, she found the PEP store. Yeah, you heard me--PEP. You might know its apparel lines from such fine stores as "Dollarama" and "Pick 'n Save." While I was a bit embarassed shopping for underwear next to the "luggage" section, I must say that I was very satisfied with some $4 track pants, a $1.50 tank top, and a $4 shirt. While it may come as a shock to many of you, Premal even bought some clean clothes. I mean, at those prices, how could she resist?
So a brief word about the working environment. Let's see. The days are not short and we do work. I work in a hospital that U. Penn is doing extroardinary work in to introduce academic medicine to a country that very much needs Batswana physicians (key - 1 person = Motswana, 2 people = Batswana, country we're in = Botswana). It is different from most hospitals we've seen in the developing world in that orders are placed in charts and may be followed, and medicines/supplies are not fee-for-service (as in the DR, where families had to buy the ET tube for patients that needed intubations). However, resources are still limited. Some patients still have beds on the floor. Housestaff (namely, medical officers, med students [Penn], and interns) do all procedures, from blood draws/IVs to foleys, to LPs and thoracentesis. IVs, foleys, and central lines are not dressed--they're held on with tape. Daily notes are in sheafs of paper held together by shoestring (not kidding). Mortality is high, and young people may die--all things that are difficult to get used to, but better than they have been in the past (and improving).
Premal works in an air-conditioned office and drinks Fiji water all day. OK, it's not quite that stark. [Premal writing]. Matt is exaggerating- but not by much (I do however prefer tap water). My elective is through Baylor at one of their BIPAI clinics (Baylor International Pediatric AIDS Initiative). These are a global network of clinical centers focusing on treating the Pediatric HIV population. So, what am I as an internist doing here? The BIPAI clinics work on a family model whereby the child serves as the point of entry into the health system--so once they are hooked, the clinic makes every effort to bring in the adults (parents, aunts, uncles, etc) for testing, treatment and primary care as they are likely infected as well. Thus, these patients need a medicine trained doctor (me!). The facilities are very modern and high tech with very knowledgable staff and readily available services (translating, nutrition, adherence conseling, social work, psychology, etc). I don't think the patients could get better care elsewhere! The way the clinic works is interesting: patients start forming a line outside the clinic at 6am, then around 7-7:30, the doors open, patients get "registered" (meaning they write their names down). Then the entire waiting room has morning prayers and erupts in traditional inspirational singing. At 8, the singing stops and the clinic begins. It is a first come, first serve system- there are no set appointment times. Some patients may have to wait 8 hours to be seen and have traveled all night to get there! As the clinic was formulated by western doctors, it works like a clinic in the states. We type our notes which are very thorough, write for meds which they can get filled at the pharmacy in the same building, and order labs which are drawn a few doors down. Some patients are very sick with opportunitstic infections and are referred to the ER for hospitalization. Others are stable and are like any patient in the states with an undetectable viral load/good CD4 count and need better BP control. In all, it is an amazing experience!
In the end, we can't complain about much at all (and you know that we as medicine residents love to complain). We've ended up with spectacular flat-mates who are wonderful and exciting people (one of whom we have discovered I went to high school with!). Premal's experience in the HIV clinic and my experience in the hospital are rapidly proving to be amazing learning experiences. The folks in charge of our programs are passionate, intelligent, and compassionate people. The food is good. There is an Indian restaurant up the road. Pub trivia happens at an ex-pat pub on the last Thursday of the month. People hang out and do grocery shopping in malls (a little weird), but it's easy enough to get used to. There is supposedly a jazz club or two around town. We've worked out for free at a hotel gym (but don't tell them). They sell Havana Club rum here. We're 5 km from the South African border and thus, South African wine. We plan to go on a "game drive" or two to experience wildlife. This is truly an incredible country and we will certainly have more to say as time goes on.
More to come soon (especially about the city!), especially photos...
Wednesday, August 20, 2008
Holdup in H-town
So the journey began...
In typical Dacso and Patel fashion, we entered Dulles airport after a 2hr delay in H-town and watched our plane to Jo'burg run away from the gate. So at a $10 charge to the tarjeta de credito, we sit and enter our first entry into the "blog-o-sphere." (anyone else feel dirty saying "blog?")
Anyhow, we'll be posting photos and experiences at this site. I promise that we'll keep it simple and to the point. We will try to be entertaining but won't try too hard. Don't expect boring things like itineraries either--only cold hard facts punctuated by the occasional funny ha ha. We will write when the mood strikes, no more, no less.
We figure that if you're reading this, you must know us. And if you know us, you know how random we are. So get ready to join us in this great adventure to the land of the Tswana (and 25 other tribes). Know that we already miss our friends, family, and colleagues--do not hesitate to comment or email us!
In typical Dacso and Patel fashion, we entered Dulles airport after a 2hr delay in H-town and watched our plane to Jo'burg run away from the gate. So at a $10 charge to the tarjeta de credito, we sit and enter our first entry into the "blog-o-sphere." (anyone else feel dirty saying "blog?")
Anyhow, we'll be posting photos and experiences at this site. I promise that we'll keep it simple and to the point. We will try to be entertaining but won't try too hard. Don't expect boring things like itineraries either--only cold hard facts punctuated by the occasional funny ha ha. We will write when the mood strikes, no more, no less.
We figure that if you're reading this, you must know us. And if you know us, you know how random we are. So get ready to join us in this great adventure to the land of the Tswana (and 25 other tribes). Know that we already miss our friends, family, and colleagues--do not hesitate to comment or email us!
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