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...
Friday, September 26, 2008
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!
Subscribe to:
Posts (Atom)