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...