6-26 thru 28-09-Fri thru Sun

Once again, weekends prove to be amazing and eventful in Botswana. We started Friday off by joining the OU kids at the bar (this might actually have been on Thursday, but I don’t remember anymore). We watched the Brazil/SA game. Oh, yeah, this definitely was on Thursday. It was a fun night and reminded me a lot of college. On Friday night, we went out for the first of two farewell dinners for Miryah. We went to this place called Apache at river walk. American style food. Seemed a lot like chilis. But it really wasn’t that good. Oh well.

Saturday was Teen Club. I have been waiting for this event from the beginning of the month. It’s a great program that gathers all the teens from our clinic and has them come in for one Saturday a month. The teens are split into older and younger teens. One half plays sports while the other stays at the clinic to learn about something important to teenage life and HIV. This month the younger teens stayed and learned out rape ( a tough talk for younger children, but important). The older teens went with me (I was the sports leader) to a local school to play all types of sports. There were a ton of volunteers (~7 at sports) and a group of 10 “teen leaders” (clinic teens that step up to lead the group). These teens are essential. The younger kids do anything they say. Its great to see.

Anyways, the morning started in the cold with a pick up game of football with all ages (about 115 children in all). We then had ice-breakers and split up into our two groups. The older teens actually set up a very intense football game. I finally got to play football with the locals and they are indeed good. Nevertheless, it got me a lot of respect among the teens. Apparently they do not see many white kids that can play. The day ended with a wrap up, giving travel money to all the teens and lunch. I was a very nice day and all the teens seemed very happy to be there. I plan to be the sport leader at the July Teen Club (which I actually think my parents will be here for).

Sunday was the start of a very long adventure. We woke up early to finish doing laundry (we had to wash all the sheets because we were all switching rooms) and then walked got in the car (that was given to us by Ryan because his girl friend is away for 2 months). We picked up Stu, Courtney and Kate and began our adventure to South Africa. The trip down there was fantastic! Beautiful day, bright sun and very little traffic. We were able to get all the way to Madikwe (where we all went our first weekend) in only an hour including the stop at the border. And two hours after that (after sorta getting lost in Zeerust) we were in Rustenberg, SA. The town was going crazy. People all over with red, black and green flags yelling and blowing those horns you always hear on tv.

After meeting up with ryan and getting our tickets, we were able to buy a SA jersey off a street vendor for 150 pula ($20). That’s nothing! The same jersey costs 600 (~$80) Rand in the stadium. So I was happy. We made our way, in our new gear, to the alternate stadium where everyone parks for the game. Not to mention that the parking was free, but we also got free combis shuttles to the real stadium! You would never find that in the states. Everyone was singing and dancing on the way to the game. It was finally nice to be in the middle of people that live for soccer! Once again, you wouldn’t find this atmosphere in the states.

We got to the stadium, got some drinks and food and found our seats. Little did we know, but our seats were 3rd row at about the 18 yard box! Minus the sun being in our eyes, these were the best soccer seats I’ve ever had! At times I was only like 10 meters from some of the best players in the world. We took pictures and enjoyed the game. SA scored in the 72nd min and the stadium went wild! We took this as our cue to leave. We had been warned that getting out of the stadium is impossible, so we all agreed to leave early (not to mention that we had a long drive ahead of us). As we were leaving we hear Spain score. As we were getting into the combis, we hear SA score. When I get back to work on Monday (I’m writing this on Tuesday), I hear that 2 more goals were scored after that!!! I’ve learned my lesson. Do not leave soccer games early!

Even though we missed the game basically, I enjoyed it a lot. The drive home, however, was terrible. These two lane roads going at 120 kph in the pitch black raised my stress level above anything its been since I’ve been here and my eyes strained as cars flew by me in the opposite directions with their brights on. Nevertheless, we made it home, only to be greeted by a locked screen door. Clearly, our new roommate was home.

Sparing the details, we woke her up and got in side and then crashed into bed. I’m sharing a room with JW now. Its really not that bad, except the electricity supplying the electric fence around our house is generated by a box in our closet. It’s a rhythmic ticking noise. If you know me, I hate this! If there is an old school clock in a room I’m sleeping in, I take it down and put it into a different room. For Sunday night, I just put up with it. But, last night, Beth reminded me that ear plugs work well for her. So I tried em, and voila, slept like a baby. Thanks Elizabeth!


Next weekend features the Forth of July on Saturday and a zebras game on Sunday.

6-24 thru 26-09- Wednesday-Friday

The rest of the week was pretty busy, thus no blog. I spent Wednesday, Thursday and Friday in clinic switching between working with Abilash and Andres. The goal had been to see enough patients and get enough practice so that I could see my own patients for 2 hours each morning. But, after seeing 3 TB, and 4 admits all on Wednesday, I came to the quick conclusion that I am no where ready enough to take HIV patients on my own (and I probably will never be this summer). The medicine these docs do is above anything I’ve worked with yet. To think that I could take some on my own was just plain silly. I could handle the well controlled HIV kids, no problem. But just to give you a short list of things I could not handle on my own:

1. Teenager with poor adherence and probably right knee septic arthritis. I have no idea how to tap a knee!
2. Poor adherence in an 8 yo complicated with new TB. Aside from being coughed on by a kid with TB, I have no clue how to order tests and medications for TB
3. teenager with gigantic anterior cervical lymph nodes (4x4cm easily). FNB later would be + for TB. TB in a lymph node? Yeah, no clue.
4. baby form my earlier blogs with proteus, salmonella, HIV and no HAART and about to die. This is even near impossible for experienced doctors, I just was happy to see this baby back two weeks later.

This list could go on forever, but I’ll spare you all the boredom. Long story short, I will continue to shadow every once and while, but focus on getting more computer cases done. I’ve also decided to join the phlebotomy lab and try to pic up some technique while I am here. Relatively speaking, I have very little time left here and I want to make sure that my work gets done on time.

Speaking of that, this blog marks the end of my first four weeks…They did pass quickly.

Also, I forgot to mention. We heard that we were getting a new roommate to replace Miryah on Sunday…more on that later.

6-23-09- Tuesday

I have mixed feelings about today. Right before I went to bed on Monday I heard news about the Red line metro. I can’t count the number of times I’ve been on the route, passing by Takoma on my way to Fort Totten. I can’t count the number of times I’ve ridden in the front car. I enjoyed the view out the front window. My heart goes out to all the victims and their families.

The actual day was stressful. I had to finish my first case by the end of the day. The media was the toughest part. Formatting huge pictures into a size that is easily down loadable is a pain using just powerpoint and Microsoft paint. Nevertheless, I got a product out to the reviewers and I should hear back from them sometime next week.

In the mean time, I start clinic tomorrow and hopefully will find a niche for the rest of my time here.

Although I have some sort of upper respiratory virus and I’ve felt kinda crummy, I went to go work out, returned home, ate, and then went to go play soccer with the Ohio University (there are about 20 of them working on various projects around the city. 2 of them are working in the COE) students and some locals. The court was a bit far away from where we lived, but the stars were amazing and there was a black out at home. So there wasn’t anything better to do. The court was concrete and well lit. My poor, hole ridden shoes didn’t like that much. But, it was a lot of fun and they invited us out again. They said they played every night, but we will see about that.

6-22-09-Monday

Getting back to work today was chaotic. I had a very long to do list that mostly was administrative. On top of that, I had to get the media for my first case completed and show the visiting undergrads how to take good photos.

Everything went smoothly until it was time to get the photos. I had to get pictures of a 4 year-old and his mother. There were no 4 year-olds in clinic today. So I went with the closest, and 8 year-old. There was only one after the undergrads got here so it was our only shot. The problem is, everyone knows everyone in Botswana. They are afraid that if they are recognized, everyone will know they have HIV. Thus, the mother denied consent. Back to square one.

I hope to have everything completed for case one by the time I leave work tomorrow. Especially because I start taking clinic hours on my own on Wednesday. Also, two new interns arrived from Ohio today. They are nice girls and joined us for lunch at main mall. We had Botswana food and enjoyed lunch.

When we got back, Ryan frantically pulled me aside and told me about the US soccer teams progress (which I already knew). But, he informed me that if they lose to Spain on Wednesday, then they will play for 3rd place on Sunday in South Africa. The stadium was only 3 hours away! One hour later, JW and I had purchased 10 tickets and we plan on going this Sunday. So much for this weekend being a boring weekend.

6-15 thru 21-09-Mon thru Sun

Ok, this post is for my third week here. I will keep it short because the trip to Chobe was insane. This week I did a ton of work and prepped most of my first case. Also, Ryan told me that I’ll be on my own in clinic starting next week. Scary, I will let you know how that goes. But more importantly, I networked with Mary in SA to get Elizabeth plane tickets to Bots and then China. So, if Mary gets the things done, ELIZABETH IS COMING TO BOTSWANA!!!!!!!!!!!!!!

Ok, fast forward to Friday.

Friday morning. We got Tshopo to take us to the Gabs airport and we took a 2 hour flight to Kasane, bots. We were picked up there by Chobe Safari Lodge. The lodge was amazing (see pictures). This was more of a tourist type place then Madikwe, but I didn’t mind. We sat and had a beer, waiting for the boat cruise.

The cruise was amazing. It was beautiful and the weather was perfect. We saw most of the big five and had drinks while doing it. After watching the sunset we returned to the lodge to clean up and get dinner. It was great, local food. Pap, Sam and Croc were my top three choices. We retired early, preparing for the big trip to vic falls in the morning.

At 7:45 we were picked up by Mike, an enthusiastic batswana, and he drove us through the Bots/Zimbabwe (zim) border. The desperate situation of Zim was immediately apparent. The roads were unfinished and the ferns climbed slowly into the road from both directions. The ~hour drive to the dying tourist town that hosted vic falls was made enjoyable by our combi-mates. A lawyer and an accountant from Botswana. They were full of questions for us. About the US, our time here. They were well spoken and extremely kind. I would later find out that the Lawyer also owns a popular grocery store all over Bots and the wife worked at a surgeon’s office. She also would end up inviting me to come see the place and work with the docs for a while.

Anyways, we started our day buying entry into vic falls (which was practically empty, another artifact of Zim’s poor economic state) and being persuaded into getting ponchos even though it was sunny and hot outside. The walked started with light mist, fantastic rainbows and amazing falling water. This soon changed. As we got closer and closer to the main falls, the mist got more dense and more dense. Half way down the path, it was fully raining, while the sun beamed over our backs. I was a bizarre and magical experience. This, of course, made the rainbows so much brighter. I’ve never seen anything like it.

Although the falls were by far the most beautiful thing I have ever seen, what I was about to do next toped all of it. The three of us, now soaked, made our way to the Zim/Zambia (zam) bridge. It represented a no-mans-land between the two countries, so we needed to get a special visa to get there. Our walk was shadowed closely by eager traders. People offering everything from wooden statues to copper bracelets. None of it was exciting merchandise, but it again emphasized how desperate people are in this area. Nonetheless, the people were kind, well spoken and seemed to enjoy our company (until we told them that we weren’t interested in what they were selling). A large group of them walked with us for the 15 min walk to the other side of the bridge. Let me just tell you, the view was amazing. It only intensified my excitement.

I was weighed and two numbers were written on my arm; my weight, and my jump position. I was #6. I walked to the middle of the bridge and the crew grabbed me immediately and began to suit me up. I was about to jump off the bridge into the Vic falls water below. I have never bungee jumped before, but between the encouraging (although planted to get sales) words from the locals and the see-through floor of the bridge, my adrenaline had never been so high.

The bungee safety consisted of two towels wrapped around each lower leg for comfort and one strap wrapped around them. This worried me a little, but I honestly was not thinking about it too much. After a small wait (due to camera problems) they walked me to the edge. I was looking down, to make sure I didn’t slip off. I could feel the grip of the kind Zambian behind me. He told me to look to the horizon, I did. I took a deep breath preparing to count my self down from 5 when behind me I heard 4..3..2. I took a quick breath and leaped as far as I could (made difficult due to the fact that my feet were tied together). The horizon disappeared as my body tilted head first towards the water 200 meters below. I know what it feels like to fly. Weightlessness combined with amazing speed and the atmosphere of vic falls produced a epinephrine high like none other. It felt endless, but it did end with a quick and painless jerk from the cord and a slow deceleration towards the water below.

The water was cold, I was close enough to feel that, but not close enough to touch it. The first rebound took me to the other side of the bridge, and also quite close to it. Another free fall and easy deceleration brought me rebounding back to the original side where I looked up and waved to where I thought the camera might be (above me). As I hung, upside down, oscillating below this wonderful bridge, I took in the view. The inverted view added to its foreignness. High ridges lined with green and its bottom (actually roof for me) filled with blue. It looked like an abstract art gallery where all the paintings were upside down. But for once in my life, I enjoyed this “art nouveau” as I waited for the guy to come get me.

He, eventually, collected me and brought me back up to the bridge. I then had a solo walk on the underside of the bridge to the other side, were I got out and was greeted by the locals. I was without words that the time, but I smiled and answered their questions using as few words as possible. I was letting my brain enjoy the moment.

I figured out how to get the video on YouTube:
http://www.youtube.com/watch?v=vzdFtn3AEWU

"Wiedermann Bungee Off of The Victoria Falls Bridge"

The rest of the day fails in comparison to this event, and to keep it as short as possible, I will just sum up the rest of the trip.

We returned home, relaxed, showered, enjoyed the sunset and had dinner. Impala was on the menu today. Not too good, but how many people have had impala? The next morning we woke at 5:45 for a game drive. It wasn’t the best one I’ve been on, but I enjoy every chance I get to see the animals. The trip home featured a 4 hour lay-over in Maun. It was in the middle of bots, situated between the Kalahari and the Delta. Being that airport security is non-existent, we toured the town, played cards, and just enjoyed life. I made a friend on the plane ride home. Marshall was the head of security for the national bank of Botswana. A very interesting Batswana man that was full of insight about life. I enjoyed our flight together. He offered to show us around and possibly even take me down to Madikwe. Tshopo was excited to see us again at the airport and he took us home, but not before claiming that he loved us and wanted to go to America with us. Oh, Tshopo, you are a good man.

Anyways, that is the end of possibly the best weekend in my life. And, as I have already claimed to my parents and Beth, this is the best time of my life.

6-13 and 14-09-Sat and Sun

Chapo, this is going to be a long one because this weekend was quite exciting. I’m a little tired now and I will be typing fast so forgive me for any errors.

Saturday started off with breakfast, packing and a call to good old Tshopo. He showed up 50mins later and we began out journey to South Africa (SA) at about 10am. After stopping for gas (which I paid for) we took the ~30min trip to the SA border. A quick check of the passports we drove across, checked passports again and then were in SA! 11km later we were at Madikwe Game Reserve. However, we were naïve to think that we had arrived at our destination, the Thakadu River Lodge. No, Tshopo would put his Toyota carrola to the test, for 2 hours through the dirt roads that transect Madikwe. We never toped 20 KMH, and often had to get out to allow his shallow chasse clear pointy rocks (although often none too successful). Finally at our destination, we upped our price of 600 Pula to 800Pula because we felt bad for him. He took it, but seemed none to pleased. He agreed to meet up the next day (at a point before the road got too bad) at 1pm. We all hoped he would be there.

The trip, which we expected to take 1 hour 30 mins, took 3 hours and, of course, we missed brunch. We had just enough time to enjoy the cocktails and warm towel they gave to us when we walked in and check out our “tents.” I say “tents” because these were like no other tents known to man. The size of a Gaborone house, the “tent” greeted us with a larger than life bed, open showers, bath tub and a fantastic deck warmed by the inviting sunlight (see pictures). I grabbed a scone and sat outside to read my book for the half hour we had before tea and our first game ride.

Tea, of course, was amazing. I wish we had that in America, life would be so much more stress free… Anyways, we met our guide, Ignatious. A 10 year vet. of the Madikwe Reserve characterized by disfiguring burn scars covering the left side of his face. However, his charm and warm candor distracted me from his apparent accident. We joined two native SA families and go on the iconic game jeep (although it was a Toyota). It was designed to be a 3 hour game drive.

About 30 mins into it, after admiring some Zebras, a very large male elephant stepped into view and proceeded with a purpose into the road. I suggest following along with the sequence of pictures I have posted because they help illustrate the story. Anyways, we followed him at a distance while he took notice of us but didn’t seem to care much. He charged up a steep hill with disregard for a “slow” sign. Just over the hill he had lead us to his watering hole with about a dozen relaxing elephants. I should mention that this whole time we were made quite aware of this elephants “musk.” He was ready to mate and slowly leaked urine to attack females. Apparently he can leak up to 200L/day. We thought this was the purpose of the watering hole, but after a quick drink and the other elephants scattering, he turns and seeks out the youngest female. She protested immediately with a loud roar (sounded much like those machines from War of the Worlds). Nevertheless, she urinated to allow him to sample her readiness to mate. Ignatious told us that if he mounted, he would surely break her back. Just as he was saying this, a large female charges in from behind our field of view. They charge surprisingly quietly and we didn’t notice her until it was too late. She trumpeted at the offending male which got his attention and allowed the young female to stomp away. Now, 2 yards away ( I have video and pics of this) the two large elephants were joined by at least two others and a staring contest ensued. The female stared at us and put her head down (a sign of we shouldn’t be here right now). Ignatious added to my adrenalin by saying very calmly “do not move at all.” We were now locked in the same staring contest, finally broken by the defecation of the original large male that distracted the angry female. Ignatious started the truck and fled (be it only about 10 meters) where we sat and watched the fight break up peacefully. The male left, alone.

Following that, we were happy to spot Zebras, Impala, warthogs, wildebeests and various other non-threatening animals. Right before we decided to take a break for tea and drinks, Ignatious spotted lion tracks. He followed them for a good 30 mins, but gave up as it was getting close to dark and we needed to stop before then. We settled in an open field, enjoyed beers, stories, and peeing in the open bush. We took pictures of the sunset and of ourselves and simply enjoyed the moment.

We packed it up as it got too dark to see two feet in front of oneself. The stars were amazing. I’ve been a lot of places around the world, but this was the best I’ve ever seen, hands down. Too bad you cant take a picture of it.

Anyways, we started the truck and left in the very cold blackness to try to find some nocturnal animals. 400 meters down the path our lights caught a confident and intimidating figure laying down in the middle of the road. It was a male lion. We stopped dead in our tracks, Ignatious smiles and states “he was tracking us.” Great, now this is two times we’ve gotten in the way of wild African animals. Again, look at the pics for the story. Anyways, they lion looked at us, stood up and walked into the think bush. Determined, Ignatious followed, using the lion as a guide. He lead us directly to his two sisters who were enjoying a freshly caught warthog. We settled 3 meters away from this feast and sat quietly, snapping pictures feverishly (I also have video of this if anyone wants to see it, it is far better than the pictures). As one of the sisters feasted into the belly, we could all enjoy the fresh intestine smell. Reminded me of Gross Lab. Now, next to the feast, the male sat playing politely with is sister (she seemed to be injured from the kill). To the crunching of bones these two rolled around. They looked like two cute house cats but, by no means would I dangle a feather from a string in front of them.

We left the sight shocked and amazed and returned home in the cold just 30 mins late for dinner. They had transformed the reception into a nicely decorated restaurant fit for the four course meal we were about to have. After a delicious meal we returned home to a transformed tent. Our beds were turned down with a SA mint on the pillow and electric blankets turned on. I showered, read my book and went to bed, ready for my 6am wake up call from Ignatious.

Following a bizarre night of JW talking in his sleep and Mefloquine induced vivid dreams, I wake at 6:30 to loud roars followed by a loud “JOSH”! I thought it was another dream, but no, it was Lisa out side my tent. We were going to be late for the morning game ride. JW and I rushed and made it just in time for us to leave. Ignatious informs us that the roaring was from the male lion we saw from last night, declaring his territory. So we rushed off to find him. I feel like this is a stupid thing to do. The lion is saying , “this is my land, don’t come in it” and here we are rushing to it. But, no luck. A few chases into the bush turned up nothing, not even tracks. We eventually stopped for morning tea and coffee, took pictures and peed in the open bush.

However, our random darting but us into fresh territory and we were soon surrounded by dozens of Zebra, wildebeests and Giraffes. They are really amazing to see up close. And to see them interacting with Zebra but the one lone Giraffe at the DC zoo to shame. It was a majestic feeling. To be the smallest animal in sight, we just as curious as them, staring at one another. I was at my happiest here. The Giraffe just seem so happy to be alive. And to be close enough to see they long path food had to travel was interesting. How did such a ridiculous animal survive evolution? Ignatious was a wealth of knowledge and I enjoyed his scientific take on each animal.

Our morning ended with a long drive to find wild dogs. We traveled an hour away (still all in the reserve) to see them. This was apparently the rarest sight in the bush. We fond them relaxing, occasionally raising their head to sample the sounds of interested humans. This hour drive brought us in late for brunch, the cook even yelled at Ignatious over the radio. Ignatious bravely got us home by parking the truck somewhere out in the bush, getting out, and leading us as we walked the shortcut along the river (apparently filled with crocs and hippos) to the lodge.

Brunch was delicious and filling. We said out byes, settled the bill and left to meet Tshopo in the designated area. As we pulled up, he was there. Good old Tshopo. His loyalty is comforting. The drive home was pleasant and 1.5 hours shorter.

When arriving home, I showered and JW and I went to the internet café at Riverwalk. I caught up with family and friends, spoke with my grandma, Monu, and at dinner. Returning home to the others, we played a quick couple games of rummy until Elizabeth (and her dad) called. Following a quick talk with him she hung up and I sat down to write this. But not its bed time. Sorry this is so long, but hope you enjoyed!

6-12-09-Friday

So I guess I have officially made it through two work weeks. It seems like I’ve been here forever, but at the same time, I feel like time has passed quickly.

This morning I did laundry and, because we don’t have a dryer, hung it up outside. The only problem being, the sun didn’t come out till 3pm. So, my clothes remain wet and on the floor here under the space heater. I really hope the weather returns to what is was last week.

Especially so because we leave for South Africa tomorrow morning at about 9:30am. We booked a trip to a lodge down there that has us staying in a tent for one night. I mentioned this in another blog. We will have one afternoon game drive and one early morning game drive, all the while enjoying the area around the camp. We should return sometime around 2-3pm on Sunday. I do not think my phone will work in SA, but I’m going to bring it anyways. I’m realizing now that no one will read this until Monday, so never mind.

Today was a normal work day except that we got 3 new undergrads that are coming to volunteer with us for about 3 hours a week. Ryan asked me to organize the meeting and to organize tasks for them to do while they were here. Now, officially, I am the visiting scholar representative; in charge of our crew. There are about 12 of us now that the other three undergrads showed up. Anyways, when I listed off the possible tasks, which included anything from filing to clinical research, all three jumped immediately to my project. I need help finding media and some good clinical cases for my development. So, I put together a list of things I needed. They love it and the idea of designing cases. It made me feel special to see that my idea seemed entertaining enough to undergrads.

Speaking of my project, I’m about 1/5 done with my first case. The limiting factor being the design of this “perfectly” controlled HIV kid. Making his labs match his adherence to match his health is a tough job, but I am enjoying every second of it.

We spent the night going to Riverwalk to book our trip to Vic falls (next week; yay), dinner, and a movie. I saw terminator 4. It was OK. But the movie was about $4, so whatever.

Anyways, I better get to be because I have to get up semi early. Boroko (goodnight in setswana)

6-11-09- Thursday

Today was pretty cool. My trip to Thamaga began a little later than planned (about 7:30am) as, of course, we are on Africa time here. It was only about an hour out of Gaberone but, indeed, in the middle of no where. It was tiny hospital with about 3-4 doctors and 1-2 MOs and a bunch of nurses. The COE visits them about once a month, so, the hospital schedules all their difficult pediatric HIV patients for that day. The docs from the COE (Norma today) would come in and show the MOs and nurses and doctors how to treat these patients. What I should mention is that there are no pediatricians and the MOs only have general training. So when it comes to peds HIV cases, they are mostly very lost.

When we first arrived they were having their weekly lecture on adherence of all topics. The patients calmly waited outside. It was in this tiny tiny room (or atleast it seemed that way with the entire hospital staff in there) with one computer and an old projector pointed to the largest wall. It was still a small screen but no one seemed to mind. The doctor, dressed in a pretty fancy suit, gave the talk in a think setswana accent.

After the lecture we went to the ID ward where we will see out pediatric patients (just a tine room with one bed and one computer). They told us that there will be 14 patients. We had to leave by 1 to get back in time for Norma to give her advanced pediatric HIV lecture at the COE. It was going to be tight. To speed things along, Norma had me bring in the patient and start the interview and physical exam while she reviewed the chart. I’m pretty good at the specialized HIV focused exams now. Its basically a quick head to toe to develop a list of possible OI or complicating abnormalities. I have gotten this down to about 5mins per patient.

After the PE is done and I chart the findings, Norma and I discuss the plan. Believe it or not, these “difficult” patients had better adherence and better health than the ones we see at the COE. So most cases were dosing issues, simple enough. On my physical exams I found some things I’ve never seen before. Kwashiorkor, irregular regular heartbeat, Tinea Capatis (lots of this actually; also got a picture of some online) and a couple enlarged livers (one probably due to a mother giving too much medication to “get her son better faster”). Also, the General Lymphadenopathies on these children is always extensive, even if their virus is well controlled. It is a good lesson for me because I was never sure if I felt them on the bodies of patients back in the states. Now I know exactly what it feels, looks and moves like.

The entire experience was very cool and the hospital seemed to enjoy us being there. They asked a lot of questions and generally seemed in good spirits. We bonded well with them and it was hard to leave.

When I got back to the COE, at about 2:20pm, I rushed to get her lecture printed and photocopied and then sat down to get my life organized again. That’s when Mariyah told me that our trip to SA this weekend was a go and we had to fax all our payment info over to them. One problem, it didn’t work. So we left for the night not knowing if out tents were still reserved for us. Mariyah will e-mail them this morning; hopefully this will all work out.

I finished the day going to the gym, eating dinner, and watching no country for old men. What a weird movie. Goodnight!

6-10-09- Wednesday

The tenth. I’ve been here 11 days now. I have to admit, I’ve had my ups and downs of happiness being here, but today was a good day. This morning started, again, with a ton of rain. People here say it never rains in the winter, but it has rained for 3 days strait now. I’m getting a little tired of it.

I was supposed to follow Dr. Mullan around today in the COE clinic but he is leaving next week and was busy doing some paper work stuff. However, this gave me a great opportunity to get running on my Case-based project. As I said yesterday, its very hard to author these things. The network is slow and concepts are difficult. But so far so good, its just going to take we a while to do it.

Ryan tells me that there are 3 undergrads coming in to volunteer for about 3 hours a week. He gave me first picking at them to help me with my project. So far, the only thing I could think of was getting them to search for that ideal 4 year old to take pictures of and possibly to get some details for the case.

Anyways, a long day at work ended with a little excitement. 1) we decided to go a head with our trip to South Africa for this weekend! We would leave sat. morning and travel about 2 hours (no clue how we are getting there) to a game reserve near the border. We will stay there for one night (in a tent; but a pretty nice tent) go on one night safari and one morning safari, eat 3 meals and return Sunday before dark (hopefully). All this for about 1500 rand a person (~$200). Really not too bad. This trip may end up taking the place of the Victoria falls trip because that one costs over $1000 per person. Oh well. 2) I decided to go to the gym even though it was still raining. The run there wasn’t bad and it felt good to work out, but the run back was cold, it was getting dark and the traffic was heavy. I found myself getting home much faster than I normally do. But besides being very cold and wet, I was happy to be running my familiar path. Happy to see the familiar school children who still stare at me as I run by (they probably think all white people are stupid enough to run in the rain). Happy to be somewhere new.

I remember my Outward bound trip. I hated my time there (most of it) because it was hard work and there were little familiar comforts. But, I look back on that experience now with nothing but admiration. I learned a lot from those hard times and I plan to learn even more from these.

Tomorrow is Thamaga out-reach. I have no clue what to expect.

6-9-09- Tuesday

Today started off rough (as you could have read from Monday’s entry). “It never rains in the winter Doctor.” This was what one of the children told me at clinic Monday morning after I asked him if it were going to rain. They call me doctor to eliminate confusion. It’s a little weird, but I can get used to it. So, anyways, it rained all night and heavily into the morning, stopping shortly after we got to clinic, of course.

I started off the morning with Norma, the same doc I was with yesterday. I was to stay with her until the African intern came in, then I would leave to get back to my project. For the two hours I was there we focused on one child. A 16 month old that had recently been tested HIV+ but has been continually hospitalized for various vicious opportunistic infections. She seemed to have the entire taxonomy of life in her frail little body. She had salmonellae in her stool, protozoa in her blood, fungi in her lacerating diaper rash, thrush in her mouth and throat and worst off all, she would not respond to my actions. I would call for her and she wouldn’t move her head, I would move my hands and she wouldn’t watch. This kid was being attacked from all angles and it was most evident in her cry. An almost inaudible wail, too gentle to signal distress, too lethargic to elicit parental response. This child, who hasn’t even had the chance to get on HAART (because of the many OIs), that would spare her from HIV, is dying. Norma left the clinic, marched to the PMH (Princess Marina Hospital; which is right next door) and demanded immediate treatment. Norma impressed me today. I only hope I could be as whole-hearted as she is. I will check on the little one tomorrow.

After a heavy morning, I transitioned to my real project and started authoring. The idea is simple, but the process is complicated. Throughout the afternoon, I was able to partially complete 2 of 27 pages. This may take me longer than I expected. It doesn’t help that the internet is incredibly slow.

The afternoon ended suddenly with a going away meeting for 3 of the PAC docs. Listening to the respect they gathered from the COE and the accomplishments they have made while here for such a short time belittles my tiny struggle in medical school. All three are clearly great doctors and are good at treating patients. But even more, they are great people for what they have given up to better the lives of children in Botswana. These people all deserve much more then they receive.

The night ended with an egg and cheese sandwich for dinner (a tribute to Beth) and movie night with the roommates. I felt safe and comfortable with the 4 of us all sitting on one 3-person couch, laughing together at a ridiculous movie playing on a tiny MAC screen. I know this is going to be a long and difficult summer, but at least I know I will be completing it, as Beth reminded me, surrounded by especially good people. Goodnight.

6-8-09-Monday

Well, I thought I wasn’t going to write a blog for Monday, but the rain that started as we just got home from shopping has not stopped nor slowed down. As we do not have a car and we are all dressed in business clothes, we sit here waiting for the BIPAI driver to get to work and then pick us up. So, although I will get to clinic a couple mins late this morning, it gives me a chance to write about my first experience in clinic.

I was nervous. I know that the attending docs know I’m just a medical student, but there is little time for slowing down to teach. We start seeing patients at 8:00am sharp and see them until there are no more to see. No lunch, no break. It is a very intense way to practice, but seemingly the most effective because the people who come to our clinic travel from all over and none have cars. It is simply unreasonable to expect them to uphold an appointment time. So, we give them a day to come and most show up on that day.

I was with Dr. Norma Perez. An American trained doctor and a very kind woman. She was one of the most experienced doctors there having already completed her fellowship in Peds ID. Anyways, she walks through the procedure with the first kid, a child that has HIV, but is well controlled. A little talking, touching, typing in the computer and child is gone.

Next, Norma wrote down a list of 6 things.

1. Interview
2. PE
3. Staging
4. Dosing
5. Labs
6. Plan

This was for me. The room was now essentially mine (with her watching over me) and I was to talk to the family to uncover any problems with the child’s health or medication adherence, do the physical exam (which was a very focused and quick head to toe making a tally of all the problems), figure out the World Health Organization’s Clinical Stage of each child (which is important for giving medications and other organizational things), figure out if, according to weight, the child was on the correct medication, order Viral Load, CD4 counts, FBCs, Cholesterol, or a resistance assay as needed (this was the most difficult part because most of these are judgment calls). Finally, the plan. This is the hardest and I had no clue how to plan an HIV treatment, but this is where Norma stepped in. She would basically do this part (especially because 90% of our patients on Monday were failing 2nd line; which means that they have developed so many mutations that they are resistant to the drugs and now have only one shot to stay alive; poor adherence leading to a couple more mutations would lead to a 100% resistance strain and certain death).

We had many difficult patients, like I said. It ranged from poor care of a 24mo to a teenager rebelling against HIV but all the problems were from the same cause. Poor adherence.

It is shocking to see this things play out right in front of you. A 14yo with extensive HPV, a baby with oral thrush, a 15 yo with 4+ tonsils, everyone with carries and worst of all, everyone is wasting away. Every failing case we saw (again ~90%) were below 10 percentile of the normal height and weight. This type of severe wasting qualifies them as stage VI (worst stage) in the WHO. These kids, without intervention, will be eaten alive by an opportunistic infections.

But, really, enough on that. I’m sure I will have many more clinical stories to tell. I will be in clinic today (Tuesday) and then hopefully get some work done on my project in the afternoon.

6-7-09-Sunday

THERE ARE 3 NEW POSTS TODAY (WEEKEND) PLUS SOME NEW PHOTOS

Today started with a trip to Mokolodi Nature Reserve. We scheduled a 10:30am guided tour. The trip brought us again past Kgale hill, which we had just climbed yesterday. However, we are doing so much each day that time seems to be dragging on here. Although I am having a lot of fun, I have a feeling that this is going to be a very long summer.

The reserve was very cool; we saw elephants, rhinos, gazelle, impala, and a lot more (see pictures). It trip was especially authenticated by the truck getting a flat tire just after the rhino’s crossed the street. We all sat while our guide said he would be back in 5 mins. About 20 mins after darting off into the bush, he arrives down the path with a new bus to rescue us. The rest of the trip proceeded smoothly.

We spent the evening at a going away BBQ, in the dark, at the Baylor 3 house. Which is much nicer then our place. It got me thinking; theres got to be a way to set up internet at our place at Baylor 1.

So my day tomorrow will include: clinic till 2ish, work till 4ish, and then organizing our traveling and hopefully finding a solution to this internet problem. We’ll see how it goes!

6-6-09-Saturday

Our first weekend! I slept into about 9 and woke up ready to go climb a mt. Kgale. This was on the other side of the city near a fantastic mall called Game City. To get there we had to trek through the “slums” of Gaborone. It was amazing to see how there homes and villages were built. Small mud homes with sheets of thin metal held down with rocks for a roof. Many groups of children played soccer near the street where the dirt was plentiful. As we drove by, I couldn’t help but want to get and play soccer with them, but I had a feeling that a white person would not be too accepted. A couple km away sits a long strip mall featuring a brand new KFC hosting a large dance-off for free chicken. But we would return to this site later.

We met up with Stu who got a ride from his cousin and we made our way about a half km to the trail head. The trail was scarcely labeled and filled with rocks. We made our way to the top (taking about an hour and a half) where the views of Bots took my breath away (see pics). Also greeting us at the top was a religious cult of some sort and a sign reminding me of how far away I am from home and how far away Elizabeth will be when she leaves for China. It was a sad reminder, but the spirit of the air and sceneries helped me not think about it. Overall it was a fantastic and challenging hike. We plan to go back again some day.

On the way back we stopped by the mall to pick me up a cell phone. Now I can call home for about 7 pula/min and locally for about 1pula/min. And best of all, I can receive calls 100% free!! So, anyone at home, feel free to call me at anytime: +26772720542.

This trip took us so long that I missed my date for the News Café that promised us free internet if we ordered something. After about a mile’s walk there, JW and I found ourselves fresh out of luck. The girls joined us shortly after. They took the taxi driven by Tshopo, the cabbie we met our first day here. When he got here, he asked the girls if he could speak to me. I was certainly confused, but went to talk to him anyways. Turns out he was able to find tickets to the Zebra’s game that was today (The national soccer team). I was shocked. I know he was just trying to make money, but he went way out of his way to do it and I appreciated that. After we ate, we walked home (I called Elizabeth on the way to test the phone out and to say Hi). I showered and then called the Tshopo to take us to The Riverwalk (where there was another internet café). Tshopo, in another act of friendship took 10pula off his fare (making it only cost 20pula to get to Riverwalk (~$3.50)). As we got out of the cab he gave me the handshake of a friend (which is very similar to the handshake I used to do in high school, just repeated; hard to explain). I gave him an extra 20pula (100% tip) for his good nature and for thinking about the soccer match for me. He called me his brother. I think it will become important to have a Gaborone friend in the next two months.

This café worked and I was able to finally skype home which was a huge weight off my back. I relaxed, sipping Bots coffee and enjoyed the open air coffee shop. We decided to return home to save money and ordered pizza from the famous Debonairs’. We shall see if it lives up to its fame…. Ironically, as I was writing this they showed up. Wrong order, he had to go back. Maybe we will never know how good it is :(.

Also, starting this week I will be in clinic every morning so I do not have time to play around with the blog. I will try to fit in everything exciting, but I apologize if the frequency declines. Also, I never edit these things and I know there are a lot of mistakes. Sorry.

6-5-09-Friday

Friday was a good day. I got to the clinic early and the crowd (which was larger than normal today) was asked if I could take pictures. As long as it didn’t get on television some of them replied. I assured them of that and the ceremonies began. Ii took a couple pictures here and there which are now posted above.

The day, once again, was frantic. I assigned the undergrads what do to help me, finished organizing the South African curriculum and drafted by fist case outline titled: “8-year-old 3 month check up.” It focuses around a child that had been diagnosed with HIV at age 3 and has been on HAART for 5 years, he is well controlled and has only an ear infection to complain about. I will start authoring it on Tuesday following feedback from Ryan and Grace (training coordinator). Speaking of next week, I am spending by first 3 days in the COE clinic. I have no idea what to expect. And one day out in Thamaga (the-ma-ha), an out-reach clinic. I, again, have no clue what to expect.

The day ended smoothly with a birthday party celebration with signing and dancing and a lot of yelling (see pics). The women do this weird thing with their tongue when they yell and its going to take some getting used to. Pictures are up from that as well.

I went to the gym and returned home to go on our first night out! We took a cab to the local mall, Riverwalk, and went to an Italian restaurant called PRIMI (see pictures). Food was great, drinks were great and the company was even better. We ended our night (at about 9:30 mind you) at a bar/restaurant next door. Here was out night of spending:

PRIMI:
Bruchetta
Large Pizza
Large Pasta
6 Beers
2 Very Large blue drinks (Jam Jars)
Total: P370 = ~$60 (for four people, that’s pretty good)

At the other Bar:
14 shooters (they are small mom, don’t worry)
Picaso (6 different shooters around a bin of tang; drink with straw) see pictures
One Pizza
Total: P170

Over all impression; I like this place.

6-4-09-Thursday

Today started off beautifully: I got to the clinic at 7am, in time to catch the prayer ceremony from start to finish. It seems like only the receptionist (nick-named KG because it is way too hard to pronounce his name) come this early and begins only with the help of one other staff member. Anyways, they are speaking in setswana so I have no clue what they are saying, but about 5 minutes into it, the head Mma asks me to come forward. She introduces me to the group and I seem to get the adoring smiles of the children and mothers who woke up at who knows what time just to come to clinic. She asked if I wanted to address the group and I did. I spoke slowly and clearly; I said hello to all in setswana and asked how they all were this morning in English. They all smiled and gave their respective replies. I get no where near this level of attention in the states, it was a nice feeling. I proceeded to tell then that I was glad they were all here and that I hope their lives are treating them well and that I hope to see all of them again. They all smiled, and clapped for me. The head Mma repeated what I said in setswana followed by another round of praise. The head Mma turned to me and said “thank you my brother, those were kind words”

I know I am the minority in Botswana and I know that there is racism against whites, but I felt accepted by this micro population and that made me feel welcomed into their lives. This was one of the most heart warming experiences I have ever had and I will remember it forever. I plan to go tomorrow and ask the group if I could take pictures. The morning prayers progressed with song (surprisingly harmonized) and dance.

Then it was off to work for me. First task; scholar’s meeting. I met with Ryan (associate director; PAC doc from the states), Lindsay (clinical psychologist and a local), Lisa (roommate; PhD in pharm), JW (roommate and junior at Georgetown), Stu (sophomore at Mich. St.) and Dr. Dwight (education coordinator and Advanced HIV lecturer).

All small tasks that the COE needed to get done were handed out (even I got to delegate some of my project to the undergrads ). When it was all done, Dwight announces that he is leaving and he needs me to take over the education coordination. I said OK not knowing what I was getting into. I now am in charge of making sure the Advanced HIV curriculum (given to Medical Officers (equivalents of 1st year of residency in Bots) and Bots MDs) gets taught every Tues and Thurs; that everyone gets a copy of the lecture; and I have to make exams for each lecture. It turns out that Bots doctors are not well versed in molecular biology and, as a first year medical student grad, I should be. On top of this, I am coordinating the normal HIV curriculum for my case-based lectures as well as converting it into a new version for South Africa to use. Once I am done, Ryan is personally flying the hard copy down there to them.

Needless to say, I am swamped with work and by tomorrow, I have to present my outline for the first case. My schedule is full of work and I love it!

Has lunch at the hospital Caf and learned that soda is called “fizzy”

I left work after the Advanced lecture on Antiretroviral Treatment Failures (which is very interesting) and ran to the gym. The street’s air was pleasantly saturated with the smell of burring wood today. Much better than the exhaust fumes.

I returned home, ate diner and got back to work.

I’ll close with a quote I noticed at the gym today:
“Sports look past all ethnicity, race, color and gender to bring people together to compete. Bodybuilding is important for nation building.”

6-3-09- Wednesday

I decided to write these things at night now because it is kinda confusing to talk about the past couple days when it was really today. Anyways…


Today, Wednesday, I made it to work in time for morning prayers, which is a lot like one of those really enthusiastic churches you often see on TV or movies. A lot of signing and dancing. The whole clinic was involved! Walking in, hearing our thin quiet male receptionist singing beautifully to the participating crowd, all the while know that ever person in this room either has one of the most deadly viruses known to man, or has a loved one who has it. Nevertheless, the spirits of everyone in that room easily produced a smile on my face. A vision of human nature at its best. I hope to get in tomorrow even earlier to hear the whole thing.

I took a walk today to this small local market that is just on the outside of the hospital’s gates. They sell everything from oranges to “orange cards” which is the local cell phone company’s calling cards. Most phones here are pay-as-you-go. I said hello in setswana (it seems like they really appreciate the effort to speak their language; so I’m trying to learn it, although slowly) to one of the ladies at the market and asked if I could take her picture. She said yes, and I did. After saying thank you and bye, a nurse, dressed in their militarily like clothing (it helps people know what the nurses have been trained it) told me that I should not have taken a picture of her wrinkly old face. I told her she was ridiculous and we talked for a bit. She was extremely candid and opened up to me about how one of her fellow nurses became sick and was now her patient. I sympathized and then parted way wishing my best to the fallen nurse.

The day ended early enough for me to run the 2 miles down to the “village” where my new gym, “active gym” is located. The area is surrounded by Botswana culture, great smells, red dirt, children walking home from school, honking horns and many open markets (although no cows today curiously). I know I am going to enjoy running to the gym everyday, even if I am the only white person in it. It is a very nice gym, and for at least personal sanity’s sake, it was worth every penny.

The jog home was tough, 2 miles up hill. I stopped briefly to catch my breath and to watch some local soccer. Rats, they already had two goalies…

It was back home where Mariyah cooked myself and JW some curry chicken. Which was great. I did the dishes and sat down to do some work. So I leave you tonight to do more work and then my nightly chess game while sipping on some wine…you know, I think I’m finally starting to feel happy here.

6/2/09-Tuesday

AS YOU CAN SEE, PICTURES ARE NOW UP. THE LINK IS ON THE TOP OF THE BLOG.

Right now I only have pictures of the Center of Excellence (COE) and of my house. So bare with me on that.

I’m not sure how often I’ll write in this once things start to pick up at the clinic and hospital, but we’ll see.

Tuesday was probably the picture of any normal day, I got up (in 0C weather mind you) showered, dressed and took the short walk to the clinic. This was to be my organization day (make 3 month schedule, learning objective, blog, etc.). So I did that, and if all things work out well, I will be in the HIV clinic for 3 days a week alternating with the Pediatric Ward of the Princess Marina Hospital 3 days a week which is literally in the COE’s back yard. Ryan tells me that I may be of some use to both places. We’ll see how that goes. I also scheduled in a once a week In/Out-Reach trips. In-Reach, I will follow a nurse to one of the local homes in Gaberone to check up on our clients. Out-Reach, I will spend an entire day traveling to distant places in Botswana and visiting other hospitals and clinic to help out for the day.

The way our HIV clinic works is on a first come first serve basis. Patients show up at 6-7 in the morning and then doctors start seeing them at 8am until they finish; which has been around 1pm the past two days. So, with my afternoons, I will work on my Computer Based Project.

For lunch I went to the local “caf” in the hospital and had two native dishes. Ox tail and something called “pap.” It’s a bizarre twist on mashed potatoes, a denser but fluffier version. I have no clue what its made of but it wasn’t bad and filled me up in a couple of bites.

I left the office around 5pm and went home determined to find this place called “gym active.” So, I put my running shoes on and went for it. JW came with me, although he had some trouble keeping up with the pace. He was probably still jet lagged. Anyways, about two miles later I found it! It was contained in a run down “strip mall” surrounded with barbed wire (similar to our humble home) But inside the gym was nice! And for about P300 ($50) a month I can be a member. I plan to go Wednesday afternoon to get it.

Anyways, the run home was nice and I finally felt like I was in Africa. Running past cars and people of all types and sizes (and an occasional cow or two or three), I knew I stood out. Everyone looked at us as we ran past, but it didn’t matter. Running through the dirt paths and poorly lit streets (as the sun was now setting) I could see a soccer team still practicing just out side the national soccer stadium where the Zebras play.

Night time was normal and boring, but just as we went to bed, the power shut off (apparently a common occurrence in Gaberone). So bed time it was, if we liked it or not, as I drifted away in the dim candle light.

My First Three Days (5/30-6/2)

After a sad farewell from my parents and my beautiful girlfriend, Elizabeth, I started my 22 hour trip to Gaberone, Botswana. After a quick flight from Washington to New York, I boarded the large international flight to South Africa. A "quick and painless" non-stop 14.5 hour flight to South Africa pass unexpectedly quickly. I was luck enough to sit next to a young, spirited and inspirational South African native. Antje spoke emotionally and playfully about her life story (at least a small part of it). I learned about her large family, her love life and most of all, her desire to travel...everywhere. I will always remember her, however, because of her cut on her hand that left her entire blouse bloodied from sleeping. The entire front of the shirt was dotted and stained with blood. However, she was able to clean it all off with ease. Which, I'm sure, spared her family from certain shock. Antje currently works in New York for a transportation company and she was on her way to South Africa to visit family and to babysit a package. My general excitement of meeting her and enjoying life kept me awake. And somehow I managed to not get a minute of sleep on that long flight. I was sad to depart from her, as she put my anxiety of going into the unknown at ease, but we parted ways as I headed to a different international flight, now on my way to Gaberone.

It was in the South African airport (at 8am local time; 2am DC time) that I got my first taste of the relaxed African mentality. I sad half asleep for hours waiting for the "delayed" sign to remove itself from the Gaberone flight. When it finally did, and I finally boarded the plane i slept like a baby. Although the turbulent flight often woke me, I was happy to get some shut eye.

I arrived in Gaberone an hour later (3pm), got my bags, went through customs, exchanged money (5.6 pula for $1; not a good exchange rate apparently) and saw my name on the taxis sign. I took my short ride, paying 70 pula to the local Hotel (Gabs Sun). Ryan (Dr. Phelps) picks me up and drove me across the street to my home (Baylor 1). This neighborhood seems to be nice, with large white homes. However, our place is a 3Br/1Bath with a giant yard, great flowers and other plants. A wall surrounds the property and an electric fence tops that. This is a scary sight to see, but everything I've experienced so far has been pleasant.

Meeting me at Baylor 1 was Marihya (I will check the spelling soon), a pediatric resident here for a month's rotation. She is kind and has a fantastic heart. She is here primarily to help and it is great to see that in a doctor. Later that night arrived our 3rd roommate, Lisa. A PhD in Pharmacology, here to see what ever she can see in the clinic and surrounding hospital. We all settled down in our respective rooms for the night.

After a very ineasy and anxiety ridden "sleep" I woke at 6am to get my self ready for the first day at Botswana-Baylor Chlidren's Clinical Center of Excellence (COE). Following a little ironing and oatmeal I made the 5 min walk through the paved street neighborhood and one dirt alley to Clinic. The COE is beyond fantastic. Designed by American engineers, but built by Botswanan, the building is a picture of beauty and excellence. When I opened the front door I was eyed by nearly a hundred patiently waiting families with sick children all waiting to be seen by the Doctor. Patients (called "clients" here) are given a day to come to clinic, but arrive on a first-come-first-serve basis. Doctors work non-stop to move patients in a well designed flow and complete the day anywhere between 12-4pm without stopping for lunch.

I took the day to organize my ideas and plan out my summer. I ate lunch at home and then left the clinic around 3pm to make my way to the local mall (RiverWalk). We got groceries and ate dinner there. On returning home we met our fourth roommate, JW, a rising junior at Georgetown looking to learn a lot. After a better night of sleep, I awoke this morning and made my way to the clinic, presented my plan to Ryan and got the go ahead to start chugging. I also plan to do a lot of clinical events, but more on that later. So, This is where I end for the day, on my way to get work done during my first week in Gaberone, Botswana! I plan to figure out how to post pictures in the near future.