Final Blog

This is it, the last journal entry for my extended summer in Gaborone, Botswana. I must admit, I should take this time to reflect on my time here, but that would make a ridiculously long entry. Plus, I need to talk about what I did during my last two weeks here! So I will simplify my reflection to this: This has been the most amazing experience in my life. Made most special with a visit from my beautiful girlfriend and also a visit from my parents who took me on a fabulous vacation (which you are about to hear about).

I last left this blog in a pretty poor mood. Let me correct that. My first two days back to Gaborone was a bit anxiety ridden, true, but I was able to get a lot of work done and my parents arrived only 3 nights latter. So, all-in-all it really wasn’t too bad. Although I returned to a house without JW and Lisa, which was very sad, I was greeted by Mitul and Nisha, a married couple from the states. Mitul is a medpeds resident entering his 4th year and Nisha is a high school English and Spanish teacher. They got married on July 4th and have been spending their honeymoon in Africa ever since. They are a fantastic couple and they made my transition back to Africa very easy.

I greeted my parents at the airport on Friday night and escorted them back to the Gabs Sun, had a couple drinks, and left them to get some rest. It was, oddly, raining in Gabs, so Saturday was an especially lazy day, filled with football, good food and good parents. We ate dinner that night at the hotel restaurant, which was very nice. Sunday, we climbed Kgale hill (which I plan to do tomorrow; my last day here) and once again relaxed at the hotel. It was very nice just to sit and relax with them. Its something I really haven’t done since high school. Monday, they joined me at the clinic and went on rounds at the hospital. Tuesday, we left for Kasane.

We spent three nights in a lodge on the far west side of Chobe national park, called Muchenje. This small 8 thatched hut lodge was magical. By far, the best place I had yet visited. We enjoyed two nights there in ultimate, blissful happiness. Days were spent roaming the huge herds of buffalo, elephant and zebra (as well as watching a baby leopard stalk a warthog; he was cute, but unsuccessful). Night were spent with the company of the English, Australian and Kiwi. Bottles of Amarula and cartons of Chobuku birthed conversation of sports, life, and any other guy talk you can think of. By the end, besides a hang-over, I gained the understanding of cricket and rugby and a few new friends. I left Chobe an educated man, excited for the Okavango delta.

Returning to the Kasane airport led us to a small, 6-person Cessna airplane. A one and a half hour flight in the co-pilot seat of this plane left my mother grabbing for the barf bag (sorry mom) and left me in awe. We flew low enough to not only catch the turbulent hot air, but also to watch large animals move slowly through the self-made criss-crossing “roads”. A semi-smooth landing on a dirt runway in the middle of the delta marked our arrival at Kanana (paradise in setswana).

I’m going to unfortunately end my last entry here. It has been a couple weeks since I wrote this and I don’t think I’m going to have the time to finish. Thank you to all who have kept up with my adventures and e-mail me or call me if you more details or stories on any of this.

Josh.wiedermann@gmail.com

7-15 thru 7-29-09 Wed-Wed

OK, so I bet some of you have been wondering why I stopped writing in my blog a couple weeks ago. On Thursday night, while Elizabeth was still in Africa with me, I got an e-mail from her grandmother. She needed me to arrange for Elizabeth to call home. Out of respect for Elizabeth’s family, I will not go into the details, but we both had to leave for the United states as soon as we could get a flight out.

Unfortunately, the first flight out that we could both get on was on Sunday. So we just said, forget it, and went to South Africa for our weekend in Madikwe despite the current situation. Which, I was very happy about, because I already had paid for it and I had been looking forward to it for a long time. After getting about 3 hours of sleep, I got up Friday morning, walked to clinic and arranged for flights home on Sunday. I then came home to wake Elizabeth and called Tshopo to take us to Madikwe. He changed me 400 pula, I got him down to 350, but it was still too much in my opinion. But I didn’t want to argue with him, I just wanted the rest of the trip to go smoothly.

Lucky for us, the Buffalo Ridge lodge was beautiful. Breathtaking, really (BTW, Elizabeth has all the pictures of this, I will try to get them from her as soon as I can). Our room was number 7 (out of 8). It was a thatched hut complete with gigantic bed, sun deck (that faced Buffalo Ridge) and a shower that opened up to the bush. It was exactly what we needed. We spent the three days there soaking in the beauty and simply enjoying the comfort. The food was fantastic, the company even better and the game sightings, amazing.

Elizabeth befriended a South African couple who had clearly been on many safaris. They walked Elizabeth through each sighting and even helped her draft a list of everything she had seen (which was quite a bit).

Our fantastic trip was toped by two wonderful events. On our last game ride we made it our goal to find Elizabeth some warthogs. And that we did! But, just as Elizabeth was snapping the picture, an orange figure streaked across the road in hot pursuit of the hog. It was the rarest of rare. A leopard. We all gasped, including our ranger. Before we could get out of our state of shock, the hog comes leaping out of the bush back onto the road. He stares at us, with the look of “what the hell was that” and cautiously jogs to the other side of the road. Our ranger tells us to sit down and be quiet. He turns on the jeep and pulls forward. We find the leopard laying, panting just a couple yards off the path. He eyes us, and stands up to walk away. Our guide calls it in as we go off-road to track his shameful retreat into the think bush. Within minutes, 3 other jeeps arrive asking our guide permission to come see the leopard. After a few more minutes of tracking, we leave, allowing the others to see the prize.

The second event occurred just after a great dinner. We had combined all of our tables to have a large meal with all the six people on our game drive. We returned to thatched lodge to find it light gently with a half dozen candles lining the floor. Our bed nicely turned down lined with rose petals and a large snack bowl found just behind the bed. Before we could really enjoy the scene, Elizabeth had knocked over two of the candles, one of course, spilling hot wax all over my shoe and pant leg.

Needless to say, it was an amazing trip to South Africa and suitable, although sudden ending to Elizabeth’s visit.

The flight home was full of anxiety and broken entertainment systems. However, traveling with Elizabeth by my side made all the difference. I was content and I even was able to get some shut eye on the leg following our stop in Dakar, Senegal.

The week following would be trying to both of our will powers, but we both agree that we have immerged stronger than ever. Once again, sorry for the lack of details. The upside of the week, however, is that I was able to meet just about all of Elizabeth’s family and they all seemed to take a liking to me, as I did to all of them.

Last Saturday (3 days ago) we left Hartford, CT; this time parting ways. Elizabeth hopped on a flight to china, and I went home to DC. Over the next two days, I moved into my new apartment and caught up with my parents, sophie, lana, scott and Toub. On Tuesday (today), I woke up at 5 am to catch my flight back to Africa. So far it has been uneventful, except nothing has gone right on the South African Airways flight to Joberg. I am sitting in front of a kid that is scared of flying, behind two kids who wont stop making loud sound effects and next to a little girl who wont stop screaming at her video game. I would normally ignore this and put on a movie, but the damn system isn’t working!!!!!!!!!!!!!!!! I am clearly writing this on the plane now because I have nothing better to do. This is a 15 hour flight with absolutely no entertainment what-so-ever! Not to mention that just following this flight, I have a 7 hour layover in joberg. I am a very unhappy camper right now. For the first time, I am regretting the decision to go back to Africa. More to come later. Probably while I am bored in the joberg airport.

I arrived at the Joberg, SA airport (it is Wednesday now) about an hour early. I was able to get 1-2 hours of sleep, if you can call whatever I did sleep. A smile and glimmer of hope swept across me as I realized I had time to catch the early flight to Gaborone. I rushed to the ticket counter and asked to see what they could do for me. They set me up on the flight and said it would only cost me 210 rand (30 US) to get the new flight. I said hell yeah and gave her my credit card. She handed my card off to another woman who slowly walked away to charge it up in the SA airlines office. 30 mins later (10 mins before my flight was to depart) she comes back to tell me they made a mistake and that it would cost me 1500Rand to switch. I declined and waited another hour to get my ticket switched back to the original flight.

With my head hung low, I retreated to the familiar, but unsatisfying premier lounge where I plan to spend my next 8 hours. This has been a nightmare.

Following the 8 hour marathon of trying to stay awake and fighting the anxiety of being back in Africa alone, I boarded the flight for Gaborone. We actually took a big South African Airlines Jet that was not even close to full. The flight time was just about 30 mins and I enjoyed a light snack and orange juice. This was important because I didn't want to go shopping when I got to my house in gaborone, so this snack would have to hold me through the night. When I arrived in Gaborone, I kinda felt like I was home. It put me at ease to great people in setswana. And, for the first time all trip, something went well. Ernest, the Baylor driver was waiting for me, to give me a ride to the Baylor 1 house. Finally, something went well.

Once at the house, I was greeted by Mitul (a peds resident) and his newly wed wife. They seem like very nice people but they left for Bull and Bush quiz bowl before I really got a chance to talk to them.

I spent the next couple hours unpacking, showering and reading. I tried to go to sleep around 8pm with no luck. I was up and about until midnight. I'm not sure when I went to sleep after that.

I have to admit, I'm not 100% happy to be back, but I still think it was the right thing to do.

7-11 thru 7-14-09 Sat-Tues

Hi, I know it has been a while since my last post, but a combination of being sick and having Elizabeth come to visit has kept me away from my blog. So, now that I have some time to reflect, I’ll touch briefly on the last couple of days.

This weekend and this week so far:

Elizabeth came on Friday night. Her flight was a bit delayed and Tshopo wasn’t around to give me a ride, but it generally was not difficult to go get her. Saturday was lazy minus a walk to Riverwalk and dinner at Bull and Bush. I felt sicker than I did on Friday and I was in no mood to do anything else.

Sunday was equally as lazy and our only outing was going to the movies (lisa, Elizabeth, JW and me).

Monday was Elizabeth’s first day at the COE. I showed her around a bit and brought her to the morning prayers. I think she was impressed by the whole scene, but she will get a better perspective of it when she shadows on Wednesday and Thursday. We spent the day fine tuning the first case and left early to relieve Beth’s Jetlag. We cooked an amazing chicken curry and enjoyed it while watching a movie with Lisa and JW.

Tuesday was a busy day. We finished going through case two with the hopes of authoring cards on Wednesday. We plan to cook quesadillas and watch another movie tonight. We both can’t wait till this weekend for South Africa.

7-8 thru 7-10-09 Wed-Fri

Last week at work:

Was crazy busy. I was still trying to get over my sickness when Grace scheduled six KITSO students (2 docs, 2 nurses, and 2 MedEd people from the Bots government) to pilot the case in the scholar’s room, all at the same time. I was told that three would be coming in, so I had only set up three computers. Also, because they all had government e-mails, for some reason, I had to make them all yahoo.com mail accounts and set up their accounts from my computer. All-in-all it was a very stressful beginning to the morning, but it all turned out well in the end.

I had informed all of the students that the case should take about an hour, but because of the slow internet connection and their lack of computer skills, it took the slowest person about 2 hours to complete.

To say the least, I was nervous. This case was my baby and the first pilot with African students had not gone to plan. Stressed, and feeling the sickness, I reviewed the surveys they completed online and was pleasantly surprised. They all loved the case and had very good ideas about improving it.

I met with Grace (training coordinator) and had her set up a focus group with the six students for the following day (Friday). I spent the rest of the day dreaming up case #2.

I was determined to make this case more organized and full of MedEd stuff. So I made case objective and sub-goals along with a SOAP-like presentation and a case outline. The case SOAP-like presentation can be found below if you are interested:

The focus group on Friday blew my mind and my greatest expectations. It was scheduled for 10 mins but lasted about an hour. I started the meeting telling them to rip apart the case and that I needed to get criticism to make the case better. They started off by telling me what problems they had, but quickly they all started talking about how this was the new wave of teaching and how much more they enjoyed learning like this. They went on and on about how this program needs to expand and how simple the interface was and how everyone in HIV should complete this program.

By the end, the entire KITSO class had come in to listen (about 65 people). None of them said anything, but they just sat and listened. Finally, as the session concluded, they all gave me a round of applause. I have never been so proud of my work and it gave me the energy to tackle this difficult second case.

Case Synopsis:


K.M. is a 15yo boy started on AZT/3TC/NVP 2 years ago, now presenting alone to IDCC for scheduled visit. Complains of and itchy scalp and purple bumps on his skin. Denies missed doses. Lives with mother, father and two brothers but claims he is solely responsible for taking medications.

Pill count:
CBV 80% NVP 80%

PMH: PMTCT none. Had PCP, oral thrush, which is why he was tested for HIV. Had longstanding history of good adherence, until 3 months ago. Refuses to take medication because he feels fine and doesn’t think he needs it.

Meds: CBV 1 tab po bd
NVP 200 mg tab po bd

All: NKDA Immun: UTD

SHx: lives with mother father and two brothers, who have both have received adherence counseling when he was initiated on HAART. Child is in standard 5?, getting Bs. Rest of family tested negative 2 year prior (When he was initiated on HAART; probably horizontal transmission). He is currently sexually active but claims he uses condoms.

PE: Stunted and Wasted (will figure out details later)
Head and Neck: carries, generalized lymphadenopathy, white crusted sores on head with alopecia.
Thorax + Extrem: raised sores (Ddx includes: KS, etc)

Labs:
VL 21,000 (2 mos ago) → 55,000 (1 mo ago)
CD4 478/24% (9 mos ago) → 305/?% (3 mos ago)
FBC/LFTs nl (forever)

A: 15yo boy with WHO clinical 4, immune 3, on 1st line HAART, virologic failure
-Adherence: poor
-Disclosure: fully disclosed
-Risk factors: recent failure

P: Switch to 2nd line HAART once adherence improves:
ABC 300mg po bd
D4T 30mg
Aluvia 2 tabs

For now: to test adherence
Cotrimoxazole
Multi vite
Emphasize importance of adherence on 2nd line
Reinforce disclosure process (reminder that even though he felt fine, he has to take meds)
Refer to Social worker for discussion on adherence (where do these guys put their notes?)
In-reach to meet with family and discuss adherence
Refer to dietitian
Psych referral for problems at home and sexuality.
Treat tinea with systemic antifungals
Treat KS
Labs: Urgent VL, CD4
Review in 1 week (have another care giver come with him

7-6 and 7-7-09 Monday and Tuesday

Alright, I am writing this at the end of the day on Tuesday because my brain has turned to mush and I can't focus on my real work. Monday was a tough day but I ended up designing most of my second case and setting up 13 more people to view my first one. So, overall, a productive day.

I went home a little early and just laid on the couch (I plan on doing the same thing now). I went to bed early (9pm) and got up at 6am feeling great!! However, by 10am I was back where I started on Monday. I took some Advil after lunch, but now I'm just sweating for no reason. I don't like being sick.

Tomorrow I have to get to work early to prepare the Scholar's room for some of the volunteers to pilot the case. Also, hopefully Ryan will be done reviewing the outline I gave him for case #2 so I can get cracking on it before Elizabeth gets here. Alright, thats enough concentration on writing for now. Hopefully, I'll have a more upbeat post tomorrow!

7-2 thru 5-09-Thurs thru Sun

Howdy, OK this one will be short because I have come down with some lower respiratory sickness and I feel pretty bad. Thursday and Friday at work were administrative days (as will be every day this week). I’m trying to perfect the first case, evaluate it and distribute it out. This is proceeding pretty slowly because people here don’t have very much time to help.

So, to try and maximize my time before Elizabeth comes, I want to design my second case this week. I’m going for something like: a teenager that decides he doesn’t want to take his meds anymore, fails the regimen, gets sick and the doctors have to intervene medically and socially. Sounds simple when I write it like that, but I’m nervous about designing this case. Not to mention that my brain is fried from fighting this infection.

OK, I’ll stop whining now and get to the weekend. Saturday was the 4th of July. We had plans to relax outside in the sun all day, but Bots decided to be cloudy and rainy. Of course. So, we spent the majority of the day inside laying on the couch (which felt really nice) until we went to River walk to food shop and talk to loved ones back home. It was a nice and relaxing day climaxed by an incredible night at Bull and Bush.

JW and I left around 8:15 to get some food and have a couple drinks. The place was dead, but there was still a 40 pula cover. Bull and Bush has a great design. There is no paved road to the place so it makes it seem like you are going into the bush. But the restaurant is huge. Indoor and outdoor seating; everything is wooden with tall ceilings (makes it look like a BBQ place in the states). They gave us a table in front of the TV as JW and I sampled the bar food (Which was amazing) and had a couple drinks.

I think sometime around 11-1130 we saw Karabo, the local guide for the OU kids. It was odd to see him alone so I asked him what was up. He told us the OU kids were on the dance floor. Gaborone is a pretty small place…

So the remainder of the night was spent dancing the night away with the group of OU kids. A very fun night that I am paying for now. Sunday morning was rough. I slept in till 8am (which is late for me) and just sat around trying to decide if I were sick, or just feeling the late night. By the end of the day, as we walked to the Zebra’s football game, I realized that I was indeed sick. 2nd time in 1 month. Geeze.

The Zebra’s game was fun. It was nice to see all the locals singing and dancing (my camera died and JW forgot his, so I have no pics from this weekend :( ). Zebra’s ended up tying Iran 1-1. Although, the Zebra’s had many chances that they just couldn’t finish. A good game over all.

The remainder of the night I laid down trying to relax. I was too sick and had the chills. I went to bed early and got up today (after a poor night’s sleep) feeling much worse. I’m going to work for as long as I can but we’ll see how it goes.

7-1-09- Wednesday

JULY FIRST!!!

I officially made it through the month of July. Today was a holiday (Birthday of the 1st president of Bots) and we did absolutely nothing. It felt great. Life has been so fast paced recently that it felt really good just to lie around. Although, I did go to the gym in the morning and JW and I saw transformers. Overall, a very good day :). I seem to be having a lot of those lately.

I have a ton to get done before Elizabeth gets here next Friday, so I’m going to stop writing and get to that.



I added 3 posts today, so see below.