6-30-09- Tuesday

I've decided to add pics to each blog just for fun. They will not always be related to the actual blog.

Tuesday was an even better day! Although sleep is a bit difficult to deal with. The cover I have does nothing for the cold and it seems to always find its way to the floor. So, I wake up a bunch of times in the night, but its fine for now. I should only have to deal with this set up for another two weeks.

I started the morning in the lab again. For some reason my confidence and skill was high today. I started with the first patient and didn’t stop until clinic was over. 42 patients later and 38 successful blood collections I felt amazing. On an adrenaline high from the pace and danger of the job (Natifo is currently on prophylaxis for getting stuck 2 weeks ago), I smiled the whole time.

The children here are amazing. With the exception of a few 3 and younger year olds, they don’t move and rarely cry. Some of them even have their favorite places to be stuck. I will try to join the lab when I can. But now that Natifo is gone for a couple of weeks (vacation) I’m not sure I’ll be able to. We’ll see.

One story shocked me while in the lab. One 10 year old entered the lab smiling and looking at Natifo in a “different” way. She looked at him, said something in Setswana and smiled. She turned to me and told me that “this child and his mother drive on these needles.” She was pointing to the butterfly needle we use to draw blood. Naturally, I was confused, but I guessed it had something to do with drug use. She told me that shes too scared to draw his blood and asked me to do it. Why would I be able to do it if she couldn’t!?!?! I checked his arms. No scaring from needles. I asked Natifo to explain what she meant by “driving” on needles. She said “Like a broom stick, like witches drive on brooms. It was all over the news for months. This kid and his mother did black magic.”

Oh. This is different! She was too scared to draw his blood because he knew black magic. Great, why do I get to do it then!? But, its was no problem, he had good veins. He smiled, said “Thakie Gnaka” (Thanks Doctor) and left. I am still alive…

That’s a first.

6-29-09- Monday

Monday was a good day. Its getting a lot colder in Bots now. The mornings dip below 0C and the walks to work are COLD. However, the sun still does a good job of warming things up by noon and walks home for lunch aren’t bad. I started in the lab Monday morning hoping just to watch the nurse, Natifo, draw blood. I should have known better. They are so willing to teach (because it gives them a break from the regular) that she had me sticking the 3rd patient. By lunch I had attempted to stick 5 patients and was successful on 2. Not a really good batting average. I asked Natifo if it was ok that I took lunch (clinic wasn’t done) and she said “of course.” Shes too nice to me :).

I joined Courtney and Kate for lunch at debonaire’s (the pizza place). It was a nice break made possible by the fact that we still had Ryan’s car.

Monday finished with gym, dinner and late night soccer with the OU crew. I love playing soccer with the, with the exception that we are playing on concrete. My poor tennis shoes have been torn to shreds and my left big toe along with them.

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.