Dumela guys! I'm leaving today for a week long village home-stay (July 1st-July 8th) in Serowe, a little less than 200 miles north of the capital city of Gaborone. Everyone, including me, have been waiting for this trip from the beginning, especially the ones who were dorming at the university. This is our chance to experience and assimilate into Tswana culture from an actual perspective. Batsi, our director, told us that this village home-stay, for some, is going to be the most memorable part of the whole trip. Each of us were assigned to different families. I was living with the Gulubane family in Serowe. Here's the only info I received about my family.
Ms Marea Gulubane-Mom
Lesego 39yrs-Sister
Lenamile 36yrs-Brother
Tumelo 15yrs-Brother
Nametso 18 yrs-Niece
When I asked my suitemate, Tsolofelo [solofelo], about the family, he immediately recognized the surname. Tsolofelo's mom is from Serowe. He told me that families in villages are linked and people know each other well. I found this quite interesting considering Serowe is home to 47,000 people. So out of all the villages, why did the program pick Serowe for our village trip?
Serowe has a rich political history in Botswana. It used to be the capital of the Ngwato tribe prior to the country's independence and now serves as the capital of the Central District. The current president Ian Khama comes from the village of Serowe. It was also the birthplace of the first president Sir Seretse Khama and the former president Festus Mogae. Serowe has undergone tremendous expansion and development in the recent years. This would make sense considering the presidents' strong roots to the village.
Stay tuned!
Sunday, July 1, 2012
Saturday, June 30, 2012
Clinical Experience Gabz 2/2
On the second day of clinics, I was observing in the injection and dressing ward. The day was quite frustrating because I first-time witnessed a shortage of workforce in the clinic. Actually, there were enough nurses but I was with local nursing interns from a local college, who were assigned to the same ward. However, non of them had had any clue on how to get started. The patient line started to build up. I had to get the manager and let the head nurse aware of the situation, but help didn’t come until 9:00am. As for the student nurses, they didn't seem much to care other than use their phone constantly all the time. The clinic opened at 7:30am and patients were waiting since then. To meet the demands of the many patients, since we took our first an hour and a half later, we took two patients at a time. Privacy, you may ask? the clinic observes no privacy rule other than the caravan where HIV testing takes place. People were coming in to change their bandages for surgery cuts, bruises, burns and infections. The nurses would also clean their wounds with hydrogen peroxide. They were also patients who came in to do blood tests. The nurses would take their blood in two tubes. The patients would have to come in later to view their results. For a little while, I moved to the dispensary to see how drugs were distributed to patients when the injecting and dressing room was stagnant. Basically, the patients would come in with prescriptions and some were asked to show IDs for identification purposes. The clinic lacked an actual pharmacist. There was a nurse I shadowed who knew everything about the drugs and the ways to prepare them as some drugs required dilutions. Condoms were supplied for free. A HIV positive man came in to get condoms and he was given about 20 of them without any charge. This is in stark contrast to how drugs are distributed in the U.S. The country does have a private insurance system but for public healthcare they don't require it unless they wanted to be treated by private health-care providers
I managed to get more hands-on interaction with patients in the screening room the third day. I had the opportunity of recording their blood pressure, measuring their pulse, taking their temperature and administering drugs to them on site. The patients that mostly came in had fever or cold. For infants, only the temperature was taken. If their temperature was 38 C and above, two paracetamol drops were given to them. The same applied to adults. This is what I did for most of the day. The manager for the clinic briefly called me to help her in the HIV caravan outside the clinic. The caravan was where people where tested for HIV. I believe it was separate from the clinic building to preserve the privacy of patients. After I got to the caravan, I was asked to hold the baby while the nurse was taking blood samples from the heel of the baby born to an HIV positive mother. For infants, a normal HIV test, like the Elisa antibody test done for adults, cannot apply to infants because babies born to HIV positive mothers have IgG antibodies that are passed on from the mother to the fetus during pregnancy. This doesn’t necessarily mean the baby has the virus, but will give a false positive if an Elisa test is taken. So, blood samples were taken to be sent to the Harvard Research lab at the Princess Marina Hospital for PCR. Through PCR, the HIV status of babies can be determined born to HIV positive mothers. The mother was asked to come in after three weeks to check up on the results. I then walked over to the adult HIV testing/counseling room. They were doing Elisa antibody test on a local man. The man came in to do a HIV test because his partner was found to be positive. This was a notable experience because I really got to see the interaction between the health educator and the patient. He explained for a good 5 minutes how he’s going to conduct the test. There were two plastic apparatus to check if the patient was HIV positive or no. Blood drops were taken from his index finger and put in the apparatus to check for the number of lines. Two lines meant he was positive and one line meant he was negative. His result came out to be two lines on both apparatus.
I managed to get more hands-on interaction with patients in the screening room the third day. I had the opportunity of recording their blood pressure, measuring their pulse, taking their temperature and administering drugs to them on site. The patients that mostly came in had fever or cold. For infants, only the temperature was taken. If their temperature was 38 C and above, two paracetamol drops were given to them. The same applied to adults. This is what I did for most of the day. The manager for the clinic briefly called me to help her in the HIV caravan outside the clinic. The caravan was where people where tested for HIV. I believe it was separate from the clinic building to preserve the privacy of patients. After I got to the caravan, I was asked to hold the baby while the nurse was taking blood samples from the heel of the baby born to an HIV positive mother. For infants, a normal HIV test, like the Elisa antibody test done for adults, cannot apply to infants because babies born to HIV positive mothers have IgG antibodies that are passed on from the mother to the fetus during pregnancy. This doesn’t necessarily mean the baby has the virus, but will give a false positive if an Elisa test is taken. So, blood samples were taken to be sent to the Harvard Research lab at the Princess Marina Hospital for PCR. Through PCR, the HIV status of babies can be determined born to HIV positive mothers. The mother was asked to come in after three weeks to check up on the results. I then walked over to the adult HIV testing/counseling room. They were doing Elisa antibody test on a local man. The man came in to do a HIV test because his partner was found to be positive. This was a notable experience because I really got to see the interaction between the health educator and the patient. He explained for a good 5 minutes how he’s going to conduct the test. There were two plastic apparatus to check if the patient was HIV positive or no. Blood drops were taken from his index finger and put in the apparatus to check for the number of lines. Two lines meant he was positive and one line meant he was negative. His result came out to be two lines on both apparatus.
Friday, June 29, 2012
Clinical Experience in Gabz 1/2
Since, I'm in Botswana for a public-health program and that's what you typed/clicked on the address bar to get to this blog, you were probably expecting a post about my medical experiences in the country. Likewise, I was too! The following, which I will split up in two posts, is my attempt to visualize to you the profound experience I had at the Broadhurst 3 Clinic in Gaborone. Now this is by no means complete, and solely my interpretation, based on experience, of some healthcare issues in Botswana. I'm going to share with you my first three days of experiences at the clinic, wherein I observe in four departments: Child welfare care, injecting and dressing,
screening and the dispensary (pharmacy).
On my first day at the clinics, I was observing in the child welfare department. I arrived to the clinic at 7:30am with Shelby, Nikita, and Shireen. The clinic lobby was absolutely filled with people. Most of them We came in with Batsi, our director, who introduced us to the Matron of the clinic. She gratefully welcomed us and discussed the nature of the clinic along with its goals and missions. She asked us about our goals. Our goal was to learn and observe the manner in which health-care is delivered to Batswana at the grassroots level, then applying our empirical data to a larger context of public-health issues facing the country. and asked us to sign in what wards we wanted to observe in. I choose the CWC (child-welfare care). Outside in the lobby, there were mostly mothers, who came in with their infants to get a monthly checkup or were due to get immunizations. When I first arrived at the child-welfare room, I was taken by surprise with the number of health care workers in the room. There were two health-care educators and a nurse. Health-care educators play an essential role in the urban clinics of Botswana. They are responsible for educating mothers on how to take care of infants in a country ravaged by diseases in the past. In the room, a mother would come in the room and place her infant child on a hospital bed. While undressing, she would hand a booklet titled, “Child Welfare Clinic Card.” Then she would undress the child for weighing. Weighing is done to see how the child is doing physically. The system to weigh the child was different than the one in the U.S. The weighing system here involved hanging the child on a hook. In the U.S, children are weighed on a flat weigh scale. Similarly, the children, almost naked without their diapers, were put in a hanging bag. The bag was then placed on a hook. The health-educators were mostly responsible for book-keeping and marked each child’s growth in their respective booklets. The clinic card or the booklet is each assigned to babies when they are born. It entails information on schedules for the immunizations, information on breastfeeding incase the mother is HIV positive, and developmental assessment of the child, in which gross motor, fine motor, social skills and language are assessed of the child at 3, 6, 9, 12, 18 and 24 months. Mothers are supposed to bring the clinic card for their children every time they come in for a checkup, which is once every month. However, there were few who failed to come in the previous months. I saw a striking correlation of negligent mothers who failed to come in the past months, having malnourished infants. The health-educator would ask the mother and say something to her in Setswana for a couple of minutes. After the mother left, I ask the worker what she told her. She replied that she ordered her to take care of the child and feed it properly. The educator also asked the mother if the baby formula is being used other than just feeding the baby, to which the mother replied "No"! The health-educator informed me that the mother is HIV positive and was unable to breastfeed the baby. In a situation like this, the government of Botswana provides free food formulas for infants who cannot be breastfed. And for the other months she failed to bring in the child? She was just going to be defaulted for those months and if something were to happen to the child, the mother was responsible for it. There would be two patients at a time in the room. When one infant was removed from weighing apparatus the other was placed in for weighing. We were taking patients in at a considerable pace to beat the rush, allowing for little patient interaction. I asked one of the health-educators that on average, how many patients they see in a day. She estimated about 40-60 depending on how crowded the clinic is.
Furthermore, I inquired about the type of vaccination the infants were given. At birth, babies are given hepatitis B and a BCG vaccine. BCG is a common TB vaccine that is administered to newborns mostly in developing countries. My parents were given this vaccine. The only public-health concern with this vaccine is that the cheaper Mantoux skin test would lead to a false positive for people who were given the BCG vaccine. So other diagnostic tests should be done in order to determine if the person has TB. This is very relevant to a country like Botswana. In addition, at 2 to 3 months, infants were given drops of polio vaccine and a pentavalent injection. The pentavalent shot compresses vaccines for diphtheria, tetanus, pertussis, Hepatitis B and the influenza B virus. The pentavalent shot is given to infants a total of three times in a period of 5 months from birth. Another interesting element I learned was that immunizations are all free in Botswana for kids up to the age of 5 no matter what part of the world they come from. However, a child born in a foreign country like Zimbabwe is entitled to no ARVs or food formula if the need may arrive. The free services only apply to Batswana. A Zimbabwean mom came in with her child who was born in Botswana, which is a common trend in Botswana. If the mom was HIV positive, she would have to pay for the formulas to feed her child. It doesn’t matter whether the child was born in Botswana or not. Also, STI drugs, and TB medication are distributed freely to anyone regardless of their identity to reduce the spread of infection in the country.
On my first day at the clinics, I was observing in the child welfare department. I arrived to the clinic at 7:30am with Shelby, Nikita, and Shireen. The clinic lobby was absolutely filled with people. Most of them We came in with Batsi, our director, who introduced us to the Matron of the clinic. She gratefully welcomed us and discussed the nature of the clinic along with its goals and missions. She asked us about our goals. Our goal was to learn and observe the manner in which health-care is delivered to Batswana at the grassroots level, then applying our empirical data to a larger context of public-health issues facing the country. and asked us to sign in what wards we wanted to observe in. I choose the CWC (child-welfare care). Outside in the lobby, there were mostly mothers, who came in with their infants to get a monthly checkup or were due to get immunizations. When I first arrived at the child-welfare room, I was taken by surprise with the number of health care workers in the room. There were two health-care educators and a nurse. Health-care educators play an essential role in the urban clinics of Botswana. They are responsible for educating mothers on how to take care of infants in a country ravaged by diseases in the past. In the room, a mother would come in the room and place her infant child on a hospital bed. While undressing, she would hand a booklet titled, “Child Welfare Clinic Card.” Then she would undress the child for weighing. Weighing is done to see how the child is doing physically. The system to weigh the child was different than the one in the U.S. The weighing system here involved hanging the child on a hook. In the U.S, children are weighed on a flat weigh scale. Similarly, the children, almost naked without their diapers, were put in a hanging bag. The bag was then placed on a hook. The health-educators were mostly responsible for book-keeping and marked each child’s growth in their respective booklets. The clinic card or the booklet is each assigned to babies when they are born. It entails information on schedules for the immunizations, information on breastfeeding incase the mother is HIV positive, and developmental assessment of the child, in which gross motor, fine motor, social skills and language are assessed of the child at 3, 6, 9, 12, 18 and 24 months. Mothers are supposed to bring the clinic card for their children every time they come in for a checkup, which is once every month. However, there were few who failed to come in the previous months. I saw a striking correlation of negligent mothers who failed to come in the past months, having malnourished infants. The health-educator would ask the mother and say something to her in Setswana for a couple of minutes. After the mother left, I ask the worker what she told her. She replied that she ordered her to take care of the child and feed it properly. The educator also asked the mother if the baby formula is being used other than just feeding the baby, to which the mother replied "No"! The health-educator informed me that the mother is HIV positive and was unable to breastfeed the baby. In a situation like this, the government of Botswana provides free food formulas for infants who cannot be breastfed. And for the other months she failed to bring in the child? She was just going to be defaulted for those months and if something were to happen to the child, the mother was responsible for it. There would be two patients at a time in the room. When one infant was removed from weighing apparatus the other was placed in for weighing. We were taking patients in at a considerable pace to beat the rush, allowing for little patient interaction. I asked one of the health-educators that on average, how many patients they see in a day. She estimated about 40-60 depending on how crowded the clinic is.
Furthermore, I inquired about the type of vaccination the infants were given. At birth, babies are given hepatitis B and a BCG vaccine. BCG is a common TB vaccine that is administered to newborns mostly in developing countries. My parents were given this vaccine. The only public-health concern with this vaccine is that the cheaper Mantoux skin test would lead to a false positive for people who were given the BCG vaccine. So other diagnostic tests should be done in order to determine if the person has TB. This is very relevant to a country like Botswana. In addition, at 2 to 3 months, infants were given drops of polio vaccine and a pentavalent injection. The pentavalent shot compresses vaccines for diphtheria, tetanus, pertussis, Hepatitis B and the influenza B virus. The pentavalent shot is given to infants a total of three times in a period of 5 months from birth. Another interesting element I learned was that immunizations are all free in Botswana for kids up to the age of 5 no matter what part of the world they come from. However, a child born in a foreign country like Zimbabwe is entitled to no ARVs or food formula if the need may arrive. The free services only apply to Batswana. A Zimbabwean mom came in with her child who was born in Botswana, which is a common trend in Botswana. If the mom was HIV positive, she would have to pay for the formulas to feed her child. It doesn’t matter whether the child was born in Botswana or not. Also, STI drugs, and TB medication are distributed freely to anyone regardless of their identity to reduce the spread of infection in the country.
Thursday, June 28, 2012
Visiting the Traditional Healer
Medicine practiced in a traditional manner is always interesting. Even in the U.S., people use alternative forms of medicine, such as Homeopathy. However, combining medicine with superstition is a whole new story. This is the form of medicine traditional healers practice in Botswana. The traditional healer we visited gave more of a vibe of a wizard than a health-care provider. So after we got to his residence, he had already made seating arrangements for us and placed his utensils or healing gear on a coffee table in front of him. He also had a camera crew for some reason to record himself speak, for advertising purposes maybe? Nevertheless, a traditional healer usually sees his clients at home. He started off by saying that everyone cannot become a traditional healer. According to him, it is a position that is appointed from the spirits of the forefathers. Once a person is appointed, he is known of his position by another traditional healer who the forefathers summon. Declining such a position may lead to suffering and misery. Someone asked, what sign led him to believe that he was a traditional healer. He was sick one time and no one could diagnose his condition. His aunt came up to him one day and told him how the spirits want him to become a traditional healer. Surely, after he took up the job, he was alright. Then, he compared traditional healing to Christianity citing how the religion, when it was first introduced, involved traditional healing and witchcraft. Traditional healing was used for the good whereas, witchcraft for evil. He also brought up how Christians believe that when a person dies, he/she doesn't really die but sleeps to justify how his forefathers are also sleeping making communication with them possible. Someone asked what sort of medication he uses and how does he know which ones to use? His reply was during a consulting appointment, he throws a bones from a bag (also practiced during a traditional wedding), and depending on how they land, he goes on to diagnose the patient with the help of communicating with spirits of his forefathers. The traditional healer's cousin, also a traditional healer pitched in citing anyone regardless of gender, can become a traditional healer. So with which problems people come to traditional healers with? Everything! For marriage problems, financial problems and physical problems. They boldly stated that they can get people jobs and even cure cancers if caught at an early stage. If a community is facing theft problems, traditional healers are also capable of doing witchcraft and harming the criminals causing trouble. I jokingly asked if he would see me even though I don't have any pre-conceived condition or disease. He alleged "with 50 pula, I'll consult you." I didn't end up consulting with him due to my own personal beliefs. However, when asked about HIV/AIDS, they gave in and said that they are unable to treat the disease. Also, he can also refer their clients to the clinics and vice-versa.
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| Equipment traditional healers use |
Wednesday, June 27, 2012
Ancient History at Manyana
Africa is often times called the "motherland". Ancient heritage sites are a commonality in Southern Africa. "Manyana Rock Paintings" are one of the important heritage sites located in the southeastern part of Botswana. Its located 35 km west of Gaborone in the village of Manyana, hence the name Manyana Rock. The rock paintings are located on a cliff on the west side of the village. When we got to the cliff, the rock art is almost non-existent. Its only when we got closer, we saw the paintings. Some of the paintings were faint, but others were almost indistinguishable. The paintings consisted of antelopes, humans, giraffes, snakes, and geometric figures. They were drawn/painted in tints of red, orange, brown, black. Interestingly, Manyana Rock is rare in that it's one of the few rock art sites with black painting, which have potential for carbon 14 dating.
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| Manyana Rock (cliff) |
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| Giraffes and Antelopes |
The drawings are believed to be created by the San bushmen as part of their religious activities, some 2,000 years ago during the Late Stone Age and early Iron Age. Another significant piece of history can be found at this site, the Mmasechele Cave. The cave is of importance because it was used by Kgosi Sechele's wife, Mma Sechele, during the Boer invasion. She and her entourage of women hid inside the cave during the invasion. Mma Sechele was pregnant at the time and required protection.
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| Mmasechele Cave |
Tuesday, June 26, 2012
Safari #1 - Mokolodi Nature Reserve
Since we got here, we haven't been on a safari. No animals except for baboons we found on Kgale Hill. On a late afternoon, we made our way to the Mokolodi Nature Reserve. Located 10 km south of Gaborone, its spans 30 square kilometers. When we got there, our safari guide told us that the park contained many species of wildlife from rhinos, cheetah, giraffes, kudu, gembock, hyaenas, leopards, impalas, and many more. I was stocked to see all these animals and I have't been on a safari ever. I didn't know what I was in for. The reserve mostly had a hilly landscape and it was close to sunset. The atmosphere was amazing and our safari truck looked like this. Occasionally, I would have to move inward inside the truck to avoid getting scratched by thorny plants on the side of the road. In an hour and half long safari ride, we managed to spot only the impala, kudu, and spirngboks. Pictures can be found on "Photos" section or by clicking on the slideshow on the bottom right It was a disappointing safari ride, or maybe I was expecting too much. After all, the point of a safari is to get lucky in spotting wildlife. After the safari, we were provided with some delicious dinner at the nature reserve. We sat around a campfire sipping on our warm luscious carrot soup as the night started getting cold. The sky was lit up by stars, which I don't get to see often in the U.S. After an hour or so, we were surprised with another safari tour. Didn't see that one coming! Safari during the night sounded so cool! I immediately took out my flashlight and flashed it in the wilderness hoping to find a reflection of an animal's eye. I did find a couple antelopes like that. But the night safari ended being cool, when we found wildebeest and hyaenas. The hyaenas were freaky looking. It ended up being a decent safari in the end. I guess I was expecting too much.
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| Hyena |
Monday, June 25, 2012
Bathing in dust at the Kalahari-Mantshwabisi
When a part of a country turns into one large picnic area, it means something significant is happening. Everyone I talked to were talking about the big race, Mantshwabisi. I had no idea what the race was about or ever heard of it in the U.S. The 1000 km Kalahari Desert Race, which is held every year in the south African country, is undoubtedly the most popular sporting event in Botswana. It forms part of the inaugural Dakar Challenge. The Dakar Rally is an annual off-road race event, which used to take place from Paris, France to Dakar, Senegal. In the past years, the race has been taking place in South America (If you enjoyed that, you may like this too)The Kalahari Desert Race, though, was sensational to watch. It's nicknamed Mantshwabisi in Botswana, after a village in the Kweneng District where the race track passes through. The race takes place on a route that involves different types of tracks, riverbeds, thick sand, and some areas of the Kalahari. Spectators spent the entire weekend of the race 22nd-24th June chasing after cars, waiting hours at the stop-points for the cars to arrive, stop-point hopping, and camping at nights under the clear night sky in the wilderness. People save up their money and prepare for months for this event. The actual race started on a chilly Saturday morning, with thousands of spectators, me amongst them cheering on as 4x4 trucks and sand-masters battled through the 500km terrain for the day. The 1000km trek would be covered in two days on different routes, with 500 km covered each day. I attended the race both days. The family I came with to the race were stop-point hopping to catch the vehicles pass closer and where there were less people. We got to three stop-points that day with one close to the starting line, the other in the middle and the last closer to the finish line. There were a total of 14 stop-points. We set camp on the last stop-point. Along our way, we saw locals literally on tress and families preparing meals, and it was our turn to bbq, or "braai" as Batswana would call it, some quality steaks. Trust me guys! if you want to taste real beef or game meat without any hormones or additives we see in the U.S., you need to visit Botswana! The demand for African beef is so high that Botswana exports its beef to the E.U.
I got really close to the motor vehicles that passed by. If the race driver were to commit a mistake, this post would be unlikely. I managed to get some cool photos and you know where to check them out! Every time a truck or sand truck would pass by, a wave of dust would blind every living soul in the vicinity. Surely, all I inhaled was dust. I wont be surprised if the grilled food I ate was marinated with some silica. Regardless, the food was delicious while I bathed in dust at the Kalahari.
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| "Braaing"some quality food |
Sand Storm!
Toyota won the race, while also taking up the runner up position. With this win, the winner will gain automatic entry into the much awaited Dakar Rally in January 2013.
Toyota Hilux in the lead
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