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.

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.

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.  

Equipment traditional healers use

They started to talk about the equipment they use. The hairy thing you see on the left side and the far right is an antelope tail. They use that during consulting and to ward off demons if they interrupt; interesting! right? The bottle you see (it was a used whiskey bottle), is used for protection. What kind of protection you may ask? Jealousy from others and curse. It's ironic that something like a whiskey bottle is used for protection, when drunk driving is a major issue in Botswana. I'll end here. Explaining the 'significance' of each tool would make this an endless post. Although, some of the objects had some interesting uses. He also took us to the consulting room and displayed other gimmicks to treat their patients. You can check out the pictures on the album.

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. 

Manyana Rock (cliff)

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. 

Mmasechele Cave

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.

Hyena

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. 

"Braaing"some quality food

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.

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

Wedding at the Bahurutshe

Africa is often seen as a traditional and a cultural entity.  However, I was only exposed to it in bits and pieces. When we went to the Bahrutshe Cultural Lodge, things were different. The people of the lodge welcomed us with this elaborate dance. I'll be honest; I was caught off guard. But, it didn't end there. The lodge is specifically aimed at tourists to get a feel of what is/was like in the actual African tradition. They explained to us the process of a traditional Tswana marriage.  The chief and the elders are the only witnesses allowed during the marriage. The groom needs to pay lobola or dowry in the form of cattle to marry the girl he wants. Every village has a low limit to how much cattle the groom needs to pay in order to marry. For instance, I was joking around with a Motswana nurse the clinic that I wanted to marry her, and how much cattle does she want. Her answer was at least 8. I'm not sure how much a cow costs in U.S. dollars, but I'll definitely let you guys know in another post. So before the marriage services began, they sang another song for us.  

                                                         They sang for us!    

Marriages are held in a Kgotla (I’m sure you know what a Kgotla is by now) in front of elders. But we obviously didn’t reenact the marriage ceremonial in a Kgotla.  So the bride came in first wearing a shawl on her head keeping her head down. She is supposed to keep her head down and not look elsewhere; if she does, it would mean she is looking for another man. Then the groom came in, while the elders sang. One of the elder men started to talk; I guess you can think of him as the MC for the event. He started of saying how the bride is as “black as her bed, but beautiful and shining” in Setswana. Then he mentioned the dowry and how its placed far away from the eyes of everyone, because people can do witchcraft or bring bad luck to the new couple because of jealously or bad intentions. Thus, the amount of lobola was just mentioned and the groom agreed to give 10 cattle to the bride’s family (to the uncle of the bride, don’t know why). That’s quite expensive! There go my chances of marrying a Botswana woman.
So the marriage services are usually done early in the morning. After the marriage service, the groom is not supposed to kiss his bride because its taboo in Batswana culture. He can do that in their hut on their ‘first night of honeymoon.’ The elder also threw pieces of bones from a bag; depending on how they land, this would tell the family of the bride and groom if other people of the village were jealous of the couple. If the bones didn’t land properly (if they land separate), the couple wasn’t allowed to spend the night together. This is because there was a belief that people who are jealous would steal their foot tracks to not make the couple spend the night together.  It was their form of science to practice such a ritual.  The elder then talks to his late elders. He initiates the bride in to her new family with a cow horn. A cow horn is known to protect the family in Setswana culture. The elders then escort the newlywed to their honeymoon hut, where the elders will camp outside the hut. You may be wandering why the elders are being creepy? The first night of the couple is when the virginity of the bride is determined by the elders. The lady that did most of the explaining, told us how nowadays people think is a violation of human rights and the practiced has been abandoned in urban areas. But she said it wasn’t about human rights but practicing of culture. This is the norm they practiced. An important point was brought up by the elders that if the younger generation practiced this inquiring of virginity, there wouldn’t be problem of HIV/AIDS pandemic in the country. The girls were told in the olden days that if they were to be with other men, they would die.

The groom finally comes out from his honeymoon hut and goes straight to his father to explain to him how his night went. If the groom says it was good, then everything went well. However, if he says it didn’t go well, it means that bride doesn’t like her husband and doesn’t want be in a marriage. In the latter case, the marriage is invalid and the girl is free to walk out of her marriage without any consequences.

Interesting Fact

            After the marriage service, the village elder and I played a traditional board game called the Mahele. The directions for the game are confusing, but it was a notable experience to have the honor of playing it with a village elder. Check out the pictures in the "Photos" section of the blog

Visit to the Kgotla

Democracy should begin somewhere. For some nations, it's begins by overthrowing a ruler, going to war, passing a law, en-rooted in a religion or tradition. For Botswana, it is the later. My group and I visited the Kgotla (kh-ot-la) of Old Naledi (meaning old star), the oldest village/township of Gaborone. The town has about 44,000 people. Every village in Botswana has a Kgotla. Kgotla is a traditional political structure in villages that is being practiced for hundred of years. It is lead by a Kgosi (Chief). The Kgosi is in charge of all matters related to the village. In a Kgotla, public meetings are conducted, community councils with the elders, issues are resolved, and legislation is passed. Enforcement of government programs begin from the Kgotla. In addition, it also acts as a court. However, it does not run on a 9 to 5 schedule like most courts do; Botswana has other courts for that. If an issue arises in a community, the Kgotla runs as long as the issue is resolved. All members of the community are invited and allowed to share individual opinions. There are no lawyers in the system. You are your own lawyer and are expected to defend yourself. It's a sophisticated system in that no one interrupts when someone is sharing their thoughts. One can only start after the other is done. You can think of Botswana as having the world's oldest democracies! Botswana has a House of Chiefs, where all the chiefs from other districts gather to discuss issues, and its a permanent advisory to the Parliament.
However, Britain, that come off as the more civilized of nations and quick to point others as uncivilized, maybe is not so civilized after all. Ironic isn't it? Recently, the King of Spain caused a stir in Botswana in a hunting scandal. I came across an article, which gave me a different and a larger perspective on the issue, which I found to be quite interesting. You might enjoy this too. So is it fair to label one's culture or custom as primitive or uncivilized? Does skin color, economy, language, infrastructure have anything to do with it?

Kgotla of Old Naledi

In Kgotla, the highest form of war is the dialogue between people. There are no physical altercations involved. Corporal punishment, though, is still practiced in Botswana. " 2,3 on the buttocks!" the Kgotla worker avowed to warn us of committing any wrongdoing. Surprisingly, 19 U.S states allow corporal punishment at school.
Interesting Fact:
Women are supposed to wear long, full-sleeved dresses to enter the Kgotla. Trousers and jackets are worn by men

Race, ethnicity, color, class and gender in Botswana

We had a speaker come in after classes to do a lecture on race, ethnicity, color, class, and gender in Botswana. This lecture was unique and different than any lecture I have attended so far, including those of the states. Every lecturer has their own attention grabber, but Dr. Maude Dikobe had something else on her mind. As soon as she came in, she pointed each of us and inquired about our "race, ethnicity, color, class, and gender." It seemed as if she was doing a survey or conducting her research while lecturing, after all she was taking notes! When my turn came, I gave her the following answers:
Race-Human
Ethnicity-Indian
Color-Brown
Class-Middle Class
Gender- Male (This answer was incorrect, because gender is masculinity/femininity)
Other answers from students for race were, "African American," which I thought was interesting. One gave "Jewish" for ethnicity. This, however, put us in to perspective and ready for what we were going to hear.

Dr. Dikobe started off outlining some the problems facing Botswana.  Like all capitalist countries, Botswana has income disparities, and this is causing the people not living in the southeast, where there is development, to fall behind. Dr. Dikobe described to us how the HIV pandemic has affected household incomes; she boldly stated, "it's a society that spends a lot on funerals." It's a true statement but the blatancy of it made me dumbfounded. Furthermore, Botswana youth lack the luxury of working part-time jobs U.S. youth are blessed with, such as working at retail stores or fast food places. Batswana have to wait for others to resign. Accroding to Dr. Dikobe, "race is a contested issue as a student of African diaspora." This is because some might want to associate with a particular color, as people who are not black are subjected to all the luxuries by default. However, Botswana has had a different history of racial politics. Unlike Zimbabwe or South Africa, there wasn't a large presence of whites. This subsequently didn't create a fear of the white man. A french psychologist, Frantz Fanon, observed the interaction between white and blacks when Algeria was colonized and the psychic effects it had on the Africans, causing them to develop a fear. He once said, "the state of a 'native' is a nervous condition, introduced by the settler and kept by the native at his own consent." Dr. Dikobe brought up a brilliant point of how the naming system remain unchanged after the colonizers left. Africans internalized the naming system set by the settlers even after they left as they saw themselves through the eyes of the settlers. However, Botswana was spared by this fear. Its first president, Sir Seretse Khama, married a white woman. This set the stage for interracial relations and intermarriages in the country. However, it's next-door neighbor, South Africa, had an Immortality Law that banned interracial marriages.

Flag of Botswana

Dr. Dikobe pointed out the two white strips on the flag acknowledges white presence in the country. However, some Batswana do feel whites are given preferential treatment. But, from my experiences here especially during the soccer match, I observed whites and blacks celebrating together and didn't feel or observe any show of superiority by either groups. Also, all the mixed races in Botswana are considered Black. However, they are some issues with this as some people want to associate with one group than the other; their social interactions and actions makes it really obvious.

They are 8 major ethnic groups in Botswana, which are based on animals! For instance, a group called Twana have a lion totem. The current president of Botswana, comes from the Ngwato tribe and used to be a  Kgosikgolo (Paramount Chief) of the tribe. Another tribe, Malete, has a female chief. Botswana is also home to numerous minority ethnic tribes that are not well-represented in the government when it comes to voicing their concerns. Hence, Botswana is not entirely democratic due to divisions among people and lack of attention towards minority groups.

Class in Botswana is not defined by wealth, but by the number of cattle you have. Yes! you heard it right, cattle! An ordinary person in Botswana has three homes: an urban home, village home, and a cattle post. Even local CEOs of companies have cattle here. Although, I feel people will slowly abandon the cattle system due to globalization and become a customary thing. Nonetheless, it's fascinating!

Botswana is a patriarchal society. However, that is changing as women are beginning to hold top political positions. Even then, Dr. Dikobe believes women's rights are sometimes compromised. The SADEC protocol on gender, though, hopes to achieve gender equity in all areas in a certain time-frame. In 2005, Botswana passed the Marriage Act, that gave both the sexes equal rights to property.

There is an antic saying in Botswana, which mocks the "Ladies First" saying in the U.S.

"Ga nke di etelwa ke manamagadi pele."
Male cows can never be led by female cows. 

First day of classes/Shortage of physicians

On Monday, we had our first day of classes. My days usually begin at 8am and end at 2pm. Some days will be longer if I have study trips planned or if I'm working at clinics. I'm taking a total of three courses at Gaborone. Two of them are public-health related. My first public-health class focuses on public and environmental health issues in Botswana with an emphasis on primary health care. The other public-health course is a community health practicum, which is basically integrating public-health sciences and applying them in clinical settings. I'll be interning at clinics in urbanized and rural settings while working with non-governmental organizations. However, I won't start clinical internships until next week. The third course I'm enrolled in is a Setswana language course. This class is quite interesting. I'll be putting up a page soon on my blog just on Setswana! Learning Setswana has been fun so far. It's really fast paced.  What makes the course interesting is that it's only lecture based - we have no textbook. This is the first time I'm learning a language without a textbook. I'll be using Setswana frequently during the village home-stay and most importantly, during my clinical internships in rural areas.

In the context of public-health, shortages of healthcare professionals in the country is causing a major "bottleneck" to health improvement.  According to the WHO website, they are 24.2 physicians per 10,000 people in the U.S. That's one physician attending to the needs of 413 people.  Apparently, we are facing a shortage of doctors. Lets take a look at Botswana. The country has about 3 physicians per 10,000 people. How does a country deal with this issue? The country has witnessed an exodus of professionals to other countries due to lack of proper pay by the Ministry of Health in Botswana. Not many doctors are interested in practicing in villages, where help is most needed. The lack of home-visits is preventing some people from getting treatment. The government of Botswana have sent students abroad to foreign countries for medical school, only to find that the students decided to stay in their respective foreign countries. However, some do come back. In retrospect, the government needs to place effective mechanism for people to return to their country. Recently, the University of Botswana just opened a medical school in 2009 as it was getting costly for the government to send students abroad. Keeping in mind that the private sector in the country is still in its seedling stages, the major employer in Botswana is the government, thanks to diamonds. The country leaped forward by making agreements with China, Cuba, and the U.S. to allow physicians to provide healthcare services in Botswana.

Dorming at UB

I realized I didn't share my housing info with you guys. Needless to say, this called for a new post! Prior to arriving in Botswana, we were given a choice, either to do a home-stay or live in the dorms at the University of Botswana (UB). When I arrived in Botswana, we were accommodated at a motel for orientation. On Friday, we moved to the dorms, and others who were doing the home-stay moved to their respective homes. I was surprised to see that the dorms here are similar to the ones in the U.S. I have a single in a cluster sized apartment that has a kitchen, a common room and a full bath. I have three roommates: an American, a Kenyan, and a local Motswana. Did I mention I have six-legged roommates also?! Well, I have a couple of those. They like to crash in my room from time to time. I end up killing them - I'm a horrible host!

I was reluctant to do the home-stay because I had to commute 40 minutes, one-way, to attend classes at UB. Afterall, I'm here as a student  But, hearing stories from friends who are doing the home-stay, I think I made the right decision. As you all know, its winter in Botswana, and it could get pretty cold at nights. Home-stays lack heaters and only one of them has Wifi at her home-stay. The other has no hot water, and she has to boil it separately in a bucket. I remember doing this in India, when I visited during 90s. The other has to kill three cockroaches on average whenever he needs to shower. They are everywhere!
However, there are pros and cons of both dorms and home-stays. No doubt, there is more culture immersion at home-stays. The parents at home-stays expect their children to follow their traditional practices and expect to accompany them in services (but not all of them are like that). There are 19 of us and 7 of them are doing the home-stays. If you plan on doing study abroad, depending on the country you are travelling to and your values, choose the best option you think you'll get more out from your time abroad, and the option that gives you your personal space. In the end, it all comes down to if you are happy with your decision or not.

Kgale Hill Hike

Climibing Kgale hill, as they call it, was a daunting task. My confidence swelled as soon as our combis arrived at the scene. "This is easy," I thought to myself as I began my hike and snapped this picture. My director, Batsi, told us that an earlier group reached the top in 25 minutes! Whereas, another group took two hours! Obviously, we wanted to beat the 25 minute mark. The skies were clear and the weather was perfect. I couldn't ask for more. There were a total of 3 tracks to the top. But the trail we choose was full of surprises and challenges. About quarter of the way to the top, our trail just disappeared, and we were left with nothing but thorny trees and sharp rocks all around us. Instead of going back, we moved on, fighting our way through thickets and forming our own trail. It was an inhospitable environment. For others, the sharp tree leaves would stick to their clothing as they brushed against them. At the half-way point, we were able to outline Gaborone.  We reached a point where there was nothing but boulders forming deep narrow ditches. It wouldn't be a pleasant experience to get your limbs stuck in one of those. We had no other choice but to scale the rocks.

After about 20 minutes, we got to the top...actually we thought we reached the top as we saw the radio towers in front of us. We settled on the boulders and munched on our snacks waiting for Batsi, who was trailing us. As I sat down, I saw three tiny splinters on my fingers! Whaoooo! I was grossed out at first to see them just protruding out of my skin. I was quick to pluck them out, hoping I didn't catch any infection. I immediately did a quick check of myself. There was nothing but a yellow bug crawling on my head, which my friend flicked it off. Now came the best part, viewing the beautiful landscape. It was Africa at its finest.  The view was exhilarating. My bonding with Africa was suddenly interrupted with Batsi's presence. We still didn't reach the top yet!! We had to go around the radio cables and make our way to the top.

The view from up above was breathtaking. My bonding with Africa rejuvenated. With the right breeze hitting my face, I took everything the view had to offer. The horizon seemed endless. Spending a half hour on top, we made our way down, this time on a newer trail. The path down had its own surprises. People who climbed the hill before saw baboons and other wildlife. Surely, on our way down the trail that seemed like a dried up stream, we saw baboons and deer.  Finally! what I was waiting for all along - witnessing Africa's wildlife in its natural habitat. There were 6 of them! It was heart-stirring!

Check out the pictures in "Photos" section of the blog.

Bafana Bafana vs. The Zebras

There is no doubt that soccer/football is the most popular sport in the world. It is a sport that unites nations together. This is especially true for African countries when it comes to world cup games. Furthermore, it helps to unite immigrants in foreign countries when their national teams compete   I personally have never been to a soccer game but always wanted to. My wish came true when I got to go to the 2014 Word Cup qualifier match between South Africa vs. Botswana on Saturday. The South African team is nicknamed "Bafana Bafana," which means "Go boys." The Botswana team is called "The Zebras." Even though "The Zebras" never made it past the qualifiers, the country came out in full support. It seemed that the whole nation was present at the stadium, singing their national anthems and playing their vuvuzelas.To them, their country playing at a national level is analogous to your team playing in Superbowl or the NBA Finals. People started preparing for the game weeks before. Maybe one day they will make make the Word Cup just like the Ivory Coast did in 2006 (maybe Bono can then do a commentary on Botswana). On the day of the match, there were tailgating gatherings everywhere. The atmosphere in the stadium was amazing with everyone armed with their plastic trumpets (It is an African tradition to blow vuvuzelas at football matches. I wanted one so bad) It was an eye-opening experience to see everyone so passionate about their national teams and watching star players like Steven Peinaar play for their country. Although the game ended in a 1-1 draw, the full 90 minutes were filled with excitement and happiness. In essence, it was nothing like I have seen before.

Day 3

My group and I didn't tour the city since we came. So, today we were split into groups and were sent on a scavenger hunt to find popular city landmarks. Our director just expected us to use the public transportation to find these places. I had an awesome experience with my group touring the city of Gaborone, interacting with local people, reading maps and figuring out which routes to take. We used the Combis, which are vans that locals use for commuting. This little mini-van fits 20 people or even more! One of the things we had to find was the "Three Kings Monument,"  or "Three Dikosi Monument,"which was built in the honor of Khama III, Sebele I, and Bathoen I. They embarked on a journey to England in 1885 to seek protection for Botswana, establishing the Bechuanaland Protectorate. The other was called the Onion Tower, which was essentially a water tower we have back home in every suburbs. One of the landmarks that I thought was interesting was the "El Negro" grave. After some research, I found that this "El Negro of Banyoles" stirred an ethical controversy. Along with other African wildlife, a man from a certain tribe was stolen and stuffed by French taxidermists to be displayed in Paris. Due to its unethicality, and its representation of African enslavement, the body was repatriated back to its origins and buried in Gaborone. You can learn more about this here. I also got to see the broken down "The No. 1 Ladies Detective Agency" film set. Check out the pictures from the scavenger hunt in the "Photos" section of the blog. The scavenger hunt was, in essence, a terrific way to learn about Gaborone. My group and I got to interact with a ton of people and learn to use the rambunctious public transportation. One of the locals decided to become our amateur tour guide. At one point, we were so lost that kids on a school bus/van persuaded their driver to give us a ride. I guess the students figured we were lost from our non-verbal cues; we literally had no idea of where we were going. In Botswana, directions are given not by street names, but by landmarks. Riding with local elementary students, though, was an amazing experience.

Interesting Fact:

Unlike the U.S., punctuality has little traditional value in Botswana. The person who is late is given the benefit of the doubt; it's assumed that the person was late for a specific reason, for which he/she needs to provide no further explanation. Also, the importance of mothers is valued in Botswana. After it's independence, the women played a significant role in developing the country when men worked in South Africa. They would send money back to Botswana. The mothers were responsible for rearing the children and sending them to school.

Day 2

Today, we went shopping for the adapters and phone/SIM cards for our laptops and cell phones. I brought my unlocked phone from the U.S and just had to buy a SIM card here. I was amazed to find how cheap the cell phone services are in Botswana. However, adapters were a little more expensive. I also found food prices to be the same. Furthermore, the majority of Batswana are beef-lovers. I've never seen a group of people eat so much meat.  An interesting fact I learned is that the majority of the butchers in Botswana and South Africa are Muslims; so, in essence, most Batswana in the country eat Halal meat! I took advantage of this. For dinner, my group went to the "Bull & Bush Pub," which is one of the best restaurants in Gaborone. I'll have to admit..the steak here was delicious! the best I ever had.

                                         Karaoke night at the Bull & Bush Pub 

However, in between, we got to learn about Batswana society. The Africans were gifted with land, but during the colonization, land was seen as a commercializing value. But, Botswana was only colonized as a gateway or route into inner Africa as it lacked arable land; the British had no interest in it other than the fact that it acted as a route, and saw it as a hassle to govern it as a protectorate. Thus, it was never a colony. The indirect control of the British maintained the traditional customs and institutions of Batswana. For instance, the Kgotla, which is a traditional political structure in villages, still exists. The Batswana also got their independence easily without having to fight against the British. The story probably would've been different if the diamond mines of Botswana were found during the 1960s, as opposed to 1980s. You would think that the Botswana government has full control over the diamond mines. However, a foreign company always intervenes; in this case, it's none other than De Beers! Turns out, De Beers makes more profit on the diamonds than the government of Botswana does on its own diamond mines.

Day 1

I learned quite a bit on my first day at Gaborone. The day started early with a visit to the University of Botswana. The school was established in 1982, and is still expanding. You can check out the pictures of the school in the "Photos" page. Apparently, the imaging infrastructure of the university and others, including the Sir Seretse Khama International Airport in Gaborone, where I landed, was built by Chinese companies. This is causing some immigration issues in the country as China are bringing their own laborers taking away construction jobs for the Batswana leading to an increase in unemployment. The Batswana have, however, mixed feelings about the Chinese entering their country.

Furthermore, that Batswana children are taught early on about other countries in the world.  They have a better understanding of globalization and geographic knowledge than youth in the U.S. We often times analyze the significant role of China or India in the globalized world, neglecting Africa completely while focusing only on its political instabilities, corruption and human rights. A professor at the University of Botswana considers Africa to be a "global village," but is somehow astonished by the fact that it's not well-represented in the Security Council. In fact, Africa is the hub for cash crops, making it the forefront of today's globalization.

Some Interesting Facts:

Botswana was the first African country to provide free anti-retrovirals for its citizens infected with HIV. This off course came after the generic form of the drugs were developed. Also, the U.S. NGO, Global Fund, was the the top contributor of funds to fight tuberculosis in the country. But last year, they pulled away leaving the patients, with ongoing treatment, without further medications. As expected, this lead to mutations that were incurable. Since Botswana is stable now, shouldn't NGOs like Global Fund pull out? Well, a reporter from the Guardian thinks otherwise.

History Lecture on South Africa?!

Since I'm in South Africa at the moment, this stand up from Russel Peters would make a good history lesson!

Travel Itinerary/Spirit of travel

I'm at Dulles International Airport right now in Washington DC. As I wait here for my next flight to Johannesburg which is in about 6 hours , I thought to myself, "I'm gonna post something, just for kicks." Hence, I decided to share my travel itinerary with you guys since I didn't share any of my flight timings and layovers.

So, I left O'Hare at 6am and got to D.C at 8am. I'm going to take South African Airways around 6pm to Dakar, Senegal. Unfortunately, I don't get to leave the airplane in Senegal because the stopover is for refueling  purposes only. Next stop is Johannesburg, where I have a stopover of about two hours. Finally, I'll arrive in Gaborone, Botswana tomorrow around noon, central time, hopefully in an airplane like this.

Also, while booking for my tickets, I chose seats close to windows because Africa is known for its beautiful landscapes, which I hope to view from above during the Senegal and South Africa stopovers. I'm so pumped for this trip. Just hearing the sound of "Africa" and "Botswana" gives me the jitters.I felt like this when Drogba walked towards the goal to take the final penalty against Bayern in the Champions League Final or when Nadal won the 2008 Wimbledon Final.

Furthermore, I was searching through my iPod to find the perfect song that would capture the spirit of travelling for my trip. Mainstream music nowadays, however, rarely strays away from themes of sex, drugs or violence ( No offense to mainstream music lovers); so, I wasn't going to find any answers there. I still didn't find what I was looking for from music from the 90s, but found something from the 80s, U2's Where the Street Have No Name.  (Listening to the song, I feel like I'm travelling to a place that has no name, where animals roam around freely without any boundaries, a place where there are no signs, and a place I won't be able to find again if I go back, but a place I'll always remember in my mind.) In essence, this sums up Africa's history, and its current condition due to exploitation that's rapidly changing the landscape of the continent.


Stay tuned for more posts...

Geographic Description

The country is divided into 9 rural and 6 urban districts. The urban districts are located on the east side of the border. The western part is mainly dominated by the Kalahari Desert. The desert may sound familiar to you as the Kalahari Resort in Wisconsin Dells as it takes its name from the sandy savanna. The Okavango Delta lies in the northwest. The Makgadikgadi Salt Pan lies in the north. The Notwane River, in the southeast, is where the Gaborone Dam is located, close to Gaborone.