1.16.2011
12.29.2010
Ramblings on the last week
This post is going to be a bit disjointed perhaps as I want to touch on thoughts about my clinical experience here and on my trip to Zimbabwe over Christmas so here it goes.
First clinic, last week I spent about 2 to 3 hours talking with a teenager who had been suicidal and coming up with a safety plan. Today, he was suppose to return to see me and Leah, and we were worried that he wasn't going to come. But he did. And I think my time was well spent. He has this look about him that the world has become a better place to be now that he is not keeping this secret. He shared with us and with his aunt last week as we arranged a family meeting. It was satisfying and I hope he continues to do well after I leave this week.
Other thoughts. They do a step-wise disclosure for patients here. We start by telling young chlidren that they take medications to stay healthly. Then we talk about masole (soliders) who protect the body from getting sick. The next step is to add the "bad guy" who attacks the soldiers and when the soldiers are gone people can get sick. The name of the soliders and bad guy (HIV) are told at a later age, when the patient and family is ready but always encouraged before the age of 13. I was reviewing the solider concept with two children last week and when I asked what do soldiers do? I was told "drink". I didn't quite know what to say in response so I think my quick answer to both of them was ""you must know bad soldiers."" The analogy doesn't quite work when a soldiers job in a 7 year olds mind is to be a drunkard.
On to Christmas, I went with 2 of the PAC doctors to Zimbabwe. We feared that the border crossing was going to be a nightmare but where pleasantly suprised when we got through in 1.5 hours and without being asked to pay exorbitant fees for our luggage. It was beautiful around Bulawaygo, Zimbabwe. Lush, green grass and trees amongst rock towers. We saw monkeys, baboons, dung beetles, many birds, small deer like creatures, a tortoise, and squirrel-like creatures running past. We did not get to see any of the big animals, but alas one cannot control where the rhinos, giraffes and others want to eat and drink. We also saw an example of San rock art and went to the Khami ruins. At the ruins is where it got interesting. Not for the ruins, itself but for our car trouble. We had traveled 20 + K from the city and down a dirt road to get to the ruins. We toured with a guide and learned about the settlement which was occupied from around 1500-1700. It was abadonned most likely when tribes from South Africa were raiding much of the southern part of the continent. (It was because of these raids and the ""abandonned"" land that they left that Europeans thought land was unclaimed). It beautiful and cool to see. However, we got back to our car and it wouldn't start. Tried several times, no luck. A local came over and asked us to honk the horn and when it worked told us it could not be the battery. We asked him to let us at least try to jump it - knowing this was the only "quick" fix and otherwise we were probably screwed. Luckily it was the battery. And 4 jumps and a new battery later we finally made it back to Gaborone last night. Definitely the best outcome we could have had given the circumstances.
I know have a day and half of clinic work and then Jimmy gets here and our safari adventures begin. This might be my last post until we both get back to the states. I have enjoyed my time here and have again gained perspective on the what I need in a medical practice to be happy as a doctor. Now to find ways of having the practice after residency.
First clinic, last week I spent about 2 to 3 hours talking with a teenager who had been suicidal and coming up with a safety plan. Today, he was suppose to return to see me and Leah, and we were worried that he wasn't going to come. But he did. And I think my time was well spent. He has this look about him that the world has become a better place to be now that he is not keeping this secret. He shared with us and with his aunt last week as we arranged a family meeting. It was satisfying and I hope he continues to do well after I leave this week.
Other thoughts. They do a step-wise disclosure for patients here. We start by telling young chlidren that they take medications to stay healthly. Then we talk about masole (soliders) who protect the body from getting sick. The next step is to add the "bad guy" who attacks the soldiers and when the soldiers are gone people can get sick. The name of the soliders and bad guy (HIV) are told at a later age, when the patient and family is ready but always encouraged before the age of 13. I was reviewing the solider concept with two children last week and when I asked what do soldiers do? I was told "drink". I didn't quite know what to say in response so I think my quick answer to both of them was ""you must know bad soldiers."" The analogy doesn't quite work when a soldiers job in a 7 year olds mind is to be a drunkard.
On to Christmas, I went with 2 of the PAC doctors to Zimbabwe. We feared that the border crossing was going to be a nightmare but where pleasantly suprised when we got through in 1.5 hours and without being asked to pay exorbitant fees for our luggage. It was beautiful around Bulawaygo, Zimbabwe. Lush, green grass and trees amongst rock towers. We saw monkeys, baboons, dung beetles, many birds, small deer like creatures, a tortoise, and squirrel-like creatures running past. We did not get to see any of the big animals, but alas one cannot control where the rhinos, giraffes and others want to eat and drink. We also saw an example of San rock art and went to the Khami ruins. At the ruins is where it got interesting. Not for the ruins, itself but for our car trouble. We had traveled 20 + K from the city and down a dirt road to get to the ruins. We toured with a guide and learned about the settlement which was occupied from around 1500-1700. It was abadonned most likely when tribes from South Africa were raiding much of the southern part of the continent. (It was because of these raids and the ""abandonned"" land that they left that Europeans thought land was unclaimed). It beautiful and cool to see. However, we got back to our car and it wouldn't start. Tried several times, no luck. A local came over and asked us to honk the horn and when it worked told us it could not be the battery. We asked him to let us at least try to jump it - knowing this was the only "quick" fix and otherwise we were probably screwed. Luckily it was the battery. And 4 jumps and a new battery later we finally made it back to Gaborone last night. Definitely the best outcome we could have had given the circumstances.
I know have a day and half of clinic work and then Jimmy gets here and our safari adventures begin. This might be my last post until we both get back to the states. I have enjoyed my time here and have again gained perspective on the what I need in a medical practice to be happy as a doctor. Now to find ways of having the practice after residency.
12.20.2010
Listen to the music and dance.
I can't actually remember when I wrote last. But it's been awhile. I am in a routine here at Baylor now. My days usually go like this:
6 AM: awaken by my alarm. Get up out of bed. Make coffee. Pour bowl of cereal and drink said coffee. If its a Monday or Thursday, wonder if the cleaning lady will come before I leave and hopefully I have remembered to do dishes so I don't appear as a lazy American.
6:30 AM: walk to work, admiring the flowers and the huge mansions - I appear to live in the consulate laden and rich part of town.
6:38 AM: ask the kind front desk person to let me upstairs, because although I have been fingerprinted twice the fancy green fingerprint reader does not let me go anywhere in the building. Get to the office and call Jimmy on FaceTime. Smiles. Talk and check email.
8 AM: ask someone to let me downstairs (again, the fingerprint reader) and see patients in clinic. This can run anywhere until noon or 3 pm. See lots of patients. Communicate well with some of them, others go and beg for a translator.
After Clinic: eat lunch, usually this is around 2pm. Work on piling together research to help with a study they are trying to get published here. Talk with the volunteer staff (which includes Botswanans, Canadians, Americans, and a German) and listen to Botswana office drama.
5pm: Home.
After 5 pm, I do a variety of very normal American things: eat dinner, watch TV, go to movies. Last Friday, I went to a Botswana concert with two of the PAC doctors. One of their spouses is a very good saxophonist and plays in a local jazz band. He is also a physician and I cannot but wonder how he has kept up his musical abilities while studying medicine. Leah says its because he doesn't sleep.
Anyway the concert was good. And there was dancing. And there was a Botswana star, Eugene Jackson grabbing Leah, one of the PAC doctors, and serenading her on one knee. I think the local ladies were jealous and Leah was embarrassed. And then there was Ringo, a South African artist who sings in Zulu, and hence is not understood by people here, but whom the crowd was crazy for. They were screaming, singing every word, and dancing up a storm. It was quite fun.
This weekend got me thinking. I think I like traveling because I lose any ounce of self-consciousness (well maybe not all of it) and do things that I keep myself from doing back home. Like dancing.
6 AM: awaken by my alarm. Get up out of bed. Make coffee. Pour bowl of cereal and drink said coffee. If its a Monday or Thursday, wonder if the cleaning lady will come before I leave and hopefully I have remembered to do dishes so I don't appear as a lazy American.
6:30 AM: walk to work, admiring the flowers and the huge mansions - I appear to live in the consulate laden and rich part of town.
6:38 AM: ask the kind front desk person to let me upstairs, because although I have been fingerprinted twice the fancy green fingerprint reader does not let me go anywhere in the building. Get to the office and call Jimmy on FaceTime. Smiles. Talk and check email.
8 AM: ask someone to let me downstairs (again, the fingerprint reader) and see patients in clinic. This can run anywhere until noon or 3 pm. See lots of patients. Communicate well with some of them, others go and beg for a translator.
After Clinic: eat lunch, usually this is around 2pm. Work on piling together research to help with a study they are trying to get published here. Talk with the volunteer staff (which includes Botswanans, Canadians, Americans, and a German) and listen to Botswana office drama.
5pm: Home.
After 5 pm, I do a variety of very normal American things: eat dinner, watch TV, go to movies. Last Friday, I went to a Botswana concert with two of the PAC doctors. One of their spouses is a very good saxophonist and plays in a local jazz band. He is also a physician and I cannot but wonder how he has kept up his musical abilities while studying medicine. Leah says its because he doesn't sleep.
Anyway the concert was good. And there was dancing. And there was a Botswana star, Eugene Jackson grabbing Leah, one of the PAC doctors, and serenading her on one knee. I think the local ladies were jealous and Leah was embarrassed. And then there was Ringo, a South African artist who sings in Zulu, and hence is not understood by people here, but whom the crowd was crazy for. They were screaming, singing every word, and dancing up a storm. It was quite fun.
This weekend got me thinking. I think I like traveling because I lose any ounce of self-consciousness (well maybe not all of it) and do things that I keep myself from doing back home. Like dancing.
12.13.2010
It's tough being a teenager anywhere
I spent a long time in clinic today with a patient who I will call Becky. She is 15 living with HIV. I asked if her if there was anything that she was concerned about today. She told me no not with her health, but somedays with her head. I gave her a puzzled look. She then mumbled, "You know with HIV and my head. It's difficult." She went on to elaborate how some days she sits and cries because she becomes so saddened by her illness. Most of her friends do not know her status - there is still stigma here in a country where around 25 percent of the population is infected. She only feels she can talk to her sister who is away at college. This relationship appears to have become a little rocky recently as her sister, concerned about Becky, told their mother about Becky's sadness. Becky was then yelled at by her mother.
I have worked with enough teenagers to know that this is just part of the story, Becky's side. I know the relationships and situations are much more difficult, but my heart breaks for her just the same. I know that teenagers with all sorts of illness feel as isolated as Becky - like the only one and that the illness is overtaking their lives, limiting their futures. Even if this is not the case. HIV is not the death sentence that it use to be. Medications keep the infection silent when taken properly and the regimes are not as complicated as they once were. (And Becky after defaulting in 2005 has been doing well now that she is back on treatment). But how does a young person necessary believe in hope of the future, especially in a country that has so many orphans from the illness and where most people know someone who has died from its complications.
I think this visit elaborates the most difficult thing for me here. For those of you who have had the conversation with me about why I chose to do this silly thing called Triple Board know that I cannot ignore a sad child. And there have been many sad children here. I have watched them break down in tears because of a sick sibling in the hospital, because of being teased at school, because of remembering a mother who was lost to the illness that they now struggle with... this has been the hard part. Made more by the fact that many of the children do not speak my language to understand comforting words. I feel hopeless to help in this realm, and the core of my being just wants to make those tears go away.
I have worked with enough teenagers to know that this is just part of the story, Becky's side. I know the relationships and situations are much more difficult, but my heart breaks for her just the same. I know that teenagers with all sorts of illness feel as isolated as Becky - like the only one and that the illness is overtaking their lives, limiting their futures. Even if this is not the case. HIV is not the death sentence that it use to be. Medications keep the infection silent when taken properly and the regimes are not as complicated as they once were. (And Becky after defaulting in 2005 has been doing well now that she is back on treatment). But how does a young person necessary believe in hope of the future, especially in a country that has so many orphans from the illness and where most people know someone who has died from its complications.
I think this visit elaborates the most difficult thing for me here. For those of you who have had the conversation with me about why I chose to do this silly thing called Triple Board know that I cannot ignore a sad child. And there have been many sad children here. I have watched them break down in tears because of a sick sibling in the hospital, because of being teased at school, because of remembering a mother who was lost to the illness that they now struggle with... this has been the hard part. Made more by the fact that many of the children do not speak my language to understand comforting words. I feel hopeless to help in this realm, and the core of my being just wants to make those tears go away.
12.10.2010
Clinic Adventures
After the first week here, they have us see patients and staff them with the PAC doctors. Today was my first day, having spent most of the week on outreach. I have learned so much about HIV care, but seeing patients on my own was/is a little nerve wracking. I mean, these patients have the same problems as all patients but their immunodeficiency makes each illness just that much more scary. I was suppose to see the uncomplicated ones, but triage here is not necessarily the best so I saw a mixture. Most of the kids were doing well, which has been the case for many of the patients but other not so much. I saw several children brought by their older sisters who were around 13 to 15. Mother, grandmother, or auntie couldn't make it today so sister came instead. We still see them and try to communicate back to the family. We also see a lot of teenagers on their own, in part as teenagers here are seen almost monthly as so many teens default (just like any chronic illness right?). I was exhausted at the end of clinic. I think in part because of the newness and double-triple checking that I did. I also feel uncomfortable at how long patients wait for us to finish charting. In Botswana every patient carries their own medical chart so patients can't leave until providers have finished documenting. This leaves a lot of awkward silence as you hurry to type the note and then send them on their way.
Christmas around here means that most natives head back to their cattle station. Cows are BIG here and hence beef is cheap. Everyone lives away from their home village and hence travel back during the holidays and family celebrations. I tried calling a patient's grandmother today and was told she was not reachable as she had already gone to the cattle station. Definitely a different world.
Christmas around here means that most natives head back to their cattle station. Cows are BIG here and hence beef is cheap. Everyone lives away from their home village and hence travel back during the holidays and family celebrations. I tried calling a patient's grandmother today and was told she was not reachable as she had already gone to the cattle station. Definitely a different world.
12.08.2010
Christmas Party, ex-pats, and flying missions
I know it has been awhile since my last post. I have been here for a week now and still surviving. Although that's not that hard here. Many people have referred to Botswana to me as "African Lite" including the native born population. Its definitely more like the USA, one of the reasons I think that there are so many ex-pats here and a HUGE peace corp volunteer contingent.
Saturday was the Christmas Party here at Baylor. They invite around 300 kids who are HIV+ to Baylor for a day of music, fun, games, and presents. It was awesome to watch them play and it makes you realized that here in Botswana you cannot tell who does and does not have HIV. I got to be in charge of first aid as the Baylor doctors had left in a rush secondary to illness in one of their members. Anyway, I got to give some Gatorade to 2 dehydrated children who had overdone the playing in the Botswana summer heat. :) Highlights were getting to talk to the several peace corp volunteers that showed up, playing with the children (as always!), and watching the teenagers perform a native dance for the younger children. A very fun day, although it is hard for me to think of Christmas in 90 degree heat. :)
Sunday I went to dinner at Lisa, a friend of Katie's - thank you Katie - who lives here. She works for a NGO that she formed here to work with Botswana teenagers around all sorts of teenage issues. She is an amazing women and has lived/worked all over. She was in the midst of writing a grant application and I learned more than I ever knew about the struggles of getting funding for NGOs. Its rather complicated and something I am glad I don't deal with. She had 2 people from Project Hope over as well and the strangest part of the evening was that one of them, Megan, had been BK's roommate in college. Strange, small world. And we had put the two together without reference to ultimate. :)
Remembering why I like being abroad - although I don't think I really forget that - and why medicine had been a draw when I lived in India so long along. Realizing that was almost 10 years ago now. I went on outreach this week and we actually flew to one of the sights. These sights were more of what I expected - more resource and staff poor and remote. Baylor goes to these sites to help local staff learn how to manage kids with HIV. They often go with other NGO groups that help teach the local medical officers as well. I spent yesterday rounding on the wards in a remote hospital with a American doctor, an Australian doctor, a Botswanan FM resident, and the local medical officer who was from the Congo orginially. Botswana did not have a medical school until recently and most Botswanans do not want to work for the government as the government can send you whereever and at these local hospitals you are the OB, the surgeon, the internist, and the pediatrician. Its a crazy life. This also means that usually the doctor does not speak the language of the patient. Some sad cases on the wards, which I won't detail here and some cases that I was amazed had been admitted. Those cases were both kids and I think there was some discomfort with the staff at that hospital which managing children.
I am learning more than I ever knew about HIV management and getting a glimpse of yet another culture. It is only making me want to practice abroad even more than I did before.
That's it for now.
jenny
Saturday was the Christmas Party here at Baylor. They invite around 300 kids who are HIV+ to Baylor for a day of music, fun, games, and presents. It was awesome to watch them play and it makes you realized that here in Botswana you cannot tell who does and does not have HIV. I got to be in charge of first aid as the Baylor doctors had left in a rush secondary to illness in one of their members. Anyway, I got to give some Gatorade to 2 dehydrated children who had overdone the playing in the Botswana summer heat. :) Highlights were getting to talk to the several peace corp volunteers that showed up, playing with the children (as always!), and watching the teenagers perform a native dance for the younger children. A very fun day, although it is hard for me to think of Christmas in 90 degree heat. :)
Sunday I went to dinner at Lisa, a friend of Katie's - thank you Katie - who lives here. She works for a NGO that she formed here to work with Botswana teenagers around all sorts of teenage issues. She is an amazing women and has lived/worked all over. She was in the midst of writing a grant application and I learned more than I ever knew about the struggles of getting funding for NGOs. Its rather complicated and something I am glad I don't deal with. She had 2 people from Project Hope over as well and the strangest part of the evening was that one of them, Megan, had been BK's roommate in college. Strange, small world. And we had put the two together without reference to ultimate. :)
Remembering why I like being abroad - although I don't think I really forget that - and why medicine had been a draw when I lived in India so long along. Realizing that was almost 10 years ago now. I went on outreach this week and we actually flew to one of the sights. These sights were more of what I expected - more resource and staff poor and remote. Baylor goes to these sites to help local staff learn how to manage kids with HIV. They often go with other NGO groups that help teach the local medical officers as well. I spent yesterday rounding on the wards in a remote hospital with a American doctor, an Australian doctor, a Botswanan FM resident, and the local medical officer who was from the Congo orginially. Botswana did not have a medical school until recently and most Botswanans do not want to work for the government as the government can send you whereever and at these local hospitals you are the OB, the surgeon, the internist, and the pediatrician. Its a crazy life. This also means that usually the doctor does not speak the language of the patient. Some sad cases on the wards, which I won't detail here and some cases that I was amazed had been admitted. Those cases were both kids and I think there was some discomfort with the staff at that hospital which managing children.
I am learning more than I ever knew about HIV management and getting a glimpse of yet another culture. It is only making me want to practice abroad even more than I did before.
That's it for now.
jenny
12.02.2010
First Day in Clinic
I thought today I would be over this jet lag, but alas that was not to be the case. Still jet lagged and did not sleep well last night. Spent this morning shadowing Leah, one of the American doctors who has been here for 1.5 years. Lots of patients who today were well controlled. One boy will stick out in my mind a 18 year old who looks like he is 9 for issues unrelated to his HIV status. This would have been treated long ago in the USA but he wasn't even able to be diagnosed until a little over a year ago secondary to access.
Most surprising thing: the clinic here is nicer than my continuity clinic back home and they are completely electronic. Not what I was expecting.
That's it for now. More adventures to come...
jenny
Most surprising thing: the clinic here is nicer than my continuity clinic back home and they are completely electronic. Not what I was expecting.
That's it for now. More adventures to come...
jenny
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