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.
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