“I’d rather not spend Christmas alone because I’m being quarantined for TB…”

What a week it is has been since I last blogged! I’ve definitely started to get the hang of Gaborone. I can ride the combi confidently, joking with the sketchy guys rather than looking at them like a deer in headlights and I’m pretty confident that my class schedule has been finalized! Not quite home yet, but definitely much more comfortable. And it was nice to start working at the clinic.

Highlights of the week:

- SOS orphanage: After a late night of ribs, sketchy Asians, and dancing at the Bull and Bush the CIEE gang rallied and all went to play with the kids at SOS orphanage. There are about 400 kids who permanently live there ages 0-18. They all loved having us around, especially the little ones. Good thing I brought my Frisbee along…quite a few athletes in the making!! The girls all loved my jewelry and called “teacher, teacher” whenever they wanted something. Next time I will have to take plenty of pictures!
- UB Rhinos vs. Gabs Hogs Final Rugby match: big crowd in support of the UB Rhinos! Luckily one of my friends plays rugby because she explained all the rules...sorry Kelly. I don’t remember a thing from my one day at rugby practice freshmen year.
- Gaborone Game Reserve: Got to see a lot more animals than I expected in a seemingly very urban environment. Got up close and personal with a few zebras, ostriches, two kimodo dragons, and many warthogs, impalas, and monkeys. We had a picnic lunch and 1 monkey stole my friend Alicia’s banana…what are the odds!
- Old Naledi Clinic: I started working at Old Naledi clinic this week and what an experience it has been! Old Naledi, as I mentioned earlier, is one of the no-go places that Batsi pointed out during orientation. Kelsey, Alicia and I keep our guard pretty high when we walk from the combi stop to the clinic. Our days start bright and early at 7:30 am since the clinic sees the most traffic between 7:30 am and 11 am. Our professor changed our assignment so that we are all observing/working together and focus our clinical logs on the same thing every two weeks. Our first assignment is TB. Tuberculosis is an under-acknowledged disease in the US but a significant public health concern in Sub-Saharan Africa. Old Naledi really is the dilapidated “shanty town” that Batsi made it out to be. Alicia, Kelsey, and I got plenty of stares walking from the combi stop to the clinic. Lots of people making fires to warm up, brushing their teeth outside, pit toilets, and piles of garbage.
The clinic vaguely reminds me of the insane asylum that One Flew Over the Cuckoo’s Nest was filmed in. White-washed walls, freezing cold, and very outdated technology. Everything seems pretty unsanitary too. There is no soap, toilet paper, or hand sanitizer to be found. I’ve found many needles lying around and privacy (much less HIPAA) doesn’t really exist. The one doctor in the consultation room sees upwards of 70 patients a day—listening to their problems, doing a quick physical exam, and prescribing some sort of medication without any explanation of what is wrong. Nurses are pretty nice but rather unmotivated. The hour long lunch break turns into an hour and a half on any given day.
The TB room is a small consultation room where the nurses dispense pills to TB patients every day. 109 TB patients have been registered at the Old Naledi clinic since January 2010. The government requires that patients come to the clinic daily to get the medications to ensure that patients are adhering to the regimen and getting proper support. It's a little frightening to think that the only thing preventing me from getting airborne, pretty contagious TB is my probably slightly compromised immune system and a N95 mask. As Kelsey said—the last thing we want is to be quarantined in the US when we get back because we have TB! Dispensing gets pretty boring but a technician from Princess Marina Hospital (one of the public hospitals in Gaborone) came to conduct a survey about TB patients in Gaborone. The survey is incredibly interesting—detailing everything from perceptions of TB in the community, socioeconomic status, alcohol use, HIV status, reasons for defaulting, interactions with the healthcare system, use of traditional medicines, side effects of the drugs, etc. The only problem is that it takes him more than 30 minutes to do the survey. The patients started to get pretty disgruntled when they learned they had to wait to get their pills—some even left! I think the surveyors need to provide an incentive to the patients if they want them to take the time to do it. When the TB room slows down (usually around 11 am) we headed over to the H1N1 vaccination room to help with filling syringes and tallying or the doctor consultation room. We had some pretty interesting experiences on Wednesday…
We went with the flabotomist to the injection room where they do bandaging (looks basically like what we do in EMS) and blood drawing. As the flabotomist started drawing blood from this very emaciated man’s arm right into a vial, my ears started ringing and my vision got blurry, and I nearly passed out! I don’t know if I hadn’t eaten enough but the experience became very real for me. Luckily I had some water and snacks in my bag and I was fine after that! We headed over to the consultation room afterwards, which was very interesting. The doctor was from Ethiopia, so he suffered from a language barrier similar to the one we were experiencing. He was very inviting to us though— asking us what we thought the problem was before he did a physical exam during every consultation. We saw everything from a lady who had an abortion (illegal in Botswana) to a man with pneumonia, to plenty of people who simply had the flu. A nurse from the maternity ward called the doctor to come, apparently because there was a “complicated delivery” in process. He told us to come, and we were pretty stoked. However, when we arrived—our hopes were swiftly crushed. Instead, we found a lady curled up in a bed weeping with a placenta just chillin in a metal bowl at the end of the bed. We were pretty confused until the nurse opened up a pile of green sheets in a bassinette and showed us a bloody stillborn baby. The experience was shocking to say the least, but what was more horrific was how the nurse and doctor handled the situation. The nurse was insensitive to the patient (note: she was HIV positive) and made it seem like this was commonplace. The doctor didn’t even ask any questions about the delivery and whether it was a fresh stillborn or whether the baby had died during pregnancy. Negligence seems to be a pretty significant problem at clinics around Gaborone.
I’m looking forward to the upcoming weeks. I feel like I have learned so much already about the healthcare system in Botswana and even medicine in general. It has definitely been a huge learning experience. More to come next week about the clinic and this weekend’s festivities!


Plans for the upcoming weeks:
- Dinner tonight with my sister Aty, my friend Alicia, and her sister Tumisan (she is my cousin actually) at Linga Langa at Riverwalk Mall
- Cultural weekend including dinner, dancing and camping at a rural cultural village (name to be disclosed afterwards/once I know where it is!), safari in Mokoldi Game Reserve north of Gaborone, and swimming fun at Lion Water Park
- Healthy dinner (vegetarian fajitas….yumm avocado!!) and brownies on Monday for my host mother’s birthday
- Makagaldi Salt pans next weekend
- Mochudi Village Homestay and Mochudi Clinic work
- Setswana Food culture project for my Setswana language and culture practicum: my friend Alicia and I are going to be researching traditional foods and learning how to make a few dishes. Perhaps when I come back to the US I'll cook some for ya’ll!
- Walking more! I walked from the university to BBS one night (about a 40 min walk) all by myself and felt very accomplished. Its nice to get some semblance of a workout and get away from the stuffy combis! Its been unusually cold here lately (5 degrees celcius this morning!) but hopefully it will get better by the end of next week ;)

PS- check out my pictures on facebook. I wasn’t able to add them all because of poor internet connectivity, but slowly but surely hopefully I will make it work! Love and miss you all. To all my college friends, good luck with fall semester—I wish I could be there for the craziness that is NSO and the first week of classes!