Dumela!! Sorry I have been so incredibly MIA the past 3-4 weeks. Between the village homestay, a spontaneous trip to Victoria Falls, mom and dad visiting and spring break in South Africa my internet connection and free time has been slim to none. Luckily I wrote down most of my thoughts as I went to share with you all. It might take me a while to get through everything, so bare with me!!
From the clinic and home-based care work I did to my warm and friendly family, I loved, loved, loved my entire village home stay experience! The 11 of us CIEE girls were placed with families in a village about an hour away from Gaborone called Mochudi. The winding, hilly roads of Mochudi were a needed change from the flat plains of Gabs. It was nice getting away from the busy streets of Gabs and experiencing the "simple life" of the village. The people in Mochudi were all incredibly hospitable and welcoming. They aren't as used to seeing white girls like me so I think that added to their talkativeness as well. I had a mother, Caroline Mooketsi (aka Mma-Thabo: mother of Thabo) who owned and ran a shop called Kagiso General Store and Butchery. I had lots of fun helping out at the store in the afternoons, socializing with the customers, and improving my Setswana. I often helped Mma-Thabo bake her prized scones that she sold in the shop. Mma-Thabo was the greatest host mother I could ask for. Always enthusiastic, wanting me to learn about Setswana culture and including me in everything she did. It was a refreshing change from life in Gabs. She always said, "Oh my dear Malebogo, you are so free. You are my daughter. You are free to do what ever you would like" (Malebogo is my Setswana name, which means "many thanks"). I also had two brothers, Thabo (24) and Thabiso (18), though Thabiso goes to college in Gabs and wasn't around. At first I though that Thabo was going to be super quiet, but as the week progressed I realized what a fun companion he was. It was interesting to hear his rebellious, anti-traditional culture take on life. My father owns a cattlepost and is a preacher. We went to church on Sunday for three plus hours, entirely in Setswana. Although we dressed in full length skirts and head scarves, we stuck out since we didn't have the traditional garb (oh, and we are white! The service was interesting, although it got really stuffy in the church. My father was nice, though not very talkative. There is a very interesting dynamic between children and they father. In traditional society, men are always served food on a silver platter first and treated like kings. It doesn't seem like there is a lot of emotional or intimate contact between husband and wife or husband and child.
I was shocked to see my house when we first arrived-- it was bigger than my home in Gabs! I had an entire section of the house to myself and their was a maid who came everyday to clean, do laundry (including mine!!!), and sweep the dirt. Kelsey, Alicia, and I came to the conclusion one day that their obsession with sweeping the dirt is kinda parallel to our obsession with cutting the grass (since they have sand/dirt instead of grass). It seems silly to sweep the sand/dirt outside when you are just going to step on it and mess it all up, but I guess grass grows right back when you cut it too, right?
My living experience was also far different from my friends. Kelsey had too deal with her 300 + pound mother peeing in a bucket in her room every night and her drunk host sister singing in the bathtub "I'm in love with a stripper.." and "I'm sorry Ms. Jackson, I am for REEEALL" Alicia had to deal with an ipod-stealing, computer breaking host sister and enough chickens to feed a nation. At least the worst I had to deal with was a goat head on my kitchen counter, and turkeys and cows in the yard to be slaughtered for the butchery. My house even had a grapefruit tree-- Kelsey and I made grapefruit juice one day for my mother and she absolutely loved it!
Instead of commuting to classes at UB like the rest of the CIEE girls, Kelsey, Alicia, and I worked at Mochudi Clinic II from 7:30 am - 4:30 pm everyday. Let me tell you, the Mochudi Clinic was a 180 degree change from Old Naledi. The biggest difference was the staff. For the most part, the nurses at the Mochudi Clinic were all very compassionate, hard working and good-natured people. Unlike the laziness I witnessed at Old Naledi, nurses at the Mochudi clinic cared about their patients and the welfare of the greater community. The following is a rather long excerpt from my Public Health Clinical Log that details my experience in the clinic. Enjoy:
I was impressed by how Mochudi Clinic actively involves the community in their health. The daily Morning Prayer services, health education talks, and frequent home-based care visits all contribute to the clinic’s positive image. The prayer services create a connection between healthcare provider and patient beyond the examination room, allowing for a more holistic clinic experience. For many, the Morning Prayer is an enjoyable experience and makes the clinic much more warm and welcoming. Patients, nurses, and cleaning staff are encouraged to read from the Bible and lead prayers. Although such prayer services could be potentially repellent to those of other religions, I think that the prayer session focuses on being more spiritual than religious. As such, I think that the daily morning prayers are a very positive way for Mochudi Clinic II to start the day.
Health education is a critical component in a villages’ plan for disease prevention and control. The health education officer at Mochudi Clinic II was particularly active and hospitable. He was involved in all wards of the clinic—from Home-Based Care to Child Welfare. By having a very visible presence in the clinic, the health education officer is able to teach the community about healthy living and disease prevention and control.
Under the guidance of the health education officer, Alicia, Kelsey, and I were able to devise and present a short lecture about HIV/AIDS transmission and prevention. After prayer service one morning, we spoke to the patients and the health education officer translated our words into Setswana. Although it was exciting to feel like we were giving back to the community, I think that mini-lectures like what we presented are not the most effective means of education. Given the staggeringly high prevalence of HIV in Botswana, the vast majority of the community knows about the dangers HIV/AIDS. The information we gave them is of critical importance, but was not new news to them. Instead of a one-way education system, I think health education at the clinic should engage the community members in discussion and critical exploration of ways to diminish epidemics like HIV/AIDS in the community. This would facilitate active learning and would answer the questions that the patients want answered. Also, it would allow patients to be more aware and get more involved in their own health.
Home-Based Care is one of the most attractive components of Mochudi Clinic II. Almost everyday, clinic staff goes in the ambulance to visit patients at their homes. Oftentimes we accompanied staff from Motswedi Community Rehabilitation Programme. Since its inception in 1992, Motswedi has been committed to providing rehabilitation and physical therapy to patients in the community as well as providing preschool and skills training for developmentally challenged children. The program gets half of its funding from the government and half from fundraising initiatives.
Throughout the week we visited more than a dozen different patients. We visited two elderly stroke patients three times throughout the week to check how rehabilitation exercises were improving their motor function. After listening to their complaints, we also were able to give suggestions on how to improve their situation. For instance, both patients complained of hard stool so we suggested eating lots of vegetables and fruits rather than having them take medicine that would give them diarrhea. We gave them positive encouragement and reminded them to do their exercises frequently. It was rewarding to see how thankful the patients’ families were for our presence and support.
We also visited several families with children with developmental disorders like cerebral palsy and hydrocephalous. HIV/AIDS, TB, Malaria, diabetes and heart disease get so much media attention that genetic and developmental disorders are often overlooked. However, according to the Motswedi physical therapists, developmental disorders are quite common in Mochudi. Just as we saw unmotivated patients in their homes, it was particularly sad to see unmotivated parents of children with such developmental disorders. Struggling with poverty and health issues of their own, parents become “lazy” and look like they are neglectful of their child’s health needs. However, from a more empathetic perspective, the parents are just as vulnerable as their children to pain and suffering. Counseling and support should be provided by the clinic, particularly for these mothers, to help eliminate stigmatization of developmental disorders and promote adherence to exercise regimens.
Some of the Home-Based Care patients we visited had more complicated situations. One family had four children, the youngest three of which had congenital developmental problems such as hydrocephalous and cerebral palsy. All had severely stunted growth. The mother of the children had taken Depo-Provera 150, an injected birth control hormone, after having her first child. Six years later, she had the three children with congenital problems. Depo-Provera 150 is banned in the United States because of its ill side effects, including sterility, irregular bleeding, decreased libido, depression, high blood pressure, excessive weight gain, breast tenderness, vaginal infections, hair loss, stomach pains, blurred vision, joint pain, growth of facial hair, acne, cramps, diarrhea, skin rash, tiredness, and swelling of limb (Goodman, 1985). In a country like Botswana where undernourishment is a problem, weight loss could be a serious health threat. Although genetics are undoubtedly implicated in these developmental disorders, I wonder whether it also could be linked to the Depo-Provera 150 injection. The Food and Drug Administration proposed that fetal exposure could cause birth defects when they presented their case against the drug’s approval in the US (Goodman, 1985). I’d like to investigate into the harmful side effects of Depo-Provera 150 and its implication on birth control methods in Botswana.
We also visited a man who was having problems adhering to his ARV medications. He told us an elaborate and quite believable story about how both of the muscles in his legs unexplainably atrophied in 2005. Since then, he has religiously been doing his leg exercises and has gone from bed rest to wheelchair to crutches. Despite this inspirational story, the man was getting sick because he wasn’t taking his ARVs. He thought they weren’t necessary because it only takes a few seconds to swallow pills. From his point of view, they could hardly have an effect on his health if they didn’t take any time to work. When we tried to explain to him otherwise, he got angry and defensive. He began to talk about being bewitched and going to the traditional healer for better care. His mom didn’t share the same beliefs about traditional healers and was fed up with his apparent ridiculousness. It was interesting to observe the clash between traditional and modern medicine. In the future, I think that the clinic should work cooperatively with traditional healers to promote HIV/AIDS prevention and safe health practices.
The Maternal Child Health room at Mochudi Clinic was a much more integral part of the clinic than in Old Naledi. The nurse was welcoming and compassionate. Women come to MCH for pre and postnatal checkups, family planning, and gynecological problems such as urinary tract infections and sexually transmitted diseases. Pregnant women must be HIV tested before the nurse can look at them. Prenatal checkups included measuring the size of the stomach to determine the baby’s length, listening to the fetal heartbeat, and palpating the belly to check for physical deformities. Younger pregnant women are given multivitamins and tsabothle rations to ensure their health throughout pregnancy. The first time a women comes in for a pregnancy checkup, the nurse does a full physical exam and cervical examination.
During my observation of the Maternal Child Health room I saw several interesting cases. I found it particularly interesting how the nurse treated a Zimbabwean pregnant woman who came to the clinic. She was demeaning to the Zimbabwean, scolding her for working to hard and failing to take proper care of her first baby that passed after living one month. From my observations, it seems as though Zimbabweans are looked down upon and stigmatized in Botswana. As healthcare providers, nurses at the clinic should act indiscriminately, treating all patients as equals. There was also an HIV positive nurse from Princess Marina that comes to Mochudi Clinic for confidentiality. Given the stigma surrounding HIV/AIDS, I understand why the nurse didn’t want to collect her ARVs from the dispensary at Princess Marina Hospital.
Another interesting case involved a woman who came to the clinic for the first time 22 weeks into her pregnancy. Upon cervical examination, the nurse found white discharge on the specula. The nurse lectured the woman on the importance of safe sex during pregnancy and prescribed her clotromidazole, a drug commonly used for treatment of Trichomoniasis. It was interesting to see the reality of a disease we learned about in parasitology class a few weeks ago! After the woman left the examination room, the nurse and I discussed the problem of condom use in Botswana. In her opinion, men were at fault in the problem since they don't want to wear condoms. They risk the spread of harmful STIs such as HIV and the possibility of pregnancy for their own sexual pleasure. Men play very little role in the pregnancy of their child. It’s frustrating to see countless women come to the clinic alone, with serious sexual health problems and pregnancy.
Other positive aspects of the clinic that I observed were the cleanliness and sanitation protocols. There was soap in every examination room and all of the bathrooms were equipped with toilet paper. I also think that the openness of the clinic allowed for better ventilation than at Old Naledi Clinic. The clinic also wrapped free packages of condoms in newspaper for patients to take inconspicuously. Given the stigmatization of condom use in Botswana, I think it was very clever of the clinic staff to promote condom use by giving them out so discreetly. Lastly, I thought the daily morning meetings to discuss news and the previous day’s proceedings were important to keeping the clinic staff united. These morning meetings are a short yet effective way to keep the Clinic nurses on the same page.
Despite the positive experiences I had, I felt that Mochudi Clinic could also be improved in several ways. The clinic consistently ran out of vaccinations and rations. This is a problem more of the Botswana government than the clinic, but is an issue detrimental to patients all the same. I was also surprised when the MCH nurse didn’t know how to use the pregnancy test a woman brought in. As a nurse specializing in gynecology and antenatal care, administering pregnancy tests should be a fairly common part of her job description. I was likewise surprised patients could get their prescriptions free at the dispensary, but women had to buy pregnancy tests from a chemist. This differentiation puts pregnancy in a negative light, incurring a financial penalty on the woman.
After lunch break, everything slowed down to a standstill at the clinic. When we didn’t go on home-based care visits, I felt as though there was no point in keeping the clinic open. Time after lunch should be better spent in completing paper work, devising health education seminars, going on home-based care visits and having meetings. On a separate note, I noticed that the clinic needs more napkins to provide patients in home-based care. At 180 pula per pack, most patients can’t afford these medical expenses. Although resources are in high demand, its unfair to selectively give out napkins. Either all patients should be given equal amounts or they should offer the napkins at a subsidized rate for everyone. Lastly, I think there needs to be a way to help severely disabled in Mochudi. There are many people who remain without aid because Motswedi doesn’t have the resources to take the severely handicapped under their belt. Thus, those who need help the most are left in the dark. Overall, I had a very enjoyable experience at Mochudi Clinic II and I thought it was interesting to see the differences and similarities to Old Naledi Clinic.
Over the second weekend, my mother took me to pick out fabric and have a traditional skirt made at a tailor (much cheaper than in Gabs). I also went to an English church with Thabo which was smaller but just as animated and evangelical as Bible Life Ministries in Gabs. I also got to visit Thabo's 2 month old son Setso! He actually didn't mention he had a son until the day I left. I found it particularly interesting how passionate he was about the problems he saw with Setswana culture. He complained time and again about how he never got to see his son because traditionally, infants aren't allowed to leave the house until they are 6 months old. Since he isn't married to the mother of Setso, he only gets to see his boy a few days a week. But the smile on Thabo's face when he was holding Setso was truly priceless!
So the Mochudi stay was huge success. I enjoyed every minute of it and undoubtedly will go back to visit the cattlepost (since we didn't have time for that) and to pick up my skirt! I look forward to seeing all of my family and neighbors, especially Mma-Thabo again!!
