Sunday, June 30, 2013

Empowering Women and Finding Family in the Best Places

I sincerely apologize for the lack of blog posts, it's been a crazy two weeks! I just arrived back from the third largest village in Botswana, Kanye, which is located about an hour outside of Gabs and where I spent a week with a host family. I have so many pictures to share but first I want to back up a little and talk about Extension 2 clinic where I was working two weeks ago.

Although this clinic didn't have a maternal ward or a child welfare clinic area, I was able to do my first formal interview with the PMTCT Coordinator! Yes, that's rights, I used an informed consent form and everything! During our conversation she explained to me how the Routine HIV Testing (RHT) Program started from the ground up and how the PMTCT aspect is the real success story. For all the responsibility falls on the mother to ensure that her baby is safe and healthy which makes her that much more inclined to adhere to the ARV treatment during her pregnancy.  In trying to have women get consistently tested for HIV men stand in the way for full adherence because most of them refuse to get tested themselves saying that they say they aren't "ready" to know their status. Thus, though women are coming in to get tested themselves, if their partner doesn't know their own status, the program isn't able to have any real affect in lowering the rate of new infections because an HIV negative women can still easily be infected if her partner is unaware of his status. Because the PMTCT program is solely between and woman and her child, the transmission rate has dropped to 1% transmission simply because these women understand the importance of preventing the spread of HIV to the next generation--something no man can stand in the way of.

My group with the OBGYN in the scanning room
Again, during my interview, I heard about problems with drugs and alcohol especially in teenagers. But  I was at least encouraged by the persistence of such nurses and health educators such as this PMTCT Coordinator to never cease outreach activities. I spent almost an hour talking with her in her office and it was really amazing to hear her talk about all the changes she's witnessed to the health care system over the past decade, especially in helping women to see that they have the power to protect their kids from something that often they themselves can't control when it comes to protecting against HIV.

I also got to spend some quality time with some of my nurse friends that I made during my time observing in the HIV-testing and counseling rooms. They would bring me along on their breaks where I met with the rest of my group for tea, coffee, fat cakes, sometimes fries and a lot of freshly made bread and peanut butter. In addition, I received a marriage proposal from one of the male nurses at the clinic. His name was Life, and boy was he full of it! He was quite a source of entertainment for us that week!

Before I get to home stay pictures, the Thursday night before we left for Kanye, my roommates and I went out to celebrate our Motswana roommate Fiji's birthday. From there two of my friends and I met up with another Motswana friend Lera who is incredibly bubbly and energetic. She took us out to a bar called the Cigar Lounge which really turned into a club around midnight. It was quite a night! They played some really fab American music and everyone had a blast. I got to meet some more local Motswanas our age and it was awesome to feel like a part of a scene happening half way around the world from home! All the dancing sure did make me miss Iowa City though.

My bedroom 
The sitting room 
Alrighty, now to the home-stay! There's so much to talk about that I'm going to use my pictures to help you get an idea of what my experience was like. Though I must admit I had a rough first night adjusting, the next afternoon I met my 21-year old host sister and her cousin who is 22 and goes to UB also and I realized just how much I was going to enjoy my time in Kanye. I went to a clinic called Mafikhana Clinic in the mornings and then got to hang out with my family in the afternoon. Friday night my sister and cousins took me out, despite the fact that we did have water, electricity or cell service and I had such a fun night I'll never forget! Kanye is really a small town though because the next morning our combi driver who is a family friend asked me if I had a good night. Apparently word gets around fast when there's only one smiling white girl in the entire bar enjoying a night out with her new family!

The kitchen  

My little sister Ougafi playing games on my iPad

View of the compound area: I lived in my grandmother's house with my sister and cousin. My host mom and her two kids lived in the smaller house towards the back. 

Bathing with a bucket of water in a tub! Note
that the water had to be heated in a tea kettle. 

Abigail and I walking around Kanye after Clinicals

The waiting area of Mafikhana Clinic

My sister Thato taking hot water from the fire to make her bath

Walking with freshly cooked (and killed) chicken for dinner!

Mma Pearl serving Fat Cakes!
Ougafi sitting by the orange trees in the backyard 
My cousin Kgosi picking oranges

Little cousins playing outside at dusk

Dancing during a power outage!
Traditional wedding decorations at the head table 
Local wedding reception tent

Cooking tons and tons of food

The gals!

I came away from this week realizing how much more I enjoy being in smaller and more rural villages as opposed to a bigger city like Gabs. The people are just so much warmer and all the activities are so much more family based and authentic that I really didn't want to leave! I was promised that I could stay with my family any time I come back to Botswana and I told them I would be back sooner rather than later! 

Mma Donor and I during my last night in Kanye!

Tuesday, June 18, 2013

Journey to Serowe: Khama Rhino Sanctuary

Last weekend half of our group went down to spend the weekend in Johannesburg, South Africa while I ventured North to Serowe with the rest of the group. Serowe houses a beautiful stretch of small villages and is home to the wonderful Khama Rhino Sanctuary. We left UB around 11am on Friday morning and drove about 5 hours to reach Serowe. Although the ride was pretty uneventful, I must devote some time to talk about our bus driver Brian. Brian consistently blasted, and I mean BLASTED his own music throughout the entire drive up to Serowe. And no, the music was not our favorite. It ranged from odd gospel soul music to very thumpy bumpy I can't tell what the actual melody is to this song type of music. He also proceeded to make little pit stops when ever he pleased in order to pick himself up some snacks at a few side vendors we passed but wouldn't let us out of the bus so we just had to stay on the bus with his music. Oiy! Oh and also, even before we got on the main road to Serowe, Brian took us to the parking lot of a nearby mall called SquareMart because he claimed that he had to get cash for the journey. Why he didn't get cash before he picked us up that morning, don't ask me. And of course he took is jolly old time walking too and from the bank and talking to his friends on his blackberry so we ended up getting to our lunch place about an hour behind schedule. AND THEN he decides he needs to fill up the bus with gas (again, why didn't he do this earlier?) and leaves us stranded at the restaurant for about 20 minutes until we realize that the gas station he is at is the one right next to the restaurant. At this point I was ready to give him a stern talking about how to be on time, but soon enough he came back to the bus and we began our journey to Serowe.

The view driving up to Serowe
We arrived in at the Rhino Sanctuary just in time to check into our lodging for the night and headed to dinner. As we drove up to the lovely dinner spot, the power immediately went out (no surprise there) and so we had our dinner by candlelight. Let me just say, the food was FANTASTIC. I would recommend the Oxtail to anyone who can find it in the States. We all gorged ourselves on the fresh and lightly cooked veggies because cookies and crackers have become our best snacking friends back home in Gaborone, although we did manage to save room for the cake they served at the end of our meal. Yum.

Then we proceeded to our Night Game Drive where we drove in caravans around the reserve. The group was split into two caravans and my group saw a group of Rhinos REALLY up close in our caravan and although none of us could really get any great pictures because of how dark it was, just their immense shape was really cool to see. I did manage to get a video though, somehow it was able to work even though my camera couldn't capture them? Oh technology.

Ready to go on the Game Drive!

My giggling buddy in Serowe!

One of our awesome Volunteers! We huddled together to keep warm.
 After that we had s'mores and assorted local beers and ciders while enjoying the heat of the fire after being startled by the cold wind (we didn't expect it to be so cold) during our game drive. My bunk mates and I didn't stay up very late because we had a 5:45am wakeup call the next morning to go Rhino Tracking!
Getting warm after the night drive.
What does Rhino Tracking entail you may ask? Well, first off, Rhino Tracking calls for many, many, many layers. I'm talking Snowboarding in Jackson Hole when there isn't a cloud in the sky layers. In addition to that, we all used our wonderfully warm bright red comforters from our beds the previous night to bundle ourselves up for the driving portion of the Rhino Tracking that morning. It was quite a sight to see. As we drove in the reserve in the early hours of the morning, our drivers kept a flashlight on the ground in search of Rhino footprints which we hoped would eventually lead us on a path to find a pack of Rhinos up close! After driving for a while we got out and began tracking a set of Rhino footprints. However, it seems that my group have may been a little too loud, because our guides kept shushing us and telling us to walk softer so I think we may have scared that initial group of Rhinos away. Fear not though. We got back in our caravans and drove to the other side of the reserve when we learned the other group had spotted some Rhinos crossing the road just minutes after we were there. While we were doing all this driving we spotted Giraffes, Zebras, Impalas and teeny tiny Kangaroos called Springhares! Then we set out on foot again and after only 5 or so minutes we came to find Rhinos in the distance! We got as close to them as we safely good and got so many great pictures! It really is amazing to think how close we were to such a large--and yes, dangerous--animal!
A tad tired and very cold, but ready to Rhino Track!
Teeny Kangaroos in the distance.

In my blanket cocoon.
Look at those stripes!

My favorite Zebra couple!

After taking all the obligatory "look at the Rhinos behind me!" pictures, we headed back to our lodging site for a yummy and hearty breakfast and set off back to Gaborone in the late morning.

Rhinos on Rhinos on Rhinos.
Smiling Girl in Africa!
In other news, I'm at a rather slow clinic this week called Extension 2. It's the first clinic I've seen with an actual lab but they don't have any Prevention of Mother to Child Transmission of HIV Programs, Child Welfare Programs, or ARV services which seems very strange to me. I was also reminded that the IRB process in the U.S. is still in progress...oh the joys of conducting research half way across the world.

We are headed to Kanye this Sunday for our weeklong home stay in a more rural village setting. We will also be working in the clinics there. I hope I get a family with kiddies! :)

I now present to you my bungee-jumping adventure pictures!
Just flying.

Hanging over the Zambezi River!

The Daredevil Group!

Taking flight!

Nothing else like it!

Thursday, June 13, 2013

The Legal Battles within Healthcare in Botswana

I just finished my second full week of clinicals today and I wanted to share a really interesting story. This week I was at Tlokweng Main Clinic which is a much larger clinic than Old Naledi where I was last week. Initially I didn't think I liked this clinic as much because it was darker and more crowded and the doctors didn't really seemed to want to engage with us. However, I soon learned that at Tlokweng Clinic it is the Registered Nurses that are the most informed and knowledgeable about the most prevalent health problems currently in Botswana.

I was finally able to conduct a few interviews with a community health educator and a registered nurse, but in order to save from material for my actual research, all I will say now is that the nurses and health educators are very aware of the fact that it is first and foremost up to the Motswana population to help themselves stay healthy and prevent the spread of disease from others. There is a visible gap between how passionate the nurses and educators are about teaching the Mostwana people, especially young adults and teenagers--they are the most at risk for pregnancy and high rates of HIV--and how willing the population is to take that advise seriously. We are going to be spending a week at a local village in two weeks so I hope that I will be able to actually see of this community education at work and compare it to the educational methods being used for HIV and teen pregnancy prevention in the clinics.

But now, what I was most excited to talk about was my day today with a Registered Nurse who works as the HIV counselor. Her principal role is to provide guidance and education to newly HIV-infected patients who are just about to start their baseline round of ARVs. Initially I actually thought counseling was just for this purpose, but I learned today that at Tlokweng, the majority of patients that come in for counseling are those that are "defaulting." This means that patients are either failing to take their drugs on a daily schedule and at the same time every day and/or they are not coming in to refill their prescriptions and have their CD4 counts checked every two months or so too ensure that their body is responding well to the anti-retroviral therapy drugs.

The first patient that I saw today came in with his mother (he was around 32 years old) and a long conversation in Setswana ensued for about 20 minutes and it was apparent that the man was becoming very ashamed as his mother was talking to the nurse for he was looking at the floor for the majority of the conversation. The nurse eventually paraphrased the conversation and informed me that the mother was here with her son because he had previously defaulted three times which means that he has failed to take the drugs properly and has been abusing alcohol for years which in turn was creating adverse side affects to the ARV drugs. Thus, the nurse explained that because the man cannot be trusted to keep up with his medication regimen and come in routinely to have his vitals and CD4 count checked, his mother must now be in charge of not only watching him take his ARV drug every day, but she must also accompany him to his clinic visits. Furthermore, if the man refuses to go to his monthly or bimonthly visit, his mother must come to the clinic herself and inform the nurse of his actions.

This entire conversation really opened my eyes in realizing the struggles that entire families often face when one family member becomes HIV-positive, and often it has to do with not wanting to tell significant others, partners, or even family members about their HIV-status, therefore they do not want to be caught taking the drugs, so they stop adhering to the treatment program all together.

The second patient I saw was a 29 year old man who came in with his uncle (though initially I thought perhaps it was his brother or his partner). I learned from the nurse that the young man did not have any parents and that both he and his uncle were unemployed and have no money, and the 29 year old has been HIV-positive since 2009. The young man has never received any ARV treatment however, because he has never owned a National Identity Card (sort of our version of our drivers license), thus he does not have proof that he is a citizen in that way or in any other form because his parents are no longer alive. So the reason that the two men came in for counseling today was to have the nurse write a statement to the Chief of their village asking for him to sign off on the young man's uncle becoming his legal guardian so that he can obtain a National Identity Card and start ARV treatment. I was informed that because the ARV treatment program is regulated and fully funded by the government, anyone who is not a Botswana citizen is unable to participate, thus because this young man couldn't prove that he was in fact a Motswana, he has never been able to receive any treatment. And so the nurse complied and wrote a letter to the Chief of their home village and also talked to a social worker at the clinic to arrange for transportation to the village to ensure that the two men would be able to successfully get to their village and deliver the letter and ultimately have the young man come back to the clinic and start the baseline treatment for HIV.

The most interesting part about this who situation was the nurse's story about how in the past their clinic has discretely treated patients who haven't had identity cards, but often it turned out that the patients were not Motswana, but rather from a neighboring country. Thus the clinic became very conscious of the legal implications of their actions, and now have a system in place where the computer continuously alerts the nurses and doctors if there is a patient participating in the ARV program that does not have a National Identity Card. The nurse was incredibly knowledgeable about the need for proper and timely legal representation of their clinic in order to ensure that blame does not fall back on them if a patient doesn't comply with medication or treatment guidelines and decides to sue the clinic for misconduct.

This part of medicine is so fascinating to me, and I am so excited that I'm finally getting to learn about some of the legal battles first hand. I'm really starting to get a sense of how government regulated health programs often don't consider the legal implications of their programs in terms of the clinics having to figure out the kind of legal assurance they feel most comfortable with and makes the most sense for their patient population.

In other news, I am off to Serowe (in Southern Botswana) to visit the Khama Rhino Sanctuary! We will be rhino tracking in the early hours of the morning and going on a night safari as well, pictures to follow in the next post!

Tuesday, June 11, 2013

Three Countries in Two Days: Road Trip to Victoria Falls

What a weekend! 23 of us left at 4 am on Friday morning and drove 12 hours across Botswana and into Zimbabwe to visit the gorgeous Victoria Falls--a Natural Wonder of the World! Of course the bus we rented didn't actually arrive until about 4:45 am (that's African time for ya) because he some how managed to get lost on the UB campus. But never the less we set out on our journey hoping to see some animals along the way and anxious to do some physically demanding and daring excursions. 

About 5 hours into our drive we finally spotted some animals! We saw an elephant that was extremely close to the road we were driving on and then for the next half an hour we saw herds of giraffes and zebras grazing along in the distance--it was quite a sight to see! 

Finally we made it to our lodging for the night in Zimbabwe where we had dinner with another huge group of white people (we actually thought it might have been a family trip but we weren't sure). We got to see a tribal group dance performance which was really interesting but not so interesting that they immediately tried to sell CDs after their performance. Unfortunately, a bunch of got sick from either the food we ate or drinking the tap water there--some found out earlier than others, including me. I was so worried that I wouldn't be well enough in the morning to visit the Falls or Bungee Jump, or more importantly, make the 12 hour drive back to Botswana! But luckily I pulled through and the next morning woke up to start a day of walking around the Victoria Falls and getting soaked walking out to the viewing spots. 

Looking at Victoria Falls from one of the viewpoints
The two pictures above are of the actual Falls from the Zimbabwe side, and yes it was so loud being so close to them but it was GORGEOUS! It was so hard to believe that these formations were created naturally!

Attempting to get a good picture in the Falls mist 

And finally my most favorite part about this weekend was Bungee Jumping of course! Seven of us decided we were brave enough to do the combo package which included Bungee-jumping, a bungee swing which was pretty much a straight free fall and then a scenic swing over the Zambezi River--both activities which started with a Zipline across the Zambezi River to get to the end of the bridge where we were jumping off of. 

I don't have pictures of my daring jumps off the bridge yet because one of the girls in my group had a really nice professional kind of camera so she took all the pictures of us jumping, flying, swinging and screaming--but I promise I'll post them as soon as I get my hands on them! 

View of the Zambezi River from the Bridge

View of the Bridge over the Zambezi from Zimbabwe

After our active day we tried to get into Zambia in time to hang over the edge of Devils Pool--another natural phenomenon where there is a pool that looks over a cliff and you can hang over the edge with someone holding your ankles. Unfortunately though, the water level was too high for it to be safe to go and it was already starting to get dark by the time we crossed over into Zambia for the night. We ended up checking into our hotel--it was called Jolly Boys and was super cute and bright and spent the evening walking around downtown Livingstone taking in the atmosphere. Mind you, Botswana is a second-world country which Zambia is third world so it was REALLY different, but I honestly fell in love with it after being there just for that night. Though it was dirtier and much poorer, everyone was incredibly warm and engaging and just genuinely happy. Also, while we were driving to Jolly Boys, every Taxi, public radio station and bar was blasting the Zambia vs. Lesotho soccer game and cheering every time Zambia scored! I think Zambia ended up winning 4-0 and so everyone was estatic and even more energetic than usual! 

In the morning we woke up at 5:30 to make the 12 hour bus drive back to Gaborone, and nothing much happened during that drive except that a few more people started realizing that they should have had the  weird steak at dinner in Zimbabwe on Friday night...I've now termed it the Zimbabwe sickness.

Anyhoo! I'm at a new clinic this week for my rotation and I have two papers and a presentation due in the next three days (yippee!) and I'm also headed to Serowe this weekend to visit the Khama Rhino Sanctuary! This all means that I will try my hardest to post in a more timely manner than these last two posts, but who knows what will happen in a week!