Monday, June 10, 2013

Stepping Stones into the World of African Clinics

Old Naledi Clinic
Well first off, I am writing this blog at 10:40pm Botswana time preparing to leave in a little over 5 hours (yes, that means 4am) to take a 12 hours bus ride up to Victoria Falls--a Natural Wonder of the World! We are going to stay a night in Zambia and a night in Zimbabwe in order to see the falls from two different countries and with two amazing views! I will dedicate a full post to this weekend's travels and activities I promise, but first, my first week of clinically deserves proper attention. 

Our whole group of 27 was divided into six small groups of 4-5 people and given a clinic to shadow at for a week, where each group would rotate around to a different clinic the next week. This week my group was at Old Naledi Clinic which is located in the poorest neighborhood in Gaborone, so it was extremely different for, the Botswana lifestyle I had grown accustomed to seeing. Walking in, I could immediately tell that basic services were lacking. The clinic is divided into two wings, one for maternity and ARV (the drug for HIV positive patients) and the other for general care, the Child Welfare Clinic and TB (which is very prevalent here because of the high rate of HIV). Each day the side for general care was busting with people waiting to get their vitals checked and see a nurse or community health worker for their cold or wound bandage changed. In the Child Welfare Clinic, babies come in once a month to be weighed, given oral rehydration packets and vitamin A tablets until they reach they age of 5 in order to try to prevent malnutrition and other preventable problems that could develop later on in life. 

Although I wasn't able to actually conduct any interviews due to the extreme shortage of doctors--one doctor was in on Monday morning for 4 hours and a different doctor came in on Thursday for the same amount of time and that was it--I spent most of my time learning about how HIV is detected, treated and monitored at Old Naledi Clinic. The first thing that struck me is the lack of inquiries about HIV-testing despite the fact that it the primary tactic of the Routine HIV Testing Program in Botswana. When I asked why, one of the more knowledgeable male nurses explained to me that they only test patients who they are sure have the virus--which didn't sit well eight me considering testing is half about prevention as well as detection, especially in a country with an increasing infection rate. This answer also struck me as odd because the room where the nurse was taking vitals was literally right next to the room where patients were being tested for HIV, so the nurse could have easily finished the vital check up by asking the patient if they wanted to be tested and then directing them to the next room. I have a multitude of notes about such inconsistencies and health system malfunctions, but for now I'll just end this explanation with my new knowledge from shadowing an actual doctor at the clinical today. 

A typical waiting area for HIV-positive patients
Today I shadowed a doctor for four hours who saw patients actually by appointment (a rare sighting at this clinic) to discuss their CD4 counts with them and to make sure they are taking their ARV medication. First off, understanding all the different ARV drugs is immensely complicated that it was hard for me to believe that these patients were really able to understand what was happening to their body and what the drugs were actually doing. But I will say that this doctor was amazing with the patients in making them repeat to him what the ARV counselors had told them previous week (that is, if they were just starting their first dose of treatment) to try as hard as possible to give the patients as much knowledge and control as possible about what is being put in to their bodies and about prevention methods. Also, the doctor diligently asked each patient what time they take their pills each day to make sure that they recognize the importance of adherence. In addition, Adherence posters were plastered all over the wall in both English and Setswana to stress the importance of sticking to the ARV treatment retiming to ensure the best possible results and CD4 counts. 

Overall at my four days at Old Naledi clinic, I was stunned by the lack of resources available to the staff and the baroness of the facility itself, yet at the same time I could visibly see the health staff recognizing the gaps in their own system. 

I hope that in some of the larger clinics I'll be able to talk in more detail with some of the staff in order to get their opinions on what they view as the most feasible method to fill the most prominent gaps in their own clinics. 

It's so interesting to see how my original research question has allowed me branch out and ask different and more community based questions, I just hope it will all some how circle back and connect at the end. 

Off to Victoria Falls! 

Go Siame! (Setswana for good-bye with a literal translation of "leave well"). 

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