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.

Sunrise!

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!

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!

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!

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"). 

Getting the Lay of the Land

I am finally beginning to feel like I can successfully navigate my way around Gaborone, but we'll see if I'm still saying that tomorrow as we attempt to find the first of five clinics we will be working in over the next month and a half. Hopefully getting up at 6am will leave us enough time to get lost and still be on time, but African time always manages to sneak up in there some how. 

Walking. I walked so much these last two days it is unbelievable, but it really helped me to understand the city's layout and how the public transport system works which uses mini buses called "combis." Yesterday we spent the entire day running around taking pictures in front of different building and monuments and in different malls and shops. One thing that Gaborone is not lacking is malls, they are EVERYWHERE. At each stop we had to take a picture with our group and all the pictures will be turned it to our professor who will award the winning team with a free dinner at one of the best restaurants in Gaborone--obviously my group is going to win. 

The delicious caterpillar bucket!

Oh! During our picture scavenger hunt yesterday I ate a caterpillar! It tasted fishy and salty and was not my cup of tea, however I loved some of the teeny little berries that they were also selling at the same stall and I proceeded to munch on them throughout the day like sunflower seeds!

Our faces once we figured out we didn't like them

Last night all 27 of us strolled out to the street of downtown Gaborone to check out the local night life, and I have to say I wasn't that impressed. I think it was because there was such a separation between us and the locals that it felt like we weren't really able to become a part of the night life atmosphere. I'm sure I'll like it more once we learn more about the different options and where the best places to go are. 

Currently my Motswana roommate who is a graduate student here is chopping away making some sort of fish and veggie stew and yelling to her sister in another room and I am exhausted from another bustling day out. Today we climbed Kgale Hill though it really should be called a mountain because it was unbelievably steep and rocky. But nonetheless we successfully climbed up to the top and there was a breathtaking view awaiting us when we arrived--see the gorgeous view? 

Tomorrow we start our first clinical rotation (each small group will spend one week at a specific clinic, then rotate to a different one the next week) and I really have no idea what to expect. We haven't really been given any direction as to what we will be doing but I'm expecting it to be very hectic and crowded--which is making me a little anxious about the possibility of not being able to get my interviews done but I'm learning to just take each day as it comes here in Botswana. 

I feel like I've been running around non-stop since I arrived in Botswana exactly a week ago, but I'm really loving it here. I know that starting classes tomorrow will also make me even busier, but I'm excited to see how professors here structure their classes and what their opinions of their health system are and how they approach problem solving methods to critical problems. 

That's all for now! 

African Time and American Music

Well, I have officially arrived in Botswana!! I still don't think its actually hit me yet that I'm in Africa, but I can already tell it's going to be an adventurous ride. When we got to the dorms today originally thinking that the 12 girls would be split up into two flats, we quickly learned that the housing people hadn't prepare for our arrival because our rooms were not ready and we later found out we would be split up into four smaller groups--where we would all share our flats with other study abroad groups and some UB (University of Botswana) graduate students. And while I was initially annoyed at the lack of planning and willingness to give us information about where we would be staying for the next two months, I'm glad I was given a taste of how relaxed the Botswana way of life is here on my first day.

As the dorm debacle was being sorted out we heard our first lecture from a cultural feminist (storyteller by trade) who really impressed me with her emphasis on the need to learn people cultural background before trying to understand their actions towards us or their ways of life, for culture is everything here in Botswana. Her lecture made me look forward to the four hours of lecture we have tomorrow, after which we will be touring the five clinics we will be working in! I'm so excited but really nervous about that, because once we get to the clinics, that means my research has REALLY started! I'm still ambivalent about being able to talk to the doctors, and about finding the Ministry of Health to get their IRB approval letter, but at least I know I'll be getting the true Gaborone experience if their office sends me around in circles trying to get this form signed.

I also found out we pretty much have two free weeks to travel, which is really great because it gives us a chance to visit the gorgeous beaches of Mozambique and take an 8 hour bus ride up to Victoria Falls! Pictures will definitely be included in blogs during those trips I promise.

Probably the peak of my day today was getting into a taxi tonight with our driver Bethel to go to an outdoor mall called River Walk and finding him blasting One Direction!! I just thought it was hilarious that he was playing such current--and might I say girly--music and that song was soon followed by a Kendrick Lamar song and Taylor Swift which my two friends and I proceeded to sing along to. Noticing our amusement, Bethel proceeded to turn up the volume time and time again for encouragement. It just made me really happy to be surrounded by such simple happiness driving with the breeze of Gaborone filling the cab and seeing all the rush hour action as we drove down the streets.

I keep telling myself that part of this experience is getting accustomed to the natural way of life here and finding my own rhythm and to not worry so much about unnecessary annoyances which is so far working out pretty well, but only time--especially African Time--will tell.

One Week Away!

Exactly one week from today I will be somewhere in the air getting ready to land in Africa for the first time! I don't actually think that this fact has actually hit me yet, as I'm still really only beginning to settle into the post-finals routine of relaxation. Of course my blissfully stress free week in Chicago has already been bombarded with Botswana Ethical Review Board woes. Let's just say that getting research approval from another country, especially via email is not an easy feat. Though I must say I think the process of writing my grant and getting approval for it has actually taught me a lot.

For example, in the beginning of the grant writing process, I hated and quite literally dreaded getting criticism on my writing because I thought that criticism meant that I wasn't prepared to handle actually performing a research study at all. However, through the almost 12 revisions and re-writes of my grant that eventually ended up getting approved and funded, I learned that it was those critiques that made me think more critically and comprehensively about the task that I am preparing to take on during my clinical work in Botswana. And while I am still in the process of trying to get ethical approval to actually conduct the research in Botswana, with their ethics committee actually using phrases such as "this proposal is not well done," I find my self calmer and more confident then ever that I do have the tools to make this research study happen and that is something that I'm would have never been able to say if it had not been for all that constructive criticism way back when in December.

And so in this last week I'm packing and packing away...well not actually packing yet, more like just packing outside of my suitcase so that piles and piles of rolled up shorts and shirts are sprawled across my bedroom floor. I find my self not wanting to actually put my clothes in the suitcase just yet (for fear that they'll be unnecessarily squished for longer than absolutely necessary--yes clothes have feelings too) and because I love the anticipation of the packing process. Imagining what I'll be wearing when I meet new people in Gaborone for the first time or what my living quarters will look like where I'll be unpacking all my stuff to live there for the next two months. It's all part of the preparation and excitement of getting on that plane and knowing that I'll finally, finally be setting foot in a place that I've been talking and reading about constantly for the past four years.

Writing this is making me more and more antsy to start packing, perhaps it's time to drag out the backpack and start filling it with tools needed to have a successful summer in Botswana--a place once filled with the remnants of an unimaginable summer in Thailand and Cambodia from last Summer.

As I look down at my wrist that still carries the white string placed on me at a Buddhist temple in Cambodia meant to bring good fortune, I can't help but wonder what little memories I'll bring home with me from this trip!