Time flies when...you're in Africa?

I know, I know, I am a horrible blogger and haven’t posted in almost a month but I am fixing that now!  The past three weeks haven’t been too event filled but I will give you guys the few updates I have.  It seems like most of my time has gone towards this health promotion pamphlet I am trying to get started.  I have gone to 5 stores and gyms looking for financial support and haven’t heard back from any of them.  In fact, my first one should respond later today so I am actually pretty nervous right now.  I never realized just how tiring it is to interact with all of these people and try to sell the same story over and over.  Nothing is ever done straight forward here so it results in me traveling to different headquarters and making lots of phone calls.  However, if the end product is what I hope it will be, then all this will be worth it.  I find the worst part of it to be the traveling to and from campus in this ungodly warm weather.  Without a car and trying to avoid paying to combis, I tend to go through a lot of clothes these days.  I don’t know what ever happened to “winter” coming because it seems like it has been getting hotter every day!

Anyway, so it was a couple of my friends’ birthdays in the past few weeks so we went out again, my second time since coming here.  It was fun but I definitely don’t feel as comfortable going out here as I do at home.  All of their clubs and bars are in the middle of nowhere which is a little scary.  I try to keep myself occupied on the weekends doing other things though so that works out well. 

Last weekend I stayed at David’s house (the man whose family is taking care of me while I’m in Gabs).  I made them an “American meal” as they requested for dinner last Saturday.  While I fancy myself as a decent cook, I have no idea what is considered “American”.  I would have said hamburger but they already have those here so I resorted to chicken parm and macaroni and cheese.  They enjoyed both but I would say the mac n cheese was the big hit.  They want me to make another meal before I leave but I think I’m fresh out of ideas!  Anyway, the next morning I went to church with the two little girls, the son, and David’s wife, Charity.  It was interesting to see the differences in churches between the Mochudi church, the one in Gabs, and the one she took me to last Sunday.  This one was not the typical church.  They had people from the congregation reading and leading the mass and the most noticeable difference is that there was no building.  We had mass under a tent.  At least I didn’t have to cover my head like I did in Mochudi, that makes it about 10 degrees hotter anywhere.  Speaking of Mochudi, I am going to visit my host family this Saturday so that should be fun.  Also, one of my friends doing a home-stay is offering the family farm for a bunch of us to camp out and do…farm things?  It should be fun.

 Last Friday we went to the Jwaneng Diamond Mine where 80% of Botswana’s diamonds come from.  I have never seen a hole that big in my life!  I can’t even put into words how big it was.  It was about a quarter mile deep and I can’t even estimate how wide.  Its weird thinking the entire economy is based on that one spot though.  They are estimating the pit will last until 2033 but at that time…no one knows what will happen.  That’s not even mentioning the fact that something like 60% of all of Botswana’s water supply goes to cleaning the diamonds.  No wonder people are still digging boreholes here.  Guess it’s time to start rethinking some plans.  The coolest part was probably getting to stand next to a 240 TON capacity truck.  The tires were about two of me high.  Talk about feeling small!

All geared up for our tour (too bad you can't see our steel-toed boots!) 

Open-cast mine.  Those little trucks down there are the ones in the next picture.

Also, on Tuesday morning I went around with the Gaborone City Council who does waste management which sounds disgusting, and kind of is, but it was very interesting.  Again, I just don't understand some of the things they do here.  We went to a landfill which was absolutely enormous.  Apparently they did not build it up to standards so once everything decomposes, the toxins will seep into the ground water thus affecting drinking water.  Something isn’t right there considering half the time they have trouble finding water here anyway.  Don’t you’d think they’d want to protect it?  The other issue was that they use an incinerator to get rid of PLASTIC clinical waste.  Everything I have ever heard says burning plastic is not too wise. 

As for school, I have run into a few issues recently that have made me truly not understand how things work here.  My first issue is that one of my classes, the professor only shows up about half of the time.  I have an issue with that when my program is paying the school which is paying the professor to teach me but he doesn’t do half of his work.  Apparently the students don’t ever complain and at first I didn’t mind some of the days off but now it is getting ridiculous.  Also in that class, we watched a film called Slum Survivors.  While it was an extremely eye-opening documentary, I left the class extremely annoyed.  First of all, the stuff we saw was very intense as it covered the story of Africa’s largest slum found in Kenya and we did not discuss anything we saw.  I am not used to seeing something like that and just leaving after like nothing was different in the world.  The other thing that aggravated me was that the kids in the class were laughing about the whole film.  I don’t understand what they found humorous, especially knowing that is happening in their backyards and they themselves are about 20 years away from that situation themselves once the diamonds run out.  My only guess is maybe it was a defense mechanism but it really disturbed me.

My second issue I have with this school is that yesterday I had a bit of a run-in with a professor who gave me my first taste of predjudism.  In a class of 100 people, three of which are international, we are giving group presentations about traditional medicine in different regions of the world.  After one group member presents, the professor asks one male and one female to volunteer criticism about the presentation.  I wouldn’t feel comfortable standing in front of that many people to begin with but to be criticized by immature college students would make it 10 times worse.  So one girl went up and she was the only girl who actually knew what she was doing so I decided it was my turn to offer comments.   I wanted to make sure she got an honest comment rather than the ones people had been saying such as..”your font is too small” when we couldn’t even see the presenter’s note cards.  Not only did the entire class laugh at me after making my comment (which was that she did a good job and clearly knew her material because she didn’t rely on her notes) but the professor proceeded to make a joke out of my comment for the rest of class.  This really got to me because one other international student made a comment on Monday and was also laughed at yet everyone else doesn’t comment seriously and should be laughed at.  The worst part was that the professor joined in on the fun with my comment.  It is clearly just because we are international and it was clearly a lesson to be learned.  That was the first and last time I will ever raise my hand in that class, if I even go back.  I guess this should be chalked up as a “learning experience” about what people in the states go through but it was probably the most embarrassed I have been since coming here.  After talking about it with a local friend I have, I came to the realization that the students here who claim the teachers aren’t good never do anything about it because they just don’t care.  They aren’t paying for school.  In fact, they are being paid to go here by the government so what do they care if professors show up?  It makes for a very frustrating situation.

Other than my classes, everything here is going well though.  I only have 21 days of classes left which is crazy to think about but it amounts to 46 pages of papers left to write.  I hope something more interesting happens soon so I can update people about cool stuff.  Still, hoping to get to Mozambique over Easter break and will probably go scuba diving there so that will be fun.  Hope all is well at home and that everything in Northern Africa and the Middle East calm down seeing as I have to fly through all of those places on the way home.  That could end up…interesting.

Reality Check Number 2 - Ke botshelo (such is life)

Following my break in Cape Town, I knew that I was going to have to come back to Botswana and assumed I would be swamped with work but I found a couple of things that caught me off guard.  This post is going to be more of an overview for the second half of the semester and talk about some issues I have been realizing.

Initially, upon returning home (yes this has now become home), I had forgotten that I left a flat with no hot water.  You would think that during the week we were gone, someone would have made progress with this issue.  No.  We still, almost a month after losing hot water in our building, have yet to get it back.  This makes showering a daunting task as I find myself sending 5 or more minutes motivating myself to run under the freezing water before running back out and soaping up only to repeat the process for rinsing and washing my hair.  This has motivated me, however, to run more as I realized a cold shower isn’t exactly bad when you are burning up from working out.  If this were the only problem, I think I could live with it but the most recent development has been water cut from the kitchen.  

This poses a much bigger issue as we can no longer properly wash our dishes, clean our foods, or wash our hands.  Being a public health major, I have spent the semester studying the ways in which diseases are spread and basically, that’s it.  I have been taking my dishes to other people’s rooms in order to clean them but obviously it is extremely inconvenient.  I never realized the important of kitchen water in food but it is slowly becoming more and more or a hassle to cook anything.  My biggest fear is that they will cut off our water to the building completely and at the rate they are addressing this issue, it would never be resolved.  Also, we are having a building meeting tonight to address this issue as apparently some others are concerned about the spread of cholera and other waterborne diseases.  For those of you unsure, there are three types of waterborne disease, one of those being due to a lack of adequate water.  Overall, this has just reminded me again that as developed as Gaborone may be, I am still in Africa and need to take precautions. 

Moving on from the water, I have been doing some life searching and planning which has resulted in some big things.  First of all, I have decided that I need to go right into Graduate School after finishing at Nova otherwise, my major will not be specific enough in order to get positions I would like to get.  After deciding that, I have narrowed a list of schools down and it looks like I will either be in Boston or Washington D.C., mainly because I need to be near NGO headquarters.  As of right now, my top choice would be Boston University and its program for International Health but who knows, that is almost a year down the line.  Anyway, more immediate, I have realized that the project I am working on here in Bots is going to be the key to everything I want to do in public health.  

Recently, with the help of my clinical professors, my program director, and a CIEE regional director, I had decided it is time to take what I have learned from my clinical experience and do something productive.  Therefore, I have come up with the idea of developing a bi-weekly or monthly health promotion pamphlet to be distributed in clinics and other helpful venues throughout Botswana.  While the packet itself is not too terribly difficult as I just need to write helpful tips on how to live healthy lifestyles, the logistics behind getting it approved, printed, and distributed will be taking up the majority of my time this semester.  It looks like I will need to talk with the Ministry of Health which is basically our FDA at home and a few other HUGE organizations.  I am a bit nervous because I have never started a program before nor have I ever had to deal with behind-the-scenes details before but if I can get this off the ground, I will be one of the happiest people in Africa.  Not only will I be able to use this program as a basis for any public health internship, school, or job but more importantly, I can give back to the community that has so graciously hosted me.  With this, it is also possible for people to come and continue my work and eventually expand it into possibly a health promotion program to be presented in schools and workplaces.  

Obviously, I am extremely excited but in the mean time, I also have a ton of other work I need to focus on.  The one other project I have taken responsibility for is being a student representative at the University of Botswana for a new NGO to be created by my professor.  With this, I will be helping to organize their first activity which will be a “marathon” to raise awareness on anti-smoking.  That is quite as involved as my pamphlet but still excited.

Anyway, I have had a lot of time to think about my time in Botswana and the time I have left.  When I initially started thinking, I couldn’t believe I still had to be here another 65 days or something like that but now I have shifted to not believing I ONLY have 65 days left.  We have started talking about our final trip in May and all of my classes are done in about a month.  It is amazing how fast time has actually gone.  I will not lie, I have definitely had some hard times, especially in the past few weeks with being homesick but being here has been an awesome experience.  It has been nothing that I expected it’d be but has taught me so much about myself.  Being the only white person within miles at times has made me a more confident person as people stare and ask questions while I have also learned from the communities things I never thought I’d discover here in Africa such as WHY I have the motivations I do.  I guess I was going through the rollercoaster of emotions that everyone talks about when you go abroad and I am now on my second high.  Mid-semester and I have realized that I love the people in my program and can’t imagine not seeing them when we go home.  Even more than that, I love my family beyond belief and value their thoughts, opinions, and support more than anything.  I appreciate all that Botswana attempts to offer but understand where it fails to pull-through.  Despite the uncomfortable moments with people begging and men proposing, I thoroughly enjoy walking in the city and experiencing the differences in cultures.  Sitting on a combi yesterday, I came to the realization after talking with my friend Gerrica that being here IS what I needed.  While I am very excited to travel other places and work with different cultures, the people, government, and culture in Botswana has truly been an experience I would not trade for any other.  

I realize that the attitude I have right now is a completely 180 from the attitude I had the few weeks leading up to Spring Break but I hope that I keep this outlook and continue to learn and grow in my remaining weeks here.  We have a trip coming up to a diamond mine which will be interesting considering that is the basis of all of Botswana’s economy and I believe I will visit my host family in Mochudi again soon.  While I would like to take a hot shower again, I am going to make a promise to myself that I will do everything in my power to appreciate and learn from everything that happens in the next few weeks.  That’s not to say I still don’t miss home though!! 

P.S. My next big trip I am planning is to Mozambique for Easter break but hopefully I can figure out a weekend trip before then!

Cape Town

Following a week in Cape Town and my return to Gaborone and the University of Botswana, I feel as if it’s time for another post.  Let me first just go off on how my trip to South Africa was amazing.  I knew it would be a good week considering the fact that Joe was coming and I missed him so much but that was only the start.  Joe’s flight was delayed leaving me to fend for myself Saturday night when my plane landed but it was no big deal.  Our week started Sunday when Joe finally made it to Cape Town.  We walked around the V & A Waterfront which was absolutely gorgeous and basically just explored the city.  I did not feel like I was in Africa at all.  It felt like a combination of what I imagine LA looking like and Atlantic City.  It was definitely a nice break from the dry and barren environment of Botswana.  Anyway, Monday we decided we would attempt to go to Robben Island but didn’t make reservations.  Somehow, Joe’s luck pulled through and a woman returned two tickets 5 minutes before the boat left.  That was one of our favorite days for many reasons.  The history of Robben Island is incredible and unbelievable as they told about the prisoners have to construct their own prisons, being kept in solitary confinement, being denied visitors for years upon years, and their desire to help one another through teaching during lunch times.  All of this was happening with probably one of the prettiest backdrops I have ever seen.  I just couldn’t get over the fact that Robben Island is a place where people would have come for a get-away vacation to appreciate the beauty but it is scared with the ugliness of humanity during the times of political strife in South Africa.  I guess that’s how history works most of the time though.

 

V & A Waterfront

Following: Robben Island, Stone Pit where prisoners worked, Nelson Mandela's cell, an extremely windy boat ride back to Cape Town

On Tuesday, we decided to tackle the beast of a mountain in the center of town.  It was amazing that Table Mountain, over 3,000 feet high, is the center of the city.  We successfully made it up the mountain but that’s not without many breaks and close to 100 pictures.  The views were just breathtaking.  I am a bit embarrassed to say, though, that we chickened out and took the lift down but in our defense, we had no water and I probably would have fallen down instead of climbing down so it was wise of use to use technology and get down in 5 minutes rather than the hour and a half it took us to get up there.  Wednesday we continued our physical activity with a 21km wine and bike tour.  We joined forces with Kelly, Sam, and Sean who had gotten into Cape Town the previous afternoon.  While it was beautiful, the first half mile or so of bike riding was nearly impossible as it was basically straight up a huge hill consisting of sand pits after sand pits.  The easy part was coasting down but even then you had to work because it was by no means a smooth ride and there were some sharp turns that made me a little nervous.  Everyone seemed to have fun though so it was good.  Thursday was my personal favorite day as I finally got to live the dream of every girl, according to Joe.  We went horseback-riding on Noordhoek beach which was absolutely GORGEOUS.  Definitely the prettiest beach I have ever seen.  My horse’s name was Cognac and only had one eye but was a good fit for me as he loved the water and refused to leave plus he was a bit pushy with Joe’s horse (I don’t know how they matched our personalities so well!).  Joe’s friend was named Jiffie and was a bit lower key than my horse, always doing exactly what he was supposed to and a bit scared of the water.  It was a lot of fun and I realized that is a place I could totally see myself living.  Friday we rented a car and with Joe’s phenomenal driving on the wrong side of the road skills, we made our way to Cape Point and Cape of Good Hope with the other three.  It was another fun and beautiful day as we got to see most of the coastline, which is beach after beach of white sand and crashing waves.  Saturday was a sad day because Joe and I had to part ways but not before another delicious meal and some time walking around the city.  It was one of my favorite weeks ever and I should thank Joe’s family for making that happen.

 Me on top of Table Mountain

On our way up

Vineyards

Fish hoek Beach

Us at the top of Cape Point (Southern-most point in Africa)

Atlantic Ocean on the left and Indian Ocean on the Right

The weird thing about the week was that even though all of these amazing things were happening all week and I got the break I needed form Gabs, I couldn’t help but the think about what I had been seeing in the streets of Cape Town.  Even driving from Gabs to Joburg through other parts of South Africa, it seemed like the gap between people living on sufficient incomes and those in poverty was way more extreme in South Africa than in Botswana.  I’m not sure if that is a cultural thing, purely economic, or a result from the government.  I would like to research that some more but based on observations, it seems like the poor are not given the help that those in Botswana are given.  It made me uncomfortable at times when I was stuffing my face with delicious meals and doing tourist activities that cost more than they should.  At one point, we were in an extremely fancy restaurant that was entirely unnecessary in a community which had people sleeping on the streets, stick thin, right outside the doors.  It did make me appreciate what the government in Botswana tries to do for its people in need and almost made me homesick for Bots strangely enough.

Well, I’d say that’s enough about my week on vacation but I am going to write another post about what is going on in Bots.  It seemed a bit strange to combine a fairly serious post with a fun one.  Anyway, still thinking of home and occasionally getting sad about what I’m missing but big things are happening here too!!

P.S. UB has put restrictions on the amount of time you can be on a blog to 3 ten minute increments a day for some strange reason (TIA) so I apologize if the quality of posts gets worse and I apologize but until I get somewhere with better internet, I will not be able to post many more pictures.

A week in Mochudi.

Written in Mochudi:

Dumelang bo-mma le bo-rra,

(Hello ladies and gentlemen)

Fair warning: this will be an EXTREMELY long post since I have spent a week in an entirely different place.

I am currently writing this while in my host family’s home which is located in a rural village in Botswana called Mochudi.  To begin explaining my experience, I guess I should describe my family and its dynamics.  I have a mother, a granny, a sister, a niece and a nephew.  My granny is 85 and diabetic.  As a result, she has lost one of her legs so she spends most of the day lying in her bed except for the occasional walk around the house using the help of two crutches and a fake leg.  My mother works for Botswana post and only had one child.  Her daughter, who is now my sister, is 26 and currently unemployed but graduated with a diploma (the equivalent of our degree) in information technology.  Her name is Tshepiso and has two children.  The eldest is 15 and his name is Lesedi.  Yes, that means Tshepiso has him when she was 11 years old.  My niece, Tshepiso’s youngest, is 4 and is named Lone.  There is also a cousin who lives with us named Kabelo but he is rarely seen.  Also related to my family is Sean’s family.  By coincidence, we ended up being cousins and living directly next to each other. 

My family plus Tabo, Sean's brother on the far left.

This brings me to the family dynamic which I have found in this house.  I came into Mochudi expecting to find a house-hold which is entirely dominated by men.  What I found, however, was completely opposite.  Batsi and other lecturers had warned us that in Mochudi, the traditional values were still very much observed.  This meant that women were to cater to men hand and foot.  We were told, as women, that we may have to do anything from cooking, to washing laundry, to sitting on the floor when a man enters the room so he has a seat.  Now a day, at least in my family, the boys cater to the women.  I believe some of this may have to do with the fact that all the women in my family are single and there is only one son in the house.  In fact, it is to the point that I feel bad for my nephew because he is always being yelled at to do this or that for his mother and grandmother.  In fact, I started sneaking him lollipops I brought home every once in awhile because he never gets any attention compared to Lone.  Anyway, I have connected pretty well with all of them except for granny who does not speak English which makes it difficult to bond over anything. 

There have definitely been times that I have been ready to leave Mochudi just because it gets old constantly trying to fight the ideas people how about Americans’ and their finances.   I cannot tell you how many time people, even my sister, have asked me to buy them something or give them something for free.  I feel bad because most people just can’t comprehend the idea that finances are relative and that’s why I seem like I have a lot of money here.  I have also had three or four people ask me to either take them or even their children back to the United States.  At first I played along with it and said if they could afford a ticket, I’d take them but it’s gotten to the point where I just say no.  Again, I feel bad but life isn’t as glorious as it seems in the US.  We still have plenty of poverty and inequalities we need to deal with on our own.  I could vent about the misconceptions of the US based off of media for hours but I will spare everyone and move on.

Sunday, the second day living in my new home, I joined Sean’s side of the family at the cattle post.  This is basically a HUGE farm for cows that is family run and owned in order to feed themselves and make some money.  Tabo, Sean’s brother told me they only had ten cattle but that was clearly a joke when we pulled up to a pen with 100 cattle.  I have never seen that many cows in one place!! It was pretty hilarious to listen to them all mooing and watch them all jockey for positions attempting to avoid being milked.  It sounds so stupid but I was actually REALLY excited to try and milk one or at least pet one.  I guess the animal lover in me came out that day and I did in fact milk a cow!  It was my first time and it was nothing like what I expected!  I managed to get a few squirts out but it was not as easy as I thought it’d be.  After about 5 minutes I have to let the professionals take over.  There are two men who live at the cattle post permanently in order to take care of the cattle.  I cannot imagine living that way because they are about an hour away from civilization and without any form of transportation.  I was told they are to wait for donkey carts (they are exactly what they sound like) if they want to ride anywhere. 

We spent nearly the entire day there and made some new friends who also live in Mochudi.  I was the only girl there so naturally, the guys had lots of awkward questions for me.  It was interesting though to talk with people and find out what goes on in their heads.  Many of the men here honestly do not value the idea of having one sexual partner at all.  It’s hard to listen to that and know they will not understand the importance of being faithful.  Many men here believe they have the right to leave a woman if she is unfaithful but they have no problems suggesting it to a woman they have only know for a few hours.  In fact, it is very common around here to hear people say they love you after they have seen you pass on the street.  The only good thing is that it seems like women are becoming wise to those tricks and are taking a stand against cheating men.  The problem, however, is that many times, them taking a stand means they go out and cheat also.  It’s a huge problem that needs to be stopped if the HIV/AIDS issue will ever be solved. 

I did meet one person at the cattle post who I found to be very interesting.  He is from Zimbabwe and was probably the smartest and most level headed person there.  Maybe I am biased from my little trip to Zim but after talking to him for a long time I truly believe he knows what he is talking about and cared about being informed.  He talked to me about the issues surrounding Botswana and Zimbabwe along with the theories of parenting.  He has two daughters and claims that is why he is so calm and collected.  Those are the people I love talking to here because I learn so much from them and their views on the world.  That is what I came to Africa for and I’m starting to think that it’s even better that I don’t find those people everywhere.  I have to look for them and once I find them, I thoroughly enjoy their company.

Coming back from the cattle post, I was very tired and the rest of the night was not filled with much.  Monday was about the same because my paper work did not go through for me to start at the clinic so I spent the day with my sister.  We went into Gabs to get some produce but instead shopped for her.  I don’t understand that because she is constantly saying how much money she doesn’t have yet she wants to spend more.  Seems that attitude is all over the world. 

Tuesday was the start to my rural clinic experience which turned out to have many surprises in store for me.  The first day, I saw things I never would have expected.  The level of care found in a rural clinic, in my opinion, is twice as good as that found in Gaborone, the capital of Botswana.  I think I have narrowed the causes to two.  One, there is much more space which allows for more rooms in order to provide more privacy and better working conditions.  The second is a larger staff.  The staff size was something that I had suggested be increased for the clinic in Gaborone and I believe that suggestion was proved valid this past week.  The people were so much more friendly and happy to be there.  They had time for mental breaks and were able to switch positions.  This is not to say the nurses here are not overworked because they most definitely are.  I made good friends with two of them, Thabiso (male) and Onneetse (female).  After spending four days with them, I see that they are incredibly smart and know exactly what is wrong with the governmental health care system.  They know the psychology behind treating patients and the theories behind sanitation and efficient work-ethic.  As a result, they work hard but are rewarded with pleasant patients and most afternoons free because they finish with patients early.  They are each trained in general nursing which means they can literally run the clinic on their own and, in fact, sometimes do.  There are health posts which are positioned in the middle of nowhere so the men working at cattle posts can be seen.  At these health posts, ONE nurse must do absolutely everything from consultations, to dispensing drugs, to injections/drawing blood, to suturing.  The most amazing part is that they know that things should not be so that they work alone like that in the most rural of areas but they do their time without many complaints.  Despite all of their brains and knowledge, they still disregard some basic safety issues such as wearing gloves during injections and I don’t know why.

Giving injections in a classroom.

The hardest part about working with the nurses this week was that I wish I could improve conditions for them.  They still work without the appropriate equipment and are expected to provide quality health care.  One of the biggest problems has come from the Ministry of Health in Botswana taking over the government clinics rather than local governments.  Due to this, there has been a huge drop in funding and it is becoming increasingly difficult for the clinic to provide transportation for patients to the hospital if needed.  I am not usually a very emotional person when it comes to prayer or other religious events but something got to me in the past four days at the clinic.  Every morning, before starting, a prayer is sung by all patients and staff.  Each day as I sat with the nurses and listened to the people singing and looked at all of the people in need of medical assistance, I thought about the struggles each of these people go through every day.  They are to the point that they cannot feed themselves and their families.  Some cannot afford indoor plumbing, screens on their windows, or doors on their houses.  It’s amazing the conditions some of these people live in while half way around the world someone else will be living in a multi-million dollar home by themselves.  It’s disgusting; these people did not do anything to deserve the struggles they have.  Everyone at the clinic knows their situations are not right and the diseases people in this area along with many others around the world are terrible yet preventable.  The staff does all it can given the supplies they have but it is still not the best care possible.  The amazing part is that each day these people come back to work and continue their daily lives with the faith that something will change.   I cannot imagine having the amount of optimism they have given the situations they are given.  I guess that goes to show the power of faith.

Clinic

I know this is getting absurdly long but I need to talk about one more thing.  The home based care which is provided by the clinic.  Thursday afternoon I visited one woman in particular who really touched me.  She is 81 and is so arthritic that she cannot sit up, stand, cook, or bath herself.  This woman literally lays in bad all day without human interaction, a TV, or music.  She has one son who comes to feed her twice a day but other than that she is alone.  She uses Pampers at night but there is a nation-wide shortage so during the day she must slowly move her legs over the side of the bed so she can use a bucket on the floor and then struggle to get her legs back on the bed.  She attempted to show us but was unable due to the pain.  This woman’s knuckles where so swollen and painful looking.  Her hands looked like the knuckles were on backwards.  Apparently there are volunteers who are supposed to come clean the bed linens and give her a bath each day but due to the lack of transportation from the clinic, they no longer come each day.  She has no idea when she will see them next and as a result may go days without a bath and clean sheets.  I leave it to the imagination the stench of her room due to her use of the bucket next to her bed as a toilet.  This woman is probably the most helpless person I have ever seen but yet she continues on each day living this way because there is no option.  I believe this woman has sparked a new interest of creating hospice care in these countries.  There is no way a human being should live that way and not be able to speak to at least one person a day and have someone check to see she is still alive.  The nurses only stop by when she is in need of more medication or if someone reports a change in her health.  That is not enough.  It was so sad but I wanted to stay and talk with her for hours.  I don’t think that I will ever forget the look in her eyes when she saw us walk in a sit down to talk.  It was unbelievable. 

Well, I guess that’s enough sob stories for this week.  Not much else happened but this has been one of the best weeks since I got here.  I loved working with this staff and learning from their situation and experiences.  I am going to miss them so much but I believe I will come back and visit at some point before I leave for the US.  Tomorrow, Saturday, I am going to a wedding with the family from Gabs (Mosetses') that is taking care of me and then I am moving back to UB on Sunday.  This week has gone by fast but has been so valuable.  The good news about going back to Gabs though is that Cape Town is only 6 days away!!!!!

Before the wedding with the Mosetse family.

Bride and groom dancing a traditional dance.

A post not for the faint of heart.

This post is a bit different from the rest of what I have been writing.  Instead of freely writing what I am thinking and experiencing, I have decided to post a portion of my clinical log that I have written for my class.  This is the log with follows my observations and reactions to everything I have seen in the past three weeks at one government run clinic alone.  I personally don't feel like it is too graphic but I will say that some of the things which I have seen are unbelievable and quite honestly, disturbing.  I apologize if anyone is offended or just grossed out but I think it is important for me to share these things as I am here in Botswana to study public health.  Please keep in mind this is not proof read nor finished so don't fault me for any mistakes!! :-)

Also, as a side note:

I will be traveling to Mochudi in the following week which is a village outside of Gaborone.  I will be staying with a host family and therefore will not have any internet access from the 12th to the 20th.  I will definitely have lots of stories when I return from there!!

Clinical Log #1:

In order to fully understand the aspects of public health which come into play in places such a Gaborone, it is necessary to have hands on experience.  The past three weeks, I have spent my Tuesday mornings observing at a clinic in Gaborone.  My initial impressions were ones which questioned how well any health professional could actually consult and treat patients in such a small and confined space.  The observations which I have collected in the past few weeks have proved to question much more than that initial observation.

My first Tuesday in the clinic was 25 January, 2011.  Upon entering, I found a waiting room approximately half filled with patients waiting to be seen.  The time was close to 8:30 am and patients had yet to be seen.  I had been told by one of the nurses in training that the clinic opens daily at 7:30.  Immediately a queue forms.  Speaking to the nurses that were sitting around, I realized that most of the staff in the clinic are not true nurses but nurses who have yet to graduate their program.  In total, there was one doctor who would not come until the afternoon, two trained nurses, and four nurses in training.  Due to the slow start to the day, I was able to ask a few questions of the nurse I was paired with for the day.  I learned that each patient, if from Botswana, pays P5 per visit.  While speaking with her, I noticed another nurse using a tongue depressor she had pulled form a box of sterile supplies in order to rip paper in straight lines.  After using that and putting it on the table where patients are seen, she continued to place the tongue depressor back into the box of sterile supplies. 

For the first day, I was put into the maternity and family planning section of the clinic.  The women were all asked to lie down on an examination table which was covered with a red plastic material used to protect from infection.  The nurse examined the patient using a glove but did not wash her hands after examination.  The red plastic was not changed despite finding out that the previous patient was infected with HIV.  It was not until one hour and 15 minutes after the nurse began to see patients that she washed her hands with soap and water.  Another issue found in the family planning section of the clinic is the lack of supplies in order to give a proper examination or to give the actual family planning injections.  Several patients had to be turned away and sent to another clinic in order to get the medicines and treatments they were requesting.  In the event that the clinic could provide the injections needed, the nurse did not take the time to clean the skin before injecting the patient nor did she take precautions to protect herself from any contaminations as she grabbed the needles bare-handed after use.  The final major observation made in the first day was the lack of privacy in the examination rooms.  Many times, multiple patients were found in the same room and people were able to walk in on pregnant women who were on the examination table in the middle of being checked. 

The second day at the clinic was spent in the dressing, injection, and bleeding room.  The three of those procedures are all preformed in the same room.  All patients seen were in for re-bandaging.  Each patients was told to undress wounds themselves and were given soap that the nurse had brought from home in order to wash hands.  Patients were forced to stand in uncomfortable positions for prolonged periods of time while the nurse was distracted from re-dressing the wound by a passer-by talking of the malaria outbreak.  New gloves were used for each patient seen and the nurses washed their hands after each patient, however, there were two patients in the room at a time at one point.  At the registration table, there was only one blood pressure machine working and the battery died quite frequently.  In the event of a dead battery, a hand machine was used with a faulty hose causing the nurse to take the blood pressure several times in order to get a semi-accurate reading.  One patient complained of waiting for three hours before even being registered while another patient had waited that period of time before having discovered she had a blood pressure of 192/160.  In this case, she was immediately seen and took precedence over the other patients. 

My third visit to the clinic was spent with the visiting doctor who was sent by the government.  He immediately seemed more focused and motivated to see patients and quickly yet efficiently treat them.  The doctor only spoke a bit of Setswana however thus needing to call in a nurse to interpret once in awhile.  One patient he saw could not be prescribed medicines because there was no way to transfer records from one doctor to another, a flaw in using the hand written record keeping system.  Each time the doctor touched the patient, he washed his hands with soap and water.  He mentioned he would be quick with patients to keep the queue moving, however, in the event of a person needing more attention such as a nicotine addicted patient, he was more relaxed and took the time to suggest solutions.  The same problem with the red plastic covering for the bed existed, however, as a patient who had experienced a miscarriage and was now bleeding laid on the bed followed by a patient who the doctor suspected of having an STI all without cleaning or changing the plastic.  The doctor was very careful to explain to a patient the importance of going to get further tests but was frustrated when the clinic did not have the supplies needed in order to perform a simple PAP smear.  When asked, the doctor said he could see any number of patients, usually averaging 100 per day.

The situations which are found at the Broadhurst 2 clinic are unbelievable.  At no time is it acceptable for a patient to be put at unnecessary risk for contracting a disease or illness.  The attitude of the nurses as they slowly move through the registration process and the consultations makes the atmosphere anything but pleasurable.  The suffering of each patient in a three hour queue without access to water or a bathroom is not a suitable situation for a person dealing with a so-called “advanced” health care system.  Patients’ privacy is completely ignored and their dignity is stripped as they must endure the constant interruptions during their consultations.  During all that the patients encounter during their attempts at making it through the clinic, they are exposed to countless infections which are completely avoidable.  The standards at which the nurses in the clinic are allowed to work are remarkable as there seems to be no supervision which must be noticeable to patients.  If a doctor comments on how poorly run a clinic is, there must be some changes made in order to provide to services and protections that a clinic is required to provide.