Weeks 3-4: Happiness is the Truth

I'll start with a video... this song is really popular in Bots right now (and I guess in the States, but I didn't hear it until I got here), and it captures how I've felt much of the last week-and-a-half. Plus it's a great song that will almost certainly put a smile on your face. Sunday marked three weeks since I arrived in Botswana-- hard to believe I'm already through the notoriously difficult "first three weeks." 

Last week was the first week for clinical volunteering/observation and CIEE classes, so my schedule was fairly busy, but totally manageable--mostly because I have not yet been assigned a single reading for my UB classes. And there is no required reading listed in any of my course outlines. hmm..

My first couple of clinical visits--Tuesday of this week and last week--were really interesting yet slightly overwhelming.  Botswana's health care system is like a funnel of which local clinics are the point of entry for patients with a variety of conditions, and from which they are potentially referred to a smaller number of larger, better- equipped facilities downstream. It's a government policy for every citizen to have access to a clinic within 8km/5miles (walking distance). In some cases this means periodic visits to very remote areas by mobile health stations, but for most it means a neighborhood clinic staffed by nurses and usually a doctor or two. The system's HR shortage was evident to me during my visits: the environment was fast-paced, mechanical, and at times hectic.

The clinic staff have to be ready for anything. On my first day at Extension 2 a woman arrived at the clinic in the midst of a stroke.The doctor and nurses placed a needle for an IV and one of the nurses waited with her until an ambulance arrived. While the whole ordeal was surprisingly efficient, incidents like this probably increase wait times for more routine patients.

While clinics are the first stop for care I didn't really see any preventive care visits per se... client conditions ranged from acute yet non-life-threatening, to cases that would be seen in urgent care in the States or even the ER. Some people came for refills on hypertension meds (non-communicable diseases like HBP, diabetes, etc are on the rise... attributed by many to increasingly sedentary lifestyles and increases in processed foods. Sound familiar?), but there were a variety of more dramatic cases. Three different women between my two visits were told they miscarried. One of them was in her third trimester. In general the doctor I shadowed was curt and professional, if not a little callous at times. Her conversations with the women who miscarried were such times: to the woman with a nearly full term fetus inside of her, the doctor described in unnecessary detail the extraction process for the dead fetus, with no offer of sympathy.

During our second visit yesterday the doctor expressed her concern about her role in an overburdened medical system: she must be as quick as possible, while still being appropriately thorough and accurate, in order to keep wait times down in the clinic. A woman who came in with, for example, a sore throat was asked to avoid caffeine, alcohol and tobacco, to drink tea and return in two days if her symptoms did not subside. The woman's actual time spent with the doctor (ie, not including intake and triage, completed by an aide in another room) was around 3-5 minutes. A patient's time in the consultation room is strictly for conversation and/or exam--the clinic has separate rooms for dressings (ex. wound and catheter care), for injections, for TB care, and for blood draws/lab services.Yet wait times can still be up to several hours. A patient actually complained about this issue while I was shadowing the doctor, and he was especially perturbed that a few patients were jumping the queues. The patient also addressed his concerns about patient privacy. Screens are used instead of doors in some instances, and high windows between rooms and corridors are kept open. The doctor reasoned that these measures increase air flow and decrease the spread of TB. The man remained unconvinced. From what I observed, the man seemed to be making a valid point. Nurses and aides frequently interrupted patient consultations to discuss other patients' test results, scans, etc with the doctor, and in the rush of things, the screen that was meant to cover the doorway to the corridor was often left askew.

Our professor for the clinic practicum course, head of Nursing at UB, offered one explanation for the apparent lack of consideration for some patients' needs: people who come to the government clinics are those who cannot afford private care, and because of their socioeconomic status do not believe they possess the power to change aspects of the system. They may be easily taken advantage of or disrespected, (mostly) without complaint.

We spend only two weeks in each clinic and will visit a total of six clinics each, so I'm looking forward to seeing how other clinics operate and how more specialized health services are administered.

GUESS WHAT? I'M PLAYING RUGBY!

Something about going abroad has endowed me with a boldness to re-imagine who I believe myself to be and what I want to do with my time. My friend Nahara from the program played rugby for a semester at her home university and talked Anandi and I into joining. Neither of us have so much as watched a rugby game. But we're learning! The first day, last Monday, was circuit training which included tire flipping, a bag drill, and other strength building--all right alongside the men's team, 40-guys strong. The workout was cut short though when the churning crimson sunset that seemed to mirror the intensity of the workout and the hue of the running track quickly darkened into a downpour that flooded parts of the track within 10 minutes. I ran back to the dorms dodging pond-like puddles and feeling accomplished. I was sore for the rest of the week. Lucky for me, last Wednesday's practice was RUNNING! Sure, it was 100 meter sprints, so not really my thing.. but it was fun to feel fast again. Because I'm comparatively so fast I'll probably play the wing position. Don't ask me exactly what that entails, I'm still working on understanding game-play.

Monday we repeated the circuit workout from last week but I was hardly sore at all the next day! On Tuesday our really buff-and-tough-yet-smiley-and-encouraging-in-spite-of-himself coach Munja taught the newbies the basics of the ruck, maul, and scrum which are the major ways teams vie for possession of the ball. Then we joined the rest of the team for two hours of ruck an tackle drills. I surprised myself with how tough and competent I was able to trick myself into feeling even though I was way out of my comfort zone. I had a lot of fun and I caught on quickly. Sure, at one point I accidentally grabbed the butt of the guy holding the bag... but at least that means I was wrapping low enough for a tackle!

Last weekend CIEE went on an excursion with some of the other exchange students from other programs through UB's international office. We went on a hike to a cave where, in the past, those suspected of witchcraft (of the African Traditional Religion variety) were thrown to their deaths. Cheery! We also explored the landscape and had a braai before heading to Bahurutsi Cultural Lodge where we had the privilege of experiencing a performance of some traditional dances, try some traditional Setswana foods and of course sleep in tents and some poshed up mud huts. On Sunday we went on a game drive at Mokolodi Nature Reserve. Although the recent rain storms have created lots of gathering places for animals around the park in addition to the larger water sources, we were still able to see giraffes, zebras (Botswana's national animal), impalas, warthogs (don't call them Pumbas, our guide insisted, since he told us Pumba means "ugly one" in Swahili, but they are all God's creatures so none is ugly, he said), hippos, hyenas, and a tortoise. Here are some pictures from the weekend:

move it like bernie (for the older generation: it's a dance move)

A chief's welcome

Grinding the sorghum

Learning to sift the sorghum meal. When prepared its a porridge-y dish called bogobe.
It's very nutritious and I've been eating a lot of it. 

We were served mimosas before our game drive.
Delicious and refreshing? Yes. Ridiculously bourgie? uh, yaa...

I leave tomorrow for a weeklong homestay in Kanye village. I'll be observing/volunteering in a clinic in the morning and getting to know my host family and the village in the afternoon and evening. So excited. I'll post about it next week.