Monday, 30 May 2011

Day 14 – 30 May 2011

This will be a short post, because I’ve been staring at a computer all day and my eyeballs might explode if I stare at it much longer.

Got up at the butt-crack of dawn (that’s for you, Daddy :D) to go to morning report today. Apparently Monday report is usually pretty long, because we go over all the admissions from the weekend – Friday evening through Monday morning. Two kids in the regular ward died, and another three babies in the NNU passed away. Great way to start off the week, eh?

Talked with Dr. Kung about my new assignment, which is basically going through the paper charts from the A&E (the ER, here), picking out the pediatric patients, and entering their names, medical record numbers, demographics, diagnosis, and disposition into an Excel sheet, for May – July 2009. SO stimulating. Seriously though, when she showed me how the charts are stored, I instantaneously developed an infinitely greater appreciation for US health systems and their endless red tape – there are literally old boxes piled on older boxes filled with carbon copies, organized in no particular order other than that all the patients from one day are bound together with a string. I repeat, A STRING. I’ll take a picture tomorrow, so you can all empathize with the horror that echoed through my impeccably methodical and well-organized brain when I realized that I was up against (OK, dramatic, but whatever, hyperbole gets the point across).

Worked on the charts till lunch, then back to Pie City (tried the Chicken Curry this time, YUM). Finally went into the infamous SPAR store – since I may not have blogged on this before, let me explain. The first few days we were here, literally every time we went to a store at Riverwalk and we couldn’t find something, they told us SPAR would have it. But we could never find SPAR. And then once we figured out where it was, we never had a chance to go in. But today, I DID.

Yeah, it wasn’t that great. It’s basically just a grocery store.

BUT. I did manage to find crayons for my little friend in the pedes ward, which I promptly delivered when I got back from lunch. I had been worrying about finding crayons all weekend, as well as how I was going to give them to him without all of the other kids begging me for something (which was Dr. Kung’s response when I told her I had promised to get him crayons). It ended up working out perfectly – he had gone for a bath, according to his grandmother, so I gave his present to her. She said, “I’ll tell him Aunty left him something very important.” I didn’t realize that they called non-family members Aunty here, but it made me feel kind of warm and fuzzy. And VERY RELIEVED that I had actually kept my promise.

Spent the rest of the afternoon going through the same charts that I had done in the morning, because Dr. Kung wanted me to record information for all of the pediatric patients that came through the A&E, not just the respiratory ones. I have a sneaking suspicion that she told me to do that in the first place, and I just misinterpreted her instructions. Doh!

Still, I managed to get through 539 charts today, according to my tally. That’s right, cause I’m a champ ;) Also, Kat and I made an important discovery: the reason doctors write so that you can’t read their notes, is because you can’t accuse them of doing something wrong if you can’t tell what the hell they did. Pretty solid theory, huh?

Came home and went for a run with Julia and Olivia. It was really nice, until a BUG FLEW RIGHT INTO MY EYE. I’ve swallowed bugs before while running, but this was particularly startling. It resumed being a nice run once I got it out though!

Dinner, watched The Hangover. My life is complete.

Sunday, 29 May 2011

Day 13 – 29 May 2011



The day started out in a bit of a panic, because we had been planning for days to go back to Kgale Hill for another hike, but we had never verified with Boitumelo what time we would be leaving. Olivia and I set our alarms for 9, and the first 10 minutes of my morning went something like this: stumble out into the common room. Greet Olivia, ask if we’ve heard from Boitumelo. Go to the bathroom. Come out of the bathroom. Phone rings, Boitumelo calling. Asks if we still want to go on the hike. Informs me that everyone else is already ready to go. Chaos ensues.

But typical African style, after we rush to get ready in the 15 minutes that I told Boitumelo we’d need, we find out that she hasn’t called the combi to come and get us yet. So we ended up sitting, drinking coffee, wasting time. Sigh.

Had a very nice climb though, once we made it out to the hill. Last time we only had time to climb the smaller hill, but the day hadn’t gotten too hot yet, and we were fresh and vigorous, so we climbed the first hill and moved on to a bigger one. The views were GORGEOUS (see pictures). The hill is next to a big quarry, which is super highly secured, because they mine diamonds here. Apparently we would need visas just to get into the grounds. I felt kind of like a spy taking pictures of it. The group splintered a bit towards the top of the hill, but we got some good pictures together. Boitumelo went off and meditated on a rock for a bit, and we creeped on her and took a couple pictures.

Uneventful trek back down, until we RAN INTO SOME BABOONS!! THEY WERE SO COOL! At first we just saw one, so we were trying to be quiet and stealthy, but then as we made it back into the parking lot we realized that there was a whole herd of them (OK, I’m sure herd isn’t the right term, but you get the idea). There was one in a tree that got pretty close to us, and was a total diva. After we piled into the van, a female went by whom we guessed was in heat, because her… rear… looked vaguely cancerous? Kim said that she thinks their butts get swollen so the males know that they’re ready for mating. It was kind of gross looking, actually.

Some of us really wanted to go to a farmer’s market that Nikki (one of the BUP staff and basically a native Motswana, because she more or less grew up here) had told us about. The driver wasn’t sure where it was, but we stumbled on a coffee house/market where (mostly) ex-pats sold random kitschy stuff and live musicians did acoustic renditions of popular songs like “Oh my God.” Probably the classiest version of that song that’s ever been made. We were a little disappointed that it wasn’t actually a farmer’s market.

Schlepped back to the UB campus, because we all were pretty exhausted from the hike. Showered and stuffed our faces because we were also all STARVING. The post-hike exhaustion and food coma meant that we spent the rest of the afternoon lazing around and napping. Such a stimulating life we lead here.

Dinner, movie, sleep. Click on the picture at the top to see my pictures for today!

Day 12 – 28 May 2011

We all passed out last night after we got home, and slept in, which was GLORIOUS. I read in bed for a while after I woke up, migrated to the couch in the living room, and ended up finishing my book.

Went for a run with Julia and Olivia around campus, but I think the dust and the dry air got to me, because my chest got really tight and I had to stop. Only the second time I’ve run since I’ve been here, because it gets dark at 6, and the combination of getting home from work after 5 and not being allowed out after dark severely limits our ability to exercise. Clearly, I need to find a better solution to this situation before I turn into a huffing and puffing blob, as evidenced by this morning.

Sat around chatting after breakfast. We got around to showering eventually. Also, tried my first passion fruit! – They look like alien guts or something on the inside, but they have really good flavor. We finally managed to drag ourselves over to the News Café to access the supposedly free wireless. Instead, we were informed that they were out of codes for the month, so we ended up buying coffee and feeling slightly jipped. Oh well. It was still glorious to have a cup of REAL coffee. Clearly I have let my coffee addiction get more out of hand than I realized.

Came home and had left-overs and fruit with peanut butter and pralinutella (it’s a combination of nutella and praline flavors, SO delicious) for dinner. New discovery of the day: German candy store names must be pronounced with a Sean Connery-esque “sch” sound (just imagine it, you’ll think it’s as funny as we did). Watched When Harry Met Sally, because somehow Julia and Olivia had made it this far in life without seeing it (not sure how that’s possible). Planned weekend trips for the rest of our time here – itinerary TBA.

Basically, we accomplished nothing particularly monumental today, but we had a lot of fun just sitting around talking. I guess that’s what the weekend is for, after all.

Saturday, 28 May 2011

Day 11 – 27 May 11

An early day, because I wanted to go to morning report with Dr. Kung. First time walking to work on my own, since Kat didn’t need to be up as early as me. I made it to the hospital, but got a little lost trying to find the conference room.

Report was super-interesting, again, but one of the patient’s situations was really sad. A baby with hydrocephalus (basically a condition where an excess amount of cerebrospinal fluid (CSF) builds up in the brain) had a shunt placed to drain the fluid off her brain into her abdomen the day before, but in the early evening, the resident responsible for the NNU (like the NICU) noticed that blood and CSF were leaking from the incision site, which is apparently not normal. She tried calling in the neurosurgeon who had performed the operation, but the surgeon said that she was too tired and told the resident to call the on-call pediatrician. All of the attendings were very upset and declared the attending’s behavior unprofessional. It was an interesting interaction to observe, but the worst part was that the baby had ended up deteriorating overnight and was placed on a ventilator. I can see both sides of the argument, because the neurosurgeon is the only one at PMH, so at a certain point you have to make hard decisions about allocating your time without getting burned out. At the same time, that’s someone’s child you’re responsible for, and, as the attendings put it, you shouldn’t take a patient in to surgery (“the theatre,” as they call it here) if you can’t follow up on the potential complications.

Dr. Kung stayed after for a meeting, so I went back to the pedes ward and ended up chatting with one of the interns. He went to medical school in Jamaica, and it was really interesting to hear about how the residency process works here. Basically, you do all four years of medical school, then become an intern for a year, followed by a year of work as a medical officer, then apply for residencies.

Dr. Kung came back and tried to show me how the computer system works here – apparently I misunderstood, and there are two computers for the pediatric ward, not for the whole hospital – but it has to connect to a remote server, which was down. I went back to my little office to do more work, and found two nurses taking a snack break. One of them left as soon as I came in (I guess she was shy, or maybe I smell), but the other one stayed and chatted with me for some time. I may have made a friend, yay!

My little friend from yesterday came back, this time with his own little friend. I let them color with my highlighters, which they seemed to enjoy. Then the little boy found a box in the corner with stuffed animals and a giant, unopened box of 120 crayons. Before I could do anything he ran off with them, and when I caught up he was showing them to his grandmother and she was telling him to “thank Aunty” for the gift. Awkward. I had to explain to her that they weren’t mine, so I couldn’t give them to him, but that I would bring him more tomorrow. I felt like such a horrible person. It only occurred to me later that I could have just replaced the box in the office. UGH, FML.

Lunch again at Pie City, which went much more smoothly than yesterday. Kat and I even got to our training 15 minutes early, and had to sit out on a curb waiting to be let in. In the meantime, we observed the Botswana version of the ice cream truck – a guy riding around on a bike, honking an exceptionally obnoxious little horn.

Got home late from the training, also feeling a little irritated because Dr. Kung told me that the IRB was taking too long to get back to us, so she is going to have to switch me onto Kat’s project for the time being. I had been feeling fairly neutral towards the strike thus far, but now I want it to end. Apparently the government offered a 5% increase, which they refused. Grrr.

Went to dinner at Embassy, a REALLY PHENOMENALLY TASTY YUMMY GOOD Indian restaurant at Riverwalk. Stuffed our faces. Was so, so happy. It actually turned into a really stressful experience, though, because there were 9 of us, and some of us were trying to pay by card while others were using cash. Paying the bill always takes a long time, but we were even more stressed than usual because we were trying to make an 8:15 movie. Julia and Becca went ahead to make sure there would still be seats available, but then the waitress came back twice because she was confused about how much to put on the cards, and then she told us that we didn’t have enough cash. She got really frustrated with us in the end, and muttered something about not getting a tip, which made us all feel alternately embarrassed and annoyed. As a side-note that may help you understand our feeling of disgruntle-ment (yeah, I know that’s not a word): they generally don’t give tips here. Only Westerners do, and usually not even then. But the entire clientele of this restaurant appeared to be ex-pats, so I think we may have misunderstood the conventions. Still, I had been planning to leave the waitress a tip, because it’s stressful serving our group, but after that I was feeling far less generous. Also, we were late to the movie.

Next, although we had thought the movie ticket was only 25 Pula, it turned out to be 40. We were flustered, and Julia and Becca were already inside, so we were even more flustered, but we had to go ahead and pay. The movie theaters here work like an actual theater, in that you have assigned seats that you select when you buy your ticket. We went through the ticket check together, but then we got separated by a crowd. Olivia and Kat went to the bathroom, which I didn’t notice until I went into the theater and almost talked to some people sitting in what I thought were our seats. I was super confused, so I just sat down randomly. The movie had already started, so the darkness added to my confusion. By the time the other two came in, two people had sat down on the other side of me, so we were separated. Just when I finally thought everything was settled, a guy and his girlfriend came in, and told me that I was in their seat. Feeling slightly panicked, I indicated that the people next to me were in my seat, to which the guy responded, “Tell him to move.” Not wanting to confront a total stranger who happened to be twice my size, I must have made the universally recognized “deer in the headlights” face, because the guy went and got an usher to sort it out. The couple next to me ended up being forced to move, and I sat down next to Olivia, feeling like the last thing in the world I wanted to do was watch the movie.

Thankfully, the movie (Pirates of the Carribean!) ended up being pretty entertaining, if bizarre in parts (one word for you: mermaids). Entertaining wait for the cab afterwards, although, in spite of calling for a cab specifically to avoid dealing with the sketchy Riverwalk cabs, we ended up squeezing five people into the backseat of a very, very sketch “Hello cab.” We checked our list of the official cabs when we got home, and they definitely weren’t on it. Whatever, 20 Pula for 5 people and we got a good story out of it.

Day 10 – 26 May 11

Lots of pros and cons to this day. Pro: free in the morning, because we didn’t have clinic and Dr. Kung was checking out schools for her son. I sat in an office off the peds medical ward and continued working on the log book through the morning. Initially pretty discouraging, because I had a whole page of names that I couldn’t even find in the book (usually I can find the name, but there’s no medical record number recorded). Also, some of the “names” that I’m supposed to find are initials and an admission date. Even if the records were as complete as the U.S. and/or electronic, what can I do with that?! It got better once I finished that page though.

A little boy wandered down the hall around 11 and we looked at each other as he passed the open door, so I greeted him in Setswana. He apparently took this as an invitation to come in, and within 2 minutes he was jumping around on the couch in the corner and having a grand ol’ time. SO. CUTE. I wasn’t 100% sure he was supposed to be in there, but it was a nice break from work to play with him. He was very precocious too – he told me that he was four, but he understood my English perfectly, which is a rarity here. From what I’ve read (and experienced a bit), children here are taught in Setswana up until the equivalent of 5th grade, and take English as a foreign language. Then, after 5th grade, it switches, and kids are taught in English, with Setswana as a foreign language. But this little guy was too young to even be in school, so I was doubly impressed. Also, I showed him the little icons on my phone for a cat and dog, just to see if he knew the English words, and he ended up figuring out how to play a game on it all by himself. Basically, he was too cute for words, and I was sorry when I had to leave for lunch.

Pro/con for lunch: Walked to main mall with Kat, because she had been to a popular lunch spot there, Pie City, and was raving about it. We were supposed to meet Julia, but she got called into a last minute meeting, and we had to be at a training session with Dr. Kung around 2, so we left without her. We got our food (basically like a popover, DELICIOUS), and sat outside to wait for Julia to find us. She got lost, then a guy came up and asked us for food, and Kat and I ended up leaving late and being late to our training, all of which made the whole experience frustrating.
Dr. Kung also was not very pleased with us for being late. Also, she asked in the car whether I had gone to morning report (I had asked her the day before whether I was allowed to go, since she wasn’t planning on being there), which I hadn’t, and I felt even worse.

Pro: the training we had WAS SO COOL! They were teaching us how to use Microsoft Access, a database program that is apparently a part of the Office Suite. Mostly, Dr. Kung wanted us to get it for Kat’s project, but I can see so much potential for data entry for my project too. I went home full of ideas, which is always a good feeling ☺ I felt like such a computer nerd.

At home, we had planned to go to an internet café nearby, but since Kat and I got back late, it was starting to get dark. We eventually decided to scrap that plan till the weekend, and started making dinner. Talked to Mommy and Daddy on the phone, while we roasted some butternut squash/pumpkin/potato mixture that we bought yesterday. It ended up taking over an hour to cook – long enough for us to watch the Glee! season finale!! (it’s about time Rachel and Finn got it together, but honestly, WHY DO THEY KEEP LOSING AT COMPETITIONS?!?!) – but it was DELICIOUS. Aimee, get ready, because squash is going to be a staple when we get back to school!

Day 9 – 25 May 2011

Dragged myself out of bed at 6:10, because Kat had to be back at the hospital for a meeting at 7:15, and I wanted to go to morning rounds with Dr. Kung at 7:30. Ugh. Also, forgot that I was planning to wear sandals to walk to work, then change to heels, so my feet were already a mess by the time we got there. Double ugh.

We were a little late to rounds because Dr. Kung and Kat were still trying to work out a glitch in the database program. Residents were giving presentations on the patients they admitted from the night before, which was super interesting. The diagnoses were not particularly different from what you’d see at home – a bunch of pneumonias, an obstructive jaundice, and a few more complex ones that the attendings GRILLED the residents about. I felt kind of bad for one of them. Almost.

After presenting their patients (each one had four), an intern gave a presentation about “fevers without known source/fever of unknown origin” (aren’t those the same thing?). Let’s just say that reading off of their Powerpoint slides is a weakness among presenters everywhere.

Things finished up around 9, and then Dr. Kung gave me free reign until the clinic opened at 11. I went back to the peds ward to start working on the patient list she had given me, and woah buddy, do I have my work cut out for me! I mentioned the logs yesterday, but let’s backtrack a bit here – there are two computers here, for the entire hospital. Charts are all handwritten. So when a child comes onto the ward, the only record that they’ve been admitted here is this logbook. All of the entries for a given month fit on two to three pages, but somehow they’re not actually in chronological order. My guess is that kids aren’t always entered right when they get admitted, so things get pretty jumbled when they finally do get entered. Which makes my job, finding a specific admission date and trying to decipher handwriting spelling names that I can’t even pronounce, pretty difficult. I made it through about a third of the list, then headed to clinic. Being my usual directionally challenged self, I had assured Dr. Kung that I would be able to find my way to the clinic on my own, but as soon as I walked out of the ward I realized that I had no idea which of the buildings it was in. I walked in circles a few times, but I generally followed the signs to “Clinic” and actually made it there before Dr. Kung. Go me!

I already knew that today would be busier, because I had seen the list of patients the day before. To put it in perspective, yesterday we saw 5 patients; today, we planned to see 9. We started off a bit late, but then got even further behind because we were being super-thorough on one of the new patients. There was a brother-sister pair that both had pretty bad asthma, which wasn’t helped by the fact that the mom wasn’t giving their medications like she should. Dr. Kung performed a lung function test on them, which was very fancy and computerized, but she had brought all the equipment from home and had to lug it all back with her at the end of the day. It was interesting, because the program uses a graphic of the Big Bad Wolf from the Three Little Pigs, to tell kids to “blow the little pig’s house down” for the test. Unfortunately, none of these kids knew that story. Needless to say, the makers of that program are not culturally sensitive.

Clinic seemed to go on FOREVER, because we had so many more patients. Dr. Kung kicked me out around 2 to get lunch. I only missed one patient though. The last patient of the day was THE cutest kid I have ever seen. The poor baby has been sick since age 3 mos. Part of the right lung collapsed because the illness was so bad, and it still hasn’t reinflated properly. An invasive procedure would let us look inside and see what’s wrong, but there’s neither the equipment nor the pulmonologist to perform it here. The family would have to go down to South Africa to get it. Boo.

Earlier in the day, I mentioned to Dr. Kung that with the medical record numbers I had found in the morning, I was thinking of submitting a request to medical records to start pulling the patients’ charts. We were anticipating that it would take a while for our request to be processed, so I thought it would be good to get the ball rolling. She told me that she was still waiting for IRB approval, even though she submitted the paperwork at the beginning of April! This is beyond normal Africa time delays – there has been a strike going on here since Easter, with almost all of the teachers and government employees asking for a 16% salary increase. A few other interns’ projects have been affected, but this is the first time that I’ve encountered a problem personally. Ugh.

After the last patient, Dr. Kung, a nurse and I cleaned up, then she gave me a ride home again, which was nice because I was really tired. In spite of that, we decided to go to Riverwalk when I got back, because the Rice girls hadn’t been there yet, and we needed groceries for dinner. Between the three of us who are splitting groceries, we somehow managed to spend over 600 Pula. That food better last us a few weeks.

We knew before we left that we would have to take a taxi back, because it was after dark, but we realized as we got ready to go that we had 5 people, and taxis here are only allowed to carry 4 people. We tried calling a few of the numbers for reliable taxi drivers that we had in our phones, but they were all too far away, so we grit our teeth and decided to negotiate with the rando taxi drivers that hang out in front of Riverwalk. We ended up having to split up into two taxis, but we bargained the price down to 20 Pula (normally it’s 25). Lina and I made it back before the other two, and we had time to pull a splinter out of Lina’s finger (received from one of the lovely roadside bushes on the way there), put away all of our groceries and boil a pot of water, and the others STILL weren’t back. Minor panic moment, but it turned out that they had just gotten dropped off at the South gate and got lost trying to find the dorm. Whew.

Made pasta for dinner, yum yum! We had bought kumquats at the grocery store, because we were intrigued that the label said you could eat the skin. Basically it’s like a bite-sized orange. But Julia bit into one, and it was black on the inside, so now we’re all terrified to eat them. At least we tried.

Also, Lina managed to load the Grey’s season finale on her laptop while she was at work, so we all crowded around her computer to watch it. IT WAS AWESOME. But it meant that I stayed up later than I meant to, which does not bode well for tomorrow morning…

Life Lessons Learned in Africa, Part III:

1. Interns/residents are terrified of attendings no matter where you go.
2. It is a bad idea to become addicted to any TV show before going abroad, let alone three shows (DON’T TELL ME WHAT HAPPENS IN THE GLEE SEASON FINALE).
3. Instant coffee does not provide anything near the same level of caffeination as regular coffee.
4. If you don’t put away your food, bugs will crawl in it. In fact, bugs will crawl in/on anything. Including your bed. If you don’t like squashing them, you are SOL in Africa.
5. Grocery shopping while hungry is not advisable – even when bread only costs $1, all that crap you put in your cart adds up.

Wednesday, 25 May 2011

Picture Sharing, Attempt #1



Mwha! If you click on the picture, you can go to the whole album :) Go me, and my lack of techno-savvy...

Day 8 - 24 May 2011

First day of work! Everyone was up bright and early, at 6:30 am, because we were all super-stoked to be diving into our placements. We looked pretty sharp, if I do say so myself. Except that we were maybe slightly less impressive after walking about 30 minutes to the BUP office, with the majority of us in heels, trudging through gravel and dirt. We’re smart kids.

As soon as we reached the office, those of us assigned to Princess Marina Hospital (PMH) turned right back around the way we came, since we had passed the hospital on our way to the office. The hospital was much bigger than I expected, with probably more than 15 buildings spread out across extensive grounds. Most of the buildings, especially the wards, are only one story, which makes it very confusing to navigate. Also, covered walkways connect the buildings, so patients actually get to see the sun and smell fresh air as they get transported from place to place. Kind of neat.

Met up with Dr. Shiang-Ju Kung, the paediatrician (that’s how they spell it here) + general medicine + asthma/allergy specialist that I’ll be working with here (yeah, she’s got three specialties… she’s kind of a genius). First, Kat and I went with her to the office Kat will be working in next to the A & E (Accident and Emergency, not the TV channel) ward. Note to those of you who know me as Kat: there is another person on this trip who goes by “Kat,” I’m not just referring to myself in the third person. Ran into a few glitches loading the software that Kat will be using for her research project, which she unfortunately had to go back to the BUP office to resolve.

Then Dr. Kung and I went to clinic. Twice a week, on Tuesday mornings (900 – 1300, theoretically) and Wednesday afternoons (1100-1600, again, theoretically), Dr. Kung runs an allergy/asthma out-patient clinic out of PMH. I already thought she was brilliant, but now I have even more respect for her: she runs the clinic almost entirely herself, scheduling her own appointments, keeping her own patient charts, she carries a separate phone just for patients and lugs her lung function testing equipment (including computer) back and forth with her every day, and somehow still manages to have a balloon and sticker for every patient and remember each of their names and histories! She also spends more time with her patients than I may have ever spent with a doctor in all of my lifetime visits to doctors combined. OK, that may be exaggerating, but seriously, new patients get a full hour, and follow-up visits 30 minutes. She conducts a thorough history on each patient, and with one new patient who had been experiencing problems for several years, she spent 45 minutes just getting the child’s history from the parents, then did a full 17-prick skin allergen test, plus physical exam. In all, it ended up taking over 90 minutes just for the one patient. Even though we started the day late, she never rushed the patients. As if that’s not enough, Dr. Kung is also an excellent teacher – she did each exam first, listening to the lungs, checking the ENT, etc., but then she had me repeat everything, drawing my attention to anything abnormal. She also took a moment after each patient to talk over the case with me and explain why she asked certain questions, or what a given medicine was for. Basically, she’s a goddess, and I love her and working PMH!

Work conditions are not exactly ideal, but it’s certainly not like we’re in a tent in the middle of nowhere, either. Dr. Kung has to provide much of her own equipment, and as she put it, unattended things “tend to grow legs,” so you have to be careful. That said, however, the hospital has X-ray and CT machines (though the CT is currently down), and government medical aid covers medications and testing for many families (usually there is only a 10% co-pay, if things aren’t completely paid for). Also, interestingly, patients are responsible for maintaining their own medical records, and standardized folders contain notes from every doctor they see, which makes it easy for specialists to see the care their patients may have received in the A&E, etc. It’s a neat system, especially because most of the time the Dr. doesn’t have to write a separate prescription that the patient might lose – they write it directly into the chart, which the patient takes to the pharmacy. Their new appointment times also get written there, so that (theoretically) they don’t forget when to come next. This all assumes that patients don’t lose the charts, but of the five patients we saw today, all of them had complete charts, plus lab results and x-ray films, in a few cases.

Medications have different names here – for example, albuterol is salbutamol, so I feel a bit like I’m learning two new languages here. Dr. Kung has a fabulous South African accent though, so I’m content to sit and listen to her all day long (why couldn’t I have been born South African/British and/or Australian?).

Once we had seen enough patients, Dr. Kung showed me the way to the cafeteria, then went to pick up her son from school. Typical hospital caf. I brought my lunch, so I just sat and ignored the “International News Station” (is that even a real thing, you ask? Yes, and it’s just as annoying as all the other news stations) while I staring into space and pretending that everyone in there wasn’t goggling at me. Only had one person ask me where I was from, and how they could get a job with UPenn.

Found my way back to the A&E office at the appointed time to meet up with Dr. Kung and Kat, but they got held up, so I drifted back and forth between the ambulance bay outside and the A&E waiting room. Chatted with a paramedic studying for his Master’s in psychology at UB, who asked if I had FB. Africa myth # 213, debunked.

Got to see the pediatric ward where I’ll be working with Dr. Kung when she goes on call for the in-patient side next week. There are no private rooms, but everything seems quite cheerful, and families go in and out with food and laundry. There are no computers for charting – for example, every new patient is registered by hand in a giant 2’x3’ log-book kept at the nursing station. Their entry may or may not contain their medical record number, age, sex, nationality, admission and discharge dates, admitting diagnosis. It pretty much depends on how busy the nurses are, and whether their handwriting is legible. And lucky me, the first part of my research project is going to be taking a list of children admitted for respiratory illness between April 2009 – September 2010, sifting through the old logs, and finding their medical record numbers so that we can request their charts. Ma, I think I’m going to need glasses by the time I get home!

Dr. Kung very generously gave us a ride back to campus, thankfully (we were both exhausted). Stayed in, did some boring things, then went to bed early. CAN’T WAIT FOR TOMORROW!

Day 7 - 23 May 2011

Early day, because we started orientation! Met our contacts with the Botswana-UPenn Partnership (BUP), who are all very nice and have awesome accents of unknown origin (unknown to me at this writing, anyway). The campus security people freaked us out about locking our doors and hiding our belongings. Then we had tea. That’s right, we went outside and had cucumber sandwiches, tea, coffee, and rolls. Clearly this is a tradition that we need to bring back to the States, immediately.

After getting more information about living on campus, Boitumelo gave us a campus tour (basically an extension of the 12 tours she’s given us already to various places). We particularly enjoyed the various public service announcement signs, which I plan to dedicate a photo album to. Stay tuned.

Headed back to the administration building for lunch, which was delicious – the closest thing to “authentic” (I hate using that word) Botswana cuisine that we’ve had yet. Steaks with gravy, cornmeal, veggies, diced potatoes, and salad. OK, so it doesn’t sound authentic, but it was good. Enough so that we went back to our rooms and succumbed to a food coma for a few hours before the game drive.

Driven out to Mokolodi Game Reserve by BUP staff, which is just past Game City on the road to Lobatse, a town about 30 minutes south of Gabs. Looked like we were driving into the middle of nowhere, but it was pretty when we got there. They also served us champagne (the drinking age here is 18, OK, we’re not alcoholics, and I’m legal anyway!). I was a little skeptical initially, because it looked kind of touristy, but once we headed out in the truck it was more than worth it. We saw impala and kudu (which are basically relatives of antelope), ostriches, various birds, zebra, “Pumbas,” “hearty-beasts” (that’s what they called them), giraffes, a hyena, and a cheetah. Unfortunately, my camera battery died within the first twenty minutes, mysteriously draining from a full battery to less than half a bar at record speed. The pictures that I did manage to take are sort of in the spirit of “Where’s Waldo” – if you can spot the animal, more power to you! But really, in the interest of full disclosure, I’ll basically be mooching off of everyone else’s awesome pics for this portion of the trip. The scenery was stunning, though, especially as the sun began to set. The native flora was not quite as genial, as branches of acacia trees covered with two inch barbs reached in every few feet to grab the unlucky people sitting to the outside of the jeep. Yikes.

As it got dark, we pulled off next to a small pond (we heard hippos but didn’t see any), where a beautiful buffet, crackling fire and lavishly adorned dining tables awaited us. It was like we were royalty. So awesome. And the food was beyond words. More steaks and chicken, plus beef sausage (they apparently eat meat at every meal here, including breakfast), butternut squash, cornmeal, bean salad (sort of like a cold Indian curry, but with kidney beans), garlic bread baked over an open fire… yeah, I’m still drooling over it.

While we were finishing our meal, a group of traditional dancers came out to sing and dance around the fire. They were… scantily clad… and we all felt bad for them because it was so cold. They looked like they were having so much fun though, and they dragged a couple of us up to dance with them at one point. Yeah, it’s a lot harder than it looks. And that fire is pretty darn warm. The tableau was completed by the stunning star-studded sky – way more stars than you can ever see in Philly or Atlanta.

So, by and large, an AMAZING, wonderful, fantastic day. Went home glowing, with a new requirement for whomever I end up marrying: he better want to come back to Africa. Often.

What we learned about Africa (Part II):
1. When traveling to Africa, invest in a quality camera. You will NOT regret it.
2. Zazu birds are black, not blue.
3. Male impala that get kicked out of their herds never mate. Ever. They’re basically doomed until they become lion chow. Talk about a thankless existence.
4. It does actually get cold after dark in the bush. Like three layers of clothing plus a coat, gloves and a scarf cold.
5. Americans cannot dance.

Tuesday, 24 May 2011

Day 6 - 22 May 2011

The first day that we were not expecting any new arrivals! Having made the trek to Riverwalk several times at this point, we took it upon ourselves to show the later group how to get there. Bought still more food at Woolworths Food (are you sensing a theme here?), a branch of the British store Woolworth’s. Basically a Macy’s with food in the back. Very odd, but also sort of efficient. Hurried through because we thought everything was closing at 1, but then nothing closed.

Ducked into another store to check the jeans prices, and ended up finding a pair for 89 pula (roughly $12). Felt extremely proud of myself as I went up to pay, whereupon the sales clerk told me that her coworker wanted to marry me. The ONE DAY I didn’t wear my “wedding ring,” I get proposed to. Figures. I hope I let him down easy.

Headed back to campus, found out that poor Boitumelo was dealing with a burst water pipe in her building and wouldn’t be ready to go on our planned hike at Kgale Hill quite yet, so we putzed around and chatted a bit more.

Finally set off for Kgale around 2:45 (original departure time: 1 pm), in our wonderful combi that was in fact not the same combi, since in a small act of mercy fate had gotten us a combi without a sound system.

The hike was absolutely beautiful, and it was more or less the perfect temperature. Boitumelo assured us that the mountain that loomed above us was really not all that challenging a climb, but let’s just say that our huffing and puffing at the end told a different story. Still really fun, and the view reminded me of California. She said she’d take us back another day to climb the “big hill.” I may need to start training now.

Went back to campus to shower/hose off before dinner, then – you guessed it – back into the combi to head to Bull & Bush for dinner. Boitumelo says that the Batswana really like their food, and I’m not complaining! Had a really yummy pita wrap with steak and tzatziki. NOM. Also, mango juice in a spiffy plastic can that was see-through, both of which are made here in Botswana (as opposed to our imported South African wine…). Pictures of that to follow as well.

Day 5 - 21 May 2011

Woke up early to go for a run with Boitumelo, but since we were all so exhausted the night before (except for the three that went to a club with Boitumelo), no one was awake enough to do anything. Since we hadn’t heard from her yet, Olivia and I both went back to sleep. When we finally made it out around 9:30, it was overcast, drizzly, and cold! We walked all the way across the campus to the UB track, but it was closed because they had some kind of junior Olympics right before we came, and it needed to be resurfaced. We jogged back to the dorms, and a few girls went inside to warm up. Olivia, Estevana and I kept going a little ways, but when Olivia and I decided to take the long way around, Estevana went in too. They were smart – after jogging up to the North gate, thinking that it would loop back around to the dorms, we spent the next 30 minutes wandering around trying to find our way back. Yes, my complete lack of a sense of direction is still intact.

Showered, ate breakfast, took a nap. So productive.

Two new girls from Rice arrived, and we spent a fair number of extremely confusing minutes trying to figure out how they were involved with our program.

Bundled most of us into a combi van and headed to Game City on the other side of town (that’s right, another mall). Shopped for some jeans, but the cheapest pair was still around $50, so we gave up on that. Also, everything started closing at 4 pm, even though we weren’t meeting back up with the rest of the group until 5. We settled on buying more food instead.

So about that… as we wandered through the grocery store accumulating more and more stuff (sweetener, washing powder – they don’t have liquid detergent here, tea, ramen noodles – a college student’s staple the world over), we realized that we really should have gotten a cart. We happened to be passing a girl in what appeared to be a uniform, pushing an empty cart. Like the way people who work in a grocery store push empty carts to put them away. So we asked if we could have the cart, and after staring at us for a minute or two, she grudgingly gave it up to us. Five minutes later, in the pasta/rice aisle, the girl went by with another cart… filled with groceries. Yeah, we stole some poor girl’s grocery cart. We’re those people. Those stupid American people, to be exact.

Feeling exceptionally mortified, we headed back to campus and got ready for dinner. By which I mean we had two hours to kill, and we were all starving, so we decided to open a bottle of wine while we waited. How many college girls does it take to open a bottle of wine, you ask? As it happens, this incredible feat is not as straightforward as it seems when your corkscrew is part of a can opener that cost 10 pula. In our case, it took four of us, plus a refrigerator, a knife, a nail file, and a good 45 minutes. Pictures to follow.

Ride in what we had basically commandeered as the group combi to dinner at Fego, a very nice restaurant that was very far away from campus. Eminem and Lil Wayne kept us entertained at a bone-jarringly high volume along the way.

We arrived at with 5 minutes till the kitchen closed. Again, we were those people. But the pesto pasta was delicious.

Monday, 23 May 2011

Day 4 - 20 May 2011

Woke up early to go to the bank with Olivia, and after another (unsuccessful) attempt to get her some money, went to Wimpy for breakfast. Basically the equivalent of IHOP meets McD’s, but Olivia and I both had a fruit and granola breakfast with honey that was DIVINE. Also, pieces of bacon are called “rashers” here. But, despite the many British-isms (over 10 pages worth, in fact, if you check our welcome packets), they still spell ketchup the way we do.

A little more shopping, then home to nap. Mmm jetlag is such a complex thing.

Our new roommate Julia arrived. More shopping. More exhaustion.

Next group arrived in the evening – a boy is added to our ranks! Dinner at Linga Longa, which resulted in pretty much everyone almost falling asleep in our (quite delicious) dinners. We found our way back in our very own taxi (oh my!), though lessons for the future are: 1) make the taxi driver come to you – do not follow him into the dark, sketchy parking lot, and 2) carry change.


Life Lessons Learned So Far in Africa:
1. 60 degrees is cold, and may require wearing a parka.
2. African time could give Indian Standard Time a run for its money (watch out K. Patel, “fashionably late” is being redefined!)
3. Chinese construction companies are making bank.
4. American pop stars and rappers have no idea what a big following they have here.
5. The shower curtain should be kept inside the shower, unless you want to mop up the mess yourself.

Myths About Africa – Debunked
1. It is not always hot here.
2. Yes, they do have cars, and roads, and traffic lights (occasionally).
3. They have malls – lots and lots of malls. And the UB library may be bigger than ours.
4. “Jambo” is not a universal greeting (though any iteration of “dumela” will get you pretty far…)
5. There’s chicken!

More to come in the next installment… the Housing Special Feature. American domination (accidental) in the grocery store. A modest proposal. Zebras!

Day 3 - 19 May 2011

Landed in Johannesburg. Really beautiful airport. The sinks in the bathroom were very interesting – no basin, just flat marble slanted away from you into a kind of trough. Pretty ingenious really, don’t have to worry about the drains getting clogged, I guess.

Passed through two security stops on the way to the international transfer terminal. Laurel got patted down by a guard. We didn’t have to take off our shoes or separate out our liquids, which was nice. The bins you put your stuff in to go through x-ray were odd looking. Sort of military issue square blocks.

Bought some water because we couldn’t find a water fountain (something that would become a common theme in our travels). Paid in USD, which was nice, but got change in rand – seriously, what am I going to do with R 4.20? Whatever, they look cool anyway.

We parked ourselves in front of a store selling purses in the duty-free area, and creeped on one of the sales guys because we were too tired and jetlagged to do anything that required intelligent though. He was a giant – probably at least 6’ 4” – and he had on a bright orange sweater that wouldn’t have worked on anyone else, over a turtleneck, so it made his broad shoulders look even bigger. He hovered around every customer that came in, and actually had a pretty impressive success rate in getting people to buy things (very overpriced things, I might add). We dared each other to go in to pretend to buy something, but we were all too lazy. It was fun to listen to the South African accents though.

Finally meandered down to the gate, which was basically one out of a line of little cubbies opening right out onto the tarmac. Buses pulled up at each gate, which regularly loaded up with passengers and disappeared. Chatted with a guy from Seattle at the next gate who was headed… somewhere (I was in the bathroom when the chatting started). He was Mormon and went to BYU, and when we said we were from Penn he said, “Oh, Penn State?” Ouch.

Got on the plane, which could have seated about 60, of which we only had probably 15. I was seated in the exit row, but since the seat next to me was empty, I put my bookbag on the seat. No dice, according to the male flight attendant with arms as big as my waist. I stowed my bookbag and kept my jacket on my lap, with the vague intention of trying to sleep as we puddle-jumped up to Gaborone. Also no go. Sorry, Mr. Steward, for being such a troublemaker. I guess fate punished me by keeping me from sleeping, still.

Landed in Gaborone after only about 45 minutes, during which time we were served not only a full beverage selection, but also an entire snack box, complete with a roll, pasta, asparagus, dessert, and fruit cup. Delta, you have a lot to learn.

The Gabs airport was beautiful, but fairly empty – we were the ONLY plane on the tarmac.

Met Boitumelo, our trusty student mentor, who is about 7 feet tall and one of the most graceful, long-limbed human beings I have met in my life, and Khuong, one of our drivers. Felt super bad that he took my bag for me, but I was too tired to argue. I felt like the Kalahari had replaced my eyeballs.

Went back to the University of Botswana (UB) campus, settled into our rooms and then set out on the walk to Riverwalk Mall (an activity that would be repeated about 1000x over the course of the weekend). Very dusty because there aren’t really sidwalks, but not too hot. Saw a Kumon sign, which I found highly entertaining in my state of semi-comatose. Got money from the ATM, which, even with only three of us, took about 20 minutes on its own. My card got rejected from 2 of the 3 machines, and Olivia’s got rejected by all of them. Very mysterious and frustrating.

Got lunch at Nando’s, a chicken place kind of like Pop-Eyes (not that I’ve ever been to Pop-Eyes at home) which turned into a bit of a fiasco when we asked for separate checks after ordering. Laurel, Olivia and I stared blankly into the distance while Boitumelo worked something out with the waitress in Setswana (something that would also become a common theme). We pretty much all ordered a quarter chicken with either wedges or chips (not actually chips—french fries!) with mild sauce. Suffice it to say, their definition of mild runs along the lines of jabanero pepper hotness. Had appletizer to drink, which is basically a carbonated apple juice. Pretty refreshing, especially since we were all pretty desiccated from the flight.

Shopped for groceries (Pay-less) and discovered some interesting things – the only regular milk that is available is whole fat, otherwise there’s a “long-lasting” shelf-stable milk. Or soy milk, which is much cheaper than in the States. The eggs are not kept refrigerated either. They have Cheerios, and they’re actually multi-grain (and much tastier than our Cheerios, but that part came later). There’s not actually any different “African” fruits or vegetables in the grocery store.

We also bought towels (Mr. Price) and padlocks for our dorm doors (PEP). Once you buy things at one store, you have to “check” your plastic bags at every new store that you go into – we’re not sure whether it’s because shop-lifting is a problem?

Took a taxi back to the dorm, showered, did a happy dance to finally be clean, and passed out by 7:30 pm. No internet, but none of us cared. The beds are gloriously soft.

Day 2 - 18 May 2011


Up bright and early to head back to JFK, and I must have been having a run of luck, because somehow I made it to the airport again without getting lost. Two run-of-the-mill taxi/bus/airport transfers in a row seemed like a pretty good omen. The international terminal was beautiful, my bag was apparently still under the weight limit, and I got ABP coffee before going through security. I couldn’t ask for much more.

Ran into Olivia before going through security, so we commiserated together about: a) stupidly getting coffee right before going through security, and b) the ridiculously long security line that materialized the instant we decided to get in it.

After finally making it through security, we found Laurel as well, and had a nice chat until boarding. I didn’t get in line until the very end, since all 1000 people on the flight got in line as soon as they announced that it was boarding. Pretty much the most intense security I’ve ever been through – they had a bomb dog sniffing everyone’s bags up and down the line as we went up the jetway, and oodles of TSA officials lined up to pull random people out for questioning…

… including me (because I’m so suspicious looking). Where are you going, how long are you staying, how much cash are you carrying – blah blah blah. Made a new friend in line, who was going on to Zambia after Johannesburg, and asked for my name to friend me on FB. She was from Toronto.

Not the first friend I made either! My seatmate was Blessed from Vermont, née à Zambia, and we chatted on and off throughout the flight. He is starting nursing school in the fall, and is pretty much one of the most interesting people I have ever met. Worked for USAID in Zambia. Got a grant to run an after-school program for Zambian youth for a year. Is currently a squash player/instructor and full-time student. His wife is doing her PhD in social justice, and interviewing for jobs in NYC. He wants to specialize in child development and go back to working for USAID in Zambia after working as a nurse in the states for four years. Awkward conversation point: why I was wearing a wedding ring, but am not actually married.

Sleep on the plane was not accomplished. I dozed for about 30 minutes around 4 pm our time (i.e. 12 hours to go), and possibly another 20 minutes around midnight our time (i.e. 5 hours to go). In the meantime, watched No Strings Attached (terrible), Love and Other Impossible Things (sad, but fairly good), finished Botswana Culture Smart Guide, read some articles for my placement, got over halfway through The Portrait of a Lady, did laps around the plane. Thought I was literally going to lose my mind at several points.  

Day One - 23 May 11


Fairly uneventful flight out of Atlanta to DC. My suitcase was wrapped up like a rotten hoagie (picture to come), which ended up being pointless because it was three pounds over the weight limit and we had to rip the saran off to take things out. So much for that idea.

Flight to JFK got delayed by rain. Bleh.

Somehow I actually found my way to Auntie Susan’s apartment from JFK, and after a minor complication with the bus fare for the next day (I’d printed the confirmation number instead of the voucher I needed to get back to the airport) we had a nice quiet dinner at a sushi restaurant. YUM.