The day began like any other day – I got up, was running late, but managed to get to morning report just in time. Then, 10 minutes into the report, one of the attendings got a phone call and interrupted the resident who was presenting with, “There’s a resuscitation on the ward.” Prema and one of the medical officers got up to go, and I hurried after them, dumping the contents of my bookbag on the floor in the process of pulling out my stethoscope.
I have been dreading this for the entire time I’ve been here, though I had thought that it would have happened sooner, with the high acuity of the patients and the lack of basic equipment. I also had a morbid curiosity, though, about how a resuscitation would be run in the middle of the ward, since there are so many other parents and children in the same room. The answer is: it’s pretty much run in the middle of the ward. There were some dividers on wheels positioned around the bed, but you could still see 10 people crowded behind them, and hear every word that they were saying. And the dividers didn’t extend all the way to the head of the bed, where Changi was bagging the child. It was eerily quiet, as all the parents looked on in horror or tried to shield their children’s eyes.
Part of my interest was purely for myself – I’ve known the whole time that I’ve been here that the true test of whether or not I want to go into pediatric critical care is whether or not I can handle the death of a patient. We lost a patient last week, but I wasn’t there to see it happen, so in a lot of ways it was still pretty remote. The baby was there one day, and not the next. But this was very, very real – compressions, alarms on the monitor, medicine bottles, discarded gloves and syringes. There was a debate about whether or not to intubate the child, because it was a case of TB meningitis, and there is no isolation ward for children. TB is usually not a problem in kids, because they can’t work up the strength to cough out any infected droplets/sputum; intubating them just opens all of that up to the world. The decision was made not to intubate, and within 5 minutes, it was over. Time of death was called at 7:50 am.
To be honest, it all felt pretty surreal. I didn’t really take part in the resuscitation, because there were already enough people. I kind of hung around on the edges, then walked back to morning report with Prema. I couldn’t tell which of the mothers was the child’s, if she was there at all. But overall, I felt the same as I have when I’ve seen other patients pass in the ER – it’s a tragedy, especially for a child, but it also is a relief to their suffering. You hope that they’re in a better place.
I passed the rest of the day in clinic, where I can pretty much zone out anyway. A lot of these kids are absolutely beautiful, and incredibly adorable, and I wanted to take them all home. We had a few cancellations, so Dr. Kung spent the down time quizzing Dr. David, one of the second year residents who’s doing a sub-specialty rotation this month and is shadowing Dr. Kung with me in the clinic. Dr. Kung gives balloons and stickers to every patient, and the last patient was a super-cute little boy who discovered that dropping his balloon and making Dr. David pick it up was a really fun game. I was also endlessly entertained.
Entered some charts in the afternoon, and avoided the wards for the rest of the day.
I was cranky and hormonal when I got home, and maybe I was more affected than I realized by the morning's events, because I nearly set the dorm on fire after putting olive oil in a pan to heat on the stove and forgetting about it. Good job me. Went to bed early.
Thursday, 30 June 2011
Day 42 - 27 June 2011
Super long morning report – so long that they ended up not doing report on all the patients, and Dr. Kung rushed through her usual Monday morning talk, the syndrome of the week.
Since I finished all of my data entry last week, I was a little unsure what my new task for this week would be. Dr. Kung and I sat down briefly, and we talked about coding my data, and about how I could help Kat with her project. Her data entry is similar to mine (though charts from 2010 as opposed to 2009), but she has to enter much more information than I did, and she’s using a database program called Microsoft Access that’s ONLY made for PCs. The original plan was for her to enter three months’ worth of data from 2009 – July through September. However, it’s much more labor intensive than Dr. Kung realized, so Kat only just finished the first month, last week. Dr. Kung asked me to go through the July charts, and cherry-pick all of the pediatric patients.
She took me to the new place where I’d be working on the charts, because that’s where there is a desktop available for me to work on. It’s in the Gaborone Dental Clinic, which is a sort of forgotten, tucked-away corner of the PMH compound. We were admitting again today, so I decided to spend the morning working on charts, and join things on the ward in the afternoon, if anything interesting came in. The new office is cold as mess, though, so I spent most of the morning moving the space heater progressively closer to my desk.
Boring rest of the day – missed rounds to work on charts ☹, got through a few days’ worth, had lunch with Kat, etc.
Since I finished all of my data entry last week, I was a little unsure what my new task for this week would be. Dr. Kung and I sat down briefly, and we talked about coding my data, and about how I could help Kat with her project. Her data entry is similar to mine (though charts from 2010 as opposed to 2009), but she has to enter much more information than I did, and she’s using a database program called Microsoft Access that’s ONLY made for PCs. The original plan was for her to enter three months’ worth of data from 2009 – July through September. However, it’s much more labor intensive than Dr. Kung realized, so Kat only just finished the first month, last week. Dr. Kung asked me to go through the July charts, and cherry-pick all of the pediatric patients.
She took me to the new place where I’d be working on the charts, because that’s where there is a desktop available for me to work on. It’s in the Gaborone Dental Clinic, which is a sort of forgotten, tucked-away corner of the PMH compound. We were admitting again today, so I decided to spend the morning working on charts, and join things on the ward in the afternoon, if anything interesting came in. The new office is cold as mess, though, so I spent most of the morning moving the space heater progressively closer to my desk.
Boring rest of the day – missed rounds to work on charts ☹, got through a few days’ worth, had lunch with Kat, etc.
Day 41 - 26 June 2011
I slept somewhat fitfully, but I woke up feeling completely rested, if a bit stiff from lying in the same position all night. I have concluded that being here and waking up at 6:15 every morning has definitely destroyed my natural sleep rhythms – I woke up, and I could tell it was getting light outside, so I tried to very quietly stick my head of the tent to get one last look at the incredible stars. Instead, the sky was already light at the horizon, though the moon was still out, and Julia heard me moving and asked if I was going to the bathroom. We both crept out into the freezing cold, and admired the sunrise. Becca woke up just a little afterwards, and we started poking around Tim’s various boxes, looking for a way to restart the fire. We were unsuccessful in that endeavor, but we made enough noise that Tim woke up and started the fire for us. Yay!
Had some tea and rusks when everyone was awake – rusks are basically like the British version of biscotti I guess, though not quite as sweet, but definitely delicious (especially dipped in tea). Then we bundled into the car for a morning game drive. Again, I was dragging my feet at the thought of looking at more antelope, but I was happy once we got out there and saw some giraffes. They’re so dignified and peaceful looking. Also, I did not adequately explain the phenomenon that is the Kalahari desert in my last post, and many of you are probably looking at my pictures of lions and ending up quite stumped by all the grass. So the Khutse/Central Kalahari Game Reserve is, as the name suggests, in the Kalahari desert – it’s just now what we traditionally think of as a desert. It looks kind of like a grassland, with lots of scrubby, thorny bushes, some white/tan sand/fine brown dirt, and a tree here and there. According to wikipedia, it "supports more wildlife than a typical desert." Go here if you want to learn more :)
Came back, and had breakfast of yogurt and granola (basically what I have for breakfast every day). A few of the more adventurous among us had some leftover sheppard’s pie and chocolate mousse (gross). Then it was time for dishes and packing up the tents. I now officially know how to set up and take down a tent – be proud. Also, folding up the tents got us all moving, so by the time we were done I was quite toasty, and able to remove some layers. It was kind of amazing to get back down to two shirts. I felt like I’d lost 20 pounds.
Once everything was loaded, we piled back into the car. We stopped at the research center again on our way out, to give them our pictures and tell them about where we’d seen the lions. We ended up staying to chat for quite a while, because they gave us tea, and the guy who helps them catch the cats was there (he’d been napping the day before). He was American, and a very super cool cowboy type. We learned a lot about the differences between cheetahs, leopards, and lions. Other fun fact: pumas, cougars, and panthers are apparently all the same thing.
When we finally managed to tear ourselves away, we settled back in for the 4-hour drive back to Gabs. For whatever reason, Tim decided to take back roads back most of the way, so instead of spending just an hour or two bumping around on the dusty dirt donkey lanes, we spent closer to three. We also had to pee in the bushes, and cut our quiche (aka lunch) with a porcupine quill because all of our utensils were packed up. Very classy.
Made it back to Gabs after what seemed like an eternity, where Olivia, Lina and MK were waiting for us with a bottle of wine and 90s music. The only thing to put a damper on this outstanding reception was the fact that the water had apparently been off most of the day, and was freezing cold now that it was back on. Julia and I had both been looking forward to hot showers – apparently, we brought the desert cold home with us. Awesome. Still, we enjoyed telling stories from the weekend, and relaxed the rest of the evening, in our clothes that still reeked of campfire.
Had some tea and rusks when everyone was awake – rusks are basically like the British version of biscotti I guess, though not quite as sweet, but definitely delicious (especially dipped in tea). Then we bundled into the car for a morning game drive. Again, I was dragging my feet at the thought of looking at more antelope, but I was happy once we got out there and saw some giraffes. They’re so dignified and peaceful looking. Also, I did not adequately explain the phenomenon that is the Kalahari desert in my last post, and many of you are probably looking at my pictures of lions and ending up quite stumped by all the grass. So the Khutse/Central Kalahari Game Reserve is, as the name suggests, in the Kalahari desert – it’s just now what we traditionally think of as a desert. It looks kind of like a grassland, with lots of scrubby, thorny bushes, some white/tan sand/fine brown dirt, and a tree here and there. According to wikipedia, it "supports more wildlife than a typical desert." Go here if you want to learn more :)
Came back, and had breakfast of yogurt and granola (basically what I have for breakfast every day). A few of the more adventurous among us had some leftover sheppard’s pie and chocolate mousse (gross). Then it was time for dishes and packing up the tents. I now officially know how to set up and take down a tent – be proud. Also, folding up the tents got us all moving, so by the time we were done I was quite toasty, and able to remove some layers. It was kind of amazing to get back down to two shirts. I felt like I’d lost 20 pounds.
Once everything was loaded, we piled back into the car. We stopped at the research center again on our way out, to give them our pictures and tell them about where we’d seen the lions. We ended up staying to chat for quite a while, because they gave us tea, and the guy who helps them catch the cats was there (he’d been napping the day before). He was American, and a very super cool cowboy type. We learned a lot about the differences between cheetahs, leopards, and lions. Other fun fact: pumas, cougars, and panthers are apparently all the same thing.
When we finally managed to tear ourselves away, we settled back in for the 4-hour drive back to Gabs. For whatever reason, Tim decided to take back roads back most of the way, so instead of spending just an hour or two bumping around on the dusty dirt donkey lanes, we spent closer to three. We also had to pee in the bushes, and cut our quiche (aka lunch) with a porcupine quill because all of our utensils were packed up. Very classy.
Made it back to Gabs after what seemed like an eternity, where Olivia, Lina and MK were waiting for us with a bottle of wine and 90s music. The only thing to put a damper on this outstanding reception was the fact that the water had apparently been off most of the day, and was freezing cold now that it was back on. Julia and I had both been looking forward to hot showers – apparently, we brought the desert cold home with us. Awesome. Still, we enjoyed telling stories from the weekend, and relaxed the rest of the evening, in our clothes that still reeked of campfire.
Wednesday, 29 June 2011
Day 40 - 25 June 11
7 am on Saturday dawned bright and far too early, but Julia and I somehow managed to drag ourselves out of bed. We had no idea what to expect for our camping trip in the Kalahari – Olivia had helpfully passed on that her friend who had gone on the trip last year said that it was the coldest she had ever been in her life – but we pretended to be enthusiastic. I literally packed every piece of non-work clothing I had into my book bag. And the layering began…
Phase 1 - Base layers:
Bottom - Leggings + jeans = 2 layers
Top – sports bra + thin, long sleeve cotton shirt (not to be removed the whole weekend) + white light-weight jacket + pea coat = 4 layers
We had heard that we were potentially riding in an open-air truck for the 4 hour drive to Khutse. That, combined with the 8 am departure time (the second coldest time of day), meant that we started out heavy on the layers.
Tim, our driver and guide for the weekend, picked us up at UB, and we happily piled into the truck when we realized that it was an 8-seater Land Rover with doors and windows. We didn’t even care that there was no heat, we were so ecstatic that it was covered. And so the adventure began.
Most of the drive to Khutse, which is in central/eastern Botswana slightly north of Gabs, was on a paved highway. At the 2-hour mark, by which time we had all gotten sick of talking to each other, fallen asleep, and then realized that we had to pee worse than ever before in our lives, we stopped at a gas station to refuel/deal with basic bodily functions. Thank goodness we did, because past there it was an unpaved dirt road into the bush for two hours, with all the jostling and bouncing that entails.
Just when we thought we must have reached the ends of the earth, we got to the gate for the Khutse Game Reserve, just south of the Central Kalahari Game Reserve. Just outside the gates is a Leopard Research Center. Tim knows the staff and scientists there, so he drove us over to check out their set-up and learn about big cat research. There we met Cleo, Jan, and their adorable two-year-old son, Luka. What they do there is super cool – trapping cats, putting tracking collars on them, and then studying their movements – and they also have a pretty sweet camp for being in the middle of the desert. People have been doing research there for 10 years, though they’ve only been living there for a year, and they have solar panels, hot-water showers, and computers. If I didn’t already love what I do at the hospital so much, I definitely would have been asking where to sign up.
After we were done, we climbed back into the truck to drive out to our campsite within the game reserve. It was a longer drive than I expected, and I was just starting to doze off when we finally got there. We were literally in the middle of nowhere – it was basically a clearing in the grass with a tree, a fenced latrine and bucket shower, and us. Tim unpacked the trailer that we had been toting, and we set up our tents. Now, dear readers, I have never been camping before, and this was quite an entertaining and somewhat dirty experience. I loved it. Then we had a quick lunch of egg sandwiches with tomatoes. Very British, I think.
Phase 2:
Top – Added on a grey wool sweater = 5 layers
After lunch, we washed our dishes and packed back into the truck for a game drive. It was about 3:15, so we only had a few hours of daylight left. There was a fairly steady breeze that was quite chilly, despite the sun, so as a preventive measure I added on another sweater before we set out, since we’d be getting back after dark probably.
It was at about this point in the trip that I decided I’m getting quite tired of game drives. We go on them pretty much everywhere we go, and mostly all you see is lots and lots of antelope (usually impala). Here, the pans are big and the animals spread out a lot, so on top of being a bunch of antelope you’ve already seen before, they’re so far away that you can’t really get a decent picture of them either. Harumph.
Started dozing off after a while, then came across some ostriches that were too absorbed in their mating ritual to run away from us. Snapped some pictures, moved on. Then, there were lions. I didn’t even see them at first, they were hidden in the grass, which was lit by the fading sun. There were 7 of them, a pride that Chloe and Jan had been saying they were trying to get more information about, but seemed to be a mother and her 5 male cubs. They sat watching us, and we watched them, mesmerized. Then the first, most curious one, started coming towards us, and we all freaked out. Cameras were clicking, flashes were bursting, and pretty soon we were surrounded by lions. It was AWESOME. (Don’t worry, pictures will come eventually).
After about 20 or 25 minutes of “oohs” and “aahs,” Tim started trying to drive away, because we aren’t allowed to be out after dark (more for the animals’ safety than ours), but one stubborn cub kept staying in front of us. We had to stop, and wait for him to decide to join the rest of his pride in walking the opposite direction. Even when we finally did drive off, I was vaguely worried that they would follow us.
Phase 3:
Bottom – Added pajama pants + another pair of socks = 3 layers
Top – Added blue, long-sleeved running fleece + hat = 6 layers
The temperature drops super quickly once it gets dark, which it more or less was by the time we made it back to camp. Tim immediately started working on the fire, and we all added another layer. At this point, I was starting to feel a little bit like a Pillsbury Dough-Boy, and couldn’t quite put my arms down.
We all took our seats by the fire, which became quite comfortable within a few minutes. The fee we paid for our tour included food, and, we were pleasantly surprised to find, drinks as well. Tried “St. Louis,” a local beer that we’ve seen signs for EVERYWHERE. Tea was much more satisfying though.
Tim also started cooking dinner, which was a mystery hidden under foil in a large lasagna dish. It turned out to be sheppard’s pie, which was quite tasty and filling. Also garlic bread warmed in foil, which they have at every braai here and is one of my favorite things EVER. Mmmm, drool.
To top it all off, there was chocolate mousse, and before long we were stuffed and happy.
Phase 4:
Bottom – Another pair of pajama pants + a third pair of socks = 4 layers
Top – Long-sleeved, cotton shirt = 7 layers
As long as we stayed by the fire, we were quite cozy, but every time we wandered further than 3 feet, a startling, mind-numbing cold immediately set in. It was quite shocking.
By the time we finished eating, it was pitch black outside, and the stars emerged. It was the most incredible night sky I have ever seen in my life, and made it totally worth it to brave the cold. I wish that I could do justice to how beautiful it was, but I’m just not that poetic. Suffice it to say, we are missing out on literally THOUSANDS of stars in the States. We all stayed up as long as we could to soak it in (and avoid leaving the warm fire), but eventually it was time to sleep.
We retired to our tents, where our beds consisted of foam pads, a sheet, a comforter, and a pillow. It was also as cold as I imagine the surface of the moon would be. I tried to stay awake to read for a little while, but my hands became so painfully cold even through my gloves that I had to stop. I doubled up my comforter, so everything was warm except my feet, which have terrible circulation to begin with. As long as I didn’t move, and remained in a position reminiscent of a mummy/Dracula, I was actually quite comfortable. I also stole a fleece blanket from the car, and pulled it over my head, then eventually fell asleep.
Total number of pieces of clothing on my body = 18
Overnight low = -2.5°C
Phase 1 - Base layers:
Bottom - Leggings + jeans = 2 layers
Top – sports bra + thin, long sleeve cotton shirt (not to be removed the whole weekend) + white light-weight jacket + pea coat = 4 layers
We had heard that we were potentially riding in an open-air truck for the 4 hour drive to Khutse. That, combined with the 8 am departure time (the second coldest time of day), meant that we started out heavy on the layers.
Tim, our driver and guide for the weekend, picked us up at UB, and we happily piled into the truck when we realized that it was an 8-seater Land Rover with doors and windows. We didn’t even care that there was no heat, we were so ecstatic that it was covered. And so the adventure began.
Most of the drive to Khutse, which is in central/eastern Botswana slightly north of Gabs, was on a paved highway. At the 2-hour mark, by which time we had all gotten sick of talking to each other, fallen asleep, and then realized that we had to pee worse than ever before in our lives, we stopped at a gas station to refuel/deal with basic bodily functions. Thank goodness we did, because past there it was an unpaved dirt road into the bush for two hours, with all the jostling and bouncing that entails.
Just when we thought we must have reached the ends of the earth, we got to the gate for the Khutse Game Reserve, just south of the Central Kalahari Game Reserve. Just outside the gates is a Leopard Research Center. Tim knows the staff and scientists there, so he drove us over to check out their set-up and learn about big cat research. There we met Cleo, Jan, and their adorable two-year-old son, Luka. What they do there is super cool – trapping cats, putting tracking collars on them, and then studying their movements – and they also have a pretty sweet camp for being in the middle of the desert. People have been doing research there for 10 years, though they’ve only been living there for a year, and they have solar panels, hot-water showers, and computers. If I didn’t already love what I do at the hospital so much, I definitely would have been asking where to sign up.
After we were done, we climbed back into the truck to drive out to our campsite within the game reserve. It was a longer drive than I expected, and I was just starting to doze off when we finally got there. We were literally in the middle of nowhere – it was basically a clearing in the grass with a tree, a fenced latrine and bucket shower, and us. Tim unpacked the trailer that we had been toting, and we set up our tents. Now, dear readers, I have never been camping before, and this was quite an entertaining and somewhat dirty experience. I loved it. Then we had a quick lunch of egg sandwiches with tomatoes. Very British, I think.
Phase 2:
Top – Added on a grey wool sweater = 5 layers
After lunch, we washed our dishes and packed back into the truck for a game drive. It was about 3:15, so we only had a few hours of daylight left. There was a fairly steady breeze that was quite chilly, despite the sun, so as a preventive measure I added on another sweater before we set out, since we’d be getting back after dark probably.
It was at about this point in the trip that I decided I’m getting quite tired of game drives. We go on them pretty much everywhere we go, and mostly all you see is lots and lots of antelope (usually impala). Here, the pans are big and the animals spread out a lot, so on top of being a bunch of antelope you’ve already seen before, they’re so far away that you can’t really get a decent picture of them either. Harumph.
Started dozing off after a while, then came across some ostriches that were too absorbed in their mating ritual to run away from us. Snapped some pictures, moved on. Then, there were lions. I didn’t even see them at first, they were hidden in the grass, which was lit by the fading sun. There were 7 of them, a pride that Chloe and Jan had been saying they were trying to get more information about, but seemed to be a mother and her 5 male cubs. They sat watching us, and we watched them, mesmerized. Then the first, most curious one, started coming towards us, and we all freaked out. Cameras were clicking, flashes were bursting, and pretty soon we were surrounded by lions. It was AWESOME. (Don’t worry, pictures will come eventually).
After about 20 or 25 minutes of “oohs” and “aahs,” Tim started trying to drive away, because we aren’t allowed to be out after dark (more for the animals’ safety than ours), but one stubborn cub kept staying in front of us. We had to stop, and wait for him to decide to join the rest of his pride in walking the opposite direction. Even when we finally did drive off, I was vaguely worried that they would follow us.
Phase 3:
Bottom – Added pajama pants + another pair of socks = 3 layers
Top – Added blue, long-sleeved running fleece + hat = 6 layers
The temperature drops super quickly once it gets dark, which it more or less was by the time we made it back to camp. Tim immediately started working on the fire, and we all added another layer. At this point, I was starting to feel a little bit like a Pillsbury Dough-Boy, and couldn’t quite put my arms down.
We all took our seats by the fire, which became quite comfortable within a few minutes. The fee we paid for our tour included food, and, we were pleasantly surprised to find, drinks as well. Tried “St. Louis,” a local beer that we’ve seen signs for EVERYWHERE. Tea was much more satisfying though.
Tim also started cooking dinner, which was a mystery hidden under foil in a large lasagna dish. It turned out to be sheppard’s pie, which was quite tasty and filling. Also garlic bread warmed in foil, which they have at every braai here and is one of my favorite things EVER. Mmmm, drool.
To top it all off, there was chocolate mousse, and before long we were stuffed and happy.
Phase 4:
Bottom – Another pair of pajama pants + a third pair of socks = 4 layers
Top – Long-sleeved, cotton shirt = 7 layers
As long as we stayed by the fire, we were quite cozy, but every time we wandered further than 3 feet, a startling, mind-numbing cold immediately set in. It was quite shocking.
By the time we finished eating, it was pitch black outside, and the stars emerged. It was the most incredible night sky I have ever seen in my life, and made it totally worth it to brave the cold. I wish that I could do justice to how beautiful it was, but I’m just not that poetic. Suffice it to say, we are missing out on literally THOUSANDS of stars in the States. We all stayed up as long as we could to soak it in (and avoid leaving the warm fire), but eventually it was time to sleep.
We retired to our tents, where our beds consisted of foam pads, a sheet, a comforter, and a pillow. It was also as cold as I imagine the surface of the moon would be. I tried to stay awake to read for a little while, but my hands became so painfully cold even through my gloves that I had to stop. I doubled up my comforter, so everything was warm except my feet, which have terrible circulation to begin with. As long as I didn’t move, and remained in a position reminiscent of a mummy/Dracula, I was actually quite comfortable. I also stole a fleece blanket from the car, and pulled it over my head, then eventually fell asleep.
Total number of pieces of clothing on my body = 18
Overnight low = -2.5°C
Sunday, 26 June 2011
In Review
Day 35 - 39
June 20 - 24
Now that we've settled into a weekly routine at work as well as at home, I decided that I don't have enough interesting material to make a daily post during the week. Instead, I'll summarize the funny/interesting/sad things that happened during my week, and devote the most time to that. Here goes...
Monday
Morning – report, Ward rounds w/o Tiny (not fun)
Lunch w/ Kat
Afternoon – back to chart sorting in the A&E
Tuesday
Morning – report, clinic
Afternoon – charts
Wednesday
Morning – report, rounds
Afternoon – ward work, clinic (briefly), more ward work
Thursday
Morning – report, rounds & ward work
Afternoon – ward work, charts
Friday
Morning – report, ward work, Mma Obama!
Afternoon – M&M, finished April charts!
Dinner at Embassy!
Interesting/funny/heart-breaking things that happened this week:
Interesting:
Michelle Obama came to Botswana. I was within 50 feet of her as she entered the site for the future “Baylor Adolescent Center.” Yeah, be jealous ☺ Fun fact: that lot has, up till now, been completely abandoned, full of discarded trash/junk, and overgrown with weeds. Two days ago, in preparation for her visit, they cleaned up the lot and started painting a random mural on the wall, which they were still finishing as of 7 am the day she arrived. That’s Africa (TIA – it’s a thing).
Heart-breaking:
One of our patients this week was a severely malnourished child who had Kwashiorkor, a life-threatening protein deficiency. The mom had been following a strict feeding regimen monitored by a dietician, but the child still had a critically low potassium level of 1.93, which is virtually incompatible with life. In the U.S., that child would have been started immediately on a potassium infusion and placed on continuous cardiac monitoring. Here, they don’t even carry IV potassium on the units because the nursing support isn’t there to provide the right kind of monitoring, and potassium has to be given very, VERY slowly, or it will stop your heart – they used to give IV potassium solution orally, and a nursing student misunderstood and pushed it FAST, via IV, and the patient died. So now, families have to buy multivitamins from the chemist and bring them to the hospital pharmacy for special preparation. We told the mom for two days to get the potassium, but the family took a long time, and by the time they brought it on Thursday evening, the hospital pharmacy had closed and refused to mix the preparation until the next morning. (What kind of hospital pharmacy is not open 24/7?!?) The child died that night.
Frustrating:
In order to diagnose our patients who have TB, we collect gastric aspirates, which I've written about doing before. However, what I didn't add is that said samples get sent out of the hospital for culturing. The PMH lab is able to do the first part of the test, which is a smear, but the most important thing is the culture. Seems pretty inefficient, but whatever. Well, at the beginning of last week, Dr. Joseph mumbled something to me about the lab no longer doing TB cultures, and I ignored him. Then, over the course of the week, three different nurses told me the same thing, and I had no idea what to do, so I still kept collecting the aspirates when told, and marking down the culture on the order sheet. Someone finally mentioned the issue again in front of Dr. Kung, and she unequivocally said, "No, we need the culture, it's the most important part, mark it down." When the nurses persisted in following me around telling me I was doing it wrong, she took action and called her husband, who is an infectious disease specialist, and the true story finally came out: apparently the lab contracted by the hospital to do the TB cultures had closed last weekend for renovations, and there was no other lab to do the cultures, so they were being cancelled. Thanks guys, think you could have told us sooner? Or, I don't know, arranged for a different lab to take over while you're closed? AUGH!
Funny:
Kat has joined me working in the paeds medical ward office on chart entry because all the outlets in the room she usually works in randomly stopped working. She told the doctor who’s the head of the A&E (because it’s the A&E’s office), and he told her to tell one of the nurses, because they can fix it. Honestly, some things never change – do they think that nurses just have a toolbox hidden somewhere that we can use to fix anything and everything, but we'll only bring it out to use if you pester us enough?
I drew blood on one of the kids on the ward on Thursday afternoon, and the mom roughly translated what the child was saying as “I want to eat your guts.” I suppose if someone was sticking a needle in my wrist and I was three years old, I would probably express similar sentiments myself.
One of the attendings, Dr. Brewster (AKA “Prof”) is not afraid to vent his feelings about the adequacy of the residents’ skills (or lack thereof). This morning a resident was presenting a 2 year-old patient, which he diagnosed with bronchiolitis (an inflammation of the airways in the lungs, basically, usually a viral infection in young children). As he’s said more than once before, Prof pointed out that bronchiolitis can only be made as a diagnosis in children under 2, but he let it slide on this patient. Then, the resident presented another patient, this time a 3-year-old, and again diagnosed bronchiolitis. This time, Prof lost it, and said something along the lines of, “That’s an inappropriate diagnosis, and if you persist in making it, it’s simply shameless a display of your ignorance.” Seriously, Prof, tell us how you really feel.
June 20 - 24
Now that we've settled into a weekly routine at work as well as at home, I decided that I don't have enough interesting material to make a daily post during the week. Instead, I'll summarize the funny/interesting/sad things that happened during my week, and devote the most time to that. Here goes...
Monday
Morning – report, Ward rounds w/o Tiny (not fun)
Lunch w/ Kat
Afternoon – back to chart sorting in the A&E
Tuesday
Morning – report, clinic
Afternoon – charts
Wednesday
Morning – report, rounds
Afternoon – ward work, clinic (briefly), more ward work
Thursday
Morning – report, rounds & ward work
Afternoon – ward work, charts
Friday
Morning – report, ward work, Mma Obama!
Afternoon – M&M, finished April charts!
Dinner at Embassy!
Interesting/funny/heart-breaking things that happened this week:
Interesting:
Michelle Obama came to Botswana. I was within 50 feet of her as she entered the site for the future “Baylor Adolescent Center.” Yeah, be jealous ☺ Fun fact: that lot has, up till now, been completely abandoned, full of discarded trash/junk, and overgrown with weeds. Two days ago, in preparation for her visit, they cleaned up the lot and started painting a random mural on the wall, which they were still finishing as of 7 am the day she arrived. That’s Africa (TIA – it’s a thing).
Heart-breaking:
One of our patients this week was a severely malnourished child who had Kwashiorkor, a life-threatening protein deficiency. The mom had been following a strict feeding regimen monitored by a dietician, but the child still had a critically low potassium level of 1.93, which is virtually incompatible with life. In the U.S., that child would have been started immediately on a potassium infusion and placed on continuous cardiac monitoring. Here, they don’t even carry IV potassium on the units because the nursing support isn’t there to provide the right kind of monitoring, and potassium has to be given very, VERY slowly, or it will stop your heart – they used to give IV potassium solution orally, and a nursing student misunderstood and pushed it FAST, via IV, and the patient died. So now, families have to buy multivitamins from the chemist and bring them to the hospital pharmacy for special preparation. We told the mom for two days to get the potassium, but the family took a long time, and by the time they brought it on Thursday evening, the hospital pharmacy had closed and refused to mix the preparation until the next morning. (What kind of hospital pharmacy is not open 24/7?!?) The child died that night.
Frustrating:
In order to diagnose our patients who have TB, we collect gastric aspirates, which I've written about doing before. However, what I didn't add is that said samples get sent out of the hospital for culturing. The PMH lab is able to do the first part of the test, which is a smear, but the most important thing is the culture. Seems pretty inefficient, but whatever. Well, at the beginning of last week, Dr. Joseph mumbled something to me about the lab no longer doing TB cultures, and I ignored him. Then, over the course of the week, three different nurses told me the same thing, and I had no idea what to do, so I still kept collecting the aspirates when told, and marking down the culture on the order sheet. Someone finally mentioned the issue again in front of Dr. Kung, and she unequivocally said, "No, we need the culture, it's the most important part, mark it down." When the nurses persisted in following me around telling me I was doing it wrong, she took action and called her husband, who is an infectious disease specialist, and the true story finally came out: apparently the lab contracted by the hospital to do the TB cultures had closed last weekend for renovations, and there was no other lab to do the cultures, so they were being cancelled. Thanks guys, think you could have told us sooner? Or, I don't know, arranged for a different lab to take over while you're closed? AUGH!
Funny:
Kat has joined me working in the paeds medical ward office on chart entry because all the outlets in the room she usually works in randomly stopped working. She told the doctor who’s the head of the A&E (because it’s the A&E’s office), and he told her to tell one of the nurses, because they can fix it. Honestly, some things never change – do they think that nurses just have a toolbox hidden somewhere that we can use to fix anything and everything, but we'll only bring it out to use if you pester us enough?
I drew blood on one of the kids on the ward on Thursday afternoon, and the mom roughly translated what the child was saying as “I want to eat your guts.” I suppose if someone was sticking a needle in my wrist and I was three years old, I would probably express similar sentiments myself.
One of the attendings, Dr. Brewster (AKA “Prof”) is not afraid to vent his feelings about the adequacy of the residents’ skills (or lack thereof). This morning a resident was presenting a 2 year-old patient, which he diagnosed with bronchiolitis (an inflammation of the airways in the lungs, basically, usually a viral infection in young children). As he’s said more than once before, Prof pointed out that bronchiolitis can only be made as a diagnosis in children under 2, but he let it slide on this patient. Then, the resident presented another patient, this time a 3-year-old, and again diagnosed bronchiolitis. This time, Prof lost it, and said something along the lines of, “That’s an inappropriate diagnosis, and if you persist in making it, it’s simply shameless a display of your ignorance.” Seriously, Prof, tell us how you really feel.
Thursday, 23 June 2011
Day 34 - 19 June 2011
Woke up at 5:45 to be ready for our 6:30 am game drive. At this point you’re asking yourself, “Honestly, what kind of weekend/summer vacation is this?” – trust me, we were asking ourselves the same thing. I crawled out of my warm bed/cocoon and looked outside, and the moon was still out for goodness sake. It was also SUPER FREEZING (that is a scientifically proven level of cold beyond normal freezing, truly). I pulled my jeans on over my flannel PJ bottoms, heated water for some instant coffee, and jumped back into bed.
Amazingly enough, our guide came to pick us up ON TIME for our game drive (gasp!). We pulled the comforters off our beds and dragged them into the truck with us, along with hats, gloves, and scarves. Olivia looked like a burrito (pictures to follow).
The sky was starting to get pink as we started on the drive, and we got to watch the sun rise, which was very dramatic and awesome! We were pretty psyched, in spite of the cold, because we really wanted to see rhinos, and the sunrise was beautiful. After the first 20 minutes or so, though, our chattering died down, and we were bordering on cranky when Olivia finally spotted them! FOUR RHINOS! Including a BULL RHINO! We almost died of excitement, and I think I took close to 100 pictures. I felt bad for our guide, because she was trying to tell us things, but we were only half listening. She also got very sassy with Lina when Lina asked questions – she would make a sound that I can only describe as a typical Motswana sound akin to what they describe in books as a woman “clucking” in disapproval, and say, “I was getting to that” every time Lina asked a question. Out of a sense of guilt for what terrible tourists we were, as a brief homage to our tour guide I will now share…
Things we learned about rhinos:
1. There are white rhinos and black rhinos (no, I am not a racist, that’s what they’re called) – they’re both grey, but the two kinds have a different hoof shape. Don’t ask me which one’s which, but one is a C shape and the other is a U shape.
2. White rhinos live longer (45 years vs. 40 years)
3. White rhinos are more social – the moms and babies travel in groups, while black rhinos tend to hide out… somewhere.
4. Rhinos occasionally eat dirt, because they need the salt that’s in the soil.
5. Rhinos actually do roll around in the mud – it’s their version of sunscreen.
6. All rhinos are stinky.
Once we saw the rhinos, we all settled quite contentedly back in our seats and were not particularly picky about everything else we saw. But in fairness to the other creatures of the Khama Rhino Sanctuary, I’ll give an honorary mention to: kudu, elan, wildebeest (prn. wild-beast, not wil-dee-beast, the way they pronounce it in Lion King; aka gnu), impala, yellow hornbills, wild dogs, quail, and springboks (those were my favorite – I love saying the name).
Our guide dropped us off back at our chalet, and I changed into normal clothes, because the temperature outside changes dramatically once the sun comes up. It was still a little chilly, but definitely trending warmer. Then we packed and girded ourselves for our next great adventure: getting the bus back to Serowe. Remember how I mentioned that the bus dropped us off in the middle of nowhere the day before? Yeah, well “the middle of nowhere” does not by any definition include a bus stop, and the middle of nowhere in Botswana is no different. Essentially the process of returning to Serowe had been explained to us like this: stand next to the road, and flag down the next bus you see. In other words, hitch-hiking. Awesome.
Our guide returned to take us back to the front of the reserve, and luckily we had the brilliant idea to stop in the main office to check out before giving ourselves up to the hazards of the road. The lady at the desk asked us what we had been laughing about the night before, which set us off laughing again as we explained our lack of cell signal. When we mentioned that we needed to get the bus back to Serowe, she went running out the door to try to catch “America,” who happened to be driving away in a combi. She didn’t catch him, but some of the other employees called him, and he came back within a few minutes to pick us up. Score!
He actually didn’t take us all the way to Serowe, but he dropped us off at a bus stop so that we could catch a combi. Also, the girl that he had originally been driving to the bus stop got off with us, and after a little while we (warily) started a conversation with her. She recently graduated from a university in South Africa after studying public relations, and she currently goes back and forth between Serowe and Gabs, visiting relatives. She was really nice, and there were also some totally adorable children playing behind the bus stop. They kept peeking around the walls to look at us, and eventually some of them worked up the courage to walk in front of us. We talked them into letting us take pictures of them, and then some of them went running up the street shouting in Setswana – our new friend (Mpho) translated for us: “The whites are here!” Excellent. (According to Mpho, the kids had only ever seen white people driving along the road in cars, so they probably had never seen any up close, and certainly not waiting at the bus stop).
The combi came after about 10 minutes, and after a quick pit-stop at Choppies (for breakfast) and an ATM (for me – unsuccessful again) with the help of our trusty guide, Mpho, we hopped on the bus to Gabs. We gave her our number, and she gave all of us hugs before we got on the bus. It was refreshing to have made a friend that we had initiated a conversation with, as opposed to being harassed for our numbers.
The ride to Gabs was (thankfully) not terribly crowded, and after eating we all were tired enough from our early morning to doze most of the way back. It was still only 4 hours back, but it felt like DAYS. The bus driver elected to play (very loud) Setswana gospel songs for the first half of the trip, then somewhere along the way switched to house/electronic/dance music, including some Usher and other popular American artists. I felt like I was in the middle of a club by the end of the ride.
Uneventful rest of the day – a bit of grocery shopping, cab back to UB, showers, phone calls for Father’s day, watched Pleasantville, slept.
Amazingly enough, our guide came to pick us up ON TIME for our game drive (gasp!). We pulled the comforters off our beds and dragged them into the truck with us, along with hats, gloves, and scarves. Olivia looked like a burrito (pictures to follow).
The sky was starting to get pink as we started on the drive, and we got to watch the sun rise, which was very dramatic and awesome! We were pretty psyched, in spite of the cold, because we really wanted to see rhinos, and the sunrise was beautiful. After the first 20 minutes or so, though, our chattering died down, and we were bordering on cranky when Olivia finally spotted them! FOUR RHINOS! Including a BULL RHINO! We almost died of excitement, and I think I took close to 100 pictures. I felt bad for our guide, because she was trying to tell us things, but we were only half listening. She also got very sassy with Lina when Lina asked questions – she would make a sound that I can only describe as a typical Motswana sound akin to what they describe in books as a woman “clucking” in disapproval, and say, “I was getting to that” every time Lina asked a question. Out of a sense of guilt for what terrible tourists we were, as a brief homage to our tour guide I will now share…
Things we learned about rhinos:
1. There are white rhinos and black rhinos (no, I am not a racist, that’s what they’re called) – they’re both grey, but the two kinds have a different hoof shape. Don’t ask me which one’s which, but one is a C shape and the other is a U shape.
2. White rhinos live longer (45 years vs. 40 years)
3. White rhinos are more social – the moms and babies travel in groups, while black rhinos tend to hide out… somewhere.
4. Rhinos occasionally eat dirt, because they need the salt that’s in the soil.
5. Rhinos actually do roll around in the mud – it’s their version of sunscreen.
6. All rhinos are stinky.
Once we saw the rhinos, we all settled quite contentedly back in our seats and were not particularly picky about everything else we saw. But in fairness to the other creatures of the Khama Rhino Sanctuary, I’ll give an honorary mention to: kudu, elan, wildebeest (prn. wild-beast, not wil-dee-beast, the way they pronounce it in Lion King; aka gnu), impala, yellow hornbills, wild dogs, quail, and springboks (those were my favorite – I love saying the name).
Our guide dropped us off back at our chalet, and I changed into normal clothes, because the temperature outside changes dramatically once the sun comes up. It was still a little chilly, but definitely trending warmer. Then we packed and girded ourselves for our next great adventure: getting the bus back to Serowe. Remember how I mentioned that the bus dropped us off in the middle of nowhere the day before? Yeah, well “the middle of nowhere” does not by any definition include a bus stop, and the middle of nowhere in Botswana is no different. Essentially the process of returning to Serowe had been explained to us like this: stand next to the road, and flag down the next bus you see. In other words, hitch-hiking. Awesome.
Our guide returned to take us back to the front of the reserve, and luckily we had the brilliant idea to stop in the main office to check out before giving ourselves up to the hazards of the road. The lady at the desk asked us what we had been laughing about the night before, which set us off laughing again as we explained our lack of cell signal. When we mentioned that we needed to get the bus back to Serowe, she went running out the door to try to catch “America,” who happened to be driving away in a combi. She didn’t catch him, but some of the other employees called him, and he came back within a few minutes to pick us up. Score!
He actually didn’t take us all the way to Serowe, but he dropped us off at a bus stop so that we could catch a combi. Also, the girl that he had originally been driving to the bus stop got off with us, and after a little while we (warily) started a conversation with her. She recently graduated from a university in South Africa after studying public relations, and she currently goes back and forth between Serowe and Gabs, visiting relatives. She was really nice, and there were also some totally adorable children playing behind the bus stop. They kept peeking around the walls to look at us, and eventually some of them worked up the courage to walk in front of us. We talked them into letting us take pictures of them, and then some of them went running up the street shouting in Setswana – our new friend (Mpho) translated for us: “The whites are here!” Excellent. (According to Mpho, the kids had only ever seen white people driving along the road in cars, so they probably had never seen any up close, and certainly not waiting at the bus stop).
The combi came after about 10 minutes, and after a quick pit-stop at Choppies (for breakfast) and an ATM (for me – unsuccessful again) with the help of our trusty guide, Mpho, we hopped on the bus to Gabs. We gave her our number, and she gave all of us hugs before we got on the bus. It was refreshing to have made a friend that we had initiated a conversation with, as opposed to being harassed for our numbers.
The ride to Gabs was (thankfully) not terribly crowded, and after eating we all were tired enough from our early morning to doze most of the way back. It was still only 4 hours back, but it felt like DAYS. The bus driver elected to play (very loud) Setswana gospel songs for the first half of the trip, then somewhere along the way switched to house/electronic/dance music, including some Usher and other popular American artists. I felt like I was in the middle of a club by the end of the ride.
Uneventful rest of the day – a bit of grocery shopping, cab back to UB, showers, phone calls for Father’s day, watched Pleasantville, slept.
Tuesday, 21 June 2011
Day 33 - 18 June 2011
An early morning, because the bus ride to Serowe is four hours, and we wanted to make sure we had some time to walk around when we got there. MK decided not to go because she was feeling bad and she needed to work on her med school applications. Bummer. ☹
Left at 9:15, only fifteen minutes after our planned departure time because Lina for some reason hadn’t packed yet. Walked to the west gate to catch a combi to the bus rank. Unfortunately we couldn’t remember which combi we were supposed to take, because we took a cab the last time, but Lina thought it was the Broadhurst 5 (opposite direction from last night). The first one that came had room, amazingly enough, so we hopped in and were there in about 7 minutes. We were super confused, because a) it was so much faster than the last time we went to the bus ranks, and b) we weren’t actually at the bus rank. Julia and Lina haggled with the driver a bit out of frustration, but then we just decided to walk back to the main road. Luckily the next person we asked was more articulate than our driver had been, and explained that we were just up the street from the bus rank. We walked in the indicated direction, and sure enough, we were on the far side (the bus stop is actually split by a highway, and you have to walk across a skybridge to get to the other side). That problem resolved, we quickly found the row for the bus to Serowe, and after a bathroom stop for Olivia and a phone credit buying mission for me, we were off!
Like last weekend, the bus to Serowe was a big tour bus, because it was a longer trip. The seats were fairly comfortable, and luckily the bus wasn’t full, so we ended up spreading out across two rows. We played “I’m going on a picnic” again, but it was harder with four people, and poor Olivia had started to get some indigestion before we left, so the game died out after a while and people went to sleep. Lina and I did a crossword, which proved to be virtually impossible. Then Lina fell asleep, and I worked on my blog (hand-written, because I didn’t bring my computer, oh my!). We stopped after about 2 hours for a bathroom/food stop, and all hell broke loose. Basically vendors just hang out at bus stops waiting for buses to come, then they all rush on at once and compete with one another in the meager space available in the tiny aisle of a bus to sell as much as they can in the 5 minutes that the bus is stopped. Usually this would just be purely entertaining, because I didn’t want to buy anything and they quickly lose interest in me, but unfortunately, Lina wanted a drink. Two of the male vendors were seriously SHOVING one another while they leaned over my seat to push their drinks in Lina’s face. It was incredibly overwhelming.
At the next stop, we faced a similar situation, except all three of them got off to go to the bathroom, and I stayed to watch our stuff. Most of the vendors lost interest in me, except one, who leaned over the row of seats in front of me and proceeded to stare me down for 5 minutes. I kept saying I didn’t want anything, and after a few minutes of this, she replied, “I want you to buy a drink for me.” It took a couple of repetitions before I realized what she meant, at which point I replied, very uncomfortably, that I couldn’t. An older woman who was also selling things and had lingered behind my seat (possibly touching my hair – creepy, but that’s what it felt like) said something in Setswana to her and made a swiping motion. My best guess is that she was telling the girl that foreigners only use credit cards. I was quite alright with her applying that stereotype if it meant that they would leave me alone. Yeah, I’m a horrible person. Not only that, but then the bus started moving forward before Julia, Lina and Olivia had come back, so I sprinted down the aisle to tell the driver to stop. Luckily the ticket girl knew they hadn’t come back, and as soon as she saw me she told me not to worry, they were just moving the bus to a different spot.
We finally made it to Serowe and disembarked, at which point we were immediately rushed by people offering us taxis. We knew that we needed to find the bus to Orapa to get to the Khama Rhino Sanctuary, where we were going to be staying, so we politely declined. We ate lunches that we had brought, made a bathroom stop, then set off to check out the town. We realized that we didn’t know whether or not we could drink the water there (it’s safe in Gabs), so we decided not to risk it and bought water bottles at a grocery store. Our walk about town lasted about another 10 minutes, then we concluded that there really wasn’t all that much to see and we all just kind of wanted to sit and chill, so we walked back to the bus station.
We found a bus to Maun, another city in northern Botswana, that would apparently drop us at the Sanctuary on our way there. This bus was WAAAAAAY more packed than the first one, and we had to spread out to get the available seats scattered all over the bus. I ended up in the back, next to an old woman and man. After a little while, the man started chatting with me – he was some kind of supervisor in the Ministry of Environment and something or rather, and his job was to manage forest conservation. Pretty neat actually. Deforestation isn’t a huge problem in Botswana, because a large portion of the country is desert, but in the northern part of the country near the Okavango Delta, the climate is much more tropical. Botswana doesn’t have a well-developed construction or manufacturing industry, but people will apparently chop down trees to sell across the border in Zimbabwe or Zambia. He told me that one of the Ministry’s programs involves growing saplings, and a few times a year they have a big event in which they distribute the saplings to people around the country to plant. In some ways, I think Botswana may have better ideas about taking care of the environment than we do (although there’s no recycling here, at least not anything significant, and every combi we’ve ever ridden in has reeked of exhaust fumes).
After spending a good 20 to 30 minutes packed like sardines on the bus, we stopped, and the driver called out, “Whites, get off!,” which the whole bus found wildly entertaining. Somehow I managed to squeeze out from all the way in the back, and we found ourselves standing basically in the middle of nowhere. Don’t worry, they hadn’t left us stranded, we were at the sanctuary – it just looked like the middle of nowhere. We went in and found the office where we were supposed to check in. The poor desk clerk unfortunately didn’t speak very good English, so we confused her a great deal, and she was unhappy with us because we hadn’t brought a car. First of all, no one told us we needed a car, and we can’t drive here anyway. We got charged a fee to have a driver and combi at the sanctuary drive us to our chalet and back for dinner, but it wasn’t expensive, so we signed on the dotted line and went our merry way. Our driver was very chatty, and he said that he had lived in Miami and worked at Disneyworld (two facts which confused me a bit) – we found out later that the other employees apparently call him “America.”
We were pleasantly surprised when we got to our chalet – when we had made the reservation, we had chosen the cheaper chalet option, one that was unelectrified and had no bathroom. However, we were charged a cheaper rate than the one that had been quoted on the phone AND our chalet had electricity, a working toilet, an electric kettle, and FOUR beds. We were thrilled. After setting our stuff down, we took a walk outside, because it wasn’t quite dark yet. We saw some really neat, electric blue birds, and wasted a great deal of time stalking them trying to get pictures, which was a ridiculous endeavor in the first place because none of us had a camera nice enough to take decent pictures of them except Lina. We eventually gave up and dragged our table and chairs outside to sit in the dusk and do crosswords together until dinner. We got excited again about trying to take pictures of a Zazu bird (actually called a yellow hornbill, but the Lion King names are so much funner) in a tree really close to us, then felt supremely stupid when it came up to us 20 minutes later while we were sitting and doing puzzles.
We had asked the driver to come back and get us at 6 for dinner. The sun went down, and the temperature started dropping, so we went back inside to wait. And wait and wait and wait. It was pitch black outside, but by 6:30 there was no sign of our driver. He had given us a number to call, because he said that he wouldn’t be the one to pick us up, but someone would come for us. As we pulled out our phones to check on our transportation status, we realized that none of us had cell phone signal. Great. The only food we had left was a bunch of oranges, apples, and fruit rolls from lunch, and some crackers that we had bought to help settle Olivia’s stomach. It was also incredibly cold. Like we all put on all the clothes we had and we were still freezing, kind of cold.
After a while, I decided to go outside to try to find some cell signal. I wandered around waving my phone in the air like a crazy person, then shouted much louder than was necessary when I finally got a bar of reception. I could only get it if I held the phone up over my head, though, so Lina came out to call with me, and I dialed the number on speaker phone. When the receptionist answered, she proceeded to jump up and down, shouting into the phone. This proved to be so hilarious to both of us that it took several minutes for the poor woman on the other end to understand what we were calling about, and she certainly had no idea what we were laughing about, though by the end of the call I think she had decided that we were so insane that she started laughing too. Maybe you had to be there. I could hardly breathe I was laughing so hard.
20 minutes later, the driver finally pulled up, and he and his passenger thought we were insane too, because we opened the door and started jumping up and down and clapping like 5-year-olds when we saw them. They drove us to dinner, and we chatted with the other passenger, who was an Australian named Robin who was employed by the Sanctuary for brush/fire control. He was friendly, though he clearly thought that we were ridiculous for acting like we were stranded when they didn’t show up at the appropriate time. Yeah, we did a lot to improve the American image on this trip.
We had dinner at the lodge, which was slightly warmer, but not much. We realized that the reason that our chalet and the lodge were so cold was because even though they have roofs, there’s a gap between the roof and walls that let’s ALLLLL the cold air in (you’ll have to look at the pictures to understand). We had yummy dinners, and about 20 million cups of hot tea each. We were feeling fairly toasty by the time we left, though the quote of the trip was Olivia’s “Is that an ice cube?” as we were looking at a potted plant next to the door. Someone had apparently poured out their drink, but it was so cold that the ice cube hadn’t melted. Great.
Our original driver, “America,” was at the lodge when we showed up for dinner, and he had apparently mentioned us to another group of ladies staying at the Sanctuary who worked for the UN in Gabs. They were having a fire and had invited us to join them, so we decided to be friendly and check it out. One of them was named Princess, and they were very friendly, though much older, Batswana who were very interested in us. We chatted for a while, and Robin came also, so he told us a little bit about the southern hemisphere’s constellations and a weird fruit on the tree next to us. It was called monkey oranges, and the Setswana word for it was mohorohowatsi (that’s an entirely phonetic spelling by the way, please don’t take my word for it that that’s right). The entire concept of the Southern Cross was extremely difficult for us to grasp, and took about 15 minutes and three people explaining it for us to grasp. Again, doing a lot of good things for our image.
After 20 or 30 minutes, we decided to leave, and unfortunately we think we kind of offended the ladies because we didn’t want to give them our phone numbers. They were very nice, and said they wanted to invite us to a braai at their house in Gabs, but we’re going to be traveling every weekend between now and when we leave. We also have just become really wary of giving our numbers to people. Oh well, we tried to be social.
We got back to chalet and grudgingly changed into our (freezing cold) pajamas, then put back on all the other clothes we’d had on before, and immediately crawled into bed. Each bed had two pretty thick comforters on it, and despite my anxiety about a spider we had seen earlier (which I tried unsuccessfully to kill -- twice), fell right to sleep.
Left at 9:15, only fifteen minutes after our planned departure time because Lina for some reason hadn’t packed yet. Walked to the west gate to catch a combi to the bus rank. Unfortunately we couldn’t remember which combi we were supposed to take, because we took a cab the last time, but Lina thought it was the Broadhurst 5 (opposite direction from last night). The first one that came had room, amazingly enough, so we hopped in and were there in about 7 minutes. We were super confused, because a) it was so much faster than the last time we went to the bus ranks, and b) we weren’t actually at the bus rank. Julia and Lina haggled with the driver a bit out of frustration, but then we just decided to walk back to the main road. Luckily the next person we asked was more articulate than our driver had been, and explained that we were just up the street from the bus rank. We walked in the indicated direction, and sure enough, we were on the far side (the bus stop is actually split by a highway, and you have to walk across a skybridge to get to the other side). That problem resolved, we quickly found the row for the bus to Serowe, and after a bathroom stop for Olivia and a phone credit buying mission for me, we were off!
Like last weekend, the bus to Serowe was a big tour bus, because it was a longer trip. The seats were fairly comfortable, and luckily the bus wasn’t full, so we ended up spreading out across two rows. We played “I’m going on a picnic” again, but it was harder with four people, and poor Olivia had started to get some indigestion before we left, so the game died out after a while and people went to sleep. Lina and I did a crossword, which proved to be virtually impossible. Then Lina fell asleep, and I worked on my blog (hand-written, because I didn’t bring my computer, oh my!). We stopped after about 2 hours for a bathroom/food stop, and all hell broke loose. Basically vendors just hang out at bus stops waiting for buses to come, then they all rush on at once and compete with one another in the meager space available in the tiny aisle of a bus to sell as much as they can in the 5 minutes that the bus is stopped. Usually this would just be purely entertaining, because I didn’t want to buy anything and they quickly lose interest in me, but unfortunately, Lina wanted a drink. Two of the male vendors were seriously SHOVING one another while they leaned over my seat to push their drinks in Lina’s face. It was incredibly overwhelming.
At the next stop, we faced a similar situation, except all three of them got off to go to the bathroom, and I stayed to watch our stuff. Most of the vendors lost interest in me, except one, who leaned over the row of seats in front of me and proceeded to stare me down for 5 minutes. I kept saying I didn’t want anything, and after a few minutes of this, she replied, “I want you to buy a drink for me.” It took a couple of repetitions before I realized what she meant, at which point I replied, very uncomfortably, that I couldn’t. An older woman who was also selling things and had lingered behind my seat (possibly touching my hair – creepy, but that’s what it felt like) said something in Setswana to her and made a swiping motion. My best guess is that she was telling the girl that foreigners only use credit cards. I was quite alright with her applying that stereotype if it meant that they would leave me alone. Yeah, I’m a horrible person. Not only that, but then the bus started moving forward before Julia, Lina and Olivia had come back, so I sprinted down the aisle to tell the driver to stop. Luckily the ticket girl knew they hadn’t come back, and as soon as she saw me she told me not to worry, they were just moving the bus to a different spot.
We finally made it to Serowe and disembarked, at which point we were immediately rushed by people offering us taxis. We knew that we needed to find the bus to Orapa to get to the Khama Rhino Sanctuary, where we were going to be staying, so we politely declined. We ate lunches that we had brought, made a bathroom stop, then set off to check out the town. We realized that we didn’t know whether or not we could drink the water there (it’s safe in Gabs), so we decided not to risk it and bought water bottles at a grocery store. Our walk about town lasted about another 10 minutes, then we concluded that there really wasn’t all that much to see and we all just kind of wanted to sit and chill, so we walked back to the bus station.
We found a bus to Maun, another city in northern Botswana, that would apparently drop us at the Sanctuary on our way there. This bus was WAAAAAAY more packed than the first one, and we had to spread out to get the available seats scattered all over the bus. I ended up in the back, next to an old woman and man. After a little while, the man started chatting with me – he was some kind of supervisor in the Ministry of Environment and something or rather, and his job was to manage forest conservation. Pretty neat actually. Deforestation isn’t a huge problem in Botswana, because a large portion of the country is desert, but in the northern part of the country near the Okavango Delta, the climate is much more tropical. Botswana doesn’t have a well-developed construction or manufacturing industry, but people will apparently chop down trees to sell across the border in Zimbabwe or Zambia. He told me that one of the Ministry’s programs involves growing saplings, and a few times a year they have a big event in which they distribute the saplings to people around the country to plant. In some ways, I think Botswana may have better ideas about taking care of the environment than we do (although there’s no recycling here, at least not anything significant, and every combi we’ve ever ridden in has reeked of exhaust fumes).
After spending a good 20 to 30 minutes packed like sardines on the bus, we stopped, and the driver called out, “Whites, get off!,” which the whole bus found wildly entertaining. Somehow I managed to squeeze out from all the way in the back, and we found ourselves standing basically in the middle of nowhere. Don’t worry, they hadn’t left us stranded, we were at the sanctuary – it just looked like the middle of nowhere. We went in and found the office where we were supposed to check in. The poor desk clerk unfortunately didn’t speak very good English, so we confused her a great deal, and she was unhappy with us because we hadn’t brought a car. First of all, no one told us we needed a car, and we can’t drive here anyway. We got charged a fee to have a driver and combi at the sanctuary drive us to our chalet and back for dinner, but it wasn’t expensive, so we signed on the dotted line and went our merry way. Our driver was very chatty, and he said that he had lived in Miami and worked at Disneyworld (two facts which confused me a bit) – we found out later that the other employees apparently call him “America.”
We were pleasantly surprised when we got to our chalet – when we had made the reservation, we had chosen the cheaper chalet option, one that was unelectrified and had no bathroom. However, we were charged a cheaper rate than the one that had been quoted on the phone AND our chalet had electricity, a working toilet, an electric kettle, and FOUR beds. We were thrilled. After setting our stuff down, we took a walk outside, because it wasn’t quite dark yet. We saw some really neat, electric blue birds, and wasted a great deal of time stalking them trying to get pictures, which was a ridiculous endeavor in the first place because none of us had a camera nice enough to take decent pictures of them except Lina. We eventually gave up and dragged our table and chairs outside to sit in the dusk and do crosswords together until dinner. We got excited again about trying to take pictures of a Zazu bird (actually called a yellow hornbill, but the Lion King names are so much funner) in a tree really close to us, then felt supremely stupid when it came up to us 20 minutes later while we were sitting and doing puzzles.
We had asked the driver to come back and get us at 6 for dinner. The sun went down, and the temperature started dropping, so we went back inside to wait. And wait and wait and wait. It was pitch black outside, but by 6:30 there was no sign of our driver. He had given us a number to call, because he said that he wouldn’t be the one to pick us up, but someone would come for us. As we pulled out our phones to check on our transportation status, we realized that none of us had cell phone signal. Great. The only food we had left was a bunch of oranges, apples, and fruit rolls from lunch, and some crackers that we had bought to help settle Olivia’s stomach. It was also incredibly cold. Like we all put on all the clothes we had and we were still freezing, kind of cold.
After a while, I decided to go outside to try to find some cell signal. I wandered around waving my phone in the air like a crazy person, then shouted much louder than was necessary when I finally got a bar of reception. I could only get it if I held the phone up over my head, though, so Lina came out to call with me, and I dialed the number on speaker phone. When the receptionist answered, she proceeded to jump up and down, shouting into the phone. This proved to be so hilarious to both of us that it took several minutes for the poor woman on the other end to understand what we were calling about, and she certainly had no idea what we were laughing about, though by the end of the call I think she had decided that we were so insane that she started laughing too. Maybe you had to be there. I could hardly breathe I was laughing so hard.
20 minutes later, the driver finally pulled up, and he and his passenger thought we were insane too, because we opened the door and started jumping up and down and clapping like 5-year-olds when we saw them. They drove us to dinner, and we chatted with the other passenger, who was an Australian named Robin who was employed by the Sanctuary for brush/fire control. He was friendly, though he clearly thought that we were ridiculous for acting like we were stranded when they didn’t show up at the appropriate time. Yeah, we did a lot to improve the American image on this trip.
We had dinner at the lodge, which was slightly warmer, but not much. We realized that the reason that our chalet and the lodge were so cold was because even though they have roofs, there’s a gap between the roof and walls that let’s ALLLLL the cold air in (you’ll have to look at the pictures to understand). We had yummy dinners, and about 20 million cups of hot tea each. We were feeling fairly toasty by the time we left, though the quote of the trip was Olivia’s “Is that an ice cube?” as we were looking at a potted plant next to the door. Someone had apparently poured out their drink, but it was so cold that the ice cube hadn’t melted. Great.
Our original driver, “America,” was at the lodge when we showed up for dinner, and he had apparently mentioned us to another group of ladies staying at the Sanctuary who worked for the UN in Gabs. They were having a fire and had invited us to join them, so we decided to be friendly and check it out. One of them was named Princess, and they were very friendly, though much older, Batswana who were very interested in us. We chatted for a while, and Robin came also, so he told us a little bit about the southern hemisphere’s constellations and a weird fruit on the tree next to us. It was called monkey oranges, and the Setswana word for it was mohorohowatsi (that’s an entirely phonetic spelling by the way, please don’t take my word for it that that’s right). The entire concept of the Southern Cross was extremely difficult for us to grasp, and took about 15 minutes and three people explaining it for us to grasp. Again, doing a lot of good things for our image.
After 20 or 30 minutes, we decided to leave, and unfortunately we think we kind of offended the ladies because we didn’t want to give them our phone numbers. They were very nice, and said they wanted to invite us to a braai at their house in Gabs, but we’re going to be traveling every weekend between now and when we leave. We also have just become really wary of giving our numbers to people. Oh well, we tried to be social.
We got back to chalet and grudgingly changed into our (freezing cold) pajamas, then put back on all the other clothes we’d had on before, and immediately crawled into bed. Each bed had two pretty thick comforters on it, and despite my anxiety about a spider we had seen earlier (which I tried unsuccessfully to kill -- twice), fell right to sleep.
Day 32 - 17 June 2011
Off to the A&E to sort records. I was a little bummed to miss rounds this morning, especially since we actually had two new admissions – it was Team B’s admitting day, but if a patient comes in who’s been admitted to a different team before, they’re readmitted to the same team. Quasi-continuity of care.
I forgot to take pictures of the A&E records when I first started, but as I think I’ve mentioned before, they’re a disaster. I volunteered to reorganize them so I wouldn’t have a coronary every time I walk in there, especially since I’m missing a third of April. Supposedly all the charts from a given month and year are in one box, but as soon as you start digging through them you realize that they’re all mixed. They’re also extremely dusty, and half of them are torn, folded, crumpled, curled, moldy, and/or have unidentified stains on them. For whatever reason I chose to wear a white blouse and white jacket this morning, knowing that I was going to be working with the charts. Needless to say, this was revealed very early on to be a bad decision.
The area that I was working in was an open reception-type desk, which is usually empty, next to the A&E waiting room and triage room. Unfortunately, the first thing the patients think when they see me standing there sorting papers is that I’m either a doctor or receptionist – either way, every 5 minutes people kept coming up to me and asking for help. I could only lamely reply, “I don’t work here,” and explain in a mixture of Setswana and English to go talk to the nurse. The nurses, meanwhile, looked at me like I was a crazy person. Especially since one of the areas where the files are stored is the triage room, so I would skulk outside the door when they were with patients, then shoot in to grab as many boxes as I could before they brought another patient in. I was pretty pleased with my progress by lunchtime, because I had already found one of the missing April days!
I broke for lunch with Dr. Kung, Tiny, and Dr. Joseph (our new medical officer from the DRC), because Dr. Kung was treating all of us since it was Tiny’s last day in paeds. Apparently she’s actually only a first-year resident (a fact which shot her even higher in my esteem when I found out), and she’s taking vacation next week before moving to radiology. We went to Fresh Café, another very expat-heavy locale, but with delicious food. I got a salad (the first in a while – Botswana is not a very agriculturally inclined country) with chickpeas, chicken, and feta, and freshly squeezed mango juice. YUM. Lunch was nice, although Dr. Kung spent a lot of it in conversation with Tiny, which left me to make some very awkward conversation with Dr. Joseph. Like Chengi, he concluded that I’m a godless heathen, and was appalled to hear that (to my knowledge, anyway) I’m not baptized. Oh well, can’t please everyone.
Back to work on the files after lunch – it went by quickly, and before I knew it it was already dark. I headed home, and Lina and I had a combi adventure to get to Riverwalk to join Olivia and Julia for dinner (they had gone ahead to get groceries). Our directions went a little like this: “Take the Broadhurst 5 to the T-junction. Then take any combi until you see Riverwalk.” Great, except what’s a T-junction? And which way is it?
Two combis and 6 pula later, we made it to Riverwalk, and had a DELICIOUS Ethiopian meal with real cappuccinos. We ate til we were stuffed full of the best quality meat we’ve had since we’ve been in Botswana (I would have taken a picture but I left my camera at home), then had coffee cake for dessert. We felt disgustingly full but happy afterwards, and we managed a 20 pula cab ride back to UB. Score!
Packing for Serowe and sleep.
I forgot to take pictures of the A&E records when I first started, but as I think I’ve mentioned before, they’re a disaster. I volunteered to reorganize them so I wouldn’t have a coronary every time I walk in there, especially since I’m missing a third of April. Supposedly all the charts from a given month and year are in one box, but as soon as you start digging through them you realize that they’re all mixed. They’re also extremely dusty, and half of them are torn, folded, crumpled, curled, moldy, and/or have unidentified stains on them. For whatever reason I chose to wear a white blouse and white jacket this morning, knowing that I was going to be working with the charts. Needless to say, this was revealed very early on to be a bad decision.
The area that I was working in was an open reception-type desk, which is usually empty, next to the A&E waiting room and triage room. Unfortunately, the first thing the patients think when they see me standing there sorting papers is that I’m either a doctor or receptionist – either way, every 5 minutes people kept coming up to me and asking for help. I could only lamely reply, “I don’t work here,” and explain in a mixture of Setswana and English to go talk to the nurse. The nurses, meanwhile, looked at me like I was a crazy person. Especially since one of the areas where the files are stored is the triage room, so I would skulk outside the door when they were with patients, then shoot in to grab as many boxes as I could before they brought another patient in. I was pretty pleased with my progress by lunchtime, because I had already found one of the missing April days!
I broke for lunch with Dr. Kung, Tiny, and Dr. Joseph (our new medical officer from the DRC), because Dr. Kung was treating all of us since it was Tiny’s last day in paeds. Apparently she’s actually only a first-year resident (a fact which shot her even higher in my esteem when I found out), and she’s taking vacation next week before moving to radiology. We went to Fresh Café, another very expat-heavy locale, but with delicious food. I got a salad (the first in a while – Botswana is not a very agriculturally inclined country) with chickpeas, chicken, and feta, and freshly squeezed mango juice. YUM. Lunch was nice, although Dr. Kung spent a lot of it in conversation with Tiny, which left me to make some very awkward conversation with Dr. Joseph. Like Chengi, he concluded that I’m a godless heathen, and was appalled to hear that (to my knowledge, anyway) I’m not baptized. Oh well, can’t please everyone.
Back to work on the files after lunch – it went by quickly, and before I knew it it was already dark. I headed home, and Lina and I had a combi adventure to get to Riverwalk to join Olivia and Julia for dinner (they had gone ahead to get groceries). Our directions went a little like this: “Take the Broadhurst 5 to the T-junction. Then take any combi until you see Riverwalk.” Great, except what’s a T-junction? And which way is it?
Two combis and 6 pula later, we made it to Riverwalk, and had a DELICIOUS Ethiopian meal with real cappuccinos. We ate til we were stuffed full of the best quality meat we’ve had since we’ve been in Botswana (I would have taken a picture but I left my camera at home), then had coffee cake for dessert. We felt disgustingly full but happy afterwards, and we managed a 20 pula cab ride back to UB. Score!
Packing for Serowe and sleep.
Monday, 20 June 2011
Last Week in a Nutshell
Days 28 - 32
Cliff Notes version:
Monday – long report from the weekend; finished data entry on the May charts; got the April charts from the A&E to start
Tuesday – clinic in the morning, charts in the afternoon. Fairly routine day.
Wednesday
I anticipated that today would be a long day, because it was our admitting day. It was pretty uneventful for most of the day – I went to clinic for the first few hours with Dr. Kung, and saw some REALLY cute twins, although it was kind of creepy too because they dressed exactly the same – but right after Dr. Kung came back from clinic, around 4:45, she came out of the office saying that there was a really sick new admission. I was in the middle of entering charts, but I really wanted to see the patient, so I jumped up and followed her.
It was an almost textbook case of congestive heart failure, which, oddly enough, does happen in kids, though it’s relatively rare. The baby lived with an aunt, and the mom only visited on weekends, but she could tell that something was wrong with the child over the weekend – a cough and puffy extremities, which progressively worsened over the beginning of the week to shortness of breath and rapid breathing. The baby had initially gone to SLH, a regional hospital near their home, but they had referred to us when they saw how sick the child was.
Things were complicated a bit because a sibling at home was currently three months in on anti-tuberculosis therapy, which fit the time frame for the baby to have contracted it and be showing symptoms. Unfortunately, our X-ray was still out of commission, but we had a film from SLH, and lung sounds pretty clearly pointed to fluid build-up in the lungs. Combined with the edema, the child’s respiratory distress, and weak distal pulses, everything pointed to heart failure.
Luckily, the head of the pediatric department, Dr. Mazhani, is also a cardiologist, and he hadn’t left for the day yet. We called him in to consult, and he performed an echocardiogram on the spot, after some rearranging of the beds to find an outlet that worked in a spot that also had an oxygen hook-up. The best ejection fraction he could measure for the child’s heart was 33% ☹
After the echo, I placed a TB skin test, in case the child could be stabilized and also needed TB treatment, then Dr. Kung started an IV. I secured it and bootlegged an arm board (made of tongue depressors, tape, and cotton swabs for padding) to tie to the baby’s arm to keep it straight. The mom didn’t speak much English, but a combination of pantomiming and two-word phrases seemed to communicate pretty effectively that I wanted her to keep the baby from pulling the IV out. She was very scared, so I tried to reassure her, but the situation was pretty bleak. The baby needed to be in an ICU and get a dopamine drip to maintain systemic blood pressure, because as the heart tired it would bottom out the child’s BP. PMH doesn’t have a pediatric ICU, and Dr. Kung explained that the ICU is run by anesthesiologists “who don’t like kids,” and they didn’t have any beds anyway. The nursing support in the paeds ward is too inconsistent for them to continuously monitor the baby if we were to start a drip ourselves, so we had to make do with diuretics and oxygen. Tiny and Dr. Kung also called a cardiologist they knew to see whether they could transfer the baby to a private hospital with an ICU. He was “still eating his supper” (it was well past 6:30 by this time), and not in a hurry to come in, so Dr. Kung gave me a ride home.
Thursday
Came in early to do a gastric aspirate on the sick baby from last night, but miraculously, Tiny had arranged the transfer overnight and taken the child to Bokomoso, a district hospital about an hour away. We got updates throughout the day that the baby was improving on dopamine, though not out of the woods yet. Yay!
MK and Lina presented their designs during morning report; Finished April chart entry!
Cliff Notes version:
Monday – long report from the weekend; finished data entry on the May charts; got the April charts from the A&E to start
Tuesday – clinic in the morning, charts in the afternoon. Fairly routine day.
Wednesday
I anticipated that today would be a long day, because it was our admitting day. It was pretty uneventful for most of the day – I went to clinic for the first few hours with Dr. Kung, and saw some REALLY cute twins, although it was kind of creepy too because they dressed exactly the same – but right after Dr. Kung came back from clinic, around 4:45, she came out of the office saying that there was a really sick new admission. I was in the middle of entering charts, but I really wanted to see the patient, so I jumped up and followed her.
It was an almost textbook case of congestive heart failure, which, oddly enough, does happen in kids, though it’s relatively rare. The baby lived with an aunt, and the mom only visited on weekends, but she could tell that something was wrong with the child over the weekend – a cough and puffy extremities, which progressively worsened over the beginning of the week to shortness of breath and rapid breathing. The baby had initially gone to SLH, a regional hospital near their home, but they had referred to us when they saw how sick the child was.
Things were complicated a bit because a sibling at home was currently three months in on anti-tuberculosis therapy, which fit the time frame for the baby to have contracted it and be showing symptoms. Unfortunately, our X-ray was still out of commission, but we had a film from SLH, and lung sounds pretty clearly pointed to fluid build-up in the lungs. Combined with the edema, the child’s respiratory distress, and weak distal pulses, everything pointed to heart failure.
Luckily, the head of the pediatric department, Dr. Mazhani, is also a cardiologist, and he hadn’t left for the day yet. We called him in to consult, and he performed an echocardiogram on the spot, after some rearranging of the beds to find an outlet that worked in a spot that also had an oxygen hook-up. The best ejection fraction he could measure for the child’s heart was 33% ☹
After the echo, I placed a TB skin test, in case the child could be stabilized and also needed TB treatment, then Dr. Kung started an IV. I secured it and bootlegged an arm board (made of tongue depressors, tape, and cotton swabs for padding) to tie to the baby’s arm to keep it straight. The mom didn’t speak much English, but a combination of pantomiming and two-word phrases seemed to communicate pretty effectively that I wanted her to keep the baby from pulling the IV out. She was very scared, so I tried to reassure her, but the situation was pretty bleak. The baby needed to be in an ICU and get a dopamine drip to maintain systemic blood pressure, because as the heart tired it would bottom out the child’s BP. PMH doesn’t have a pediatric ICU, and Dr. Kung explained that the ICU is run by anesthesiologists “who don’t like kids,” and they didn’t have any beds anyway. The nursing support in the paeds ward is too inconsistent for them to continuously monitor the baby if we were to start a drip ourselves, so we had to make do with diuretics and oxygen. Tiny and Dr. Kung also called a cardiologist they knew to see whether they could transfer the baby to a private hospital with an ICU. He was “still eating his supper” (it was well past 6:30 by this time), and not in a hurry to come in, so Dr. Kung gave me a ride home.
Thursday
Came in early to do a gastric aspirate on the sick baby from last night, but miraculously, Tiny had arranged the transfer overnight and taken the child to Bokomoso, a district hospital about an hour away. We got updates throughout the day that the baby was improving on dopamine, though not out of the woods yet. Yay!
MK and Lina presented their designs during morning report; Finished April chart entry!
Sunday, 19 June 2011
Day 27 - 12 June 2011
HAPPY BIRTHDAY MOM!
Slept in, SO glorious, except that I woke up at 9:30 – work is ruining my college student’s talent for sleeping half the day.
Brunch at Newscafe with Lina, Julia, Becca, Sarah, Kat and Jose was nice, though in addition to my bank card currently not working, my credit card decided to peace out too. Great. Luckily I had cash.
Lazed the rest of the day – the power went out briefly while we were gone, so poor MK lost part of the med school application she was working on. Botswana imports something like 80% of its electricity from South Africa, so there are scheduled outages in most parts of the city, though we were told that UB is generally exempt from them. This was the first time the power had gone out for us, and it was back on by the time we got back, so no complaints here.
Slept in, SO glorious, except that I woke up at 9:30 – work is ruining my college student’s talent for sleeping half the day.
Brunch at Newscafe with Lina, Julia, Becca, Sarah, Kat and Jose was nice, though in addition to my bank card currently not working, my credit card decided to peace out too. Great. Luckily I had cash.
Lazed the rest of the day – the power went out briefly while we were gone, so poor MK lost part of the med school application she was working on. Botswana imports something like 80% of its electricity from South Africa, so there are scheduled outages in most parts of the city, though we were told that UB is generally exempt from them. This was the first time the power had gone out for us, and it was back on by the time we got back, so no complaints here.
Day 26 - 11 June 2011
Before I begin this post, let me apologize, my dear readers, for the long lapse in communication. The work days seem to be getting longer and longer, and the weekends and evenings shorter and shorter. I was also feeling a bit under the weather this past week, so I decided to be lazy. I will fill you in in due time, I promise!
We got up super early, because Boitumelo wanted us to be ready to go at 8, which meant that we didn’t actually leave till 8:45. There was a bit of a conundrum about our clothes, because I wanted to wear my dress, which was fairly conservative, plus I wore leggings underneath it, but Boitumelo said that it had to be below the knee, which it wasn’t. I really didn’t want to wear my work clothes yet again, but they’re the only nice clothes I have other than the dress and two skirts. Harumph.
Poor Olivia was up half the night throwing up – food poisoning or the flu, we weren’t sure – so we plied her with medicine, DVDs and magazines, and promised to take lots of pictures for her.
We took a combi to the bust station, because pretty much our whole group was going (minus Olivia ☹). None of us really knew what we were going to be doing, just that there had been vague promises of “dinner at Boitumelo’s house” and “a wedding.” We were excited though, and enthusiastically piled onto the bus to Ramotswa (roll the R’s, it’s really fun to say). Jose had overslept and said he would meet us at the bus stop, and he made a dramatic entrance by running after the bus and jumping on it as we were pulling out. We all cheered, like the obnoxious Americans we are.
The buses can be combis for shorter trips (like a minivan), but since Ramotswa is about an hour outside the city, we took a big tour group type bus. It’s very comfortable, though some of the seats have questionable smells (like any other public transportation…), and people walk up and down the aisles selling candy, water, and trail mix. One guy was selling plastic folders, which was a bit bizarre. Julia, MK, and I played “I Spy” and “I’m going on a picnic and I’m brining…,” and we got up to an impressive list of about 50 items (for those of you who don’t know this game, you’re missing out). Yes, we are easily entertained.
We got off the bus in Otse, which is where Boitumelo’s family lives. We went to a pottery places, which wasn’t as interesting as Gabane, but it was in a nursery which was pretty (see pictures, when I get around to posting them). They also had orange trees with the biggest oranges I’ve ever seen. They were delicious, and free(ish).
Next, we piled into Boitumelo’s parents’ car (an older model Mercedes!), and truck. We went to her house, which they just build a few years ago and was super nice. I would have taken pictures, but I thought that would be kind of weird/rude. Her parents own some kind of cattle company, which is one of Botswana’s main exports and therefore means that her family makes a fair amount of money. They also grow peanuts and things – we had some freshly picked peanuts, which taste kind of like uncooked green beans. Then we had boiled peanuts, which are super yummy (I don’t know why I’ve never liked them at home). Boitumelo also picked us prickly pears off a cactus in her front yard, and cut them up for us. They apparently have pretty wicked thorns, and their juice stained all of our fingers, but they have a really interesting tart flavor.
Next we piled back into the various vehicles – I joined the contingent riding in the bed of the truck, which was way more fun than cramming in the backseat of the car. We went to vulturary outside of town, and Boitumelo’s dad passed around handouts from the reserve nearby, about vultures. They live in these very dramatic cliffs above the town, but they’re usually only out in the morning, so we didn’t see many. People also were starting to get hungry and tired, so we looked around for about 10 minutes, then headed back to the cars.
We stopped at the village kgotla (prn. ho-t-la), a traditional meeting place, on the way back. We took pictures, but the group energy was definitely ebbing. We were relieved when they apparently decided that they had showed the tourists enough of the sights, and took us back to Boitumelo’s for tea, coffee, and tea sandwiches with cheese and tomato. It was very sweet, her family had like 12 mugs set out and boiled water for all of us. Our tea time was fairly uneventful otherwise, though at one point I did somehow manage to lock myself in the bathroom. Awesome.
We sat around chatting (a few people dozing – and yes, I still have the pictures, mwha) for a few hours, until Boitumelo and her family were ready to go to the wedding. Weddings here are full-day affairs lasting several days. It was already 3, so we had missed a lot of the ceremonial parts, but we went to the reception. They showed us around, and basically the entire village was there, so they were cooking massive amounts of food. Boitumelo explained that weddings are considered to be open to everyone, so a lot of the expense for the wedding is related to making sure that you have enough food for everyone.
They seated us in the middle of the dining tent, so that everyone could stare at us, basically. They gave us gingerbeer first (not actually alcoholic), which is a traditional drink at weddings. Next, they brought us huge bowls of meat, coleslaw, beet salad, and papa (a cornmeal dish). We tried everything, but unfortunately a lot of the meat here is very fatty, so we mostly ate papa and boiled peanuts that Boitumelo’s mom sent with us. The wedding party made a few turns through the tent, changing outfits in between. Boitumelo explained that a blue cloth is considered traditional Batswana attire, and it’s how other Africans identify a Motswana, because each country has a different color/pattern. In South Africa, for example, red cloth is the tradition. Once I figure out how to post videos, I’ll share the recording I made of the wedding party singing as they walked through the tent. It was super neat, and Boitumelo said that they came into the tent just so we could see them, which was really nice. We congratulated the bride, then took our combi back to Gabs, because it was getting dark. It was a little disconcerting when the combi had to be pushed for the first few hundred feet by a couple of guys before it started, but after that we were good to go.
We got up super early, because Boitumelo wanted us to be ready to go at 8, which meant that we didn’t actually leave till 8:45. There was a bit of a conundrum about our clothes, because I wanted to wear my dress, which was fairly conservative, plus I wore leggings underneath it, but Boitumelo said that it had to be below the knee, which it wasn’t. I really didn’t want to wear my work clothes yet again, but they’re the only nice clothes I have other than the dress and two skirts. Harumph.
Poor Olivia was up half the night throwing up – food poisoning or the flu, we weren’t sure – so we plied her with medicine, DVDs and magazines, and promised to take lots of pictures for her.
We took a combi to the bust station, because pretty much our whole group was going (minus Olivia ☹). None of us really knew what we were going to be doing, just that there had been vague promises of “dinner at Boitumelo’s house” and “a wedding.” We were excited though, and enthusiastically piled onto the bus to Ramotswa (roll the R’s, it’s really fun to say). Jose had overslept and said he would meet us at the bus stop, and he made a dramatic entrance by running after the bus and jumping on it as we were pulling out. We all cheered, like the obnoxious Americans we are.
The buses can be combis for shorter trips (like a minivan), but since Ramotswa is about an hour outside the city, we took a big tour group type bus. It’s very comfortable, though some of the seats have questionable smells (like any other public transportation…), and people walk up and down the aisles selling candy, water, and trail mix. One guy was selling plastic folders, which was a bit bizarre. Julia, MK, and I played “I Spy” and “I’m going on a picnic and I’m brining…,” and we got up to an impressive list of about 50 items (for those of you who don’t know this game, you’re missing out). Yes, we are easily entertained.
We got off the bus in Otse, which is where Boitumelo’s family lives. We went to a pottery places, which wasn’t as interesting as Gabane, but it was in a nursery which was pretty (see pictures, when I get around to posting them). They also had orange trees with the biggest oranges I’ve ever seen. They were delicious, and free(ish).
Next, we piled into Boitumelo’s parents’ car (an older model Mercedes!), and truck. We went to her house, which they just build a few years ago and was super nice. I would have taken pictures, but I thought that would be kind of weird/rude. Her parents own some kind of cattle company, which is one of Botswana’s main exports and therefore means that her family makes a fair amount of money. They also grow peanuts and things – we had some freshly picked peanuts, which taste kind of like uncooked green beans. Then we had boiled peanuts, which are super yummy (I don’t know why I’ve never liked them at home). Boitumelo also picked us prickly pears off a cactus in her front yard, and cut them up for us. They apparently have pretty wicked thorns, and their juice stained all of our fingers, but they have a really interesting tart flavor.
Next we piled back into the various vehicles – I joined the contingent riding in the bed of the truck, which was way more fun than cramming in the backseat of the car. We went to vulturary outside of town, and Boitumelo’s dad passed around handouts from the reserve nearby, about vultures. They live in these very dramatic cliffs above the town, but they’re usually only out in the morning, so we didn’t see many. People also were starting to get hungry and tired, so we looked around for about 10 minutes, then headed back to the cars.
We stopped at the village kgotla (prn. ho-t-la), a traditional meeting place, on the way back. We took pictures, but the group energy was definitely ebbing. We were relieved when they apparently decided that they had showed the tourists enough of the sights, and took us back to Boitumelo’s for tea, coffee, and tea sandwiches with cheese and tomato. It was very sweet, her family had like 12 mugs set out and boiled water for all of us. Our tea time was fairly uneventful otherwise, though at one point I did somehow manage to lock myself in the bathroom. Awesome.
We sat around chatting (a few people dozing – and yes, I still have the pictures, mwha) for a few hours, until Boitumelo and her family were ready to go to the wedding. Weddings here are full-day affairs lasting several days. It was already 3, so we had missed a lot of the ceremonial parts, but we went to the reception. They showed us around, and basically the entire village was there, so they were cooking massive amounts of food. Boitumelo explained that weddings are considered to be open to everyone, so a lot of the expense for the wedding is related to making sure that you have enough food for everyone.
They seated us in the middle of the dining tent, so that everyone could stare at us, basically. They gave us gingerbeer first (not actually alcoholic), which is a traditional drink at weddings. Next, they brought us huge bowls of meat, coleslaw, beet salad, and papa (a cornmeal dish). We tried everything, but unfortunately a lot of the meat here is very fatty, so we mostly ate papa and boiled peanuts that Boitumelo’s mom sent with us. The wedding party made a few turns through the tent, changing outfits in between. Boitumelo explained that a blue cloth is considered traditional Batswana attire, and it’s how other Africans identify a Motswana, because each country has a different color/pattern. In South Africa, for example, red cloth is the tradition. Once I figure out how to post videos, I’ll share the recording I made of the wedding party singing as they walked through the tent. It was super neat, and Boitumelo said that they came into the tent just so we could see them, which was really nice. We congratulated the bride, then took our combi back to Gabs, because it was getting dark. It was a little disconcerting when the combi had to be pushed for the first few hundred feet by a couple of guys before it started, but after that we were good to go.
Day 25 - 10 June 2011
This day in a nutshell: half-day at work because today was the day of our mid-internship lunch. Walked to the BUP office at 11, then we got driven to the Gaborone Game Reserve for lunch. We saw tons of monkeys (pictures to come) and more antelope, then had a lovely braai (their equivalent of BBQ) for lunch. Driven back to UB, and we did laundry during the afternoon, hallelujah! Walked to Riverwalk, spontaneously decided to have popcorn for dinner and see the new X-Men movie. (It was PHENOMENAL! I highly, HIGHLY recommend it!) Groceries, home, bed because we had to get up early.
Sunday, 12 June 2011
Day 24 – 9 June 2011
I woke up extra early so that I could be in to work by 7:15 to help Tiny collect the gastric aspirate on one of our patients. I was super excited, but nervous that the mom might have fed the baby or something, which had happened on previous occasions. Everything went smoothly, though, and Tiny showed up a few minutes after I did. She talked me through everything, and I managed to get the NG tube in without too much trouble, but when I pulled back on the syringe nothing came out. Tiny didn’t go through all of the things I’ve seen nurses in the States do to check whether the tube was in the right place – residents tend to cut corners, it’s a bad habit – so I hesitated a bit when she told me to flush the tube with saline. She ended up taking over, and after a bit of finagling we got the sample. I was bummed that I hadn’t gotten it, but I figured I just need to get a little more practice.
Dr. Kung didn’t have to worry about making it to clinic, so there was a little bit less of a rush to get through rounds, but our team was set to admit today, which meant that the afternoon might get pretty busy. Dr. Kung decided not to have the residents do pre-rounds, and we all just started seeing everyone together. We quickly realized that at least one of the new patients needed an X-ray, but apparently the X-ray machines had joined the CT scanner in whatever revolt they seemed to be staging, and we had to refer out to private for that too. Since we needed to pick up the paperwork from social work for the two kids from Thursday, plus a request that Tiny put in sometime yesterday, I headed over to the social work office to gauge the likelihood of getting our new requests approved.
The good news was that one of the kids from Tuesday and the one from Wednesday had been approved. The bad news was that we were missing the mom’s ID card number on one of the forms for the other child, so we had to resubmit the paperwork. They didn’t completely shut us down, though, because they said that if I completed it and brought it back, they could have it ready by 2. They also agreed to have the new paperwork finished by then (why so much faster this time, I have no idea). I didn’t want to walk all the way back to the other side of the hospital and back, so I dropped in to visit Kat in the A&E and called Dr. Kung to get the information I needed. I think I shocked the social work staff by reappearing in less than 10 minutes, probably a record here.
Ducked back into the ward to finish rounds, then took the new paperwork to the social worker’s office before they left for lunch at 1. Since Dr. Kung was going to the department M&M (morbidity and mortality report, not the candy), I decided to go ahead and take lunch myself. I had brought ramen, because there’s a microwave at work, but I realized that I didn’t have anything to cook it in, so I walked home. Julia goes home for lunch every day, so we chatted while I cooked my food. We had been planning to try to go to Serowe, another town a little further from Gabs that has a rhino sanctuary, this weekend. We called the sanctuary to reserve a chalet, but were told that they were fully booked for this weekend and next. Boo.
I took longer for lunch than I meant to, because it’s a 15 minute walk back to UB, so by the time I got back to the hospital it was already 2. I went straight to the social work office, and seriously sat there for 45 minutes waiting to get my paperwork. The woman who had been helping me before took the papers and disappeared when I arrived, while the rest of the staff in the office did the following: the woman in one corner fell asleep, the guy next to me listened to music on his phone and read the newspaper, the woman in the opposite corner listened to music or watched some kind of video on her computer, and the other guy read the news on his computer. After a while the guy listening to music started chatting with me about sports. Seriously people?
I did finally get the paperwork I needed, so I walked back to the ward with a vague sense of accomplishment, tempered by a much stronger feeling of astonishment at the ridiculousness I had just witnessed. Once I’d handed off the paperwork to Tiny, I started on the second set of May charts that I had dug out of the horrid A&E storage room the previous day. Dr. Kung and I went over my questions over the first set of charts, then I stayed late to make up for the time I’d lost over lunch.
Home, dinner, early to bed because I had to get up early.
Dr. Kung didn’t have to worry about making it to clinic, so there was a little bit less of a rush to get through rounds, but our team was set to admit today, which meant that the afternoon might get pretty busy. Dr. Kung decided not to have the residents do pre-rounds, and we all just started seeing everyone together. We quickly realized that at least one of the new patients needed an X-ray, but apparently the X-ray machines had joined the CT scanner in whatever revolt they seemed to be staging, and we had to refer out to private for that too. Since we needed to pick up the paperwork from social work for the two kids from Thursday, plus a request that Tiny put in sometime yesterday, I headed over to the social work office to gauge the likelihood of getting our new requests approved.
The good news was that one of the kids from Tuesday and the one from Wednesday had been approved. The bad news was that we were missing the mom’s ID card number on one of the forms for the other child, so we had to resubmit the paperwork. They didn’t completely shut us down, though, because they said that if I completed it and brought it back, they could have it ready by 2. They also agreed to have the new paperwork finished by then (why so much faster this time, I have no idea). I didn’t want to walk all the way back to the other side of the hospital and back, so I dropped in to visit Kat in the A&E and called Dr. Kung to get the information I needed. I think I shocked the social work staff by reappearing in less than 10 minutes, probably a record here.
Ducked back into the ward to finish rounds, then took the new paperwork to the social worker’s office before they left for lunch at 1. Since Dr. Kung was going to the department M&M (morbidity and mortality report, not the candy), I decided to go ahead and take lunch myself. I had brought ramen, because there’s a microwave at work, but I realized that I didn’t have anything to cook it in, so I walked home. Julia goes home for lunch every day, so we chatted while I cooked my food. We had been planning to try to go to Serowe, another town a little further from Gabs that has a rhino sanctuary, this weekend. We called the sanctuary to reserve a chalet, but were told that they were fully booked for this weekend and next. Boo.
I took longer for lunch than I meant to, because it’s a 15 minute walk back to UB, so by the time I got back to the hospital it was already 2. I went straight to the social work office, and seriously sat there for 45 minutes waiting to get my paperwork. The woman who had been helping me before took the papers and disappeared when I arrived, while the rest of the staff in the office did the following: the woman in one corner fell asleep, the guy next to me listened to music on his phone and read the newspaper, the woman in the opposite corner listened to music or watched some kind of video on her computer, and the other guy read the news on his computer. After a while the guy listening to music started chatting with me about sports. Seriously people?
I did finally get the paperwork I needed, so I walked back to the ward with a vague sense of accomplishment, tempered by a much stronger feeling of astonishment at the ridiculousness I had just witnessed. Once I’d handed off the paperwork to Tiny, I started on the second set of May charts that I had dug out of the horrid A&E storage room the previous day. Dr. Kung and I went over my questions over the first set of charts, then I stayed late to make up for the time I’d lost over lunch.
Home, dinner, early to bed because I had to get up early.
Day 23 – 8 June 2011
Typical morning: early breakfast, then hauled myself in for morning report. The residents all had some kind of class this morning, so there were fewer people than usual there for report. Additionally, everyone was running late, so for a while it was just me, the attendings, and two interns sitting there twiddling our thumbs. Report took all of 5 minutes because there were very few admissions, and then the intern that was supposed to be giving a presentation didn’t show up and didn’t answer his phone when we called, so we gave up and headed to the ward for rounds. Epic fail.
Dr. Kung wanted to wait for Tiny to get back around 9 before doing rounds, so I spent a few hours working on charts. The class ran long, so Tiny didn’t end up getting back till 9:45, and we didn’t start rounds till about 10:30. Dr. Kung had clinic starting at 12, so we rushed through everything with poor MK trying to keep up. On the upside, the baby with intestinal obstruction had finally gone to surgery the previous day, and had had 5 cm of bowel resected, but seemed to be recovering well. I helped Tiny collect a gastric aspirate on one child, and she agreed to let me do it myself tomorrow morning – yay! For you non-medical folks out there, I will take a moment to explain – children who develop TB are actually much less infectious than adults, even when they have full-blown disease, because they usually can’t produce enough force with their coughing to expel any sputum. Whatever stuff they do manage to get out of their lungs they usually swallow. So to test for TB, we put a tube in their nose down into their stomach (an NG, or nasogastric tube), and collect some of their stomach contents early in the morning, before they’ve eaten. We usually take three samples, so it’s a bit of a drawn out process, even though the actual sample collection only takes about 5 minutes. It doesn’t hurt them, but it’s kind of uncomfortable.
Dr. Kung headed off to clinic, but I elected to finish entering the May charts I still had before joining her. It took me about 2 hours, but I did it. Then I carried the box of June charts that I still had back to the A&E storage room on my way to clinic. It was super heavy, and my arm muscles were quivering when I finally made it to clinic. Dr. Kung offered to let me do another skin test, but I was too shaky, and I had to offer a very embarrassed explanation to the patient and Dr. Kung. The rest of the afternoon was fairly uneventful, and we left a little early.
Julia had a film screening for a big conference that her organization was putting on, so we all just kind of chilled at home because we didn’t want to watch a movie without her. We basically just talked all evening. Somehow the subject of songs and games we used to play as kids came up, and we sang “Miss Susie had a steamboat” and various other things for over an hour. We’re such fun, adventurous people.
Dr. Kung wanted to wait for Tiny to get back around 9 before doing rounds, so I spent a few hours working on charts. The class ran long, so Tiny didn’t end up getting back till 9:45, and we didn’t start rounds till about 10:30. Dr. Kung had clinic starting at 12, so we rushed through everything with poor MK trying to keep up. On the upside, the baby with intestinal obstruction had finally gone to surgery the previous day, and had had 5 cm of bowel resected, but seemed to be recovering well. I helped Tiny collect a gastric aspirate on one child, and she agreed to let me do it myself tomorrow morning – yay! For you non-medical folks out there, I will take a moment to explain – children who develop TB are actually much less infectious than adults, even when they have full-blown disease, because they usually can’t produce enough force with their coughing to expel any sputum. Whatever stuff they do manage to get out of their lungs they usually swallow. So to test for TB, we put a tube in their nose down into their stomach (an NG, or nasogastric tube), and collect some of their stomach contents early in the morning, before they’ve eaten. We usually take three samples, so it’s a bit of a drawn out process, even though the actual sample collection only takes about 5 minutes. It doesn’t hurt them, but it’s kind of uncomfortable.
Dr. Kung headed off to clinic, but I elected to finish entering the May charts I still had before joining her. It took me about 2 hours, but I did it. Then I carried the box of June charts that I still had back to the A&E storage room on my way to clinic. It was super heavy, and my arm muscles were quivering when I finally made it to clinic. Dr. Kung offered to let me do another skin test, but I was too shaky, and I had to offer a very embarrassed explanation to the patient and Dr. Kung. The rest of the afternoon was fairly uneventful, and we left a little early.
Julia had a film screening for a big conference that her organization was putting on, so we all just kind of chilled at home because we didn’t want to watch a movie without her. We basically just talked all evening. Somehow the subject of songs and games we used to play as kids came up, and we sang “Miss Susie had a steamboat” and various other things for over an hour. We’re such fun, adventurous people.
Day 22 – 7 June 2011
The day started out fairly normally – morning report, then to work in the wards. Dr. Kung had clinic in the morning, so I hung around with the residents helping with various labs and things. I placed another TB skin test, this time unsupervised! I also examined a baby that Dr. Kung admitted on Friday, whose exam I had missed the previous day. It was a pretty sick baby, probably HIV infected, and it had an enlarged liver and spleen in addition to a heart murmur, all of which I found on my own. I was pretty proud of myself ☺ The baby who needed surgery for an intestinal obstruction STILL hadn’t gone to theater – I overheard something about a problem with the lights in the operating room – which worried everyone, because the longer the obstructed segments of bowel go without oxygen/blood, the worse the prognosis and the greater the chance of infection. Sigh.
The CT scanner here is still broken, and two of the kids with TB meningitis need scans to show us whether they’re improving or worsening on treatment, so we have to refer them to a nearby private hospital. Since most people here have 90% of their health care costs paid for by the government, accomplishing a referral requires that we go through the hospital social worker to get approval. I helped Tiny fill out all of the paperwork (three forms for each child, talk about bureaucracy), then dropped them off in the social work office on the other side of the hospital campus. When I asked how soon they could be approved, they told me to come back on Thursday. Great. If someone in the States had to wait two days for a CT scan, they would sue the hospital. Here, one of these kids might have had a stroke from increased intracranial pressure, and there’s nothing we can do about it.
Once I was no longer useful on the ward, I joined Dr. Kung in the clinic. She was in the middle of assessing a new patient, and right after I sat down, she offered to let me do the skin allergy test on the patient. I was surprised, because I had watched her do quite a few and felt comfortable with the procedure, but I hadn’t expected to be performing one myself. I quickly agreed though, and despite having a little trouble mastering the art of leaving small drops of solution, I managed a passing job. Then Dr. Kung surprised me again by offering to do a skin test on me. I felt a little awkward doing it in front of the patient, but Dr. Kung said that it would help me understand what the patient was going through. Turns out that I’m apparently not allergic to anything in Botswana, and Dr. Kung made a joke that I should come and live here because it’s clearly the ideal environment for me. Hmmm…
The rest of the day went pretty quickly and uneventfully: lunch, entering charts in the afternoon, home. One funny story: I was sitting and working on the charts, listening to my iPod, and I heard a tap on the window next to me. The room I sit in has windows all along one wall, but they’re covered by curtains all the time, except one small part of the window in the corner. A little boy playing out on the playground had apparently spied this one small opening, and was looking in at me and waving. I waved back, and then he ran around the building and opened the door to the room I was sitting in, marching in with a couple of his friends. I laughed and said hi, but since the room I work in is the paediatrician’s office, I figured that they probably weren’t allowed in, so I led them back to the door and said bye. A little while later though, he repeated the process, except this time Dr. Kung had come back in the office, and was looking slightly worried that the little boy had come in so casually. I quickly led him back out, and he went willingly, but then held out his hand at the door. I tried to give him a high-five, but he just continued holding out his hand and then pointed at me. I thought he was pointing at my stethoscope, which was around my neck, or my name badge, but he shook is head and kept pointing. I realized that he was pointing at the pen I had clipped to the front of my shirt, and he nodded when I motioned to it and asked if he wanted it. I shrugged and gave it to him, and he ran away. It was so odd! It’s the second time I’ve had one of the kids want my pen – the other time a group of three or four kids surrounded me and one of them started digging in my pockets and took my pen. Whatever, I’ve got like a million of them. What’s so great about a pen though, is what I want to know.
Talked to Mom and Dad on Skype ☺ We made frozen mac’n’cheese for dinner that was DELICIOUS. Definitely going to be a repeat meal. Then we were all still kind of tired from staying up the night before, so we tried to go to bed early, but nature had other plans. It had gotten kind of cloudy in the late afternoon, and it was really windy, but around 8 it started thundering. By 9 it was pouring BUCKETS of rain, and we all rushed into the living room to look out the window. It was pretty dramatic, and huge bolts of lightening lit the whole sky. Very Lion King-esque, especially since it’s been kind of creepily perfect sunny, cloudless sky, Pleasantville weather since we arrived. Everything looked like it was flooding, and we all groaned at the thought of how muddy our walk to work would be in the morning.
The CT scanner here is still broken, and two of the kids with TB meningitis need scans to show us whether they’re improving or worsening on treatment, so we have to refer them to a nearby private hospital. Since most people here have 90% of their health care costs paid for by the government, accomplishing a referral requires that we go through the hospital social worker to get approval. I helped Tiny fill out all of the paperwork (three forms for each child, talk about bureaucracy), then dropped them off in the social work office on the other side of the hospital campus. When I asked how soon they could be approved, they told me to come back on Thursday. Great. If someone in the States had to wait two days for a CT scan, they would sue the hospital. Here, one of these kids might have had a stroke from increased intracranial pressure, and there’s nothing we can do about it.
Once I was no longer useful on the ward, I joined Dr. Kung in the clinic. She was in the middle of assessing a new patient, and right after I sat down, she offered to let me do the skin allergy test on the patient. I was surprised, because I had watched her do quite a few and felt comfortable with the procedure, but I hadn’t expected to be performing one myself. I quickly agreed though, and despite having a little trouble mastering the art of leaving small drops of solution, I managed a passing job. Then Dr. Kung surprised me again by offering to do a skin test on me. I felt a little awkward doing it in front of the patient, but Dr. Kung said that it would help me understand what the patient was going through. Turns out that I’m apparently not allergic to anything in Botswana, and Dr. Kung made a joke that I should come and live here because it’s clearly the ideal environment for me. Hmmm…
The rest of the day went pretty quickly and uneventfully: lunch, entering charts in the afternoon, home. One funny story: I was sitting and working on the charts, listening to my iPod, and I heard a tap on the window next to me. The room I sit in has windows all along one wall, but they’re covered by curtains all the time, except one small part of the window in the corner. A little boy playing out on the playground had apparently spied this one small opening, and was looking in at me and waving. I waved back, and then he ran around the building and opened the door to the room I was sitting in, marching in with a couple of his friends. I laughed and said hi, but since the room I work in is the paediatrician’s office, I figured that they probably weren’t allowed in, so I led them back to the door and said bye. A little while later though, he repeated the process, except this time Dr. Kung had come back in the office, and was looking slightly worried that the little boy had come in so casually. I quickly led him back out, and he went willingly, but then held out his hand at the door. I tried to give him a high-five, but he just continued holding out his hand and then pointed at me. I thought he was pointing at my stethoscope, which was around my neck, or my name badge, but he shook is head and kept pointing. I realized that he was pointing at the pen I had clipped to the front of my shirt, and he nodded when I motioned to it and asked if he wanted it. I shrugged and gave it to him, and he ran away. It was so odd! It’s the second time I’ve had one of the kids want my pen – the other time a group of three or four kids surrounded me and one of them started digging in my pockets and took my pen. Whatever, I’ve got like a million of them. What’s so great about a pen though, is what I want to know.
Talked to Mom and Dad on Skype ☺ We made frozen mac’n’cheese for dinner that was DELICIOUS. Definitely going to be a repeat meal. Then we were all still kind of tired from staying up the night before, so we tried to go to bed early, but nature had other plans. It had gotten kind of cloudy in the late afternoon, and it was really windy, but around 8 it started thundering. By 9 it was pouring BUCKETS of rain, and we all rushed into the living room to look out the window. It was pretty dramatic, and huge bolts of lightening lit the whole sky. Very Lion King-esque, especially since it’s been kind of creepily perfect sunny, cloudless sky, Pleasantville weather since we arrived. Everything looked like it was flooding, and we all groaned at the thought of how muddy our walk to work would be in the morning.
Day 21 – 6 June 2011
Work began again. Morning report as usual, but with quite a few deaths for the weekend, unfortunately. The one that stuck out the most was a child who had come in in renal failure – in those patients, it’s really important to keep track of their electrolyte levels, particularly their potassium. However, the lab’s machines and the unit’s arterial blood gas machine, which could give an electrolyte reading in about 2 minutes, were both down. No one realized that the baby was in renal failure for a day or two, and even then they couldn’t recheck the electrolyte levels to know whether treatment was helping. The baby died. Talk about cold hard reality.
At some point last week, MK and Lina met with Dr. Kung to discuss the devices they’ve brought from Rice. Just to clarify – in some round-about way that I don’t entirely understand, MK and Lina are associated with the Botswana-UPenn partnership, and that’s why they live with us, but they actually both just graduated from Rice, and work in the Baylor clinic part of the time. They were both biomedical engineering majors, and senior design projects for all biomed students are to develop medical devices that could be produced and used in low-resource settings. Part of MK and Lina’s job here is to show off previous year’s designs, and to get ideas for future projects. They asked Dr. Kung to shadow with her for a week or two to get a feel for where new devices might be beneficial, so MK joined us for rounds today.
Things were kind of chaotic because it was Monday and we were getting started late because morning report ran long. We started on rounds, then I got dispatched to print forms for one patient, which turned into a 30-minute long ordeal of trying to find a non-existent paper jam in the printer, etc. On the upside, that meant that I was in the nurse’s office for a while, and someone pointed out my keys that had been found in the bathroom and taped to the window over the weekend. Hallelujah!
We worked our way through the old patients that were left after the weekend, and the new ones that had come in. The last patient we saw was a baby that they had presented at morning report as having dysentery, but it rapidly became obvious that the poor kid actually had an intussusception that the resident hadn’t caught. Dr. Kung was really unhappy, because we had lost over an hour that we had spent rounding on the other, less acute babies that could have been spent on getting this baby into surgery. We jumped into doing labs, etc. In addition to helping Dr. Kung draw blood and start a couple of IVs, I placed my first TB skin test on my own! YAY! Tip: If you have to dress in nice clothes (rather than scrubs) to go to work in a hospital, don’t wear black pants. Especially if the gloves are powdered. It just creates problems.
Before we knew it, it was already 2, and MK and I were both starving. We ran out to the front of the hospital and grabbed some hot dog/sausage things that the street vendors sell, and stuffed our faces. We stopped in the caf and split a pot of coffee (you get a full tea service here when you order coffee, including your own mini-pot of hot water with which to brew your incredibly scrumptious instant coffee), then headed back to the ward.
Dr. Kung was still working on getting labs and things sent off, and everyone was flustered because apparently the intestinal obstruction baby’s labs had been sent hours ago, but it had been discovered while MK and I were at lunch that the lab techs had promptly buried all of the lab work under a pile and not done them. Which meant that the baby’s pre-op hemoglobin, etc. had not been done. Which meant that the operation could not be done yet. Which meant that surgery was pissed, and the baby probably wouldn’t go to the operating theater (they call it the OT, as opposed to the OR, here) till 10 tonight. Great.
Did charts the rest of the afternoon, because everyone was too busy on the ward to give me something to do. Stopped in the ward before heading home, and heard Dr. Kung discussing an interesting differential with Changi and Tiny about a baby that had come in with lower extremity weakness, and had the worst stranger anxiety I’ve ever seen in a child. All Dr. Kung had to do was look at the baby for it to start screaming.
Got home exhausted, but it was Kim’s birthday, so they had invited us to join them at Bull and Bush for dinner. I didn’t feel inclined to spend money on dinner after buying lunch, especially since I was totally cleaned out of cash because the ATM didn’t work on Sunday. We all ate dinner together at home, then crammed in a cab for the ride to BAB. It was fun, though we mostly ended up talking amongst ourselves because the others were mid-meal when we arrived. Headed home around 8:45, then went straight to sleep without blogging because I was so exhausted.
At some point last week, MK and Lina met with Dr. Kung to discuss the devices they’ve brought from Rice. Just to clarify – in some round-about way that I don’t entirely understand, MK and Lina are associated with the Botswana-UPenn partnership, and that’s why they live with us, but they actually both just graduated from Rice, and work in the Baylor clinic part of the time. They were both biomedical engineering majors, and senior design projects for all biomed students are to develop medical devices that could be produced and used in low-resource settings. Part of MK and Lina’s job here is to show off previous year’s designs, and to get ideas for future projects. They asked Dr. Kung to shadow with her for a week or two to get a feel for where new devices might be beneficial, so MK joined us for rounds today.
Things were kind of chaotic because it was Monday and we were getting started late because morning report ran long. We started on rounds, then I got dispatched to print forms for one patient, which turned into a 30-minute long ordeal of trying to find a non-existent paper jam in the printer, etc. On the upside, that meant that I was in the nurse’s office for a while, and someone pointed out my keys that had been found in the bathroom and taped to the window over the weekend. Hallelujah!
We worked our way through the old patients that were left after the weekend, and the new ones that had come in. The last patient we saw was a baby that they had presented at morning report as having dysentery, but it rapidly became obvious that the poor kid actually had an intussusception that the resident hadn’t caught. Dr. Kung was really unhappy, because we had lost over an hour that we had spent rounding on the other, less acute babies that could have been spent on getting this baby into surgery. We jumped into doing labs, etc. In addition to helping Dr. Kung draw blood and start a couple of IVs, I placed my first TB skin test on my own! YAY! Tip: If you have to dress in nice clothes (rather than scrubs) to go to work in a hospital, don’t wear black pants. Especially if the gloves are powdered. It just creates problems.
Before we knew it, it was already 2, and MK and I were both starving. We ran out to the front of the hospital and grabbed some hot dog/sausage things that the street vendors sell, and stuffed our faces. We stopped in the caf and split a pot of coffee (you get a full tea service here when you order coffee, including your own mini-pot of hot water with which to brew your incredibly scrumptious instant coffee), then headed back to the ward.
Dr. Kung was still working on getting labs and things sent off, and everyone was flustered because apparently the intestinal obstruction baby’s labs had been sent hours ago, but it had been discovered while MK and I were at lunch that the lab techs had promptly buried all of the lab work under a pile and not done them. Which meant that the baby’s pre-op hemoglobin, etc. had not been done. Which meant that the operation could not be done yet. Which meant that surgery was pissed, and the baby probably wouldn’t go to the operating theater (they call it the OT, as opposed to the OR, here) till 10 tonight. Great.
Did charts the rest of the afternoon, because everyone was too busy on the ward to give me something to do. Stopped in the ward before heading home, and heard Dr. Kung discussing an interesting differential with Changi and Tiny about a baby that had come in with lower extremity weakness, and had the worst stranger anxiety I’ve ever seen in a child. All Dr. Kung had to do was look at the baby for it to start screaming.
Got home exhausted, but it was Kim’s birthday, so they had invited us to join them at Bull and Bush for dinner. I didn’t feel inclined to spend money on dinner after buying lunch, especially since I was totally cleaned out of cash because the ATM didn’t work on Sunday. We all ate dinner together at home, then crammed in a cab for the ride to BAB. It was fun, though we mostly ended up talking amongst ourselves because the others were mid-meal when we arrived. Headed home around 8:45, then went straight to sleep without blogging because I was so exhausted.
Thursday, 9 June 2011
Day 20 - 5 June 2011
Yes, the moment you all have been waiting for has arrived – the cheetah petting.
So in our packet of fun things to do whilst here in Botswana, there was a flier for the Mokolodi game reserve, the place BUP took us after our orientation a few weeks ago. A small line on said flier indicated that you could pay 175 pula and pet cheetahs for half an hour. Why this line was not bolded, starred, and in all caps is beyond me, but luckily for our group of adventurous and highly observant interns, we found out about this deal and chose to take full advantage of it on this past Sunday.
We got up early, because our reservation was for 10:30 and we wanted to make sure to be there on time (even if nothing here ever starts on time). We called a cab. We squished all five of us in, again. We disembarked at Mokolodi.
OK, enough with the dramatic lead in. WE WERE IN A FENCED ENCLOSURE WITH TWO MALE CHEETAHS FOR 45 MINUTES. IT WAS AWESOME. Mokolodi is actually a game preserve, so their main reason for being is not actually just to show off to tourists, it’s to take care of animals. The cheetahs were acquired as cubs, after a farmer shot their mother because “she was killing the livestock,” or some such nonsense. So the cheetahs have been raised their entire lives in captivity, and are as harmless to humans as an enormous clawed animal with really sharp teeth and primitive instincts can be. They also purr just like cats, which is creepy/cool. They were about the size of a golden retriever – maybe a little taller and definitely much slimmer. They sit and lay down just like cats, and I got a video of one rolling over and showing its belly the way your favorite furry friends do when they’re relaxing. When the first one started walking towards us when we entered the enclosure, my basic instincts definitely kicked in – I wanted to run as fast as possible in the other direction. That being said, they are totally mesmerizing. When we started petting it and taking pictures, Olivia, Lina, and MK went before me, and when it got to be my turn I just pet it on the head and looked extremely self-consciously at everyone else taking pictures. Then… it happened (drum roll)… in retrospect, I think it was just playing, but the cheetah suddenly put its paw on my knee, claws extended just enough to feel through my jeans, and it opened its mouth and put it on my wrist. It didn’t bite me, but the unexpected physical contact was enough that I nearly peed my pants, I’m not going to lie. And everyone else was so shocked that they stopped taking pictures, so the closest thing we have to documenting this insane once-in-a-lifetime experience is the picture I uploaded on the side bar. It was terrifying, AND SO FREAKING COOL! Also, that is a substantial animal. Even its paw was a good 10 pounds. There is no doubt in my mind that if that cheetah had decided it wanted me dead, there would have been absolutely nothing I could have done about it.
We oohed and ahhed for about 20 more minutes after that, took a picture of the hyena in the next enclosure through the fence, then headed back to the main building. We got some more pictures of impalas and a kudu, and I was pretty ecstatic to FINALLY get a picture of a Pumba (my camera battery was dead last time), so I took about 12,000. We also took a picture with our guide at the end, though we couldn’t decide whether he was mad at us or just had a really odd way of making jokes.
We cabbed it half-way back to UB, and stopped at a place that Dr. Kung had recommended for brunch. It’s called Sanitas Teahouse, which is a nursery that’s set way back from the road, but in the middle of it is a reaaaaaaallllllly nice restaurant. It was so pretty, and the food was SO AMAZING. I know I haven’t waxed poetic about food in a while, and that’s because our diet during the week mainly consists of ramen noodles, pasta, and veggie burgers, so now I can make up for lost time by describing how every single one of our meals was SO FREAKING GOOD. Everyone but Lina got a cappuccino (though delicious, I do have to add the disclaimer that at this point, ANYTHING remotely related to real coffee would make us all giddy, because our meager subsistence on instant coffee is SERIOUSLY not cutting it). I got a morrocan chicken wrap with feta and a side salad. The greens were so fresh they didn’t even need salad dressing, and the chicken was just savory spicy goodness. Olivia had some kind of burger with amazing cheese on it that I can’t remember the name of. Julia and MK both got some kind of chorizo incredibleness, and even Lina’s bagel with kalmata olives and mozzarella and tomatoes was drooltastic. In fact, I’m making myself a little hungry just remembering it all, so I’m going to have to stop. I will add that since they have a nursery outside the restaurant, they also sold really fresh vegetables, and we bought some spinach and tomatoes that we were really excited about. Suffice it to say, we were incredibly happy with the whole experience, and hope to make Sanitas a tradition from now on.
We meandered back to the road and caught a combi back to UB, which miraculously had enough room for all five of us! We had just enough time to set down our stuff, pee, and attempt to refill our water bottles – except that in true UB fashion, the water was turned off – before heading out to the stadium for the Zebras game. We ended up arriving after the game had started, and the stands were PACKED. It was actually kind of insane – we had to walk in front of the stands in order to get to the section where there were some seats, and people started cheering. I repeat, they were not cheering for the players or something that was happening with the game, they were WAVING AT US AND CHEERING. I think it must be something like what celebrities feel like – it was a little overwhelming.
We eventually found some seats, and after goggling at some outrageously distracting costumes that some fans had dressed up in, we settled in to watch the game. I haven’t watched soccer in a while, so I had to ask Olivia a lot of questions, but it was fun. Also, they have vuvuzelas here too, and they’re obnoxious but also really entertaining. People basically have vuvuzela conversations – one person blows theirs, and then another person blows back, and they trade back and forth for a while. If they get really excited about something then they start blowing together and hitting the walls of the stands, which are corrugated metal and therefore make a huge amount of noise. Also, we quickly figured out why the fence separating the stands from the field had barbed wire on top – people legit started climbing the fence when they got excited. It was extremely entertaining. Side note: the last intern we were expecting finally arrived yesterday, so she came to the game with us. Her name is Sarah, and she’s living upstairs with Kat, Becca, and Kim.
After the game, Sarah and Becca were determined to meet some of the players. Personally, I was more interested in the crowd who gathered outside that started singing and dancing (I tried to get a video, but you can’t see much), and then trying to get home before dark. But we went and stood by the gate at the back of the stadium, and eventually the players came out, and Becca and Sarah got invited to go on their bus for a little while. Then Julia, MK and I headed back to the dorm, while Lina and Olivia went with Becca, Sarah, and a security guard who knew one of the players to go take pictures at their club house or something.
The rest of the night was relatively uneventful. Julia and I were pretty hungry, so she made some kind of concotion with the spinach, tomatoes, and some chickpeas and feta that we already had, which was AMAZING. It was really simple, but very filling and tasty, and I’m going to have to learn how to make it. NOM NOM.
So in our packet of fun things to do whilst here in Botswana, there was a flier for the Mokolodi game reserve, the place BUP took us after our orientation a few weeks ago. A small line on said flier indicated that you could pay 175 pula and pet cheetahs for half an hour. Why this line was not bolded, starred, and in all caps is beyond me, but luckily for our group of adventurous and highly observant interns, we found out about this deal and chose to take full advantage of it on this past Sunday.
We got up early, because our reservation was for 10:30 and we wanted to make sure to be there on time (even if nothing here ever starts on time). We called a cab. We squished all five of us in, again. We disembarked at Mokolodi.
OK, enough with the dramatic lead in. WE WERE IN A FENCED ENCLOSURE WITH TWO MALE CHEETAHS FOR 45 MINUTES. IT WAS AWESOME. Mokolodi is actually a game preserve, so their main reason for being is not actually just to show off to tourists, it’s to take care of animals. The cheetahs were acquired as cubs, after a farmer shot their mother because “she was killing the livestock,” or some such nonsense. So the cheetahs have been raised their entire lives in captivity, and are as harmless to humans as an enormous clawed animal with really sharp teeth and primitive instincts can be. They also purr just like cats, which is creepy/cool. They were about the size of a golden retriever – maybe a little taller and definitely much slimmer. They sit and lay down just like cats, and I got a video of one rolling over and showing its belly the way your favorite furry friends do when they’re relaxing. When the first one started walking towards us when we entered the enclosure, my basic instincts definitely kicked in – I wanted to run as fast as possible in the other direction. That being said, they are totally mesmerizing. When we started petting it and taking pictures, Olivia, Lina, and MK went before me, and when it got to be my turn I just pet it on the head and looked extremely self-consciously at everyone else taking pictures. Then… it happened (drum roll)… in retrospect, I think it was just playing, but the cheetah suddenly put its paw on my knee, claws extended just enough to feel through my jeans, and it opened its mouth and put it on my wrist. It didn’t bite me, but the unexpected physical contact was enough that I nearly peed my pants, I’m not going to lie. And everyone else was so shocked that they stopped taking pictures, so the closest thing we have to documenting this insane once-in-a-lifetime experience is the picture I uploaded on the side bar. It was terrifying, AND SO FREAKING COOL! Also, that is a substantial animal. Even its paw was a good 10 pounds. There is no doubt in my mind that if that cheetah had decided it wanted me dead, there would have been absolutely nothing I could have done about it.
We oohed and ahhed for about 20 more minutes after that, took a picture of the hyena in the next enclosure through the fence, then headed back to the main building. We got some more pictures of impalas and a kudu, and I was pretty ecstatic to FINALLY get a picture of a Pumba (my camera battery was dead last time), so I took about 12,000. We also took a picture with our guide at the end, though we couldn’t decide whether he was mad at us or just had a really odd way of making jokes.
We cabbed it half-way back to UB, and stopped at a place that Dr. Kung had recommended for brunch. It’s called Sanitas Teahouse, which is a nursery that’s set way back from the road, but in the middle of it is a reaaaaaaallllllly nice restaurant. It was so pretty, and the food was SO AMAZING. I know I haven’t waxed poetic about food in a while, and that’s because our diet during the week mainly consists of ramen noodles, pasta, and veggie burgers, so now I can make up for lost time by describing how every single one of our meals was SO FREAKING GOOD. Everyone but Lina got a cappuccino (though delicious, I do have to add the disclaimer that at this point, ANYTHING remotely related to real coffee would make us all giddy, because our meager subsistence on instant coffee is SERIOUSLY not cutting it). I got a morrocan chicken wrap with feta and a side salad. The greens were so fresh they didn’t even need salad dressing, and the chicken was just savory spicy goodness. Olivia had some kind of burger with amazing cheese on it that I can’t remember the name of. Julia and MK both got some kind of chorizo incredibleness, and even Lina’s bagel with kalmata olives and mozzarella and tomatoes was drooltastic. In fact, I’m making myself a little hungry just remembering it all, so I’m going to have to stop. I will add that since they have a nursery outside the restaurant, they also sold really fresh vegetables, and we bought some spinach and tomatoes that we were really excited about. Suffice it to say, we were incredibly happy with the whole experience, and hope to make Sanitas a tradition from now on.
We meandered back to the road and caught a combi back to UB, which miraculously had enough room for all five of us! We had just enough time to set down our stuff, pee, and attempt to refill our water bottles – except that in true UB fashion, the water was turned off – before heading out to the stadium for the Zebras game. We ended up arriving after the game had started, and the stands were PACKED. It was actually kind of insane – we had to walk in front of the stands in order to get to the section where there were some seats, and people started cheering. I repeat, they were not cheering for the players or something that was happening with the game, they were WAVING AT US AND CHEERING. I think it must be something like what celebrities feel like – it was a little overwhelming.
We eventually found some seats, and after goggling at some outrageously distracting costumes that some fans had dressed up in, we settled in to watch the game. I haven’t watched soccer in a while, so I had to ask Olivia a lot of questions, but it was fun. Also, they have vuvuzelas here too, and they’re obnoxious but also really entertaining. People basically have vuvuzela conversations – one person blows theirs, and then another person blows back, and they trade back and forth for a while. If they get really excited about something then they start blowing together and hitting the walls of the stands, which are corrugated metal and therefore make a huge amount of noise. Also, we quickly figured out why the fence separating the stands from the field had barbed wire on top – people legit started climbing the fence when they got excited. It was extremely entertaining. Side note: the last intern we were expecting finally arrived yesterday, so she came to the game with us. Her name is Sarah, and she’s living upstairs with Kat, Becca, and Kim.
After the game, Sarah and Becca were determined to meet some of the players. Personally, I was more interested in the crowd who gathered outside that started singing and dancing (I tried to get a video, but you can’t see much), and then trying to get home before dark. But we went and stood by the gate at the back of the stadium, and eventually the players came out, and Becca and Sarah got invited to go on their bus for a little while. Then Julia, MK and I headed back to the dorm, while Lina and Olivia went with Becca, Sarah, and a security guard who knew one of the players to go take pictures at their club house or something.
The rest of the night was relatively uneventful. Julia and I were pretty hungry, so she made some kind of concotion with the spinach, tomatoes, and some chickpeas and feta that we already had, which was AMAZING. It was really simple, but very filling and tasty, and I’m going to have to learn how to make it. NOM NOM.
Wednesday, 8 June 2011
Day 19 - 4 June 2011
Woke up early so we could get started on our day trip as soon as possible – how sad is it that getting up at 9 on a Saturday in June is “sleeping in”? Clearly I’m getting old.
We had decided earlier in the week to head out to some of the villages around Gabs for the day – Gabane was our projected first stop, which is famous for its pottery, and Thamaga, where there’s apparently a glass factory and a traditional village meeting place, called a kgotla (prn. ho-t-la). We only had a very vague idea of how to get there, but that started with catching a combi outside the west gate of the UB campus, to the central bus station. Combis are the buses here, and they roughly adhere to a set route, though not to any kind of schedule. According to Jose, another intern in our program who works near Gabane, we needed to get the Tlokweng 4 bus. We thought we had gotten really lucky when the first bus we flagged down turned out to be a Tlokweng 4 – but then it was totally full, and there were 6 of us (Kim joined us). Same story for the next three buses. We eventually gave up and hailed a cab, then openly flaunted the traffic laws by cramming all 6 of us into the one cab (five in the backseat). We got to see some new parts of the city, including the Ministry of Health, which looks like something out of 1984. We also saw where the president lives, though by saw I mean we saw the wall topped with barbed wire surrounding it.
Julia had made us all a little apprehensive about going to the bus station, because she had been once with Boitumelo in the middle of the day, and she said it had been really crowded and confusing. It was busy, and there were buses everywhere, but it was also kind of neat because there were a bunch of vendors selling clothes, shoes, vegetables, candy, etc. Our cab driver was nice and dropped us near the ranks for Gabane, so we found the bus fairly quickly. Only 3 pula!
We piled in and enjoyed the ride out, seeing cows and traditional houses along the way, though we got a bit anxious towards the end because we had no idea where to get off. Also, a girl on the bus told Olivia that she looked like Rhianna, which was really sweet.
Got off at the last stop, which basically looked like a dirt road with some random buildings. We saw a sign for Pelegano Pottery, 1.5 km, so we started walking. It was definitely more like the stereotypical African village – dusty dirt road, chickens and cows wandering about, thatched roof huts mixed in with more modern cinderblock houses. Basically it was awesome. The weather was really nice, so we enjoyed the walk, and everyone that passed us was really friendly and greeted us. Two mothers passed by with their children and told us that they wanted to be our friends – people say that a lot here, and we’ve decided that it clearly means something different than what we think it means.
Made it to the pottery place, which basically seems to be like an arts collective. Everything seemed to be closed – they told us that two of the buildings had been closed for renovations, so we were a bit disappointed. The door to the pottery building had a sign that said “Open – call Martin” and a number, but when we tried the number it didn’t work. We sat around wondering what to do for a few minutes, then Kim had the brilliant realization that the big black mark in the middle of the phone number that we had been including as a 1 wasn’t actually part of the number. We tried it again, and it worked! Within a few minutes, Martin had appeared, let us into the building, and was giving us a tour of the works!
The pottery is made from clay that they take from the hills around the village, which is a typical sort of brownish red. They have two kilns, but they import the glazes from South Africa. Martin’s job is to throw the pots on the wheel, which he did right in front of us! It was fantastic, and we all very enthusiastically purchased some of his wares afterwards.
We wandered back to the main road, stopping at a “general supply” on the way, which is basically like the equivalent of a CVS here (they had Cokes in glass bottles!). We asked for the bus to Thamaga, but the vendors told us that we’d have to bus back into Gabs to get the bus to Thamaga. It was only 1 or so, so we headed back into the city, where we discovered that the bus to Thamaga would be another hour and 45 minutes one way. None of us particularly relished the idea of being out after dark, so we headed to Riverwalk to get tickets to the soccer game the next day and pick up some groceries, while Kim split to go to a French music festival.
I was running a little low on cash, as were a few others, so the first stop at Riverwalk was the ATM. Olivia’s card has still never worked, so her dad transferred me some money to withdraw for her. So of course, my card decided not to work. Great. Next we got our tickets to the Zebras game (yes, that is the national team’s mascot – Botswana is SO much cooler than the US), got ice cream at Milky Lane (the ONLY ice cream shop in Gabs), picked up some wine, and headed back to UB.
Sat around talking, pretending we were going to watch a movie, and drinking wine the rest of the night. Very classy.
STAY TUNED! -- Next up, CHEETAH PETTING!
We had decided earlier in the week to head out to some of the villages around Gabs for the day – Gabane was our projected first stop, which is famous for its pottery, and Thamaga, where there’s apparently a glass factory and a traditional village meeting place, called a kgotla (prn. ho-t-la). We only had a very vague idea of how to get there, but that started with catching a combi outside the west gate of the UB campus, to the central bus station. Combis are the buses here, and they roughly adhere to a set route, though not to any kind of schedule. According to Jose, another intern in our program who works near Gabane, we needed to get the Tlokweng 4 bus. We thought we had gotten really lucky when the first bus we flagged down turned out to be a Tlokweng 4 – but then it was totally full, and there were 6 of us (Kim joined us). Same story for the next three buses. We eventually gave up and hailed a cab, then openly flaunted the traffic laws by cramming all 6 of us into the one cab (five in the backseat). We got to see some new parts of the city, including the Ministry of Health, which looks like something out of 1984. We also saw where the president lives, though by saw I mean we saw the wall topped with barbed wire surrounding it.
Julia had made us all a little apprehensive about going to the bus station, because she had been once with Boitumelo in the middle of the day, and she said it had been really crowded and confusing. It was busy, and there were buses everywhere, but it was also kind of neat because there were a bunch of vendors selling clothes, shoes, vegetables, candy, etc. Our cab driver was nice and dropped us near the ranks for Gabane, so we found the bus fairly quickly. Only 3 pula!
We piled in and enjoyed the ride out, seeing cows and traditional houses along the way, though we got a bit anxious towards the end because we had no idea where to get off. Also, a girl on the bus told Olivia that she looked like Rhianna, which was really sweet.
Got off at the last stop, which basically looked like a dirt road with some random buildings. We saw a sign for Pelegano Pottery, 1.5 km, so we started walking. It was definitely more like the stereotypical African village – dusty dirt road, chickens and cows wandering about, thatched roof huts mixed in with more modern cinderblock houses. Basically it was awesome. The weather was really nice, so we enjoyed the walk, and everyone that passed us was really friendly and greeted us. Two mothers passed by with their children and told us that they wanted to be our friends – people say that a lot here, and we’ve decided that it clearly means something different than what we think it means.
Made it to the pottery place, which basically seems to be like an arts collective. Everything seemed to be closed – they told us that two of the buildings had been closed for renovations, so we were a bit disappointed. The door to the pottery building had a sign that said “Open – call Martin” and a number, but when we tried the number it didn’t work. We sat around wondering what to do for a few minutes, then Kim had the brilliant realization that the big black mark in the middle of the phone number that we had been including as a 1 wasn’t actually part of the number. We tried it again, and it worked! Within a few minutes, Martin had appeared, let us into the building, and was giving us a tour of the works!
The pottery is made from clay that they take from the hills around the village, which is a typical sort of brownish red. They have two kilns, but they import the glazes from South Africa. Martin’s job is to throw the pots on the wheel, which he did right in front of us! It was fantastic, and we all very enthusiastically purchased some of his wares afterwards.
We wandered back to the main road, stopping at a “general supply” on the way, which is basically like the equivalent of a CVS here (they had Cokes in glass bottles!). We asked for the bus to Thamaga, but the vendors told us that we’d have to bus back into Gabs to get the bus to Thamaga. It was only 1 or so, so we headed back into the city, where we discovered that the bus to Thamaga would be another hour and 45 minutes one way. None of us particularly relished the idea of being out after dark, so we headed to Riverwalk to get tickets to the soccer game the next day and pick up some groceries, while Kim split to go to a French music festival.
I was running a little low on cash, as were a few others, so the first stop at Riverwalk was the ATM. Olivia’s card has still never worked, so her dad transferred me some money to withdraw for her. So of course, my card decided not to work. Great. Next we got our tickets to the Zebras game (yes, that is the national team’s mascot – Botswana is SO much cooler than the US), got ice cream at Milky Lane (the ONLY ice cream shop in Gabs), picked up some wine, and headed back to UB.
Sat around talking, pretending we were going to watch a movie, and drinking wine the rest of the night. Very classy.
STAY TUNED! -- Next up, CHEETAH PETTING!
Tuesday, 7 June 2011
Day 18 - 3 June 2011
Morning report with lots of new admissions. Dr. Kung and I spent an hour afterwards putting together a folder with all the order forms, etc. that we need when we do rounds, while the interns and residents prepped the patients for Dr. Kung to see them. She’s super organized, and she wanted to have all the paperwork with us while we rounded so that she could write the orders on the spot, instead of having to search for the right form. As I’ve mentioned before, nothing here is computerized, and there are very few (if any) copy machines. Orders are all handwritten, the “filing system” consists of a huge three drawer cabinet with poorly labeled cubbies for the different forms (usually filed in the wrong place or mixed together), and forms that have to be filled out in triplicate are done the old fashioned way – get a piece of carbon paper (if you can find one) and stick it in between the sheets before you start writing. Having the forms collected in advance saves us SO much time. Yet Dr. Kung complimented me on my organizational skills, which made me feel pretty warm and fuzzy ☺
Rounded on the patients – amazingly, everyone except one patient was doing much better. I had been more or less certain that at least one of the babies was going to die. Needless to say, it was a pleasant surprise.
Finished rounds around 1, then Dr. Kung talked me through how to do the TB skin test and got one of the nurses to show me how to place it. She told me that I could do the next one, if I feel comfortable. YAY!
Started working on charts while I waited for Dr. Kung to come back. I was done with most of the data entry for June, and I had physically looked at every single one of the 2,233 charts, but as I had been going through I had had to mark the ones that I absolutely could not read to go over with Dr. Kung. We tried to start on my questions in the morning, but then we had to do rounds. I also had not included in my original data entry the charts for dead/aborted fetuses found in dumpsters and brought in by the police to certify death – there were 5 for June ☹ I still had to double-check the dates on all the charts I had reviewed before I noticed the mixed up charts, plus add in those few entries, so I was fine with Dr. Kung taking a little while. It got past 1, so when she reappeared she suggested we each take 30 minutes for lunch, and reconvene at 2. I worked through lunch to finish up the last bit of charting, and had just finished when she came in at 2:45 to say that there were a bunch of critically ill new admissions. So I ended up going to the storage room in the A&E to pick up the next month’s charts (May 2009), while she did what she needed to do (stopping for a 15-minute coffee break on the way, because I had basically scarfed down my peanut butter sandwich in between organizing charts).
Once I walked into the storage room, though, I almost became the next new admission – Dr. Kung had showed me the files before, but I hadn’t realized the true extent of the barely contained chaos that lay within the seemingly innocuous cardboard boxes filled with files. Dr. Kung had said that the records for May 2009 were in boxes in two different rooms. I quickly located one of the ones she had mentioned, but luckily decided to dig through and make sure that ALL of the papers were actually May 2009 before I lugged it back to the paeds medical ward on the other side of the hospital. They weren’t. In fact, only the first stack was from May – the rest were a mix of January and February 2009, with April 2008 thrown in as a bonus. Awesome. I then found the second box Dr. Kung had found, which was not only overflowing, but also completely ripped open on one corner. The people in (what I presumed was) the A&E waiting room next to the two records rooms seemed to get a kick out of watching me flit back and forth with what I’m sure was a comical expression of confusion, horror and borderline hysteria. I escaped after about 20 minutes with a half-filled box of May charts that I managed to cull from four different boxes. I’m still shuddering at the thought of having to go back in that room.
I worked on the new charts until almost 5, when Dr. Kung finally managed to get away from the ward. We were both pretty worn out, but she wanted to get the June charts done once and for all before the weekend, so we plowed through them, and didn’t end up leaving till 6:30. At that point it was after dark, so she gave me a ride back to UB. I hadn’t ever been at the hospital after dark before, and it was PITCH BLACK once we left the building. There aren’t a lot of lights between the buildings, so I literally couldn’t even see my feet as I was walking. Somehow I managed not to trip over anything.
Relieved to make it back to UB unscathed and with a vague sense of accomplishment for the day, I was quickly robbed of said satisfaction by the discovery that I had lost my keys. How that is possible, I’m not really sure, because I had them CLIPPED TO MY BELT WITH A CARIBINER THE WHOLE FREAKING DAY. THEY JINGLE WHEN I WALK, SO I KNOW THAT I HAVE THEM. AUGH. (Sound familiar, Aimee? ;D) Luckily, everyone else was already back from work, so they let me in. That did not, however, mean that I could get in my room. We individually padlock our doors, and I had given my spare key to Boitumelo for safe-keeping on the first or second day. So then I had to interrupt her Friday night to come and let me into my room – she didn’t end up appearing until almost 10, at which point we had all given up on the idea of going out for drinks because we were too tired. Such ballers we are.
Dinner, movie, bed.
Rounded on the patients – amazingly, everyone except one patient was doing much better. I had been more or less certain that at least one of the babies was going to die. Needless to say, it was a pleasant surprise.
Finished rounds around 1, then Dr. Kung talked me through how to do the TB skin test and got one of the nurses to show me how to place it. She told me that I could do the next one, if I feel comfortable. YAY!
Started working on charts while I waited for Dr. Kung to come back. I was done with most of the data entry for June, and I had physically looked at every single one of the 2,233 charts, but as I had been going through I had had to mark the ones that I absolutely could not read to go over with Dr. Kung. We tried to start on my questions in the morning, but then we had to do rounds. I also had not included in my original data entry the charts for dead/aborted fetuses found in dumpsters and brought in by the police to certify death – there were 5 for June ☹ I still had to double-check the dates on all the charts I had reviewed before I noticed the mixed up charts, plus add in those few entries, so I was fine with Dr. Kung taking a little while. It got past 1, so when she reappeared she suggested we each take 30 minutes for lunch, and reconvene at 2. I worked through lunch to finish up the last bit of charting, and had just finished when she came in at 2:45 to say that there were a bunch of critically ill new admissions. So I ended up going to the storage room in the A&E to pick up the next month’s charts (May 2009), while she did what she needed to do (stopping for a 15-minute coffee break on the way, because I had basically scarfed down my peanut butter sandwich in between organizing charts).
Once I walked into the storage room, though, I almost became the next new admission – Dr. Kung had showed me the files before, but I hadn’t realized the true extent of the barely contained chaos that lay within the seemingly innocuous cardboard boxes filled with files. Dr. Kung had said that the records for May 2009 were in boxes in two different rooms. I quickly located one of the ones she had mentioned, but luckily decided to dig through and make sure that ALL of the papers were actually May 2009 before I lugged it back to the paeds medical ward on the other side of the hospital. They weren’t. In fact, only the first stack was from May – the rest were a mix of January and February 2009, with April 2008 thrown in as a bonus. Awesome. I then found the second box Dr. Kung had found, which was not only overflowing, but also completely ripped open on one corner. The people in (what I presumed was) the A&E waiting room next to the two records rooms seemed to get a kick out of watching me flit back and forth with what I’m sure was a comical expression of confusion, horror and borderline hysteria. I escaped after about 20 minutes with a half-filled box of May charts that I managed to cull from four different boxes. I’m still shuddering at the thought of having to go back in that room.
I worked on the new charts until almost 5, when Dr. Kung finally managed to get away from the ward. We were both pretty worn out, but she wanted to get the June charts done once and for all before the weekend, so we plowed through them, and didn’t end up leaving till 6:30. At that point it was after dark, so she gave me a ride back to UB. I hadn’t ever been at the hospital after dark before, and it was PITCH BLACK once we left the building. There aren’t a lot of lights between the buildings, so I literally couldn’t even see my feet as I was walking. Somehow I managed not to trip over anything.
Relieved to make it back to UB unscathed and with a vague sense of accomplishment for the day, I was quickly robbed of said satisfaction by the discovery that I had lost my keys. How that is possible, I’m not really sure, because I had them CLIPPED TO MY BELT WITH A CARIBINER THE WHOLE FREAKING DAY. THEY JINGLE WHEN I WALK, SO I KNOW THAT I HAVE THEM. AUGH. (Sound familiar, Aimee? ;D) Luckily, everyone else was already back from work, so they let me in. That did not, however, mean that I could get in my room. We individually padlock our doors, and I had given my spare key to Boitumelo for safe-keeping on the first or second day. So then I had to interrupt her Friday night to come and let me into my room – she didn’t end up appearing until almost 10, at which point we had all given up on the idea of going out for drinks because we were too tired. Such ballers we are.
Dinner, movie, bed.
Monday, 6 June 2011
Day 17 - 2 June 2011
70% of the population here (according to our sources) is Christian, so we got Thursday off work because it was Ascension Day. Or at least, everyone else did. I was taking longer than I wanted to in going through the June 2009 charts for my research project, so I went into work for a half day to try to finish up the month. I got up at the usual time (read: too early) to try to go to morning report, only to find out that none of the attendings had come in for report. I shrugged it off and decided to dive right into the charts, but since I left them in the on-call room the previous evening, I had to find someone (i.e. a resident) to let me in to get my boxes. Unfortunately, Changi, the guy who had been on call overnight, didn’t have a key to the room. He had had to sleep on a bed in the ward, poor guy. So that left me at work, at 7:40 a.m., with absolutely nothing to do. Yay.
I chatted with Changi and the Team C intern for a while, which turned from slightly awkward to super awkward when the resident asked me whether I was religious. When I answered that our family didn’t really go to church, he replied, “Oh, so you don’t believe in God.” Yeah, they cut to the chase around here.
When Tiny came in to take over for the day at 8:30, she let me into the office, much to my relief. I pored over the charts for 4 ½ hours in blissful solitude, and I FINISHED! MWHA! Much to my dismay, however, about halfway through I realized that although all of the charts for a given day were supposed to be bound together, they actually periodically had different days mixed in, which meant that some of the data I had previously entered was probably wrong, and my tallies for the number of patients seen for each day were DEFINITELY wrong. Great. Fantastic. Thanks, PMH record keepers.
Lunch at Pie City with Julia, Olivia, and Lina. Walked through Main Mall and they bought some souvenirs. Groceries at Spar. Home. Nap for me, while Julia, Olivia, and Lina went to Riverwalk to pick up everything we didn’t get at Main Mall. Basically a fantastic use of my day off.
I chatted with Changi and the Team C intern for a while, which turned from slightly awkward to super awkward when the resident asked me whether I was religious. When I answered that our family didn’t really go to church, he replied, “Oh, so you don’t believe in God.” Yeah, they cut to the chase around here.
When Tiny came in to take over for the day at 8:30, she let me into the office, much to my relief. I pored over the charts for 4 ½ hours in blissful solitude, and I FINISHED! MWHA! Much to my dismay, however, about halfway through I realized that although all of the charts for a given day were supposed to be bound together, they actually periodically had different days mixed in, which meant that some of the data I had previously entered was probably wrong, and my tallies for the number of patients seen for each day were DEFINITELY wrong. Great. Fantastic. Thanks, PMH record keepers.
Lunch at Pie City with Julia, Olivia, and Lina. Walked through Main Mall and they bought some souvenirs. Groceries at Spar. Home. Nap for me, while Julia, Olivia, and Lina went to Riverwalk to pick up everything we didn’t get at Main Mall. Basically a fantastic use of my day off.
Day 16 - 1 June 2011
First day on the wards. I was super excited all morning, and could barely sit still through morning report.
Explaining what I did for most of the day requires a bit of a break from regular programming to explain how the hospital is set up here. Keep in mind that I haven’t worked on an in-patient unit before, so some of this may be similar to the States, and I just don’t know it yet. Here goes:
The ward is divided up into five different rooms, called cubicles, each with (roughly) six beds. Some of the beds aren’t actually beds, just mattresses on the floor, but thankfully there’s only one patient to a bed. Besides the bed, there’s a nightstand for family members to put food, etc., and besides maybe an oxygen hook-up on the wall (not available for every bed) and the occasional IV pole, that’s pretty much it. The beds may or may not have side rails. There are no IV pumps or cardiac monitors. There is one portable machine for assessing vital signs, for the whole unit. There is a TV on the wall in one of the five rooms. Three medical teams – team A, B, and C (very original, I know) – rotate admitting patients every third day, so the patients in a given room may all belong to different teams. The cubicle directly in front of the nurses’ station (cubicle B) is sort of supposed to belong to the most acute patients, with the same reasoning as home, being that the staff can keep a closer eye on them.
As far as the teams go, there is an attending in charge of each team, who switches every month – hence why Dr. Kung was taking over on June 1. We’re Team A (it would also be acceptable to refer to us as the A-team, because we’re that awesome). Interns are assigned to a given team for the duration of their rotation, but I think the residents rotate teams. Not as sure about that one.
Also, I think this is an appropriate time for a tangent within a tangent, to explain how medical training happens here. So the ultimate objective of the Botswana-UPenn partnership (the specific organization that I am working under) is to establish a medical school (they previously didn’t have one in Botswana) and train Batswana doctors to apply our standards of practice. The medical school was officially opened in 2007, so now the first wave of Batswana interns are hitting the wards. What did they do before Penn, you ask? Doctors trained in other countries – so far I’ve met people who went to medical school in Jamaica, Australia, Russia, and the Congo – then came back to Botswana to finish their intern years and residencies. There’s another, intermediate step here though. First, you do a year as an intern, then spend at least a year as a medical officer, working for the government, and then you apply for your residency. But you don’t have to – a person can remain a medical officer for their whole career, working basically as the equivalent of a family nurse practitioner or primary care doctor.
Finally, working our way back to my day – along with Dr. Kung, I attended morning rounds (separately from morning report) with our superstar senior resident, Tiny; another resident, Changi (not sure what year he is, but definitely less than Tiny); and intern, Tsaone. Since it was Dr. Kung’s first day on call with this group, we were all trying to figure out the ground rules. Dr. Kung was very clear that she wanted each patient to be seen by one member of the team in a pre-rounding process, so that everyone would present a patient during the actual rounding. Things were complicated by the fact that we were under a bit of a time crunch, because Dr. Kung had to be able to get to clinic by noon. So not everyone was covered in pre-rounds, but we worked our way through, and I was amazed by how sick all of the patients were. This is where I hope my earlier description of the ward will serve to help me illustrate my point – of our 8 patients, at least four had meningitis, TB, or both, three had pneumonia (including one PCP – Pneumocystis carinii pneumonia, a very severe form of pneumonia commonly seen in HIV-positive patients), one had a congenital heart defect that was dropping their oxygen levels to 70-80%, one was having almost continuous seizures, and one was in a coma (which probably will be permanent as a result of TB-meningitis that was caught too late). I know that doesn’t add up – that’s because several of these conditions were co-existing. The most sophisticated equipment any of them was hooked up to, though, was oxygen and IV fluids/antibiotics. The baby with PCP was so sick, we could hear the child gasping for breath from across the room. Dr. Kung interrupted her review of the charts to examine the baby and write orders then and there. But the only oxygen mask we had was an adult size, as was the pulse oximeter (instrument used to determine how well someone is oxygenating). Also, both the hospital CT scanner and the unit’s ABG (arterial blood gas – a machine that does a rapid blood analysis of electrolytes, blood oxygen and CO2 levels, etc.) machine were down. So one baby who may have been developing hydrocephalus (a build-up of fluid in the brain) because of partially-treated meningitis couldn’t get the brain scan we needed, and the results from the labs we drew on admission two days before still weren’t available. It blew my mind.
Most babies have one family member in with them at all times -- usually the mom, though just as often it may be an aunt or a grandmother. Charts (and I use that term very loosely) are kept on rolling tables (kind of like the bedside tables we give patients in the States) in each room, but X-rays, MRIs and immunization records are kept by the family at the bedside. If we need to compare to an old X-ray, and the family didn’t bring it, we’re out of luck. Electronic records are basically non-existent. To make things even more complicated, Dr. Kung herself doesn’t speak Setswana, so if the family member with the child doesn’t speak very good English, things can get pretty complicated.
After Dr. Kung assessed each patient and wrote the day’s orders, she headed off to the clinic. First, though, she asked where I wanted to spend the day, and after I asked to stay on the ward to help with our (quite long) to-do list, she instructed Tiny to let me practice some of my skills. She said I’m very observant and pick things up quickly, which made me very pleased ☺ We started with the sickest baby first (honestly, it’s impossible to even make such a distinction, since they were all so sick), and went to collect blood from the PCP baby. That was my next shock – there aren’t even alcohol preps here. You take a piece of cotton, pour alcohol on it, and voila, that’s what you use to prep IV sites. Unfortunately, the needles are sized for adults – we have small gauge ones for IVs, but anything with a larger bore (internal diameter) is too long. Our baby already had an IV, so we did an arterial stick to get blood. Instead of having a vacutainer (a piece of equipment with a needle in it that you screw onto the end of a needle to fill blood tubes), we have to pop the tops off of the blood tubes, drip the blood in, and then pop the tops back on. The needles aren’t retractable either, so you have to be very careful about where you put your sharps. Again, mind blown.
Worked through lunch, since the next baby we worked on, the TBM/hydrocephalus case, needed a new IV, blood, and a repeat lumbar puncture (if you don’t know what that is, you don’t want to know), and was a hard stick. In theoretical terms, I knew that IVs were sometimes started on babies’ scalps, but I had never seen it done before. Well, we ended up sticking this poor baby at least 8 times on the scalp, in addition to trying each hand and each foot. Even the LP took a couple tries. Poor bunny. I was also pretty surprised at how calm the family was – the baby’s aunt was there for all of the IV attempts, and she never once questioned whether the residents knew what they were doing, or whether we could get someone else, or any of those other questions really frustrated and concerned parents tend to pose in the States. Definitely a different culture/attitude.
I have a lot of confidence in the abilities of the two residents I was working with, Tiny and Changi, but I was also very surprised at what free reign they had. Dr. Kung was gone at this point, and there were attendings from other teams wandering in and out, but they were mostly gone too, because they were done with their rounds. Residents do all the procedures here – nurses pretty much only take vitals and give medications. Most people thought I was a resident, because: a) I’m white/foreign, and b) because I know how to do stuff.
After helping with three of the patients, Tiny sent me to get lunch. It was already past 2, so I just ran outside the hospital to a street vendor. I’d never tried the food before, but Lina liked it and said it was a more traditional meal than some of the other places we’ve been, so I went for it. I got pap (the staple cornmeal dish), some kind of cooked kale and carrot salad, butternut squash, and chicken curry. Also, a pineapple Fanta, just to try it (it tasted like gummy bears!). I took two bites of my food, then set it in the lounge because two of the nurses promised to show me how to place a TB skin test/let me do one at 2:30. They had disappeared when I got back, though, and after waiting around for 5-7 minutes, I asked a different nurse. She said that she was too busy. I grabbed a few more bites of food, repeated the process, and was told that one of the patients had already had the skin test that morning. Tiny was in a study group, so I decided not to push it any further – if I want to make friends with the nurses, it’s best not to mess with them when they’re busy.
Entered charts for an hour or two, then dragged myself home. We had been planning to go to the Yacht club to celebrate the next day’s holiday, but we were all too tired. Stayed in. So tired.
Explaining what I did for most of the day requires a bit of a break from regular programming to explain how the hospital is set up here. Keep in mind that I haven’t worked on an in-patient unit before, so some of this may be similar to the States, and I just don’t know it yet. Here goes:
The ward is divided up into five different rooms, called cubicles, each with (roughly) six beds. Some of the beds aren’t actually beds, just mattresses on the floor, but thankfully there’s only one patient to a bed. Besides the bed, there’s a nightstand for family members to put food, etc., and besides maybe an oxygen hook-up on the wall (not available for every bed) and the occasional IV pole, that’s pretty much it. The beds may or may not have side rails. There are no IV pumps or cardiac monitors. There is one portable machine for assessing vital signs, for the whole unit. There is a TV on the wall in one of the five rooms. Three medical teams – team A, B, and C (very original, I know) – rotate admitting patients every third day, so the patients in a given room may all belong to different teams. The cubicle directly in front of the nurses’ station (cubicle B) is sort of supposed to belong to the most acute patients, with the same reasoning as home, being that the staff can keep a closer eye on them.
As far as the teams go, there is an attending in charge of each team, who switches every month – hence why Dr. Kung was taking over on June 1. We’re Team A (it would also be acceptable to refer to us as the A-team, because we’re that awesome). Interns are assigned to a given team for the duration of their rotation, but I think the residents rotate teams. Not as sure about that one.
Also, I think this is an appropriate time for a tangent within a tangent, to explain how medical training happens here. So the ultimate objective of the Botswana-UPenn partnership (the specific organization that I am working under) is to establish a medical school (they previously didn’t have one in Botswana) and train Batswana doctors to apply our standards of practice. The medical school was officially opened in 2007, so now the first wave of Batswana interns are hitting the wards. What did they do before Penn, you ask? Doctors trained in other countries – so far I’ve met people who went to medical school in Jamaica, Australia, Russia, and the Congo – then came back to Botswana to finish their intern years and residencies. There’s another, intermediate step here though. First, you do a year as an intern, then spend at least a year as a medical officer, working for the government, and then you apply for your residency. But you don’t have to – a person can remain a medical officer for their whole career, working basically as the equivalent of a family nurse practitioner or primary care doctor.
Finally, working our way back to my day – along with Dr. Kung, I attended morning rounds (separately from morning report) with our superstar senior resident, Tiny; another resident, Changi (not sure what year he is, but definitely less than Tiny); and intern, Tsaone. Since it was Dr. Kung’s first day on call with this group, we were all trying to figure out the ground rules. Dr. Kung was very clear that she wanted each patient to be seen by one member of the team in a pre-rounding process, so that everyone would present a patient during the actual rounding. Things were complicated by the fact that we were under a bit of a time crunch, because Dr. Kung had to be able to get to clinic by noon. So not everyone was covered in pre-rounds, but we worked our way through, and I was amazed by how sick all of the patients were. This is where I hope my earlier description of the ward will serve to help me illustrate my point – of our 8 patients, at least four had meningitis, TB, or both, three had pneumonia (including one PCP – Pneumocystis carinii pneumonia, a very severe form of pneumonia commonly seen in HIV-positive patients), one had a congenital heart defect that was dropping their oxygen levels to 70-80%, one was having almost continuous seizures, and one was in a coma (which probably will be permanent as a result of TB-meningitis that was caught too late). I know that doesn’t add up – that’s because several of these conditions were co-existing. The most sophisticated equipment any of them was hooked up to, though, was oxygen and IV fluids/antibiotics. The baby with PCP was so sick, we could hear the child gasping for breath from across the room. Dr. Kung interrupted her review of the charts to examine the baby and write orders then and there. But the only oxygen mask we had was an adult size, as was the pulse oximeter (instrument used to determine how well someone is oxygenating). Also, both the hospital CT scanner and the unit’s ABG (arterial blood gas – a machine that does a rapid blood analysis of electrolytes, blood oxygen and CO2 levels, etc.) machine were down. So one baby who may have been developing hydrocephalus (a build-up of fluid in the brain) because of partially-treated meningitis couldn’t get the brain scan we needed, and the results from the labs we drew on admission two days before still weren’t available. It blew my mind.
Most babies have one family member in with them at all times -- usually the mom, though just as often it may be an aunt or a grandmother. Charts (and I use that term very loosely) are kept on rolling tables (kind of like the bedside tables we give patients in the States) in each room, but X-rays, MRIs and immunization records are kept by the family at the bedside. If we need to compare to an old X-ray, and the family didn’t bring it, we’re out of luck. Electronic records are basically non-existent. To make things even more complicated, Dr. Kung herself doesn’t speak Setswana, so if the family member with the child doesn’t speak very good English, things can get pretty complicated.
After Dr. Kung assessed each patient and wrote the day’s orders, she headed off to the clinic. First, though, she asked where I wanted to spend the day, and after I asked to stay on the ward to help with our (quite long) to-do list, she instructed Tiny to let me practice some of my skills. She said I’m very observant and pick things up quickly, which made me very pleased ☺ We started with the sickest baby first (honestly, it’s impossible to even make such a distinction, since they were all so sick), and went to collect blood from the PCP baby. That was my next shock – there aren’t even alcohol preps here. You take a piece of cotton, pour alcohol on it, and voila, that’s what you use to prep IV sites. Unfortunately, the needles are sized for adults – we have small gauge ones for IVs, but anything with a larger bore (internal diameter) is too long. Our baby already had an IV, so we did an arterial stick to get blood. Instead of having a vacutainer (a piece of equipment with a needle in it that you screw onto the end of a needle to fill blood tubes), we have to pop the tops off of the blood tubes, drip the blood in, and then pop the tops back on. The needles aren’t retractable either, so you have to be very careful about where you put your sharps. Again, mind blown.
Worked through lunch, since the next baby we worked on, the TBM/hydrocephalus case, needed a new IV, blood, and a repeat lumbar puncture (if you don’t know what that is, you don’t want to know), and was a hard stick. In theoretical terms, I knew that IVs were sometimes started on babies’ scalps, but I had never seen it done before. Well, we ended up sticking this poor baby at least 8 times on the scalp, in addition to trying each hand and each foot. Even the LP took a couple tries. Poor bunny. I was also pretty surprised at how calm the family was – the baby’s aunt was there for all of the IV attempts, and she never once questioned whether the residents knew what they were doing, or whether we could get someone else, or any of those other questions really frustrated and concerned parents tend to pose in the States. Definitely a different culture/attitude.
I have a lot of confidence in the abilities of the two residents I was working with, Tiny and Changi, but I was also very surprised at what free reign they had. Dr. Kung was gone at this point, and there were attendings from other teams wandering in and out, but they were mostly gone too, because they were done with their rounds. Residents do all the procedures here – nurses pretty much only take vitals and give medications. Most people thought I was a resident, because: a) I’m white/foreign, and b) because I know how to do stuff.
After helping with three of the patients, Tiny sent me to get lunch. It was already past 2, so I just ran outside the hospital to a street vendor. I’d never tried the food before, but Lina liked it and said it was a more traditional meal than some of the other places we’ve been, so I went for it. I got pap (the staple cornmeal dish), some kind of cooked kale and carrot salad, butternut squash, and chicken curry. Also, a pineapple Fanta, just to try it (it tasted like gummy bears!). I took two bites of my food, then set it in the lounge because two of the nurses promised to show me how to place a TB skin test/let me do one at 2:30. They had disappeared when I got back, though, and after waiting around for 5-7 minutes, I asked a different nurse. She said that she was too busy. I grabbed a few more bites of food, repeated the process, and was told that one of the patients had already had the skin test that morning. Tiny was in a study group, so I decided not to push it any further – if I want to make friends with the nurses, it’s best not to mess with them when they’re busy.
Entered charts for an hour or two, then dragged myself home. We had been planning to go to the Yacht club to celebrate the next day’s holiday, but we were all too tired. Stayed in. So tired.
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