Planning and Executing!

Sixth night in this new and exciting country and I feel almost at home. This is definitely because of the people here. Everywhere I go I am greeted with friendliness and curiosity and kindness. In the streets, in stores, and around campus, once I say Dumela-mma or Dumela-rra (Setswana greeting for female and male), I get smiles and questions and generosity in return. Also, this country seems to be very slow-paced, slower than California. This is really refreshing for day-to-day interactions, but of course this could be frustrating sometimes like when we examine some glitches in the healthcare system.

Today was an exciting day for me. The past few days Jodi, our instructor, has been working hard to set up our clinical sites and get us started but, like I said earlier, things move slowly here. Today however, some of us went back to the Kamogelo Day Care Centre, which Derek described in the previous blogs (with the awesome pictures and video of kids dancing), and talked to Father Tony about how we can be most helpful to the community. He told us about a sewing project they have set up for the community where they provide sewing machines (with donated money) and teach the locals how to sew; this way they can then sell the clothes they make and feel ownership over a newfound talent… I wish I could sew! Some other projects include finding a way to get water to some remote villages (digging underground for wells), buying chickens for a few families to use for eggs and eventually to sell, and building rooms or roofs onto homes so that their aren’t 8 people in a small room – one can imagine how that cannot be healthy. It was an incredible experience just to witness how this type of work can be set up for students and volunteers. Conversations like the one we had today is vital around the world; as cheesy as it sounds, helping one another is the best thing we can do. Next week, we will teach the teachers at the Day Care about CPR, the Heimlich Maneuver, and basic first aide, like what to do when a child gets a cut or has ringworm. We will also do physical assessments on the children, and record their health info so that in the future, they have a baseline to compare to. In my experience, organization in many countries with needs secondary to poverty and inadequate healthcare is hard to come by, so we were all incredibly excited when Father Tony was so accommodating for us to come and help in any way we could. I can’t wait to get involved in these projects!

Bean Leaves and Duck-Duck-Goose, Of Hippie Beliefs and African HIV Politics, MDR and XDR

Bean Leaves/DDG: So, you'll have to check out some of the videos i posted on here, but this night was incredible. The University of Botswana had some international student orientation business (which none of us Penn nurses attended cuz we slept in too late still adjusting from jet-lag! :-)), but we were still invited to the "traditional botswanan dinner" out in some village on tuesday night. First of all, this "village" they spoke of was deceiving: i was thinking it was going to be out in some hut and all, but this woman's house was POSH. it was like a mansion out on some farm, with an outdoors area for all the students to sit and eat and talk. After introductions of about 30+ international students, we formed a long line buffet style for dinner. It was not that good, but i was really happy to experience a traditional dinner. And there was this alcoholic drunk mexican who kept interrupting introductions...so short story: The introductions included name and favorite drink, so when it got to the mexican PH student in the circle, and he said "tequila", the drunken mexican guy was like "Ehhhh!!!! TEQUILA!!! Corona!? Mi amigo!" and it was hilarious. the shy germans were very put off but it was a good time, and it wasn't til later that the host (big african woman in red in the first pic) announced that he was her husband! We had a LONG laugh about that and continued to enjoy our meals...(my favorite part being the bean leaves which were hella salty, mixed with the white BLAND-ASS sorghum which is what the states uses to feed livestock!)


Pic 1: The meal (clockwise from the bread): Bread biscuits, bean leaves and veggies (REALLY salty), some small portion of meat i accidentally grabbed, white corn/sorghum stuff that is apparently fed to livestock in the states (it was incredibly bland and tasted a bit like plastic), semp or kemp or something high in fiber that they feed to malnourished kids here, and some sweet sauce thing that i dipped the bread in.








Pic 2: Ginna and Andrea's response to the meal provided above, lol








Pic 3: Komal and I havin' a grand time singing.









Video 1: The host is on the right, dancing and singing, and two other students, from UBotswana but who studied in the states for one year are on the left, singing at dancing as well. we are all clapping along to the beat:)



After dinner, we sat around and got taught traditional setswana dance and song, and it was KICK ASS. there were probably 5 botswanan students who just got back from studying in the states for one year, mainly at Kalamazoo College in Michigan (WTF!?), and they took trips to CA and their favorite place was (drumroll please....) San Francisco, DUH! she said she loved it, and they all clung to be instantly. obviously, me, the californian who loves SF and we hit it off. it was fun....then we played games. and we played this version of Duck-Duck-Goose and it was SO FUN! kinda random, but after they (the hosts) were all done showing us games and songs, they asked us if we had anything to teach them. One of the germans (random) taught everyone "if you're happy and you know it..." so we had a grand ol time shakin our booties to that. after like 5 hours of playing, we finally left on the trip back home in the Combi van seating 15 or so of us. crazy...everytime we go somewhere, i think we're gonna get taken off to some slaughterhouse like in hostel, lol.......thanks for making me worry dad! ;-)

Video #2: Follow-the-Leader Type dance, i am at the end in my red sweatshirt, peacing out at the end of the line...



Hippie Beliefs/HIV Politics: So, i don't have any pics of my instructor, Jodi, yet, but i wanted to talk about her for a bit. Jodi, Jenny, and I visited Mallach house yesterday, which is a house that Penn owns that houses all the visiting MDs when they come to work here every couple months. In the car ride back from Mallach House, i was asking Jodi about HIV and the politics and she is EXACTLY like me: she was basically saying how here, adults don't get put on ART (Anti-Retroviral Therapy to control their HIV) until they are "really sick", as in stage 4 HIV, which is classified as progression from HIV to AIDS, and their CD4 counts are as low as 0-4. I got enraged, and so did Jodi. She prefaced this conversation with "I am extremely biased in my opinion, so i am not sure i should go blabbing about it", but it's all corrupt bureaucracies and politics associated with paying for the meds. New patients will come in and get counseled on HIV preventions, but will be turned away from drugs because they "aren't sick enough". We all talked about how Penn and other associations paid with PEPFAR money (PEPFAR: President's Emergency Plan for AIDS Relief. go here for more info: http://www.pepfar.gov/about/) spend their money on brand-new beautiful buildings, and pill counters for the MDs and pharmacists, and how they are salaried in the high triple-digits and how none of the money gets trickled down to the people dying of AIDS who actually need it. It makes me sick. and one of the residents at Penn in ID work has talked with me extensively about PEPFAR and how Bush's signing of this bill to aide African nations in the fight against AIDS is the biggest in history, however it focuses 60% or so of the relief money to Christian Organizations which PREACH abstinence, which DOES NOT WORK.














(Both sides of the debate: FOR abstinence: http://www.youtube.com/watch?v=SmRrJFffkSA

Against Abstinence (this video kills me): http://www.youtube.com/watch?v=ZtL-NRBmHug

Make your own decision!)

So, Jodi and I went back and forth agreeing with each other for a while, and how POOR the policies the Bush Administration has administered are regarding abstinence-only education, and the Global Gag Order..

(Against: http://www.commondreams.org/news2001/0606-04.htm
http://www.bayswan.org/gagorder/mainpage_gag.html

For it: I couldn't find any official sites FOR it...how funny....google is pretty good at finding stuff too!)

...which mandates anti-abortion policies for clinics in Africa receiving US Aide, which leads to abortions being performed illegally and incorrectly, leading to poor women's health. Ugh, anyways, it was amazing to know that this awesome instructor of our's shares nearly the same opinions on all subjects related to our trip here! Jodi ROCKS!

MDR/XDR: So, Jenny and I met with a nurse and an MD from the HIV/TB clinic where we'll be working for the next 4 weeks, yesterday. They said we'll be in contact with MDR/XDR (Multi-Drug Resistant and Extensively Drug Resistant) Tuberculosis. Ugh.....i was so intrigued and kinda scared, but this is the kinda work i wanna do. Once i told them i used to counsel people in STIs and sexual health, the nurse piped up and was like "we could use you at the clinic to counsel new patients who have seroconverted (HIV- to HIV+, new status), because the first step is counseling the patients about safe sex and HIV prevention (Um, HI. My name is derek, and that is my specialty!). At first, they were both apprehensive to have students at this busy clinic of their's, but after seeing how excited we were when we met with them at Mallach House, they were fine. I will be working there M, Tu, Th from 7:30-4ish, racking up clinical hours, but moreso racking up experience. Every other week Jenny and I will be switching off between the HIV portion/management of the clinic and the TB portion. Then, the last week we're here, we'll be doing outpatient visits to/from people's houses, who have TB, which is awesome. There is also the option of flying up to the NE border of Botswana/Zimbabwe and working with Zimbabwean refugees from the civil war there from the election, cuz there is apparently NO food and killings and lots of IDPs (Internally Displaced Persons), but some of the other girls wanna do that. While i would LOVE to do that and help with aide, house-building/shelter/food and healthcare, but i'll stick to my HIV/TB clinics, as that most pertains to my future as an HIV/ID NP.


Pic to the right: Yana, Andrea, and I making dinner in the dorm and getting ready to see the Dark Knight at the local cinemas!

Love made visible

As Derek mentioned below, last night we went out to dinner, and the servers' jackets' had the above message on the back. I thought it striking, and an appropos message to ponder as we embark on our nursing clinical work. Something like love is exactly why I'm going into nursing.

The note was all the more poignant at the very end of the night. As we were leaving, we mentioned that we were nursing students. The server stopped cold. "I'm glad you are here. Our people are dying." He went on to tell us that his cousin had just died; he was going to her funeral in a few days.

We were all humbled by what he said. On the way home that night, we talked about how interesting it is that wherever we go around the world, we tell people that we are becoming nurses, and they are suddenly willing to open up to us about the most intimate parts of their lives. In my opinion, that trust is one of the best parts about this profession.

Love, made visible.

Kamogelo Daycare Center

We took a long drive out to the Kamogelo Daycare Center today for HIV/AIDS-affected kids. 17% of these kids have HIV, and most others have one or both parents who are HIV+ or have died from AIDS. When we first entered we heard lots of singing and then shortly saw dancing of the kids with the teachers. I felt a sudden rush of empathy for what some of these children have been through, excitement for the smiles on their faces, and it basically changed my whole view of kids and pediatrics in one swoop or visit. it was amazing. just knowing what these kids have gone through, many of them taking ART (Anti-Retroviral Therapy) for their HIV at such young ages (starting at 6 months of age if they were born with it), or having lost parents to AIDS and the fact that these kids can still have smiles on their faces and laughing and dancing around. It gave me chills and tingles...

Most of the 6 and 7 year olds speak some english, and taught me their names. The one in the beanie in the pictures was one of my favorites, named Okaf. Another girl, not pictured, whose name was Amakgala, was also one of my favorites. They loved my shaved head, my tattoos on my feet (see pics below), and absolutely LOVED my digital camera to see themselves on it! they went crazy. we played with them mostly after lunchtime, which consisted of beans and semp (some type of veggie stuff) porridge, high in protein. I was ecstatic to have this experience, which had nothing to do with our clinical experience, because i will be mainly working with adults. We left after an hour of playing to go to the mall (weird transition) to get lunch, grocery-shop, browse, and.....

Pic #1: Kids playing around and singing with the teachers in traditional Setswana tongue....they were so happy!




Pic #5: We were all showing how old we were on our hands and fingers....most were 6 or 7, i was apparently 10.





Pic #6: They were obsessed with my tattoo. see he's pointing! the 6 and 7 year olds know some english. and in order to teach them, you say "Ere Tattoo" which means "Repeat, tattoo" so they learn new words.


Pic #7: they don't see boys often, so when a "strong" boy comes around, they flex and grab the boy's arm muscles, and hang off of him. you can kind of see it here, but behind the front row of boys, there's a couple boys grabbing onto my bicep as i flexed for them! it was cute!



Pic #8: Kgale hill behind me. it's famous, but apparently forbidden to tourists now due to high rates of mugging. i won't be venturing up there...

Video #1: kids dancing around when we arrived, it was amazing to see. check out the kid in the front, shakin his booty to the rhythm! awesome moves bud!

Botswana Days 2 and 3

Pic #1: Our grad dorms, suite-like space with the shower room on far left, toilet room in the middle, and down the long hall on the right is my small room with a heater, closet, bed, table, mirror, and bookshelf!

Globalization: It is so weird. There are poor people everywhere, people riding in cars with 12-14 people were van (not enough seats), people trying to sell things on the street in the HIGH UV indexed sun with signs that read "talk to me", meanwhile those who have money go to the Riverwalk mall, where there is a 4-theatre cinema playing Dark Knight, WallE, Hancock, and Wanted (all new movies!), places to buy imported smoked salmon, ALL electronics needs (like a HUGE warehouse best buy, called "Game"), and high-class dinners and lunches served to those willing to foot the bill. Last night, we went out to Dinner at Primi, this awesome Italian Restaraunt, with the 8 students and our instructor, Jodi (who rocks cuz she knows SO much about botswana!). I ordered a HUGE serving of Frutti di Mare seafood pasta, and 4 dark chocolate brownies with cream/ice cream for dessert and it cost me 90 Pula, and it's about 6.75 Pula = $1, so it was about $15, which was NOT BAD. i was so surprised. After spending a good 3+ hours there, our waiter, Timothy, (pronounced Te-mo-tay) wanted a picture with us, so we took one with him and promised to get a developed photo back to him. He spoke to a small group of us afterwards, and we told him we were nursing students and his response was almost heartwrenching: "Thank you, our people are dying of AIDS". You could see the humanity behind his dark brown eyes, this waiter, clad in a bright orange uniform with "Work is Love Made Visible", opening up to us as we give him his tip. Jodi, our instructor, was explaining that tips in Botswana usually are around 10%, which was like 90 Pula or $12, which wasn't a whole lot. She said she likes to give more because many of the service workers go home to places with no running water, none of the amenities that we are luxuriously granted at the dorms. Timothy said his cousin died of AIDS last week and that he is going to her funeral next week, that he is raising 3 kids at home and trying to save up to install running water and a water heater. this was a huge reality check for me, coming from America. I rag on America all the time, but i am realizing it COULD be worse. I mean, some things here are all "westernized": Ford dealership in the main downtown area, people driving Mercedes all over, traffic jamming the freeways during rush-hour, self-proclaimed hip-hop booths at the mall, etc. It's all very interesting and eye-opening. Basically, White = Money = Power, and it's more apparent here than anywhere else i have seen.

IDCC: So, we are here for my community clinical experience for nursing at Penn. I will be working with one other student at the Infectious Disease Control Center clinic near the Princess Marina Hospital. Supposedly, 70% of patients have HIV with 50% of those co-infected with TB. The hospital doesn't turn any patients away, so there are apparently many people lying on the ground, some dying, and it can get very intense, from what i've heard. i don't start working there til next week i think (this week is more orientation, buying things to settle in, technicalities cuz some people still don't have luggage or working keys to their room doors). This is pretty much EXACTLY what i want to do, so i am SO excited at this prospect. I was asked to wash hands frequently, wear a mask, and don't get near people who sneeze, to prevent myself from acquiring a latent TB infection, for which i would need to get chest xrays instead of PPDs to be tested for TB for the rest of my life :(

Pic 2: Best sign ever! They have these random postings about healthcare all over campus, and of course, this is my favorite one! There is another one about Cervical Cancer and Testicular Cancer screening for students, which we don't have anything like on Penn's campus or any campuses in america!


Pic #3: I hate to get political in my postings, but EVERYONE here wants Obama to win. I have seen 4 guys wearing Obama shirts already here, and this awesome bumper sticker with the "O" as a globe! UH!!! I mean, Obama has heritage from Kenya, so the whole african continent wants him, as well as all of us, so we were HELLA excited to see Obama supporters here!

The first 12 hours!

12 hours after I got off of the plane in Botswana, I was walking down a dusty road in a major slum settlement, headed to church with a toddler on my hip.

I suppose I should back up for a second and explain.

We arrived late last night, exhausted from over 24 hours of transit. There was some confusion over rooms and room keys, but finally most of us got settled in. We were lucky to meet some fellow international students who were living in the dorms as well; they did an amazing job helping us get oriented to the area - they even invited us out for the night. Despite being unshowered and road-weary, a few of us decided to venture out with them, and miraculously made it until about 4am.

A few of the our new friends were telling us about the children they had been working with in a settlement called Old Naledi. The settlement is the poorest and largest in Gaborone, and we heard reports that the HIV rate is over 90% there. Our fellow students invited us to come visit - to attend a church service with them the following morning.

So we got up with just a few hours of sleep, put on our Sunday best - something I haven't done in ages - and hopped the crowded combi busses for the edge of town. When we got to Old Naledi, our student friends took us to visit some of the homes of the kids they have been working with. Little by litte, young children started to gather around us. A little girl walked over to me, looked up at me with her big brown eyes, and gave the international symbol for "please pick me up."

After we gathered a number of kids, holding our hands and riding on our shoulders and hips, we headed to the church - a tiny, double-wide trailor on a large empty lot.

I sat with that little girl on my lap during the entire church service. Without a stethoscope, I could hear that she had an intense respiratory infection - the wheezing was just that loud. I hugged her tightly as we listened to the sermon and I could actually feel the crepitus from her lungs. I wondered about the type of medical care that was available to children like her. How could she get the help she needed? Are there antibiotics? Could her mother afford them for her? I spent half of the service patting the little girl on the back with my cupped hands, respiratory-PT style, while these questions were brewing in my mind.

I'd love to come back and work with some of the families in Old Naledi. The great news is I think I may be able to - one of our clinical sites, the Holy Cross Hospice, is located in this settlement. I won't know until later in the week at the earliest about my placement, so for now I'm left with a lot of questions... and a vague understanding that there is work to be done here, if we can find a way to do it.

We're HERE!

After 24+ hours of transit, we made it to our new home for the next five weeks: the University of Botswana Grad dorms. Half of our bags didn't make it with us, and we've had a lot of complications with our housing, but those are other stories all together. Our first day in Botswana has been very eventful - stay tuned for more posts!

Our first adventure...

... and we haven't even left the country yet!

It all started a few days after our meeting with our clinical instructor. Jenny was browsing the Craigslist "Free Stuff" postings earlier this week, and she came across a posting for "Free Medical Supplies."

She got in touch with a woman who said they had "cotton balls and gauze" and some other things. Envisioning a few small boxes of supplies, I picked Jenny up early on Thursday morning, and we headed towards the heart of West Kensington to go pick them up. (For those of you not familiar with Kensington, it's perceived as one of the poorest, most dangerous neighborhoods in the city of Philadelphia.)

Once we got the the address, we realized we had been directed to Prevention Point , a non-profit organization that focuses it's efforts on injection drug users and sex workers. The organization runs the only clean-needle exchange program in the city; they also run a drop-in center and help connect their clients to vital services like HIV testing and drug rehabilitation services.

The employees were excited to see us. They were working on cleaning out their storage room, and wanted to get rid of boxes of extra supplies that had been laying around for a long time.

We were shocked when they showed us all of the stuff that they no longer had a need for. Cases of gauze, cotton balls, syringes, medical tape, gloves. They gave us a hand truck and told us we were welcome to whatever we wanted. In three trips, we filled up the entire backseat of my car with cases and cases of supplies.

Jenny and I were completely wowed by their generosity. In my experience, I've had a hard time getting medical supplies donated from the huge University of Pennsylvania Health System, but here we were in the basement of a Kensington non-profit, filling up my car. It was hard not to laugh at the irony.

The moral of this story is: We now have a TON of medical supplies - everything from gauze 4x4s and 2x2s to respirator masks and urine sample cups - to bring with us to Botswana. All we'll need to get are more gloves and hand sanitizer, and I think we'll be all set!

Two weeks to go!

In exactly two weeks, we'll be boarding an Africa-bound airplane. Two weeks couldn't be further away - and at the same time, it seems way too soon. So much to do before we get on that plane!

This week we began the lecture portion of N340, Community Health Nursing. While our classmates started their Community Health clinical rotations, the students going to Botswana have Tuesday and Thursday clincal days off for the next few weeks.

We're not worried though - with three clinical days a week (instead of the standard two), we'll more than make up for lost time when we start at our clinical sites in Gabarone.

We also were fortunate to meet our clinical instructor this week - the School of Nursing brought her out from Oregon spefically to meet us and the other course faculty. She's had a lot of expereince working in Botswana, and she seems as excited as we are for the experience. I think she's going to be a great resource for us.

That is vital, considering we're heading to a place where resources of all kinds can be scarce. Case in point: in our meeting, one of the things we discused was the possiblity that some of our clinical sites will probably be low on vital supplies like gloves and bandages. Our instructor suggested that we bring our own gloves and big bottles of hand sanitizer.

We're entertaining the idea of reaching out to friends and family in a sort of mini-fundraiser, in order to purchase extra supplies to take with us and leave at our clinical sites. More on that soon!