Reflections

This is Ginna writing from Michelle's name (sorry, I am not normally a blogger). I want to take some time to reflect in general upon my experiences here in Botswana. Although things were slow to start for some people, I was able to begin clinical immediately at the Baylor-Botswana pediatric HIV clinic. Although I had to sometimes be creative in my endeavors at Baylor, I can honestly say that I learned an incredible amount in terms of community nursing as I was able to get a true glimpse of many different communities within Botswana, nurses' roles both in the clinic and out in the community, and pediatric HIV treatment. The most powerful thing I have learned since being here is that a person can possess all of the clinical skills and theoretical knowledge possible, yet without a positive rapport and an understanding of one's patients and community a health care provider is unable to fully care for a patient. From the very first week I was told that the majority of work done at the clinic is social work and not medicine. While that may be true on some levels, I feel that it is an admirable quality to be able to take a holistic view of a patient because in pediatrics a child cannot raise himself/herself. It requires family and community assistance, especially here in Botswana. I have had the opportunity to directly observe how the common African proverbs "It takes a village to raise a child" and "We are, therefore I am" play out in everyday life. It has brought with it a unique and wonderful learning opportunity as well as a plethora of life lessons and opportunities for personal growth. I am certain that I return home a changed person and I will carry this experience with me in my heart for a long time to come.

Community Based Home Care

So Yana and I have been working in Mmopane (a nearby village) to make home care visits with the community health volunteers. The volunteers explained that home visits involve going into homes and consulting with the family to assess the patient’s needs. First they start by greeting and praying with the patient. Then the volunteers will ask the family if the patient has eaten. If water is needed, they will fetch it. If food is needed, they will go and buy food to cook for the patient. They will also do physical labor that the patient cannot such as cleaning the yard and making sure the patient’s home environment is in order. The volunteers and the nurses play a pivotal role in this community. If there is no caregiver in the family, the volunteers and nurses become the primary caregivers. This care concept is almost unheard of in the United States; the selfless, compassionate nature of these volunteer caregivers is insurmountable. Due to the work of these caregivers, the acuity of the patients has significantly decreased making it easier for the caregivers to provide care and see outcomes. These volunteers earn a meager 100 pula/month (about 16 US dollars). Some of this money may even be used to buy food for the most impoverished of families. Needless to say, we have come to find that those who have the least give the most.

Since Yana and I are making home visits with the volunteers, they've somewhat modified their approach. Our visits are more focused on disease-related issues rather than the ADL-focused care that volunteers provide. It has been a very humbling experience and what is more astonishing to me is that the volunteers and patients have trusted us to provide care. I have never been in a patient care situation where I was the sole provider. So home visits involve assessment, diagnosis, and treatment! This concept is fairly new to many of us because in our undergraduate nursing education, we're not necessarily responsible for dx and tx (obviously, this is more in the NP or doctor realm of practice). Nonetheless, it has been a very challenging and interesting experience.

Homesick as an astronaut...

(Disclaimer: I have so many nursing-related things to write about, but for now, this is all that's on my mind... I'll write something more substantial soon, I promise.)

In my room tonight, it caught up with me.

That crushing weight of lonliness that I’ve travelled so far to escape. I don’t know how it got here - which airline it flew in on, or how exactly it knew I was living at the University of Botswana graduate student dorms - but it found me tonight. My chest tightened, making breathing difficult as my mind raced to find a comforting thought, some fantasy in which I could take refuge.

It felt like I was rushing to climb a tree, so I could be safe from some dangerous predator that was biting at my ankles - only every branch I grabbed for snapped off in my scramble. I tried to think of my work here, but instead my mind flooded with images of the abject, crushing poverty of my patients and their families. I thought of home, but instead of envisioning the familiar comforts, all I could picture was the vast ocean, cold and dark, that marked the separation between where I was lying and where I wished I could sleep.

I tried to pull back and remember what I’ve been told in every study abroad orientation I’ve ever sat through: This feeling of lonliness is normal, inevitable even. Home sickness? Somehow the term doesn’t fit. I’m not sick, and I don’t necessarily want to go home. I just want to feel, see, taste something familar.

Strangely enough, the only familar thing tonight seems to be this feeling of isolation. I think of moments in Mexico, New Zealand, India - everytime I’ve moved, the lonliness has caught up with me sooner or later. Across time zones, international date lines, hemispheres, it has always found me. Each time it does, it seems to take hold of me with a grip that is even stronger than the time before. I mean - shouldn’t I be an expert by now? Better yet, shouldn’t my previous exposures grant me immunity against this sickness?

I want this tightness to leave my chest, this wave to wash over me, but I know it’s just not that easy. The truth is that it never really gets any easier.

Even when the lonliness greets you like an old, long-lost friend.

Want to help us make a difference?

As some of the other students have mentioned, we have been spending time at Kamogelo, a day care center for children who are infected with - or affected by - HIV.

We've had a wonderful time at this site because it has allowed us to use our creativity and enthusiasm for nursing and community health and channel it into something really meaningful (for us) and useful (for the people who run Kamogelo).

I put together a short video about the center, and about our work and the work we hope to be doing there in the next few weeks. Take a look and tell us what you think!



(View a larger version at YouTube: http://www.youtube.com/watch?v=flT2fya7VWo)

Let me elaborate on some of the things mentioned in the video:

What we've already done:
We've already created a health record form for the children's files, completed physical exams for about a third of the children, and held basic first aid and CPR classes for the teachers and administrators at the center. Tomorrow, we'll return to Kamogelo and conduct more physical exams, as well as provide health education to some of the childrens' parents; In the afternoon we'll tour some of the sustainable community projects that have been coordinated by Father Tony, the man who is responsible for many of the community health sites where we're doing our clinical rotations.

What we hope to do:
We have a lot of projects that we would like to take on before we leave the country at the end of the month.

• First, when school lets out for recess next week, we're going to put together food packages for the most impoverished families of the Kamogelo children. As mentioned in the video, the meals that some of these children receive during the school days may be the only food that these children eat all day. Imagine what would happen if those families are left with one more mouth to feed for three weeks?
• We hope to raise funds to start a few sustainable projects for some of the community members that live around Kamogleo - for example, we hope to buy chickens for some of the adult HIV patients in the area; these would provide both food and a source of income, which are both extremely difficult to come by for the very sick patients.
• We need to buy supplies for the center's volunteer nurse. She comes two or three days a week to address any health issues that the children might have, but as Kamogleo can't afford to supply her even with simple gauze, she is sometimes limited in her ability to treat the children. A recent outbreak of ringworm can attest to this.
• Other identified needs include preventive oral health education and treatment (we'd need toothbrushes, toothpaste, and single-applicator tooth varnish for 150+ children) and a women's health class for the teachers and staff of the center (judging from the many questions about everything from breast cancer to bathing that we received during our first aid talk earlier this week.)

So, where do you, our families and friends come in?

In the next few weeks, we'll be doing some fund raising via paypal. Donations can be made to holshue@nursing.upenn.edu via the paypal website; feel free to donate as little or as much as you would like. Even just a small amount will go a long, long way here.

And of course, we'll keep you updated on our progress. Thanks, everyone!

Poem 2 - "Compression, Bandaged"

"Compression, Bandaged"

his thumb:
the pulp of a blood orange
throbbing, pulsing
in her trembling hands

her calm words coming out
from some other
mind

his infected blood
spilling over her
white white
gloves
his gasps
his eyes clenched squeezing
out this sight
like two swollen fists
on his face

she wrapped
around and around
and around and around
until the red heat
was tamed
into nothing but gauze
into a secret underneath

but the scarlet splashed
dripping
across his chest
it gave her away

and she lifted his elbow
the very simplest of measures
and told him to squeeze
to make pressure

pressure pressure,
to disobey his instincts

but did he even understand her?

and then the doctor
said put him in an ambulance
but he was already gone
so she ran

out
into the parking lot
into the street
past the hoards
the throngs of people
staring
like meerkats
frozen
watching the others out of the corners of their eyes
to know what to do

she yelled
she yelled
but she did not know his name
still she yelled out for him

and then
there he was
his blue overalls
deep purple now,
these from the job
he might never do again

he'd become another one
of the jobless masses
sitting all day
underneath the trees
shooting the breeze
and starving

crushed by some machine
lost: a thumb

the thing that separates us
from all the other animals
somehow tied to wisdom

My First Post - A Poem, "A Fence for the Wild"

Glossary:
chibuku - a local alcohol, like beer
thebe- Botswana "cents"
pap- a local maize meal, like grits
Pula- the Botswana currency, money
pula- the Setswana (The local language) word for rain
Turkish Delight - A food which casts a spell on you, from C.S. Lewis' Chronicles of Narnia




"A Fence for the Wild"

my hands have broken
frozen in this heat
they have no electricity
no tools
not even rags to wash with

gray dust is turning everything to ash
the green gone in the leaves
our skin
white and black
is all the color
of under your tongue

mouthes are snapping
like venous fly traps
but empty
these flies are clinging
to our ankles, cheeks,
to inside our ears

they've licked clean the coke cans
swirling in the dirt
around our shins
rolling hills of beer cans, chibuku cartons, chips
all these non-foods
that somehow sustain them

and everywhere, like confetti
crinkling candy wrappers
from the women selling them
on the side of the road
for thebe, only thebe
for a whole day in the sun

Father comes up with that plan after
each other fails
Are they too sick to cook?
To ill to crochet?
Or too content sitting all day
watching the children run
somehow, some magical carousel
around them?
dust devils spinning, disturbing
the carefully combed yards, of dirt
they sweep each morning
backs bent
hunched over like the old women they'll never live to become
Or are they too hungry?

Botswana takes such pride
in their ARVs
and yet
Where is the water
to swallow them?
The pap, the maize
to keep them down?

this sun dries everything
except for the tears
they never arrive
they have gone to where
anywhere
they still bring relief
Here there is no Pula
no pula
and no one remembers the prayers
to call it down
they know the Our Father though
in a language they don't even speak

We hold hands
making some kind of fence
to keep out the wild
to keep in the hope
a wild animal itself
always finding holes
to sneak out from
We must cling tightly

I saw a boy today
raised by a wolf
swooning, moaning in the sun
drool and porrige covering
his chest
wracked, mucous dried black
in his nose
he cannot open his eyes
But what is there to see?

only a mother who raises glasses
more than children
whose barred teeth
look like gaping windows
shut
keeping us
and everyone else
Out.

in this village
donkeys and wheelbarrows
(usually reserved for farms
but in this dead earth
not even cacti are growing)
these wheelbarrows are Trucking
water jugs
Thank God!
and on the side someone has painted
"We are fighting the wrong war"
here
The water is work
it does not quench your thirst, only creates it

I smack my lips
stomach clenching hungry
but what fraction of hours ago
have I eaten, less than they?
i dig
for a granola bar
in the bottom of my bag
and break it into four
peices
so we can go on, together

these angels
to be paid in another lifetime
these people
who walk and pray and clean and cook and wash and cry
for the people who can not
any longer

She holds hers
minutes longer
than the rest of us
gazes at it
like it's Turkish Delight
and slowly licks her fingertips
for every last bit
of sugar

The Politics and Pains of Poverty....

Politics and Poverty: So, last night Jody wanted to take us all out to dinner. Us being the maid who used to work for Mallach House (where the MDs stay when they visit here) and her four children, and four of us nursing students. We had to go pick the family up with our car, because they couldn't afford one of their own. Hilde (pictured above) was the mother of 4, and they lived all together in a very small flat located directly behind the medical students' flats. It looked like an alley way when we approached it: narrow walkway bordered by the flats on one side and a wire fence on the other. Firewood was strewn about the ground, and a small cooking area with one pot and pan, and a metal wirey grate is what they used to cook with. Their "broom" was nothing more than a collection of rubber-banded tall pieces of grass, and there was no running water or electricity.

This highlights the gross social inequities throughout the world, felt in both the states and abroad. Not to say this sort of thing doesn't happen in the states, internally, but it was especially noticeable here, 9,200 miles away from PA, yet this woman, who supports her four children on 1000 Pula per month (~$166/month!) is the epitome of the classist society in which we live. Imagine, the five of us, 4 white people (which they all "Le Cura", with a rolled "r"), and Komal, many of whom have our laptops in our backpacks, digital cameras to take pictures, and greeting this family (and other family's children who were playing outstide) with nothing but smiles. I noticed that many of the kids we saw had clothes on that were very tight, did not fit, or looked very worn down. They cannot afford clothes for many growing bodies, and Jody usually brings old clothes that she doesn't anymore from her kids and grandkids to donate to this family and group of families. We took a bunch of pictures together, and then we headed to Riverwalk, to this large restaurant where there was a playpen for kids. Jody drove the family, and we took a cab there.

When we arrived, we figured out what we wanted to order and then i was responsible (that being a relative term, cuz i had a LOT of fun!) for taking Lewo, the youngest girl, and Tato, the only boy, to the playpen where they could jump, slide, "drive cars", play foosball, and just play outside and be kids. It was amazing to me, to see the excitement, pure joy, and enthuse in their eyes and bodies, despite everything they have been through (One of Hilde's daughters, Sinsane, is a Zimbabwean refugee and does not have papers to be living in Botswana, so her English is the poorest of any of them, and cannot attend a Botswana school. The father is not a part of the family and does not contribute any finances to help raise the kids; that responsibility is left entirely to Hilde and her meager wages.

I was so impressed with how composed and how fun Kwasabo (pictured left) was, the middle child of Hilde's. She liked hip-hop music, her favorite artist being 50 cent (LOL!), she loved to dance, read, go to school, pose for the camera, and aspires to be a Medical Doctor when she grows up (she is 15). Being the only male in a household full of estrogen, Tato, age 10, was very soft-spoken, but when he wanted to play foosball or go outside, he would not hesitate to grab my hand and take me for a stroll. Lewo, the youngest at 7 years of age, was also soft-spoken, and her english wasn't as progressed as the others, but i could form simple sentences (is that sunday good? did you have fun!?) and she would be able to nod or shake her head in agreement or not. As i was watching her bounce in the play pen with the other kids, she would tap the screen and say "Hey!", as if "Hey, look at me jump!", then she would flash her pearly whites just in time for me to snap one picture of her. I have to admit, being their with 2 kids as my responsibility made me feel all paternalistic and fatherly, something i have never felt (as my professed "hatred" of kids until now was too strong to allow me to feel that), and it was SO NICE and fun. I have finally discovered a feeling that i wish to bestow onto others, a feeling of love for those in need of love and caring, and those less fortunate than I....

After eating full entrees, and desserts, and after yoinking 2 balloons for Lewo (she wanted red) and Tato (he wanted yellow!), we parted and left for the dorms (we spent a good 3 hours with the family. and when we parted, they all smiled enthusiastically, as if in anxious anticipation for our next meeting at the playpen). We all thanked Jody for dinner and basically told her that she was our new role model in life. This woman, Jody, has many kids and grandkids and has a heart of gold. Hilde's kids all called her Grandma, appropriately, and they loved her so much. To see Jody walking hand-in-hand with each of the kids at one point of the night was quite a site. She is so happy all the time, and has so much to give to others, so much insight, so much worldly knowledge and experience, and so much love for those in need of something just a little bit better.

Ranting time: So, what do i say about the Wealthy Institutions of the West. This gross act of disparate living within the greater systems established is sickening to me. Literally, living directly behind students, Hilde and her family don't have proper sanitary appliances and devices as to make sure sickness would be avoidable. These flats are rented from the landlord here, and the students get the side with running water and electricity, while the maid for these students doesn't get the same treatment, even though the landlord is held responsible for the same living conditions for Hilde as the students receive. All the tenants would have to do is make a little push here and there to get the compliance from the landlord. It aggravates me and makes me sick, and it is all the more worse that, even though this family lives in utter poverty here, they kept up their cheerful demeanors and smiling faces when we greeted them, probably because they don't know any different. And that is not how it should be!

So, long story short, i wish i could save everyone and the world, but i recognize and realize i cannot. One by one, i will do my best to touch lives and use the privilege and fortunate background to which i have been accustomed in order to better life across the globe, as well as in the states. I KNOW i come from privilege, and i can recognize it (i'm a white male, i mean, come on!), and that realization can in turn empower me, like it has Jody, help those around me and those less fortunate than I have been (not meant to sound like a bleeding-heart here, or some sort of living martyr!). This is my calling, this is my life, and this is my future....