whirlwind

the last few months have been a whirlwind....in a nutshell (or bullet point list/attempt to be concise) i have:

- road-tripped with the howards to chobe national park (awesome game park)....supposed to go to victoria falls as well but like a genius left my passport at home
- gone to benghazi, libya for the BIPAI annual network meeting
- spent a week in egypt (cairo + 3 day nile river cruise to aswar/luxor)
- ridden a camel around the pyramids
- hiked table mountain (cape town)
- driven all over namibia in a giant 4x4 truck
- gone SKYDIVING (this was huge, totally afraid of heights)
- 4-wheeled in the namib desert up and down sand dunes
- kayaked in the atlantic with dolphins and lots and lots of seals
- rappelled down a waterfall (or right next to one) which happens to be the world's tallest rappel (again, scary)
- gone on a donkey pub crawl in a small mountain town in lesotho
- hiked mt kilimanjaro
- all in all traveled to 6 countries outside botswana (libya, egypt, south africa, namibia, lesotho, tanzania)



wow. i can hardly believe i got to do all that - when i list it out it makes me realize even more what amazing opportunities i've had over the last few months. i may have no money or vacation time left, but both were well spent and i'm so thankful to be able to see/experience so much while i'm here. and i promise i've been working too!

speaking of work, exciting news....i just finished my last week of wards!!! we're transitioning our role in the hospital to the new pediatric department at the university of botswana - they just started a residency and recruited new doctors, making it the perfect time for us to start phasing out. don't think i'll miss wards too much, at least not as it is now. i'm hopeful though - the new staff have started the long and difficult process of overhauling princess marina...we'll see.

so i mentioned sharing some patient stories....kinda dropped the ball on that! there are so many though, the children here are some of the most precious i've ever met. i'll start with 2 recent patients, each heartbreaking in their own way...

kefilwe - a 7yr old girl i saw in clinic while on outreach in mochudi (smaller town about 1hr from gabs). she was there with her granny - an entity to both fear and admire here in botswana, they can be either your best friend or worst enemy. this granny was the best friend type. she appeared to be in her mid-70's or so, sharp as a tack, and doing an awesome job of taking care of her granddaughter (many children have lost one or both of their parents and are taken care of by relatives). clinically kefilwe is doing very well, taking her meds 100% of the time, can tell you why she's taking medicine, and overall is happy and thriving. it was a joyful visit with lots of storytelling/laughing (in setswana, but didn't need to know the language to catch the feel of it), which was a welcome break from some of the more somber encounters. at the end granny announces that kefilwe likes to pray after she takes her medicines and asks her to pray for us before she leaves. in one of the sweetest voices i've ever heard and less-than-perfect english, kefilwe recited the Lord's prayer. it struck me in a way that's difficult to explain - full of innocence and hope, a beautiful accent and made up words, it was perfect. a pure reflection of our Father, the kind of moment that pierces your heart.

there have been many heartbreaking moments here in botswana - some break your heart with joy such as kefilwe, others not....heart wrenchings that you can't possibly prepare for. my last week on wards had one of those moments....a child on my team with a pulmonary hemorrhage (bleeding in the lungs) from extensive tuberculosis. her name was jan. she was 10yrs old, also HIV+ on medicine, doing well until this admission. she came in very ill and i knew from the beginning her prognosis was poor. knew from the beginning that there would be no one to perform the procedure that might have found the source of the bleed and stopped it. but it's no easier to accept now than it was at the beginning. between leigh and i we called/consulted everyone we could think of, but the answer was as expected, no one could help. i spent some time in her room, wracking my brain for alternatives, trying to comfort her and myself, and i will never forget her eyes when she opened them briefly to look at me....she knew too. all we could do was try to make her comfortable, she died later that night.

as i said, precious....precious faces, voices, laughs - thankfully these are the majority and fill most days. precious souls gone home early - these often fill our memories, but we must remember they are even more precious in His sight.

"yet this i call to mind and therefore i have hope: because of the Lord's great love we are not consumed, for his compassions never fail. they are new every morning, great is your faithfulness." - lamentations 3:21-23

another month....

i've been in botswana 7 months. i'm at that point where it feels like a moment and a lifetime. it's also starting to feel more like home, finally. this transition has taken much longer than i expected, but i suppose i was naive to think that moving, living, working somehwere would be as easy as going for a month long mission trip. cultural difference that are quirky for one month can be a real struggle when it's several....you tolerate things when you're a visitor, but when you make a place your home you selfishly expect it to be like home. that expectation is totally natural, but also unreasonable and incredibly frustrating. i realized this early on but it has been, and is, a process to brek that fixed notion. certain things still drive me crazy....i.e. everyone says "don't you have" instead of "do you have" and "you will give me" instead of "will you give me"...."don't you have 10 pula? don't you have a pen? don't you have a sticker for me?? you will give me your banana." the work ethic and order of priorities is different than i'm used to, and you often feel like your presence here is not necessarily desired/appreciated....but honestly, when i put myself in their position i can see why they're wary of me. and these things aren't necessarily wrong, just different. slowly but surely i'm starting to accept them, and a million other things, as home in botswana. the patients are now familiar, the clinic staff more friendly/helpful (they had to warm up to us as well), and every day it becomes easier to let the little things go and appreciate the beauty of some of our differences.

the last 2 weeks leigh and i were in serowe (outreach site 3 1/2 hrs north of gabs). life is much slower there and with no internet access and no friends, we'll just say that it made me miss home....then i realized that "home" was gabs, this was a serious breakthrough :). the work there is tedious....days spent mentoring nurses/doctros who often don't want you there and trying to sort out patients who have been mismanaged for years. scary too since baylor may only be here another 2-3 yrs and it seems we have so far to go. we did have some fun though - took a trip to the salt pans (5hrs northeast of serowe) and stayed at a really cool lodge....cool as in awesome because it was approximately 1000 degrees there. we stayed in traditional rondavels, which in english translates as oven (sarcasm). needless to say we spent more time sweating than sleeping and it made me understand why people wear sweaters and turn on the heat in the middle of the summer. apparently being this hot is actually preferable. despite the hotness it was beautiful - we went on a 1/2 day trip to the pans (leaving at 5:45am, bleh!) and drove for about 6hrs total in the middle of nowhere. i mean, NO people. the only person we saw works for the lodge....he stands all day in the desert sun tending the meerkats so that they're used to people. talk about a hot and lonely job. we were thankful though because it works and you can get out and walk alongside the meerkats as they bounce through the desert. we followed them around for a while, so stinkin cute! we also saw one of the oldest/largest baobab trees in the pans - very cool. i now have the distinguished honor of relieving myself behind (sort of unavoidably on as the roots stick out everywhere) a 3-4 thousand yr old tree :).

we happened to go in the middle of zebra and wildebeast migration so we spent most of the day alongside literally 100's of zebras and wildebeasts. it was amazing - even better than a game reserve cause they were just out doing their zebra/wildebeast thing. at some point stopped for breakfast, prepared from the back of our 4x4, then ventured to the vast pans. it's "wet" season (side note, all "rivers" in the area resemble dirt paths rather than rivers, but apparently this is wet) so didn't get to 4-wheel which is the main activity in the pans :( however we did take some pretty fun pictures (see below), as usual acting our age ;). our guides were a lot of fun and full of information teaching us all about the area. we later went on a "bushmen walk" and learned all about that culture, medicinal plants, anectdotes, etc. they carried walking sticks and made us walk single file, they were for real. the day finished with a sunset drink by an animal watering hole then retired to our oven for the evening. such a good day.

serowe also has a rhino sanctuary which we got to do a self-drive safari through. have to say self-drive safaris are a bit intimidating at first, i mean what the heck would i do if some crazy animal attacked our car?? kind of fun though cause you really feel like you're on an adventure. this was a pretty tame game drive, but still, it was leigh and i with a map against the world....if you know how well i read maps, this will scare you. thankfully leigh is better at it than i and we made it around the park with minimal problems. at one point we encountered a waterhole that had rhinos, zebras, wildebeasts, ostriches, kudu (deer-like animals), and some other crazy birds all in one place. it was straight out of the lion king, i'm telling you. if leigh didn't hate disney montages so much i definitely would have busted into the "circle of life." never fear, i refrained.

so that was serowe....now back in gabs and heading to the wards next week. trying to steel myself for the days to come, it's only a week so totally doable, just such a wild card....you never know what you're going to get there, and 9 times out of 10 what you get is bad. it can be more than a little defeating. leigh just finished a few weeks on wards and it was hellacious....6 resuscitations in one week, really in 2 days, only 1 successful. bleh. it's so hard when your best is never good enough, but such is the nature of working in resource-limited settings....have to remember that your best is the best you can do, and at minimum is better than nothing.

last week i read a friend's blog where he had posted multiple "patient encounters," a series of short stories about patients he saw during his years in swaziland. many were familiar, all were touching, and i decided to steal his idea. i haven't focused enough on the precious patients i'm blessed to work with each day....they're by far the best part of this experience. i'll try my best to do them justice in sharing their stories, stay tuned :).

African Holiday

my goodness, i started this blog entry over 2 weeks ago and am just now posting!! oops, better late than never i suppose.....

so my african holidays - AWESOME. it was definitely hard to be far away from family and any semblance of cold weather that would make it feel like christmas, but a whirlwind of travels made it a little easier to deal with :) we worked through christmas eve than flew to durban (southeast coast) for christmas weekend - short but really fun. got to spend christmas day with a friend's family which was lovely, just really nice to be with a family on christmas, even if it's not your own :) they were amazingly generous and welcomed us in as their own with a delicious christmas lunch then time chatting and sharing stories. the next day we went to a cricket match (south africa vs. england) which was really fun - similar atmosphere to a baseball game, though much slower process. it's a 5 day tournament and south africa didn't even finish batting the first day! i.e. one VERY LONG inning. headed to a pub afterwards and witnessed some proper south african drinking....amazing what some of those guys could put away before 5pm! got to spend a little time on the beach (the friend we stayed with has an apartment on the beach, SO nice) and put away a fair amount of sushi in our 3 day weekend. also managed to skype with the family on christmas day, a little touch and go there for a while....here's before/after we thought we couldn't connect to the internet:

so that was christmas....came back and worked the next week through new year's eve, then left for an AMAZING trip to cape town. after clinic had to book it to joburg then caught a late flight to CT and managed to get to the NYE party before the countdown.....of which there were 2 by the way, one at roughly 11:57 and 39 seconds, and one at actual midnight. classic. we met up with some friends from lesotho at hands down the biggest NYE party i've ever been to and danced the night away with approximately 53 million 18yr olds (ok, slight exaggeration, but that's the legal drinking age in SA and i think every 18yr old in CT was out celebrating that fact). spent the next several days seeing cape town.....new year's on the beach (again with sushi), next day touring the wine country, the next seeing table mountain, the next driving down to simon's town to see the penguins then on to the cape of good hope, and the last day relaxing/shopping before heading back. CT is beautiful by the way, definitely in the top 3 places i've visited. the water is blue blue (not just regular old blue), the city fun and alive, the food amazing....not to mention the cape which is breathtaking - an expanse of raw, untouched beauty and powerful wind/waves that leave you speechless. already planning to go back for easter :)





so that was new year's.....then back to work where clinic has been CRAZY post-holidays. tons of patients, deadlines for abstracts....all in all has been a bit hectic! starting to slow down a bit, thank goodness, so hopefully will be a bit better this week. next week leigh and i head to serowe (smaller town 3 1/2 hrs north) for 2 weeks, where life is definitely slower! have a trip to the salt pans (kalahari desert) and a rhino sanctuary planned while we're there so not too bad :) hope all is well at home and that everyone had a blessed christmas/new year's - love y'all!

christmas parties

look at me, blogging again after only a week, miracles do happen :) had to though cause we've had not one but two christmas parties in the last couple of weeks and i haven't said anything about either of them! the grown up party was just that, a party - lots of food, dancing (learned some traditional dancing, or at least tried), and a chance to spend time with everyone from work outside of the stress of clinic. we also had some friends from south africa who came through on a motorbike trip and tagged along to the party....we were quite the spectacle with our car + 3 motorcycles! good times had by all....i think the clinic is getting used to leigh and i making spectacles of ourselves :)

the other was the christmas party at the clinic for the kids.....a carnival really. and though i was dressed in a santa hat with tank top, shorts, and a lot of sweat, it somehow still felt like christmas. probably had something to do with the joy overflowing from hundreds of children as they played games, got their faces painted by a clown, jumped on blow up castles, went kareening down the water slide (don't worry, only one head busted open and a dozen stitches), danced, laughed, and the grande finale....a fun new back pack filled with books and markers from santa (aka me and leigh in santa hats). there's just something about the joy of children that reflects their Maker and points beautifully to the reason for christmas....Christ. and so, despite being 100 degrees and playing in water rather than snow, the kids' christmas party was the closest i've felt to christmas this season.

"'truly, i say to you, unless you turn and become like children, you will never enter the kingdom of heaven. whoever humbles himself like this child is the greatest in the kingdom of heaven. whoever receives one such child in my name receives me....'" --matthew 18:3-4

hope....

a friend recently gave me a devotional book that is written specifically for christian physicians. it is published by the international christian medical and dental society and has entries from physicians all over the world. it could not have come at a better time as the first page i read talked about the overwhelming amount of death in third world countries and the challenge of seeing and reflecting light amidst so much darkness.....as i read the page and the scriptures mentioned in it i wept for all of the precious lives lost since i got here. i wept first in great sadness but then in hope and joy as i imagined them praising their Father in heaven. why is it that my heart first goes to sadness/darkness instead of the light that overcomes it? i know that grief is natural and healthy and necessary even, but i pray that the hope of eternal life might be greater than the burden death brings....that such hope may overcome any despair and fuel my heart and life here.



"and i heard a loud voice from the throne saying 'behold, the dwelling place of God is with man. he will dwell with them, and they will be his people, and God himself will be with them as their God. he will wipe away every tear from their eyes, and death shall be no more, neither shall there be mourning nor crying nor pain anymore, for the former things have passed away.'" --revelation 21: 3-4

november....

another month gone by in africa.....wow. hard to believe it’s already been 4 months! as it goes, in some ways it feels like so much longer, in others it feels like yesterday that we got here with our 2 tons of luggage. the last month has definitely flown – i spent the first 2 weeks on wards and then went to serowe (smaller town 3 ½ hrs north of gabs) for 2 weeks. between the two i got to go to south africa for one of the most beautiful weddings ever. needless to say, it’s been a full month :)

so wards....yet again a difficult experience, yet better this time not being quite so fresh out of residency or quite so fresh to botswana. i think somewhere along the way i learned to let go of some things – i.e. getting labs in a timely fashion, or at all, same with xrays, even medicines sometimes. you have to pick your battles around here or you’ll go crazy! i find myself much saner picking a handful of things that i feel strongly about and focusing on those. little bit different than our do absolutely everything we can (sometimes to a fault) mentality in the states. the limitations are often frustrating, but now only really get to me when they affect my patients. the number of deaths is still overwhelming....this past month i had 2 that were particularly difficult. one, an 8 month old with HIV and pneumonia that i took care of for a week and a half before he died....he was very sick, but still it was the first child i’d had die that i’d been taking care of for a while and had had sole responsibility for. and again, with better respiratory support he probably would have lived. the second was my very favorite patient ever....just the most precious 3yr old boy with soulful eyes and a contagious sweetness that touched the whole pediatric ward. i admitted him my first month here with a disease called langerhan cell histiocytosis - which is a bad disease even for the states - but he’s been getting chemotherapy in the hospital since that time and has looked so well, then got worse quickly and died because we were out of blood transfusions. heartbreaking.

serowe....definitely a different experience than working in gabs. our role there is more of a mentoring role, which means we work with doctors in local clinics to help them learn pediatric HIV care. as you can imagine this gets a little tedious....there are so many patients that come to these clinics (sometimes over 100/day for 2 doctors) that they don’t have time to spend on details and understandably just try to crank through as fast as they can. another opportunity for picking battles. the town is much smaller with very little to do so life is quieter there, which is a nice break. one of our doctors is there full time so we’re not alone, and she has some cuban friends that make excellent food and provided free salsa lessons – definite bonus!

south african wedding....AMAZING. we were in a town called pietermaritzburg which is about an hr from durban (on the coast). our ex-neighbor and pyschologist at the clinic, lindsay, got married to one of the old PAC doctors and it was such a lovely wedding. very similar to a wedding in the states except that many of the rehearsal dinner speeches are given at the wedding (best man, father of bride & groom, and groom himself). it was neat cause everyone got to share in their story. oh and i forgot the best part - there was a trampoline. leigh and i spent a good amount of time with said trampoline, once again acting our age :)
















k, that’s definitely enough for one blog! hope all is well at home, will try to be more faithful with the blogs so they’re not always so long! lot’s of love :)

halloween weekend africa style....

just in case anyone was wondering, they don't celebrate halloween in africa. but don't worry, that didn't stop us from creating some of the best costumes EVER and bringing halloween to africa. our local friends already think we're crazy and this pretty much confirmed it.....though i'm happy to report there were at least a few that we've brought over to the dark side. i wouldn't call it dark exactly, more like the incredibly wonderful world of costume parties. i'm telling you, once you've been there, you'll never turn back. see below for the spectrum of costumes created between leigh and i and our neighbors.....definitely missed my call as a costume designer :)





pirate, prostitute, cheese, mouse, and bumble bee....quite the crew!






life has been good post-boards.....definitely more time for things such as making halloween costumes :) experienced a bit more of gaborone, and hopefully will see more of africa soon. for some reason it's still managed to be crazy busy even without board studying! i'll post more soon, just wanted to give a quick shout out since i haven't posted anything since being back, and let's face it, needed to brag about the halloween costumes :)