our big safari....

hmmm, so maybe i use the phrase "big safari" a little loosely....as you can see by my amazing pictures, there was a serious lack of animals. apparently they don't like cloudy/rainy weather - who knew? you'd think it would be a nice break from the blazing desert sun, but what do i know about being an african animal.

the big adventure took place in an area called tuli block, which is a strip of privately owned game reserves that runs along the southeastern border of botswana. it's around a 5-6 hr drive from gaborone, but the roads are good and the trip is broken up by a variety of things.....first of all, there were around 6 different stops where people were supposed to pull over and get a brochure on road safety. this is because people drive REALLY fast and rather recklessly around here and motor vehicle accidents are a common occurrence. while i applaud the government's attempt at public service, i have to say it seemed to have the opposite effect....after being forced to pull over, get out of the car, and listen to someone talk about road safety, everyone seemed to be in even more of a hurry and drove like a herd of bats out of hell. oh well, it's the thought that counts.

and speaking of herds, there were approximately 5 trillion herds of goats, donkeys, and cattle at various places along the road. they evidently have very little regard for their lives because they consistently walk out into oncoming traffic, stand in the middle of the road staring at you, or prance dangerously close to the shoulder. seriously i think the trip would be an hour shorter if it weren't for all those goats.

so we finally got to our lodge in tuli block and it was beautiful and tranquil and just what i needed after burning myself out studying for boards. i think i even said something to the effect of "you know, even if we don't see any animals i'll be perfectly happy just being here and getting to rest." little did i know i had cursed us....our driver picked us up for a sunset safari in what looked like a toy truck from the 1970's with seats taken from who knows where precariously attached to the truck bed with bunji cords (to give some perspective, most game drive vehicles are pimped out land rovers with stadium seating. very close to our vehicle, very close):

we took off down the dirt road and drove and drove and drove....and after 2hrs had seen several impala (african gazelles) and a lot of dirt road, and that was pretty much it. it was a beautiful night though and really it was nice to just be out in the bush relaxing. we tried again in the morning and drove and drove, but alas, nothing but impala. we even went on a 2hr walking safari in search of hippos and waded through a vast amount of large poop mounds (indicating that there are indeed animals), but no one came out to play. we did make one friend who inspired my favorite picture from the whole weekend:

i mean, priceless. truly embodies the entire safari experience. all of us staring at our biggest find, a turtle. it was an adventure though and we had a lot of fun searching for animals, even if there were none to be found :).

as some of you know i've been in the states for the past 2 weeks taking boards and visiting family/friends. it was so good to be home but definitely went by too fast! i'm now back safe and sound and free of boards (at least for now), which means i'll definitely be more faithful in the blog/skype/email/facebook department. and we don't have tv so it's either that or stare at the wall :)

been way too long!

wow.....so you might think i've been doing something super exciting that has kept me from updating my blog, but sadly my only excuse is that i've been sucked into a black hole of pediatric board studying. that's right, living in wildly beautiful and fascinating africa and have spent the majority of my time either at the dining room table or on the couch studying! ahhh but don't worry, this will soon change....cause ready or not boards will be OVER after oct 12!!!! (those are both terrified and excited exclamation points btw)

some quick updates....the past 3 weeks i've been in the clinic (as opposed to the hospital), which has been refreshing and far less stressful. it's an extremely busy clinic and every day children seem to be overflowing the waiting room, which really is amazing considering that 10yrs ago most of them would have died from their HIV. it blows my mind what a difference the introduction of antiretroviral drugs has made, not only on child mortality but on transmission rates (both of which have plummeted since the clinic opened and the government started supplying these meds). the majority of the children are happy and healthy thanks to their parents dutifully giving them 3-5 pills twice a day - NOT an easy task, but haunted by the memory of their country ravaged by this disease, most do very well.

one of my favorite parts of clinic has been outreach - every day one of the doctors goes with our outreach nurse, boitumelo, to a rural clinic and works with doctors there to help see patients and mentor them in pediatric HIV care. it's a bit intimidating since i myself am still using my handbook to look up drug regimens, monitoring labs, etc, but it's been great to see the villages and meet local doctors/nurses. above is a picture of boitumelo and i in front of a clinic in phutadikobo/molepolole (mo-lay-pah-lo-lay). below are some pictures of the clinic and a nearby house. we get to go on outreach about once a week and visit clinics throughout botswana, some by car and some by plane (haven't gone on one of those yet but there will def be a picture of the plane when i do!).

one of my least favorite parts of clinic is covering the hospital referral clinic.....aka where any doctor in botswana can send a child to see a "specialist".....which means we end up seeing/managing a lot of things we're not specialized in, and doing so with limited resources. interesting, but frustrating as you can imagine! at least 2/3 of the kids are there for seizure management and have varying degrees of neurologic impairment, another challenge....any neuro friends want to come spend some time in botswana??

let's see what else....it's warming up so all of the creepy crawlies are crawling into our apartment, awesome. leigh and i had a battle with a GINORMOUS black spider the other night, and after much throwing of shoes/soccer balls/various inanimate objects and even more screaming, we totally lost. it was the fastest spider i've ever seen, seriously. we later learned it's dubbed the "kalahari ferrari," that's how fast it is. how did we learn this? we broke down and had to call our neighbor to kill the thing. he came armed with a bottle of "doom," aka super spider killer, and had a good laugh at our girlie expense. bleh, i hate spiders, what was i thinking moving to africa?!?? oh well, at least i've got doom....as long as i don't have to get close enough that the spider crawling on me is even a remote possibility, i should be ok. i took a picture so i could post it to prove i'm not just a huge sissy, but posting it means i'll have to look at it every time i go to my blog and i still have a little PTSD so it may have to wait.

ahhh, we have monkeys!! can't believe i forgot to mention that. there are totally little grey monkeys that run around the neighborhood and this morning were swinging through our backyard. craziness! they're super cute but our neighbor tells us not to trust them, or make eye contact....not sure what happens if you do, but going to try my best not to find out.

last but not least, this week we celebrated botswana's independence day - they've been independent since september 30 1966 and have a yearly 2 day celebration filled with music and festivals and food in all the villages. it's quite the party! i mostly heard the celebration from our backyard where i was (shockingly) studying, but did celebrate the fact that we got a 2 day holiday....and because of it and the fact that i got some extra study time, am going wild and going on a game drive this weekend!! which means it shouldn't be light years till my next blog post since i'll definitely be sharing pictures. hopefully the animals will cooperate :)

good times in gaborone....

hi friends! since my last few posts have been on the heavy side, i decided to go with something light this week :) below is a slideshow of my birthday festivities, along with a couple of random outings and happenings. speaking of, big THANKS to my new friends here for an awesome birthday! i thought i'd also include a list of some firsts i've experienced so far....i'm sure there are many more to come....

1. first time to drive on the left side of the road (see previous blog, more than a little traumatic)

2. first time to realize that i even walk on the wrong side, never dawned on me we walk on the right cause we drive on the right! duh.

3. first botswana power outage - darker than dark!

4. first time to truly tap into my martha stewart roots - many made up recipes including homemade salsa, guacamole, hummus, and brown sugar (not all together, don't worry). yes that's right, they don't sell brown sugar here, but turns out you can make it with plain sugar + molasses, who knew?! gotta love google :)

5. first time to accept a gecko as a roommate....i mean, he'd already lost his tail in some other skirmish, i didn't have the heart to throw him out.

6. first time to wear 3 layers in the middle of august - i like this first!

7. first running route to include a game reserve (ok so it runs behind the reserve, but it sounds more exotic to say it that way)

8. first time to go more than 30sec without adding parmesan to something...in fact i went TWO WHOLE WEEKS before finding a $15 block, which i definitely bought.

9. first african barbie phone, oh yeah.

10. first african hamburger, oh no.

11. first african dance lesson - turned out to be 1 session of latin dancing with an african twist, and 1 session of hip-hop....you can guess who the least coordinated in the room was!

12. first african aerobics class - again, looking totally natural and coordinated.

13. first month on wards as an attending - i survived!

weeks #3 & 4...

goodness, where to start. the past 2 weeks have been difficult....i spent 1 week in the NICU, was on call over the weekend, and then went back to wards last week. it was a long stretch, and one that proved to be both physically and emotionally exhausting. first, i no longer have the protection of being a resident....as an attending the hard conversations and decisions fall on me, which almost makes me miss residency, almost :).

second, while i had been warned about the tragedy i would see here, there's really no way to prepare for it...in one weekend of call i had my first conversation with a family about their child being brain dead with no reasonable hope of survival. 12 hrs later i had my second. i walked into the NICU to find a baby's monitors going off with oxygen saturations of 35% (normal 100%) and heart rate of 60 (normal 140-160)....no one had responded to the monitors, and in fact the one nurse in the room was getting vitals on another baby. i have no idea how long the baby was like that, but i quickly launched into running my first code/resuscitation, which after an hour was unsuccessful and we ultimately withdrew care. all in all that weekend 1 child and 5 infants died.

the hardest part is that most of the deaths that occur here seem unnecessary....whether lack of monitoring, lack of response to monitoring or to clinical warning signs, lack of personnel, lack of resources, or misuse of the resources we have....there's so much that seems preventable. but where do you start? death is unfortunately very normal here - the number of deaths overnight are reported as casually as the number of admissions. you can imagine how difficult it must be for the medical officers and nursing staff to keep any sense of hope, and thus how challenging it is to overcome that sense of defeat/acceptance. i'm starting to realize that while our patient care is important, it's not enough. the greater need is education and empowerment of the people and the system toward change. this is not really baylor's mandate as we're here primarily for outpatient pediatric HIV care, but i hope to be a part of tackling this issue. there's a new medical director, medical school, and pediatric residency program in the works, all of which open up new possibilities for growth.

hmmm, sorry to be so debbie downer! on a happier note, there are a lot of ADORABLE kids in the hospital who do well - see pics :) most of those are kids from the surgical ward who like to run around and terrorize the medical ward, always a good time. the families here are kind and grateful, and medicine in general is just simpler....the benefit of tragedy is that it yields perspective; when everyone is focused on survival it leaves little room for more trivial details. and the best part - there are no ICD-9 codes and the term "medical-legal" is nonexistent!

week #2...

well the first week of wards is over and as far as i can tell, everything went ok...big sigh of relief! my biggest struggles have been logistical so far, as i navigate the hospital about as well as i do the roundabouts. not to mention the fact that even when i do manage to find my way to the lab, radiology, etc., whatever i'm looking for has inevitably sprouted legs and walked away. i shouldn't complain because really we have a lot of resources for a hospital in the developing world, but it's still hard when your management of patients is hindered by systems issues. an example - last week we had a child with presumed pneumonia and pleural effusion (fluid in the lung). i say presumed because it took 3 days to get an xray. and then after it was taken it took a scavenger hunt and s.w.a.t. team to track down the film. nevermind what it took to actually find a chest tube so that we could drain the fluid!

this is not just the hospital though, gaborone in general seems to move at its own pace. in some ways it's nice (anyone who knows me knows that when it comes to being on time i was born in the wrong country)....lunch is always ALWAYS an hour - at a minimum - and no one misses lunch. that is unless you're the freshly graduated resident who's used to missing lunch....though i'm realizing that if everyone else stops for lunch, so should i! tea is not a privilege, it's a right...and one that comes twice a day (change that to coffee and i'm set :)). however, in other ways it's been a serious test of patience...there is no sense of urgency to get things done, period. whether trivial or life-saving it will get done when it gets done, or when you do it yourself. coming from a drive-thru culture to more of a crockpot culture (cheesy analogy, sorry) is challenging to say the least. my patience is apparently non-existent these days, and the thing is i get just as frustrated by my dinner order taking 2 hrs as i do a lab test taking 3 days! problem #1: i'm ridiculous. problem #2: i have to realize that i am the stranger here....my culture and sense of how things should be is not the norm. the struggle is not to judge them by my standards but instead to learn theirs. so far i am not succeeding in this, but i pray for grace that is so much bigger than me and peace in the process.

on to lighter things....while i'm mostly work and studying for boards these days, true to form i'm still trying to make time to play :) below are some pictures from a hike this weekend - it's called kgale hill, and while it sounds benign the straight up rock climb to get to the top is not easy! apparently only expats climb it cause when we stopped to ask some locals for directions they looked at us like we were crazy. thankfully we saw no snakes, and the baboons that are the supposed kings of the hill did not come out to play....truth be told baboons kinda scare me so i wasn't sad.

this week i'm attending in the NICU.....ummm, yikes! the first few days the neonatologist will be there and then i'm on my own for the second half of the week. which by the way is CRAZY because most people do a 3 yr fellowship before running a NICU, but apparently that's a minor detail. thankfully the medical officers (MOs) here are very good and spend a lot of time in the NICU, so hopefully between all of us the babies will be ok. scary larry is all i have to say....till next time!

some small adventures...

this weekend a group of us went out to the gaborone dam where they have a yacht club (which was closed, and i didn't really see a club or any yachts, but i'm sure these are technicalities), and watched the sunset. it's amazing how you can drive 10min from our house and be in rural africa....desert, brush, wildlife, beauty. oh and crocodiles too, awesome. there is actually a game reserve in gaborone, crazy huh?? i'm hoping there aren't any cats in said reserve since i run by it on the dirt road/running route that's a block from my house...if my blog updates ever mysteriously stop, you'll know why....kidding mom! don't worry, i have a pocket knife. here are a few pics of some new friends and the beauty in our back yard:

and after the serenity of an african sunset, the next day was my first attempt at driving on the left side of the road....we'll just say it was an experience. you see, not only are you driving on the opposite side of the car and the opposite side of the road, there are also roundabouts EVERYWHERE. try doing those going the opposite direction as well, totally weird....i may or may not have been spotted going round and round a roundabout because i couldn't figure out how to exit without crashing into someone. maybe. that's the rumor. as you can see though, i'm still in one piece, and actually pretty much used to the driving thing. i am QUEEN of the roundabout, mmm hmm...here's me sporting the right-sided driver's seat in our cute honda CRV:

i'm taking votes on names for the car....send me any suggestions, winner gets a trip around a roundabout when they come to visit!!

week #1

o kae? that literally means "are you here" to which you respond "ke teng," meaning "i'm here..." similar to "how are you...i'm fine." setswana phrases number 2 and 3, watch out!
these are some pictures of the clinic where i will spend a lot of my time. it's a beautiful facility with kind and helpful staff...so far i've only met 2 whose names i can pronounce, but we're taking setswana lessons so maybe in a year i'll have 3 names down :).

so the past week....after all my angsting about starting work, we were actually in orientation all week learning....and after week #3 of lecture i've decided i have the attention span of a 2yr old! we spent a lot of time being trained in the pediatric HIV curriculum that we will be teaching to rural botswana health care professionals during week long courses called "kitso" (setswana for "knowledge"). apparently the minute we stepped off the plane we became "specialists," which is code for "expert" in everything pediatric...kinda scary since i'm pretty sure nothing miraculous happened to me on the plane ride over! regardless, "specialists" we are, and as such are responsible for a lot more than i realized: clinic, hospital, occasional NICU (neonatal intensive care unit), codes, and every subspecialty under the sun! we also spend around 25% of our time traveling to more rural areas for education and help with difficult patients. there are also about a billion projects to get involved in...so far i'm signed up to help with general pediatric eduction (designing the core curriculum for the new med school/peds residency as well as lectures for medical officers), advanced pediatric CPR training for the staff, and teen club/adolescent services.

i start this week on wards (the inpatient hospital service) and am more than a little scared...the hospital is called princess marina hospital and it is the national referral center for botswana. there is a pediatric ward partitioned into 4 pods that hold anywhere from 20-60 beds (in the busy season they cram matresses together), and a 60 bed NICU with 6-8 ventilators. these are covered by 3 ward teams and one NICU team. there is 1 pediatric surgeon and one of our docs who is a pediatric oncologist (both the only ones of their kind in the country), and for anything else we are the specialists. all in all botswana has a much better health care system than other african countries, but it is still very different and resource limited. despite that they're doing a wonderful job with what they have and i'm excited to learn from the people here.

so i'm off to another week...and while at the moment i feel inadequate and nervous about my scope of "expertise," i know that the variety will be both challenging and stimulating, and in the end will grow me as a person as well as a physician...i'll let you know how it goes :).