Monday, August 30, 2010

The Feast of St. Louis…

August 26, 2010 3:45 PM

Yes you might notice that I am writing this entry for Wednesday after starting the one for Thursday. But I won't post 'em that way in order to keep everything less confusing…


Wednesday, August 25, 2010

Wow, is that today? Well it was when I started this entry, but not anymore. Surely I can remember today that was today but is now yesterday right? We'll see…


I got up a little earlier than usual Wednesday because I wanted to make sure to get a shower in early enough and fast enough to leave hot water for my roommate. It's one of the things I've found I've been trying to do ever since my stint at living alone ended…taking fast showers, closing the door when in the bathroom, etc. Too much?? Okay, fine, I just wanted to convey the idea…you get the picture. No no, don't get that picture! Sheesh!

First, though, as I was sleepy (as usual) I put some water into a pot, put a lid on, and set it on the stove to boil. I brushed my teeth, went back into the kitchen, then finished up and got into the shower. I had planned on making the shower brief, but about 2 minutes in I thought about the water on the stove. I suddenly couldn't remember if I had remembered to turn off the burner or if had only thought about it. I started to panic just slightly thinking about the boiling water overflowing everywhere and onto the electric stove. I washed faster than ever before, dried off, threw on my clothes as fast as I could (which is difficult when your skin is still slightly moist from the shower…clothes stick!), and ran out to the kitchen. Fortunately I had turned off the burner, which, now that I was out of the shower, was promptly switched back on.

About 7:15 I was still getting dressed, while Meg patiently waited. I was supposed to be there by 7:30 and was to show her how to get to the clinic from the house. After finally getting everything together, I quickly drank the cup of coffee that she offered to make for me while I was running late, and we were off. We talked on the way about how long she'd be here, her application for fellowship in infectious diseases, and the like. When we arrived, it was time for me to head out with Dr. Abid as Wednesday was a day for the Moshupo outreach clinic. I jumped in and we were on our way.

Along the path we picked up one of the nurse prescribers (what I have gathered is the equivalent of a nurse practitioner here). The road was familiar, as it took the same route as the one we had driven to get to Thamaga three weeks prior. As we drove, I was quick enough to capture photographic evidence of perhaps the most absurd and disturbing billboard I have seen.

Imagine for me, if you will, a billboard with a picture of a man and a woman enjoying a drink on a sunny day sitting at a table. To their right, in big, bold letters are the words:









Yes of course, you are shocked. Where is this place where rapists' go to thrive and enjoy themselves, and why in the world would the nation of Botswana be advertising such a horrible idea and destination?

If you took the time to carefully examine the billboard (which you might not do if you were driving down the road without stopping at a light), however, you would notice, on the bottom left of the billboard, in relatively tiny letters, the words "Break the habit. Stay sober, stay safe." And "Sober is cool."

So this is a billboard advertising the idea that getting drunk is harmful to you in the sense that it makes it much easier for you to be targeted by a rapist. Hmm, that's interesting. You would think maybe, that the words "Stay sober, stay safe" would be a bit more prominent! Sheesh! I almost left Botswana thinking that they were the world's 'Rapist's Paradise' and very proud of it. To prove my point, I have provided a picture of it for you, obtained by quickly grabbing my backpack from the backseat of the car, pulling out my camera, and making the doctor I was with wonder about me until I explained why I was so enamoured by the Rapist's Paradise billboard.


After about an hour's drive, we finally arrived at our destination of Moshupo. Along the way I learned that "Choppies" is apparently the Walmart of Botswana (not sure why or if you wanted to know that, but whatever). We arrived at a small freestanding clinic, about the size of four US classrooms put together. There were five exam rooms, three on one side, and two on the other, with the last room being reserved for the pharmacy, where there were about two regular Tylenol sized bottles of most medications…that's it. My friends, we had arrived at resource-limited, to be sure. The exam room was a bit larger than the one I had encountered in Thamaga, but contained a desk, shelves, an exam table that wobbled back and forth when your weight wasn't in the right spot (a characteristic I soon learned to take advantage of to break the ice and make some of the kids smile…nothing like thinking you are about to fall on your head and then not doing so to make you laugh), and a sink. On the wall there were two windows, one of which was broken (and had been since the PAC docs could remember) but partly covered with random flyers and posters, though incompletely.

I thought we would go right to work once we arrived, but we ran into a problem. You see, the idea behind the PAC doctors doing outreach visits is that one of the local doctors will work in the same room as them, being mentored and taught by the PAC docs each time, and eventually coming to the point where they would be able to manage even the most difficult cases on their own. Then, the PAC docs would stop coming. Unfortunately, at this clinic, the past few times had essentially resulted in no local doctor in the PAC doc room. This pretty much meant that they were using them as an extra body to see kiddos and reduce patient load. After talking with one of the docs there, it became clear that they would not be sitting in with us that day either. This was NOT okay with the nurse prescriber, and didn't sit well with the PAC doc either. Therefore, while I spent the next hour taking pictures and reading posters on the wall, the NP and PAC doc were negotiating, talking on the phone with supervisors, and getting things set straight. Eventually, about 10 AM, they decided that for the patient's benefit they would start, but that serious discussions would take place before PAC docs would return. As a sort of compromise, one of the clinic nurses joined us for the day.

We began to see patients, but after finishing with the first and going to wash my hands, I was informed that this clinic did not have any SOAP. That's right, no soap. Ever so thankful to my wife, who insisted I bring a small bottle of hand sanitizer, I set to work rinsing my hands with water and then rationing the sanitizer to make it last until the end of the day. Again, this clinic had no otoscope, one computer from what I could tell, no gloves, etc. Also, to make a duplicate copy of the note so that the patient could take one copy and the clinic could retain one, the doc had to use two copies of the same form and then place a piece of special "carbon paper" (that's what I'll call it because I've no idea what it's actually called) in between in order to transfer the writing onto the second copy. I know this is not a huge deal, but it just speaks to the fact that there was so much less than the luxury we enjoy in American hospitals and clinics. In addition to this, the adult patients were being seen in a two room, 8 by 15 foot shack outside, which meant while they waited they sat on a bench in the cold weather. The rooms in this shack were TINY. Needless to say, it was a far cry from what I've been used to in TCH and the Texas Medical Center.


(Okay, I have to interrupt this note…I'm sitting at the Sun catching up on the blog, and to signal the end of happy hour the bartender just rang a bell…how did he ring it? Ding-ding-ding-ding, ding-ding, ding-ding! Hullabaloo Canek Canek! Whoooooooooooooooooooooooop!)


We saw about fifteen patients that day, and I was blessed enough to do the exams on all of them. Seriously, I'm telling you half of them had flow murmurs (benign heart murmurs that kids just have). Intermixed were patients with a case of tinea capitis (read as "ringworm of the head") that was worse than I had ever seen, a dehydrated baby who had diarrhea and cried for the first half of the visit, and the obligatory cuties. By about two we were finished for the day, and using the last of my hand sanitizer to clean my stethoscope and my hands, we were off and headed back to Gabs. Truly, the outreach experiences are an invaluable component of this rotation. Doing so much with so little makes one more appreciative of the "excess" we enjoy in the States.

On the ride back, I took a few pictures, but then I was DONE. I tried to stay awake for a time, but then was nodding off here and there until we stopped to drop off the NP just outside of town. We arrived back at the clinic, but since I hadn't brought my lunch or my computer, I ran home to grab both. After a quick encounter with peanut butter and crackers (Thanks Chrissy!), I headed back to the clinic for free wifi. I checked my email for the day, which really means checking my email for the previous day (by 3 PM here it's only 8 AM in Texas, so I get to see what people sent me between about 10 AM and 5 PM the previous day). About five PM I headed home, ready to both catch up on the blog and commemorate the feast day of St. Louis in my own special way.

Essentially that meant I went home, enjoyed the evening sunset in the backyard as I prayed the Evening Prayer for St. Louis's feast day, and then headed over to the Sun to journal. Why at the Sun? Well, you see, as we've discussed, the Sun pool bar area is very pretty, and from 6-7 it is happy hour. What we have not discussed is the fact that the only beer brewed here in Gabs is a beer called….you guessed it "St. Louis Lager." (I won't comment on the fact that it's essentially like water because Saint King Louis would not appreciate it.) So of course I came here, journaled for a bit, and enjoyed one of the beers in honor of the saint of the day….isn't being Catholic great???

Unexpectedly, I was blessed enough to run into Dr. Patel and Dr. Mr. Patel, who had come to the Sun for dinner just to get out of the house. I spoke to them briefly, asked them how they were doing (they are really super friendly people), and wished them a good night. After that I closed my netbook, packed it up, paid my bill, and headed home.

At home I decided to try to make do with what groceries were leftover rather than trying to restock three days before leaving. Therefore, I heated up some vegetables in the microwave and prepared some of the "Generous serving of Coriander and Chili Couscous." Both of these were left courtesy of my first roommate, who we have decided shall be referred to as Chrissy. Granted, I've never had couscous before. I don't even know how to spell it appropriately for sure. But it was GREAT! And it went very well with the vegetables. I was pleased, and can fully endorse consumption of couscous to all my friends.

Following the thrown-together dinner, I called it a night early, said my night prayers and read as I fell asleep…my third to last night in the Baylor 1 house.

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