Tuesday, August 10, 2010

A tale of two clinics

Tuesday, August 10, 2010 2:36 PM (entry for Monday, August 9)

To start:

Another reason Botswana is "My World Turned Upside-Down":

7) Yesterday, I was folding clothes as I took them off the clothes line. As I did, a flock of geese, or some other such sounding birds, flew across the sky in a V formation. "Oh," I thought, "it's winter here! They must be flying south for the winter!" WRONG: Sorry, geese, little did you know that you are in fact flying NORTH for the winter because, what's that? Yes, that sign that says "Equator: Thousands of miles", well it is facing UP.

And now back to your regularly scheduled blog already in progress…

Monday morning greeted me with an alarm clock going off at 6 AM, and darkness outside my window. I had planned on going to 6:45 daily Mass, but it's SO hard to wake up before you absolutely have to when it is still dark outside your window. In any case, the alarm was reset for 7, and with an appropriate level of light streaming in, I was up, dressed, filled with the quickest inhalation of a bowl of corn flakes in history, and out the door.

For the day's work, I had been assigned to one of the Medical Officer's rooms on the pediatric side of the clinic. Having worked with him before, I knew he was efficient, which I loved because it kept me from falling asleep, and therefore saw a lot of patients (who he allowed me to examine on my own…hooray!) All this was a good start, and despite taking a slight turn for a portion of the day, turned into a great clinic day.

For starters, the hug brigade continued, though on slightly different route. My very first patient was a small kiddo about 2 years old. I watched him as the MO and his mom talked, and then when it was time for the exam, I went to work. I quacked when I squeezed his tummy, I mooed when I listened to his heart. I tickled him when I felt for any lymph nodes in his neck (though that was inadvertent…everyone is so ticklish here!).

After the exam was over, as I waited for the MO to continue talking with mom about the plan, he stood up, leaned forward, and grabbed onto me. All of a sudden 6'4" Whitey McWhiterson was holding this tiny Batswana (read: Botswanian) toddler just as if he were my own. Whether he was comfortable with me, liked climbing onto people, or just wanted to be high up, I held him for a good five minutes as they talked. Throughout, he of course grabbed at the stethoscope around my neck, trying to put first the metal bell, then the plastic body, into his mouth. Naturally I let him go to town…

NO I DID NOT LET HIM EAT MY STETHOSCOPE. That would be nasty. Sheesh. But I kept playing keep away with him, and he thought it was fun. We are now great friends…I just wish I could remember his name.

After a couple more cuties came through our clinic, it was time for the MO with whom I was working to head out for an hour or so to his doctor's appointment. He told me that it would be fine if I went to work in the Family Medicine Clinic (FMC) with one of the other physicians at the BBCCOE. Don't get me wrong, the people were friendly, the doc was great, but boy did that hour and a half show me how much more I enjoy pediatrics. The patients had so many problems, took so much longer, and were, no offense, much less cute in the family clinic. Whereas in the Pedi Clinic I was awake, clucking like a chicken, and being my silly self, in the FMC I was sleepy, less interested, searching for a source of coffee, and waiting for my return from exile. Okay, so it wasn't THAT terrible, but it was such a stark contrast. I love making a doctor's appointment as much of a game for kids as possible. Adults just look at you funny when you make strange faces or puff out your cheeks and then push slowly against them, letting the air gradually and audibly leak out.

Perhaps the most meaningful experience of the day, however, was our trip to take one of the kiddos over to be admitted to the hospital. It wasn't enough for this kid to have HIV. He had HIV, congestive heart failure, chronic lung disease, and was a repeat offender as far as hospital admissions go. As soon as my MO found out that the kid had an oxygen saturation of 65%, it was an automatic admission. He was breathing hard, his lungs sounded junky, and he was not happy. After getting him all squared away, we wheeled him over to the Pediatric Ward of the next door Princess Marina Public Hospital.

Now of course, I don't have any photos, but imagine a building that looks a lot like an elementary school. Now put a sign on that school that reads "Pediatric Ward." Not pediatric ER, not pediatric triage area. Pediatric Ward. At first I couldn't believe that this was the actual building and not just a sign that indicated that we were indeed headed in the right direction toward the pediatric ward. Now, this place wasn't super filthy, with people moaning and groaning. However, the layout of it did remind me of the Emergency Center at Ben Taub, the public hospital in the Texas Medical Center. The "ward" consisted of beds lined up right next to each other, about 8-10 in each row. No private rooms. Not even a curtain between each bed.

Toto, I don't think we're in Kansas anymore.

Now I know that I didn't expect Texas Children's. It was just a wake-up call. After living in the comfort of the very American BBCCOE for the first week, I finally got a stark and tangible example of the way things are different here with regards to inpatient medicine.

After a few minutes searching for the team on call, we handed our patient over to the docs at the hospital, and were headed back to the clinic. The rest of the day was enjoyable as ever, but in the back of my mind I held onto the two stark contrasts that I had witnessed that day: the one between adults and children, and the other more serious one between the quality of care here as compared to the TMC.

Once clinic had ended, I tried to get some things done on the internet until about 5:30, when I could have sworn I looked over the balcony in the atrium of the clinic to see the front doors locked. Scared to be locked inside all night, I closed my netbook quickly and tossed it in my bag, hurried down the stairs, and I promise you during my time in the stairwell an elf had come by and unlocked the doors. I walked out into the nice cool evening air calmly, grateful for the freedom I had thought had been in such danger.

So it's been a week, and for the past four days or so I've been toying with the idea of taking a combi ride to the Riverwalk to see "Inception," especially since the tickets are P35 (about $5) even at night. It's like being in Aggieland all over again! Actually, that's about the only thing that the two have in common, I suppose.

Finally last night, I went. After waiting about 15 minutes for the right combi route to actually stop for me (and watching 3 "Broadhurst #5's" rush by me (seriously, it's impossible to wave them down when its dark, the headlights are on, and the number of the route is painted right above the headlamp)), I got on, asked how much, passed three coins to the driver sitting at the front of the van, sat down, quickly realized that people pay when they get off, and felt silly. The ride to Tlokweng (pronounced "Cloak-wayng) Circle was short, seatbeltless, and otherwise uneventful. After wondering how to ask to stop, I was relieved when someone else did for me, in Setswana that I could never duplicate, of course.

A short 10 minute walk in the dark along the side of the road later, and I was there. As I approached the theater, I realized that a bathroom break might be necessary before the start of the movie. However, as it was about 8 minutes to showtime, and the poster had a sign on it saying that "This movie has no previews and begins exactly when scheduled", I wasn't sure I had time to get a ticket, make a stop, and get in my seat before the film began. It was right about when I picked out seat I-12 (seriously assigned seating in a movie theater…brilliant!) that I realized that a pit stop WOULD be necessary.

I did my best, but as I walked into the theater I realized I was about 2 minutes late. Of course, even though I had no idea the plot of the movie (people who know me know that I don't watch movie trailers AT ALL once I know that I will be seeing a movie) other than that involved dreams and was directed by Nolan, I did know that it was likely a movie you needed to watch START to FINISH. Now, without ruining anything and being a hypocrite, I'll only say that I wondered throughout if I had missed something crucial, wondered still once the movie had ended, and only today was relieved to find out that I really hadn't missed too much. I guess I wasn't as late as I thought.

By the way, the movie is AWESOME. I don't care if some people claim the idea was stolen from a comic about The Beagle Boys trying to steal the combination to Scrooge McDuck's safe (seriously google it). It was AMAZING. Go see it. It is not gory, dirty, boring, or gushy. It is everything a movie about which you had no inkling of the plot should be. It made me forget that I was in Botswana, and I loved seeing it even though I am in Botswana…or am I? Wait, how did I get here? (Smirk)

Two thumbs (and two big toes) way up (remember now, don't get confused because from America my Thumbs up might look down, but they aren't….I'm standing on the ceiling, remember?)


  1. Great blog. Take care of yourself son. You're needed here. Love Dad

  2. One day, you and Ali are going to build good hospitals in Africa.

  3. hahaha...I really thought you fed that 2 year old your stethoscope!! :o) You sure are great with the kiddos!! :o)