SOS Children's Village

Yesterday was my first break from the routine of HIV Clinic all week. I went with three of the volunteers from Baylor to visit the Botswana SOS Children's Village. There are 247 children who live at the village.  They are mainly orphans who have no family who can care for them.  They live in groups of 10-12 in a house with a "mother" and  assistant mother who care for the children. There are 16 houses in total.

There are three villages in Botswana.  The one which I visited in Tlokweng, as well as Serowe and Francistown.

The youth leader was kind enough to give us a tour of their facility and we brought some small gifts for the children.  (Which almost caused one of the volunteers to be trampled by the kids).  Overall it was a great visit and a way to connect with other organizations working in Botswana.

SOS Villages are present in 132 countries around the world and they advocate for the rights of children.

Disappointingly, I forgot my camera, so I wasn't able to get any pictures.

Pictures from Wednesday

Salt pans dot the horizon as we approach the runway in Hukuntsi.

Walking across the tarmac towards the plane on Wednesday morning in Gaborone.
The ultrasound technician is pushing the ultrasound machine with a trolley.

Waiting to load up and leave at the end of the day.  Standing in the shade to keep cool.

Another Adventure

Yesterday I went on another outreach trip.  This time to Hukuntsi which is north of Tsabong and also in the middle of the Khalahari.  The day was not quite as hot as last time, probably around 30 degrees instead of 35.  When we were flying in you could see Pans scattered across the desert. These are flat basins with a coating of salt, which were once part of a huge lake which covered much of Botswana.  However, 10 000 years ago, it's thought that tectonic plat shifts caused the huge lake to evaporate, leaving only salt behind.

In Hukuntsi, I was doing similar work to what I did in Tsabong.  I started to learn more about the San people of the Khalahari.  They have been forced off much of their traditional lands into settlements, which I suspect will not work well for this hunter-gatherer people. 

Today I was back at Princess Marina Hospital doing oncology again.  I'm looking forward to Dan's arrival next weekend when we start our safari adventures!

Random Sightings

Just adding some points of interest.

1. Coughing Post outside the TB clinic. I can only assume that if you have active TB you're supposed to go inside and cough instead of spreading your germs around.  Nevermind the fact that there are no windows on the post and it's probably full of other people's TB (which could be multi-drug resistant)...

2. Plumpy Nut.  High protein and high energy peanut-based paste for treating acute malnutrition.  Apparently like peanut butter, only sweeter, yum. Best name of any food so far.  Although I doubt it would go over that well in North America...

More medicine, more adventures

I haven't been crossing anymore rivers in rental cars this week, so this post won't involve any loss of life or limb to wild animals.

Wednesday, I spent the day working at the Princess Marina Hospital with Dr. Parth.  He's the only pediatric hematologist/oncologist (cancer/blood doctor) in all of Botswana.  PMH is the large general hospital which is right beside the Baylor Clinic.

Since this is one of my areas of interest, I was thrilled to be able to spend some time learning from him.  HIV infection can be associated with cancer, especially Kaposi's Sarcoma, and this isn't something which I have ever seen in Canada.  As I followed him around the pediatric ward, I was amazed at how active to the children were.  Despite receiving chemo, most of them were running around the ward, dashing between the park outside in the courtyard and their beds in the "oncology" ward.

Again, I was impressed at how well the health care system is able to provide for them.  Their hospital stays, chemotherapy, and all the equipment was free.  Several children were from very far away and they were mostly being kept in hospital because it was too far for them to go home and come back before their next treatment.  When they did need to go home, they are provided with transportation home at no cost!

There are major issues with the supply of medications, and at times it is impossible to get some medications which are essential such as certain antibiotics or anti-epileptics.  Since Botswana did not have a medical school until this year, many of the doctors working here are from neighbouring African countries or further afield.

The remainder of the week, I spend in HIV clinic and the good news is that I'm now ready  to see patients alone!  I'm looking forward to the adventures awaiting me next week...including another flying visit to an even more remote part of the country.

The Baylor pharmacy, the clinic dispenses all meds for the patients after they're seen by the doctor.

The pharmacy has most of the medications we need, most of the time, which is better than most places.

The Botswana-Baylor Centre of Excellence; this is where I am working each day.

Baylor clinic waiting room (usually fulled with patients, their parents, babies sleeping on the ground, etc.

The pharmacy is where I'm standing to take this picture.

Pediatric Ward at the Princess Marina Hospital.  There are four patients side-by side along this wall of the "cubical", there are four patients facing these ones on the other side of this cubical.

There are plenty of windows in each cubical and the windows help with ventilation since TB isn't always isolated.

Tshabong Day Trip

Yesterday I flew to Tshabong for an outreach visit.  Tshabong is located on the eastern portion of the southern border with South Africa, as a result many people here speak Afrikaans.  It is the administrative capital of the Kgalagadi District and is located in the Kalahari Desert. The day was sunny and hot.
 
Along with two other physicians, a dietician, diabetes nurse, and ultra-sonographer, I was part of a team from Gaborone which flew to the local hospital. In the morning I rounded on the hospital inpatients.  Then I joined the other pediatrician in the IDCC (code for HIV) clinic where we worked with the nurse prescriber seeing children on ante-retrovirals.  The role of the pediatricians when they visit Tshabong is to provide teaching and mentoring to help the local staff of medical officiers and nurses to provide better care.

I'm starting to realize how well the Botswana health care system has responded to HIV and provides care for citizens. There do not seem to be any fees for health care services for Botswana citizens, as well ante-retrovirals and all other medications are paid for my the government. More thoughts on this later...

At the end of a hot day (no air conditioning here), I grabbed a late lunch at the local restaurant.  Chicken stew with rice and beets.  Mmmm.  Then we hopped back on plane (roasting hot inside from sitting on the runway all day), took off from the dirt runway, and flew back to Gabs.  Overall a very interesting day.

  Tshabong from the air.

Adventures in South Africa

Two days after I arrived, the entire country took a 4-day weekend to celebrate Independence Day. So I met up with my friend Nikki, who's been living in Zimbabwe for the past 2 years and headed off on an adventure.  We rented a car and drove to Mapungabwe National Park in South Africa.  The journey there was as much of an adventure at the actual destination.

Along the way, we got stuck in a dry sandy riverbed; we rented a Toyota Yaris which we discovered it is much to small and low to manage roads suitable only for 4x4s.  Lucky for us, just as we became stuck in the sand, a local farm worker arrived with his Land Cruiser and towed us out.

The "road" across the Limpopo riverbed.

Several hours later we reached the South African border crossing.  The Limpopo River forms the dividing line between the Botswana and South Africa along the eastern portion of the southern border of Botswana.  Crossing into South Africa involves crossing the river, most of which was dry, except for the portion that was still flowing.   Having come all this way, we and our Yaris were not deterred and I was determined to drive across.  (After walking through to check the depth...and for crocodiles).

Well the Yaris survived, the license plate did fall off, but no other visible damage...

Finally we were into South Africa and the next morning we were up at 4am for a game drive through the National Park in search of wild animals.  (Don't worry we didn't use our car for this).  We saw elephants, giraffe, wildebeasts, warthogs, ostrich and lots of other animals which all looked like antelope to me.

It's 5:30 am, where is our safari guide??

At our camp that afternoon, the elephants cooled themselves in the shade about 20 metres away!  We were informed that the small electric fence between us and them was keeping us safe...?!

Giraffe right outside the safari truck!

Arrived

I have been in Botswana for a week now. I am starting to settle into a routine and I've got the essentials-cell phone, transportation, groceries. I am staying at a house which belongs to Baylor and is rented for visiting scholars. Baylor is the university which runs the HIV treatment centre I'm working at. Apparently I'm now a "scholar".