Serowe, part 1

Left to right: Ashley, Scott, Derek and myself

Last weekend, Ashley, Scott, Derek and myself took a trip to the town of Serowe (say-ROH-way) to spend a night at the Khama Rhino Sanctuary. We had heard rave reviews from a group who had went the week before and all of us were itching to get off campus, so we made last minute plans and hit the road.

We got up bright and early and took a combi to the bus station in time to catch the 8am bus for Serowe. As the buses are waiting to depart, vendors are free to come on board and push various foodstuffs or fake designer items towards you, and I had skipped breakfast so I bought a chicken pie. I love the smell of spicy chicken in the morning.

The ride took about three and a half hours, but it went by in flash thanks to my penchant for sleeping in moving vehicles. As we rattled into the sleepy bus station in Serowe, the change of pace from the bustling capitol was refreshing.

We had heard about a museum in Serowe dedicated to the presidents of Botswana (all four of them are from this village) and we decided to track it down. After asking for directions a couple of times, a young girl selflessly offered to show us the way – and it wasn’t that short of a walk.

Of course, after we had trekked all the way there it was closed. We found a boy banging away on the drums to a Shakira song out back and another boy said the managers of the museum were gone until Monday. So we headed back to the station.

We were planning on cooking dinner at the campsite, so we bought groceries to make al-foil meals (potatoes, onions, and carrots wrapped in tin foil and thrown in a fire) and bratwurst. Then we stopped by a small kiosk by the bus rank and grabbed lunch before we took the bus that would bring us out to the Rhino Sanctuary.

I fell asleep on this bus, too, and this time it proved to be costly. As the bus made its stop Scott poked me awake and I was able to come to my senses with just enough time to throw my book in my backpack and head out. However, as the bus pulled out of sight I realized I had left my half of the groceries in the overhead compartment. I couldn’t believe it. My one group responsibility and I dropped the ball. We were able to get on the phone with the bus company, but they said no buses ran until the morning, by which time our sausages would be rotted or already eaten by a lucky traveler. So we would make due with half-supplies.

Tiny tent beneath the Mokongwa

From there we moved to our campsite. Each campsite at the sanctuary is centered around a large, stately Mokongwa tree and has plenty of space to set up camp, though our extra-cozy four person tent didn’t need much space at all.

As we set up the tent and explored the area, we heard music coming from a neighboring campsite and so we went to investigate. As we approached we saw a group of four locals dancing to the music and we figured we wouldn’t bother them, but they caught sight of us and invited us over.

Hornbill

They were incredibly friendly and we talked for a while. There were two guys and two girls. One of the guys was a banker, the other a teacher. They knew a lot about the birds that inhabited the sanctuary and told us the story of the mating habits of hornbills. Apparently once a female hornbill is pregnant, she sheds all her feathers into a knot in a tree to make a nest, and then the male seals her into the knot by filling the hole with cow dung. He leaves just a small hole so that he can bring her food while she minds the eggs. The male does this faithfully until the eggs have hatched, at which point the female’s feathers have grown back. Talk about commitment!

Us and the local ladies

Then they showed us how to eat sweet reed, which is a smaller, softer relative of sugar cane. You have to peel back the outer layer with your teeth and then the middle is like a natural lollipop.

To be continued…

Stepping Stones

As the semester has worn on and I have continued to experience a variety of opportunities that immerse me not only in Botswana health care but also in the social impacts of HIV/AIDS, I have begun to see that although there is a long list of beneficial national policies and noble NGOs, Botswana has a long way to go before it can relinquish the hold HIV has on the country.

Some campaigns have called for an “AIDS Free Generation” across Africa by 2015, which is a tall order, but Botswana, at least, may be well on its way. Precedents have been set for controlling and treating HIV, prevention programs are in place and global funds are surging into the area. Now, there just needs to be work done on the ground to implement this change and begin shifting the culture and behavior surrounding HIV.

Last week I had the good fortune of visiting an organization that is doing just this type of implementation through grassroots work that empowers kids and gives them a place to belong. The organization is called Stepping Stones International, and it is an NGO located in the town of Mochudi that works with orphaned children and children from destitute homes who have been made vulnerable because of how HIV hit their families, and now are at-risk to contract the disease themselves.

Here is the story of my trip to Mochudi…

I heard about Stepping Stones through a colleague at the Center for the Study of HIV/AIDS on campus, who put me in contact with Lila Pavey, one of the directors at Stepping Stones. Within a week of contacting her she asked me to come out and visit, and I couldn’t have been more excited to go.

To get to Mochudi I took a combi (a minibus that is a facet of public transport) to the main bus station, and then asked for the bus to Mochudi. The bus was only P9 ($1.50) and took about an hour to get to the town. As the bus approached Mochudi, some people were already getting off of the bus, and Lila had told me to get off at the Shell station, so when the bus passed a Shell station I hopped off. It turns out I got off one Shell station to early, however.

I needed to call Lila but my phone had conveniently run out of battery, so I went to the Shell station and asked how to get to Stepping Stones. After a short lesson in Setswana, one of the attendants pointed me to a combi that would go in the right direction. I used the combi driver’s phone to call Lila and tell her I would be late.

The driver said he knew the stop for Stepping Stones but when he left me off at a dirt road with no clear buildings in sight, I was skeptical. I followed the road anyway, and soon I ran into a group of young kids.

They were so excited to me (because of the welcoming air I give off or because I’m white is up for speculation) and we played catch with a homemade tape-ball and I taught them how to high-five. They all went crazy for high-fives after that and competed for space to slap my hand and one boy kept slapping harder and harder until I feigned an injury, which sent them into more of a frenzy. I said hello in Setswana and they answered, but then I said, “my name is Mike” in Setswana, and they echoed, “my name is Mike” in unison back to me, so I figured asking the way to Stepping Stones wouldn’t get me very far.

Luckily a woman walked by who pointed me in the right direction, and I strolled into Stepping Stones fashionably late (ironic not only because that rule doesn’t apply to meeting with the director of an NGO, but also because at that point my business casual attire was dusty and sweaty and far from fashionable). The place was bustling when I arrived because kids had just arrived from school. Lila was busy meeting with a new hire, and so she had one of the students take me on a tour.

His name was Thero (pronounced TAY-roh) and he was a fantastic tour guide. He was super enthusiastic and refreshingly straightforward and thoughtful with his words and actions. To be honest, he reminded me a lot of my cousin Marcus, from whom I’ve always felt I have a lot to learn because of his genuine warmth and kindness. Thero was off to a great start at drawing me towards Stepping Stones and its kids.

I learned that the kids are split up into groups and each group is assigned different chores each week. Thero was on dishes this week. There was also an inter-team competition and when teams did something well they got rocks placed in their corresponding buckets (a “ten points for Gryffindor” kind of thing). Thero’s team was winning.

Then I learned a little bit about a profit generation program they have in place for the kids. I only got the basics, but it sounds like they have some kids who make musical beats, and then some kids who promote them and some that work on the finances. Thero is currently a finance manager for the project, and I promised to buy a copy of the CD as soon as it dropped.

At this point I should explain further my interest in Stepping Stones.

The potential that I mentioned earlier for Botswana to turn the tables on its HIV epidemic had ignited in me the desire to contribute to its progress and give back to the community of which I had become a part. My schedule during the semester wasn’t very flexible, so I started thinking, only wishfully at first, about staying here for the winter (American summer) to volunteer.

A friend of mine who grew up in a developing country once warned me about my aspirations to one day work in a poor part of the world because of the sentiment in these countries that they don’t need Americans to come and save them. So I was wary of any plans to stay and volunteer in Botswana. But as I have continued to contemplate the idea, I feel like I’m not someone coming to save anybody, but rather just a person drawn to a cause who happens to be in a place where a lot of good is being done, and I feel like good could always use an extra hand.

So I was visiting Stepping Stones to inquire about a volunteer position for the few months I would have off between semesters.

When my tour with Thero was complete, I sat down with Lila to talk more about the details of the program, as well as what they were looking for in a volunteer. The conversation went well from my point of view, and although Lila couldn’t make the decision on her own, she gave the impression that Stepping Stones would have a spot for me.

After we talked, I got to sit in on one of the group lessons. Students were acting out role-playing activities relating to prevention of risky social and sexual behavior. In the role-playing, one person was an “instigator” who was trying to bring the other person home with them and the kids had to practice saying “no” to these kinds of people in an interactive setting.

The kids really liked it and were great actors and loved being dramatic and performing in front of their peers. In one of the role-plays, a guy and a girl rounded up some old pop cans and chip bags and the boy pretended to buy the girl lunch and they flirted and then he tried to get her to come home but she said no, very emphatically. It was so cute, yet striking, because the boy looked like he was 10 and was probably only 12 or 13 and was talking about sex and bringing girls home and had such a flare for the dramatic.

The next morning the kids were going to play soccer and then a talent promoter was coming to watch the kids dance and select some for a performance or music video. The more I heard about the healthy experiences Stepping Stones created for the kids, the more impressed I became.

At the end of the day Lila gave me a ride back to UB, so I avoided any more bus mishaps. She had amazing stories from her days in public health. She told of sexual abuse, of girls sleeping out for nights at a time who were much too young to do so, and other situations that Stepping Stones was working hard to avoid for its kids.

As I got home I realized I was completely hooked on Stepping Stones. I wanted to hang out with Thero again; I wanted to participate in role-playing activities (even if I couldn’t keep up with the Setswana); I wanted to help launch the new education center that was under construction. So I started looking into what I needed to do to extend my stay. As of yet I haven’t made a decision, and some things still need to fall into place, but I might be staying in Botswana for a little bit longer than expected.

As I stepped out of Lila’s car, I had just enough money for a bratwurst from one of the roadside stands, and it put a cap on a fantastic day.

Foot long bratwurst with onions, tomatoes and chili sauce for dinner…

Princess Marina

Still in search of an extracurricular activities that are a good fit, last week Derek and I got connected with a shadowing opportunity at Princess Marina Hospital (PMH). The process was refreshingly efficient. We met with an administrator in the Medical Education department on campus, she made one call to PMH and had a meeting arranged for us later that day. At the meeting, the coordinator of clinical exposure for the hospital asked what our interests were and outlined a shadowing program that would fulfill our needs.

That same day we met with a specialist in the medical ward and she gave us a brief tour and introduction to the work she does. She told us to come back at 7:30 the next morning for the daily meeting and after that we could join teams for rounds. We obliged.

Despite the early morning wake-up, the meeting was fascinating. It opened with nurses reporting admittances and mortalities from the night before and we got to hear all of the different cases the hospital faces. The words I heard over and over were anemia, meningitis, pneumonia, TB, and the most common, unfortunately, was HIV.

More than half of all patients admitted to PMH are HIV+. Botswana is at the point in the epidemic, however, where patients are no longer coming in because they have HIV (they have already been diagnosed and are receiving treatment) but rather because of a secondary or concurrent condition caused by HIV.

Meningitis incidence is fairly low around the world, but due to its co-infectious nature with HIV, it is the number one diagnosis made upon admission at PMH. The same is true for pneumonia and TB, cases of which seemed to be everywhere I turned as I moved through the hospital.

Even if a person avoids co-infection, the antiretroviral (ARV) drugs that patients take have serious side-effects. One patient we saw had Stephen-Johnson syndrome, which is a disease of the epidermis that can be life-threatening. Rashes and painful lesions appear near mucus membranes all over the body, most notably in the mouth and eyes. Official websites list the syndrome as extremely rare, but the dermatologist at PMH said she sees it all the time here because it is a common repercussion of ARVs. Of course, the immunodepressant aspect of HIV makes the side-effects from drugs that much more serious. Also, Steven-Johnson syndrome is easily treatable by taking the patient off of the drugs that cause it, but with HIV, stopping a drug course risks the development of drug-resistant strains of the virus. It's like being stuck between a rock and a hard place and another rock.

After admittances, the nurses reported mortalities and the response from the room was not what I expected. When the first name was read, the doctor who had been responsible for that patient said, “I never saw it coming” and the whole room laughed. Apparently that’s what they say every time one of their patients die, and it's become an inside joke. Another name was read off and another joke was cracked. I was sitting there becoming quieter and more introspective, but I suppose I should have been developing my own coping mechanism; you certainly couldn’t sit through those lists day after day if you lamented the injustice of every passing.

Next, one of the doctors made a presentation about an interesting case he had the week before. It was an interactive talk, as the doctor would discuss the symptoms and ask the room what they would have done. It was such a good mechanism for professional development and keeping people on their toes. If I had understood more of the medicine I would have learned a ton.

The meeting broke after the presentation, and Derek and I were assigned to two different teams who were going on rounds for the morning. The first case my team saw was an elderly man who was recovering from a second round of TB. We looked at his chest X-ray and the doctors explained how his right lung was decreased and pointed out signs of chronic lung disease on the left side. I got to listen to his breathing through a stethoscope and experience what the breathing of a two-time TB sufferer with lung disease patient sounded like. Raspy, to say the least.

We moved on and tended to patients throughout the ward. Some were anemic, others just had dizziness. One patient had such bad fluid build-up around her brain that she was delirious. She needed daily lumbar punctures to relieve the pressure and relieve her neighbors of her nonsensical screams.

One man, who was a 62-year-old named Rocket, had originally been admitted with a mysterious illness that left him bed ridden and speechless. Over the past week, however, he had made a recovery and was walking around, talking to whomever he could. My first encounter with him occurred as he was trying to fill up his water glass. He went to sink and turned the faucet on full blast. He stared, fascinated, at the stream of water. Once in a while he stuck his cup under the water and it was running so hard that it splashed everywhere. He would pull his arm back, but eventually test it again, like a curious child. The nurses courteously shut the water off as the basin began to overflow and I asked the doctor what the fascination was all about. She responded that Rocket perhaps had never seen running water before being admitted to hospital. It reminded me of the inequalities that are prevalent in Botswana – not only between rich and poor but between urban and rural as well.

In talking to Derek afterwards, he had been in the surgical ward for part of the day, and while his team was tending to a patient, the neighboring patient started to crash. The head doctor tried defibrillation, but it didn’t work, and none of the local staff could find a ventilator, and the patient died. It highlights the lack of resources the hospital has. Some of the doctors on my team were from America, and they were constantly saying things like “well in America we would do this, but Botswana doesn’t have the supplies, so we do this instead.”

One American doctor said the supplies aren’t even the real issue. She thinks the hospital desperately needs a workplace engineer to come and solve the issue of miscommunication between nurses and doctors and between various departments. It certainly reinforces my drive to go into public health and do what I can for places like these, where they run out of tape to keep IVs in place and have nurses lose track of patients' files. The list of things we take for granted in the states was building by the minute.

The hospital was enlightening in many ways. Going on rounds is not something I could do everyday in the states, and I tried to make the most of it.

If anyone has spare medical ventilators, maybe donate them to Bots…

Chicken quesadillas (Derek’s idea) with homemade guacamole for dinner… 

Miss UB

"Has he let the suspense build for long enough?" you might ask. Yes, he has. Here's the much overdo story of the 11-hour beauty pageant...

Last weekend was the Mr. & Miss UB (University of Botswana) pageant. My friend Robin was a contestant, and so a group of us went to support her. The tickets were on the expensive side, but we were told they included dinner and performances from local artists during breaks in the pageant.

The tickets said the show started at 7pm, so we showed up at 730, thinking we would be fashionably late. They were still setting up the stage and lighting at that point though, and we were told that the show in fact did not include dinner so I swung back to the room to make some food. I hustled back at 8:30 hoping I hadn’t missed anything, but my fears were premature. Not only had the show not started when I got back, but it didn’t end up starting for another three hours.

Despite the delay, we were excited to see Robin, who had attended daily practices for the two weeks leading up the event and was always bubbling with stories of the people she met and all the work she was doing to prepare. The show opened with pairs of guys and girls coming out together in casual wear. Robin did great, and she was paired up with the most popular boy, which didn’t hurt.

Then there was an hour break while a local rap duo performed. Next, the contestants came out as a group for a few minutes, and then there was another break while another performance was set up. We had been at the pageant for five hours at that point and a friend of mine and I were sick of the breaks and were getting hungry, so we went back to the dorms for a bit. We came back and caught the swimsuit competition. Robin was full of confidence, despite having to walk in heels while wearing a bikini with bright lights on her from every angle. With the first two rounds complete, she seemed to be a contender for the top five, which is what she needed to move on.

Next there was a group dance. This was an area was a strength for Robin, but she ended up in the back of the formation, where her potential to outshine the other girls was limited.

The final round was formal eveningwear. All of the guys’ suits were too big for them, which was amusing. It was as if they all borrowed them from their dads, or maybe the school supplied them without getting measurements. The girls looked fantastic, though. Robin had on a gorgeous yellow dress that she showed-off very gracefully. We were all screaming as loud as we could whenever Robin came out, hoping the judges would be influenced by audience approval.

At this point it was around 4:30 in the morning, and they were setting up another performance while the judges deliberated. We couldn’t handle sitting around anymore and went back to hang out in the dorms for a while. Around 5:30 we figured the pageant was over but that we might as well catch the sunrise since we had made it all the way through the night. But when we went outside we could still here music coming from the auditorium. We swung by and, sure enough, the pageant was still going. They had selected the top five (Robin didn’t make it, which was a fluke) and now the judges were deliberating again after a round of interviews. We went and caught the sunrise while the judges deliberated, and we came back to hear the final results come in at 6:45 in the morning.

So that’s the story of the 11-hour beauty pageant. It was a blast, though the end is somewhat of a blur. Robin said she had a great time, though her legs felt like rubber after spending the whole night in heels. A lot of the people that had originally come for Robin had bailed by two or three in the morning, so we were able to say that we had stuck it out for her. I finally got into bed around 7:30 and I won’t say how late into the day I slept.

A rushed bowl of macaroni with fried green peppers, onions, carrots and tomatoes for dinner…