This past week was both challenging and exciting! I shadowed an Argentinean doctor, Andres, in the pediatrics medical ward at Princess Marina Hospital (the public hospital in Gaborone). I witnessed a number of interesting clinical cases rarely seen in the U.S. One memorable case was an infant born without a vessel that clears bilirubin (a metabolic byproduct) from her liver, resulting in jaundice and edema in the abdomen. An interesting contrast between the pediatric ward at Marina and those in the U.S. is the role that mothers play in patient care. Feeding and bathing these young patients, which would normally be done by nurses in the U.S., is done by the mothers, who sit by the bedside during their child’s stay. This is most likely a result of the lack of health care professionals in Botswana, but also reflects a cultural difference in the division of child care.
My plan this week was to get into the Baylor pharmacy to get an idea of how medications are dispensed and find inspiration for new design ideas. Interestingly, the pharmacy is run by the Ministry of Health and its employees are hired independently of the clinic. I suspect this occurs because the Ministry provides these expensive ARVs to its citizens free of charge and would like control over their distribution. The issue of citizenship has come up several times since I have been here, as many Zimbabwe nationals have immigrated into Botswana and cannot be provided with treatment. With regard to entering the pharmacy, its status as an independent entity adds an additional level of supervision. I had to wait about three hours to receive approval from the pharmacists’ supervisor to enter the pharmacy. Nonetheless, when I was finally let in, I demonstrated two technologies I brought from Rice: the Accudose syringes and pill scale. The supervisor was particularly fond of the Accudose syringes, which use a small plastic clamp to set a predetermined amount of liquid to be drawn from ARV medication for children. This is particularly relevant for older women who may have difficulty reading the small measurements on syringes and may not be administering the proper dose to their children. I have clamps for 1.2cc, 1.5cc, and 2.5cc doses, but this BIPAI clinic most often distributes whole number volumes. Luckily, it is relatively easy to create new clamps for these doses. The supervisor was less fond of my idea for weighing pills on a digital scale and expressed concern with issues of calibration. I am certain that once I demonstrate the use of a digital scale for counting pills to her, she will no longer have reservations. Given that ARV pills weigh about 1.5g each (!), any errors in measurements (usually on the order of 0.01) would not be significant enough to miscount a single pill. I truly believe this idea could really benefit the pharmacy, but I foresee implementing a sustainable design as a challenge.
This past weekend was great! On Friday night I went with several docs from the Baylor clinic (all of whom are extremely friendly, fun, and humorous) to see a performance at Botswana Craft. The saxophonist for the opening band, Matt Dacso, is one of the docs’ husbands and is a native of Houston! His father, Clifford Dacso, does work with Rice and Methodist. Most of the UPenn students went for a safari in Tau (South Africa), so the few of us left behind decided to stick together and do a horseback safari! We returned to Gaborone’s local safari, Mokolodi, and rode horses for two hours through the bush to see wildebeests, hyenas, and impalas. Unfortunately, I got stuck with the old and lazy horse, Savannah, who kept me trailing the group by a solid 20m the entire time and would only trot when she wanted to. She also decided to walk me into a bush, where my lip caught a thorn and began to bleed profusely. All in all: a memorable experience.
Today our good Motswana friend, Carroll, took Meghan and me to her church for service. Her church is located far outside the city (it took us an hour to get there). I must say that attending this Pentecostal church service was unlike any experience I have ever had. It included three hours of singing, sermon, and significant religious collective effervescence. The sermon was in English but every line was translated into Setswana. During the extremely powerful singing, a number of people fainted. Having been raised a Unitarian, this was as far from my notion of church as possible. Although exhausted from the five hour experience going to church, I was convinced to return for a hike up the infamous Kgale hill. Unlike last time, we were dropped off the correct mountain and proceeded to hike up in the sun. At the top, we found a stunning view of the Gaborone dam and downtown.
