Giving back to the Batswana.

    Yesterday we visited the SOS Orphanage and it was by far the most rewarding experience so far.  The children were so excited to see us and had so much energy to share.  They absolutely loved our cameras and taking pictures.

    It was almost more overwhelming for us to have so many kids running around and trying to play with us than it was for them to have 22 white kids roaming around their playground.   Their motto was “It takes a whole village to raise a child” which is so fitting for them.  The orphanage appears as a small village in itself, with kids of all ages and backgrounds.  I can't wait to go back and spend time with them after knowing how happy it made them and me.  

    I started my clinic internship today in Extension 2.  Walking in was probably the most uncomfortable and overwhelming experience thus far.  Their waiting room was packed full of Batswana, and the three of us were the only white people there; and the whitest considering we were wearing lab coats.  It is such an odd feeling when you are looked at as something completely alien.  It just seems like everyone was in shock that we were there.  Communication was difficult, and starting the day was even more so considering our arrival was not expected.  I was so conscious of the fact that I was an intruder that it was hard to be aware of everything else around me.

    I began my day in the injection room, which was incredibly busy.  As soon as the patient would open the door to leave, another would be walking in.  Most patients, about 95%, were there for Ceftriaxone, which is an antibiotic for STI’s. There was one pregnant woman there for her routine tetanus booster, and two others for their TB treatment.  A few had both Ceftriaxone and Penicillin for STI’s as well. 

    The most interesting part of the day was when I was brought into the dressing room to see an abscess treatment.  A woman had an abscess in her armpit area about the size of a small apple.  The doctor made an incision and drained the abscess, which looked incredibly painful.  Even after receiving a painkiller, the woman was writhing in pain.  A positive to seeing this was the fact that I wasn’t fazed by the abscess itself.  However, I felt absolutely terrible for the woman.  I think if I were the doctor in that situation, I would be continually apologizing.  Still, I couldn’t help but think that I would have loved to be the one with the scalpel.

    The rest of the day was incredibly slow and uncomfortable.  Most of the people spoke in Setswana, during which I could only understand “gakiitse” which means “I don’t know.” We did meet an incredibly helpful doctor there though who answered all of our questions and helped to give us a better understanding of their medical system.  In Extension 2, there are only two doctors and a few nurses.  It is incredibly understaffed and resources are scarce.  There is a maternity room, three observation rooms, a very small emergency room, injection room, dressing room, and TB room.  TB patients need to go to the clinic daily to ensure they are taking their medication, otherwise they can be prosecuted.  Most patients, if they cannot be treated at the clinic, are given referrals to other clinics or hospitals. 

    It is just a completely different medical environment than I am used to.  People will spend the night or get to the clinic at 3 am to get in line.  Others wait for hours just to see a doctor for a few minutes or have their blood drawn, which takes about 2 minutes.  I had to scour the clinic to find rubber gloves for a doctor; I felt so guilty for wasting all of those rubber gloves in Biology lab. 

    I never realized how much I took health care in the US for granted until now.  If I wait a half hour in the lobby for a doctor appointment, I’m frustrated and assume it is because people are inefficient and lazy.  I waste pipette tips and gloves in biology lab like no other.  I don’t even appreciate the fact that when I go to the bathroom in a US clinic, there is soap and toilet paper. 

    Even though health care and services are free in Botswana, the system is completely lacking in so many areas.  Nurses and doctors are overworked and underpaid.  How are doctors expected to give quality care when they are faced with hundreds of patients every day?  They are faced with the struggle to decide between helping everyone with less-than-efficient care or helping a select few with exceptional care.  Only 5% of Batswana have health care, but even they go to the local clinics to get free services and medication.

    The practical solution would be to charge the citizens for health care in order to pay for medical resources and personnel.  However, many citizens most likely cannot pay for such things.  Botswana is the first African country to pay for all ART (antiretroviral treatment) for HIV/AIDS patients as well.  But how is that affecting their economy?  Do you choose between keeping clinics and hospitals well stocked in all aspects, or between keeping your citizens healthy? 

    These questions are only skimming the surface of the problems the health care system is facing.  I can only imagine how difficult it is to decide between such vital things.

I am sure tomorrow will bring about even more observations and questions. 

On a positive note, I learned how to test someone’s blood pressure, which is surprisingly harder than it looks.  Hopefully by 4:30pm tomorrow I’ll be a pro thanks to Phage (pronounced Pah-hey), the male nurse who is looking for a wife.