Annual Traditions: Season of Reflection and Gratitude

Inspired by Jess Lively I have taken to writing an annual future letter to myself which I read a couple of times throughout the year

 Susannah Conway’s Unraveling the Year Ahead 

 This is my 7th year of keeping a daily 5 line journal. During the month of December, for the past couple of years, I have participated in “Reverb.” From a combination of this and this, and inspiration from lovelies such as: Brene Brown, Christine Mason Miller, Daniele Laporte & Jen Lemen, I have come up with the following 30 prompts that I use during the month:

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1. A place visited with special meaning

2. Ordinary sparking moments of 2013

3. A storm weathered this past year

4. Most memorable gathering

5. 5 memorable moments of the year

6. Best gift I have been given

7. What I let go of this year

8. What makes me different

9. “The” social gathering of 2013

10. Worst decision of the year

11. 11 things my life doesn’t need

12. Next step in my life

13. What I have come to appreciate this year

14. What I most want to remember about 2013

15. Best lesson(s) learned about myself this year

16. What I want to try in 2014

17. Biggest healing of 2013

18. 2013 avoidance

19. Advice to myself in 5 years

20. 2013 travel

21. Best moment proving all will be okay

22. Ordinary Joy

23. 10 Feelings associated with my greatest achievement of 2014

24. Defining experience or moment of the year

25. Best emotional gift

26. Core story of 2013

27. What I believe in

28. 2013 birthday celebration

29. This year I changed my mind about…

30. Word to sum up 2013

31. Word for 2014

Found via livin-on-lovee

Found via livin-on-lovee

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A long overdue post…

In looking at my blog I see that my last post was from Botswana in May. I have abandoned the idea of trying to catch up. A few of the highlights:

Finishing residency

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Moving to Cambridge

Starting my Global Health Delivery Fellowship

Completing the Global Health Delivery Summer Intensive

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Going to Haiti for the 1st time with Partners in Health

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Joining the leadership team of the Harvard Global Oncology Initiative

Tutoring a section of the Harvard Medical School Introduction to Social Medicine course for the 1st year med students

Volunteering at the Clinton Global Initiative Annual Meeting

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Attend the LIVESTRONG Young Leaders Cancer Council meeting and Challenge weekend in Austin with a Marfa visit

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In the midst of all of this I have been able to fit in some fun trips and visits with friends!

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Image And that is what I have been up to. It is hard to believe that my first 6 months in Boston is coming to a close. T-8 weeks to Rwanda!

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Botswana, it has been real!

I settle into a routine and often forget to post or share about ordinary things.

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We turn from Elephant Road onto Zebra Way on the way to work

The apartment, the CHOP flat is a floor below

The apartment, the CHOP flat is a floor below

The walking path shortcut to work

The walking path shortcut to work

The life saving meds

The life saving meds

The pool here was jokingly referred to as my "second home" as I spent most late afternoons pool side reading!

The pool here was jokingly referred to as my “second home” as I spent most late afternoons pool side reading!

Art in clinic

Art in clinic

We assume because it is where you leave a "sample?"

We assume because it is where you leave a “sample?”

No jet bridges in this country

No jet bridges in this country

Sunset at the yacht club (which is located at the dam)

Sunset at the yacht club (which is located at the dam)

That is a wrap on Botswana. Spending the final weekend finishing off the sites of Johannesburg.

Next up: Haiti in August!

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Making Chemo!

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 I have had the chance, over the past month, to spend a couple of mornings rounding and chatting with Dr. Jeremy Slone, the Texas Children’s pediatric oncologist from Texas Children’s Cancer Center’s International Program based at Princess Marina. Batswana children, given a wealthier health care system, have much greater availability in terms of scans and access to chemotherapeutics than what I witnessed in Blantyre, Malawi. For procedures such as port placement (although many just rely on peripheral iv’s) and procedures deemed necessary and unaccessible in Botswana, Dr. Slone is able to petition the Ministry of Health for permission to cover the expense procedures and travel to neighboring Republic of South Africa.

The oncology ward is small, only 4 beds. While it is “separate” there is no door or true barrier separating these immunocompromised kids from any of the other 50 odd children in the ward. They do keep the infectious diarrhea patients at the other end! There is no clinic space so all sick visits or follow up visits are conducted on a wooden bench in the middle of the pediatric ward. Dr. Slone makes all his own chemo! What a rare, but very interesting opportunity to take part in daily chemo making. Despite Dr. Slone’s best efforts to hang warning signs, people leave their pens, notepads and whatever else in the chemo station like it’s no big deal!

Where all the chemo magic happens!

Where all the chemo magic happens!

While I would have loved to spend more time with Dr. Slone, my time was limited given my HIV clinic responsibilities. Here is the link to a blog post, “No Children Should Have to Suffer Like This”  he posted about a few of the patients I was able to round on one day I spent with him earlier in the month. I love gaining any and all first hand exposure to pediatric oncology in limited resource settings. I look forward to comparing what I saw with Dr. Slone to the norm in Rwanda. I still struggle to see where my love for peds heme/onc fits in my greater interest in the field of global health. Hopefully fellowship will allow me to figure it out!

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Equality

Baylor Botswana Children's Center of Excellence patient, now deaf with severe cognitive impairments secondary to his HIV

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

Article 25 of the Universal Declaration of Human Rights

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Bush Plane Adventure

Flight to Gantsi

Flight to Gantsi

BIPAI, along with adult ID and orthopedics are contracted through the Batswana (and yes, this is correct vs a Leanaism) Ministry of Health to conduct outreach clinics in remote areas around the country. We flew on a 10 seater bush plane funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) and headed out across the Kalahari desert to a city called Gantsi, near the Namibian border.

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After arriving at the tiny airport we all headed to the regional hospital and on to our respective wards. From the pediatric HIV/AIDS side, we see the kids who are failing their ARV treatment that the local adult medical officers and physicians are not sure how to treat. In theory, we are supposed to be working hand in hand with the local medical personal to teach them, but in reality the medically complex patients just await the Baylor team’s arrival each month for their ongoing care.

We saw an actively suicidal patient, with a plan and no psychological support to leave her with. We met a twin teenage boy whose father murdered his mother after finding out she had infected him with HIV. The patient refuses treatment and is now failing second line treatment with few treatment options left if he decides to once again be compliant, so we suspended his treatment. His twin brother has refused therapy all together. To see the psychosocial implications of the disease, its stigma, and the abandonment issues these children face, even when taken care of by extended family is heart wrenching. Working in the capital there are lots of rural health care issues we don’t face that I was reminded of on this outreach trip. How can one take ARV’s if they have no cell phone or watch to remind them of the time? Even if a watch is suggested, are they going to be able to read it to know when to take the meds? No electricity and running water certainly compounds issues faced by immunocompromised children and families.

Bringing essential WHO meds to the hospital

Bringing essential WHO meds to the hospital

This was truly an amazing experience I will never forget. Looking forward to next weeks outreach adventure!

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Botswana-Baylor Children’s Clinical Center of Excellence

Botswana-Baylor COE

Botswana-Baylor COE

I’m a week in and I finally am getting into the groove of things. While my month is a mix of HIV clinic, heme/onc, inpatient peds, and HIV outreach around Botswana, I thought I would start with the staple of my month here, the HIV clinic. The BIPAI model is to create centers of excellence where US level care is provided. This is very different than previous health care models I have worked with and I am still trying to sort out my thoughts, but none the less, they work hand in hand with government of Botswana and provide excellent care. 1/5th of the HIV children in Botswana receive care at this center, which is ~4,500 patients. There are over 100 visits a day. In addition to University of Botswana residents and visiting scholars like myself, there are medical officers and the equivalent of nurse practitioners supervised by a Baylor Global Health Corps physician and local attendings. For the first time, in all my international medical work, I feel that my service is *truly* necessary to provide the volume of care needed.

Each day starts out with hymns and prayers shared between the patients, their families and the front desk staff. I took a short clip so you could get a feel.

[After multiple attempts to upload it, I give up for the time being :( ]

The patient rooms are truly remarkable. Each one has been painted by a community member with a plaque sharing the story of the artist and why they selected the theme they used. The entire building is full of art donated by community members committed to the cause. There is very much an inclusive loving feel to the entire clinic. While the clinic visit is often a long day for the patient and their family as they are seen by a clinician, and depending on their current needs might also meet with social work, the psychologist, dietician, and/or a peer counselor, in addition to labs and waiting for their monthly supply of antiretrovirals (ARV’s) distributed from the government pharmacy, housed within the building.

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Once stable on their ARV regimen, patients follow up every 3 months until their teenage years when they follow up every 6-8 weeks given higher rates of risky behaviors and non-compliance with this age group. Given the transmission rate for neonates is now <2% in Botswana, the pediatric HIV population is aging. This is a huge testament to the nation’s response to the HIV/AIDS epidemic. The nation’s diamond wealth has allowed it medical resources to provide its citizens with, that many Sub-Saharan African nations do not have the luxury of. The majority of patients we see are teenagers. I have a pretty good time teasing the boys trying to build rapport. I also am handing out *a lot* of condoms!

Disclosing HIV to the kids is obviously a very sensitive issue, in addition to assessing their understanding and advancement of their knowledge over subsequent visits. We have a number of tools we use, but I included an illustration from a guide used with younger children as they begin to learn the basics.

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Next up, a post on my incredible first bush plane outreach trip near the Namibian border!

“The best way to find yourself is to lose yourself in the service of others.” -Mahatma Gandhi

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