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

The apartment, the CHOP flat is a floor below

The walking path shortcut to work

The life saving meds

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

Art in clinic

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

No jet bridges in this country

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!

 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!

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!

“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

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.

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

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

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.

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.

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

It’s origin

The TED talk (every great idea has a TED talk these days, right?)

2013: participate!

Watch it, it is guaranteed to warm your soul!

A few of my favorite Thich Nhat Hanh quotes to start out the new year:

Life is available only in the present. That is why we should walk in such a way that every step can bring us to the here and the now.

It is possible to live happily in the here and now. So many conditions of happiness are available—more than enough for you to be happy right now. You don’t have to run into the future in order to get more.

 Many people are alive but don’t touch the miracle of being alive.

 Freedom is not given to us by anyone; we have to cultivate it ourselves. It is a daily practice… No one can prevent you from being aware of each step you take or each breath in and breath out.

12 Truths of 2012 (in no particular order):

Downton Abbey & Man Shops Globe have renewed my belief in good television

In moments of stress I often retreat to memories of summer bliss at Tanglewood & Hole in the Wall

Sibella Court & Terrain epitomize my sense of style & pretty

So grateful to have three grandparents in their 90′s to continue to love and learn from

I am beyond excited for my next step

The No 1 Ladies Detective Agency series has me pumped for my April rotation in Botswana

Adding a daily meditation practice to my life has been one of the best things I’ve ever done

Brene Brown & Danielle LaPorte continue to help me further examine my soul & listen to its truth

My dad has proven he is a fighter. Cancer is only apart of his story & he will continue to Livestrong!

Refinery 29 & Pintrest keep me hip & continuing to discover the style & pretty I crave

WHY, my weekly medicine

My family & friends remain the glue that keeps me together

“The value of life lies not in the length of days, but in the use we make of them…whether you find satisfaction in life depends not on your tale of years, but on your will”

Michel de Montaigne