Category Archives: Botswana

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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Filed under 8 Things, Botswana, Travels

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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Dumela from Botswana!

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It has been 4 years since my feet last touched African soil and I could not be happier to be back! [Insert perma-smile]. Coming to the Baylor International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital site feels like coming full circle. During the research year I spent in Houston at Texas Children’s, I would sit in on the monthly executive meetings for the BIPAI network of Centers of Excellence. In addition, before settling on my Boston Children’s/Partner’s in Health fellowship, I had seriously considered CHOP’s global health fellowship which would have placed me here in Gaborone operating out of the same hospital, Princess Marina, as part of the Botswana UPenn Partnership. So I come with some knowledge of the ex-pats working at the hospital through these partnerships.
BIPAI Botswana

BIPAI Botswana

BIPAI is incredibly supportive of individualizing the visiting scholars experience. In addition to seeing routine pediatric HIV/AIDS patients in the clinic, I will be participating in outreach missions around the country by prop plane. This outreach is supported by the government of Botswana in helping to support the care of challenging pediatric HIV/AIDS patients in rural areas of the nation, as there are currently only 5 Botswonian pediatricians in the nation. In addition, the outreach team consults on challenging cases on the wards while they are visiting, as each outreach site is visited by the BIPAI team once a month. Additionally, I will be
working with Texas Children’s Cancer Center’s oncologist, Dr. Jeremy Solone, and learning about the care and challenges of pediatric oncologic care in Botswana.
 
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My trip started with a 24 hour stop in Johannesburg. Thanks to Dr. Collins, I have an extensive “must do” list for Jo’burg and I was able to chip away at a few items before I borded the evangelical bus to Gaborone! Lots of weekend adventures in the works and already in my first couple of days, many stories from the wards to come…

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Filed under Botswana, Public Health, Travels