Archive for June, 2011

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Shawnda: At the end of the day…

June 22, 2011

“At the end of the day, we belong to the same race, the human race” – Prof. Phaladze

I mentioned before the benefits and disadvantages to the Botswana health care system, but I don’t think that I truly evaluated my thoughts.  Today we discussed our different experiences in the clinics throughout Gaborone, and I’ve found that although health care is free in terms of money, it comes at a price in relation to patient care.

Professionalism and confidentiality are completely different from what I am accustomed to.  Privacy does not exist in these clinics.  Workers enter exam rooms as they please, mid vaginal exam and all.  You would expect patients to be uncomfortable or angry, but at least on the exterior, you see none of those emotions; just indifference.  They are accustomed to this level of care; who knows if it is because of a different level of confidence and self-awareness or if it is because they have never experienced America’s definition of doctor-patient confidentiality.  Doctors will be on their phones during consultations, yet patients don’t interject or look phased by the blatant disrespect of their time and health. 

Now there is a caveat to these observations, Botswana’s work force is at the tail end of a worker’s strike which, for the most part, remains unresolved.  Government workers are severely underpaid and have gone years without raises.  I am sure that if I were in the same situation, it would be difficult not becoming apathetic towards my job when there were no benefits to improving.  It is unfortunate that I cannot see what work was like before the strike, and if the nurses and doctors are taking out their frustration on their occupations. 

However, today I worked with an exceptional doctor who gave me more hope.  He actually explained the conditions to the patients rather than sending them on their way with another referral.  He held his patients accountable, which is a quality I think many doctors lack.  I think it is so customary to keep educating patients while never honestly telling them that their lifestyles are to blame.  About 99% of the patients I’ve seen thus far have conditions that are brought on by their own actions.  Although doctors should make suggestions and not force certain choices on patients, they should also point out the blatant truth: we are the primary determinants of our own health. 

I think today especially strengthened my opinion on the fact that people should be accountable for their health and appreciate it.  About 40% of the patients we saw today were only there to get sick leave from work. After seeing 2 patients I could already tell the motives behind their visit.  If you are truly worried about your health, work is not on your mind; you immediately address the situation and the doctor offers an off work form. If you are using your poor health as an excuse, you come in saying your boss sent you for an off work form.  If your boss was honestly concerned about your health, he would not send you to get the form, he would give you a day off. 

I think that people should realize how valuable their health is.  Not everyone was given an equal chance at good health.  It is not fair to see people making life choices that make negative impacts on their wellbeing, while others are unjustly dealt poor health despite their lifestyles.  While some are doing everything in their power to stay well, others are disregarding a true gift. 

I would also like to see doctors offering alternative methods to reach a health goal.  It is another trend that they prescribe and move on; patients should know their options.  Sometimes medication is not the best answer, and can even be a worse decision.  The US is facing “super bugs” that are resistant to a cocktail of antibiotics, why?  Because many people are overprescribed antibiotics, are not prescribed the correct ones, and are not adhering to their dosing regimens.  Although antibiotics are necessary in most cases, they are not necessary in farming and food production which is a leading cause for antibiotic resistant E. coli.  They are also not always necessary in many medical situations.  I think that sometimes they are just a quicker solution to feel better when bed rest can often do the same job in a longer amount of time; we have immune systems for a reason. This is my opinion, however, and is not a fully educated statement. 

I would also like to see more preventative care.  This is an area that deserves an infinite amount of resources; no other sector can survive without healthy individuals to run it.  Hypertension, diabetes (type 2), HIV, and STIs are by far the most common ailments in Extension 2 patients (and most likely all other clinics in Botswana).  Each of these could have been prevented with education and check-up appointments.  And not 5 minute check-ups where the doctor asks if you’re okay and you say you’re fine.  Patients should be able to form a comfortable relationship with the same doctor; what is the point of seeing a different doctor every time?  In the time that you could have spent explaining new issues and concerns, you’re instead talking about ones of the past in order to catch up.  With each checkup, doctors can see trends and connections in your health.  They can educate you on the direction you are going, what you can do to get well, and risk factors to look out for.  I think everyone has lied to a doctor at least once because of embarrassment; that should never be the case.  I think this is the biggest development for public health; countries are paying millions on these conditions, while the solution seems so straight forward.

I find myself learning more and more each day about what goes in to public health and the progress that needs to be made.  I am forming new opinions while strengthening and building upon old ones.  I keep feeling more and more inclined to help others and seeing where I would like to be positioned in health care; on the forefront, dealing with patients one-on-one.  As for working abroad, it isn’t a question of “will I”, it’s “when can I start?” 

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Amanda: It’s been 60 days

June 22, 2011

Since I returned home 60 days ago from India, life’s looked a lot different for me.  I spent about a month at home checking my eyelids for leaks, spying on people’s literary interests at Barnes and Noble, and criticizing day-time TV (let’s not talk about Oprah leaving the air; I know some people had their qualms with O, but I, for one, found her to be funny, genuine, and encouraging).

Then, about two weeks ago, I moved to Clinton to begin summer research.  I spend my time pretending to be smart, playing board games (don’t worry–traveling to India didn’t stunt my Scrabble skills), and catching up with friends and professors I missed while I was abroad.  Lucky for me, the people at Senor Garcias still remember me even though I took a four month hiatus from their fine dining establishment.

Last weekend I got to travel to Durham, NC to visit one of my roommates in Udaipur, Lily.  From my brief trip I made several conclusions: North Carolina is a lot more travel-friendly than South Carolina, especially regarding public transportation; farmers markets are so cool; and, to affirm a truth that I’ve been thinking for a while, NPR is the perfect radio station…how else can one simultaneously become informed of what’s going on in the world and enjoy cheese-free (and by that I mean non- 80s, easy listening, contemporary Christian, or pop) radio tunes.

And now, I leave you with a piece of beauty from Rabindranath Tagore, the Indian writer/artist/musician I’m getting paid to enjoy this summer:

I know that happiness is the substance of every-day, but joy surpasses the day.  Happiness in fear that dust may soil its hands is hesitant.  Joy, throwing itself in the midst of dust, breaks down all barriers between itself and the whole world, so that for happiness dirt is a thing of contempt, for joy it is the emblem of a jewel.  Happiness is afraid lest it loses anything.  Joy feels fulfilled in giving away its last possession.  So that for happiness to be destitute is poverty, whereas for joy poverty is wealth.  Happiness within its binding measure guards carefully its intrinsic beauty, whereas joy manifests its beauty in unstinted glory, freeing itself through all disruptive elements.  For this reason happiness is bound by outside measures while joy breaks through all measures creating one that is of its own.  Happiness is only concerned in tasting sweet nectar; joy consumes the poison of sorrow accepting it in its very system.  So that happiness is only partial to what is congenial, whereas to joy good and evil both have equal value.

Food for thought!  Be well.

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Michelle: Transitions

June 21, 2011

I’ve been back for about three weeks now. Often times I find myself wishing I was back in Montpellier. I don’t know if it’s the thrill of the big city or the charm of France that I miss, but there’s part of me that yearns to go back. I want to go back to the country where the tops of my papers were always wrinkled because they didn’t fit into the American binder I brought. I miss being reminded during every food-related publicity that « Pour votre santé, évitez de manger trop gras, trop sucré, trop salé ». Constant discovery has been replaced by the mundane. Dare I say it, I’m even feeling a bit nostalgic for the thrill of narrowly avoiding piles of dog crap on the sidewalks. Most of all though, the French people, language, and bread me manquent beaucoup.

Although I haven’t hit the dark place described in the literature given to us by the Minnesota office, I feel a slight twinge whenever I see something that reminds me of Montpellier and excitement if I hear French (even if it is coming from my selection of Francophone music). I’m starting to scrapbook my trip now and am transcribing my blog posts onto the pages to serve as a background for the pictures. Reading my posts from the very beginning, it’s interesting to see how my view of France and really of myself has changed. One that’s particularly interesting now is Test Anxiety. I’m generally not a worry-wart; part of me thinks I might have suffered a minor psychotic breakdown going between the US and France (must be the thin air on the plane). All those doubts and worries were faced, and gladly I can say I survived without too much difficulty.

Now, I find myself scraping at any opportunity to re-immerse myself back into French culture. I’ve watched a couple French films, joined a conversation group, tried to replicate some of the meals I had over there. Yesterday, I had most likely my last Friday Night Dinner (FND) in Waukesha with the menu centering on food I had in France.

Menu: Fish Soup with Croutons, Rouille, and Gruyere – Catfish with Almonds – Grilled Vegetables with Aioli – Cheesecake

This is my last post from this blog. Thanks for reading. Au revoir!

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Jessica: Home and lessons learned

June 20, 2011

So… I guess I’m back!

When people ask me, “How was Ireland?” what can I really say?? I’ve been trying to come up with a sentence to sum it up, because from my last study abroad or any trip I’ve taken, people will ask and tune out 2 sentences in since, frankly, it’s hard to understand. It’s not a sad thing to realize, but there’s no way to truly capture the experience.

I saw beautiful things, sad things; I was exhausted and energized; I met some of the most amazing people, and I learned a LOT. Not just the things like Irish history, but of leadership–that vague term that people throw around without truly knowing what it means.

My basic lessons are these takeaways, outside of technical information:

  • Value of one, power of all: we all matter, and I am continually shaped by every individual I come across. Every story you hear, every person you spend any amount of time with, impacts you somehow–and it should. I’ve written in my journal the lessons I’ve learned from others, something that Emily Smith once told me to do. And there were people we met who simply stepped up and did what they thought needed to be done–and moved mountains by doing so.
  • Listen listen listen: why do we keep relearning this lesson? Because we still mess it up. I would like to get better at not always needing to chime in, just to sit, pause, and absorb before I have to open my big mouth
  • People will surprise you: What happens when you force 25 people to hang out for nearly a month? You give those people who you judge upon first meeting a second, third, fourth chance. You are exposed to them in multiple different situations till you realize, “Wow, I actually really enjoy you, and I had a bad first impression.” It’s humbling and makes you feel like an ass–so the lesson here is keep your judgments to yourself (avoid that mob mentality, dudes) and then be open to them changing.
  • On that note, avoid poisoning the well. We started expressing our displeasure with certain situations or people and that is TOXIC. If you can’t just stand up to change it, at least don’t perpetuate it to the best of your ability–because we all need to vent.
I already miss having my roommates around, and it’s weird being fully in control of my life’s schedule again… Again, what I’d like to take home with me is letting go a little bit of overscheduling myself as well as just going out to enjoy life: do MY to do list. As Kelsey says, I spend too much time doing things for others, not for myself. This trip reminds me that we all have our OWN to do list we want to accomplish–I will work on not forgetting it.
In the meantime I will definitely enjoy half and half in my coffee, abundance of public restrooms and the friends I came home to.
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Shawnda: A million questions

June 20, 2011

Another day in the clinic, another day left with questions and confusion.

I spent the majority of the day in the dressing room watching wounds being cleaned and bandaged.  The nurse, Agnes, was most likely in her mid twenties and was working her first day at Extension 2.  We talked about America and what it is like to live there, and about her applying for her green card.  I never realized the amount of money and work it took to apply for one, and how badly people want to come to the US just to work. Nurses here make just enough to get by, and most likely work twice as much as nurses in the states.  It costs over P2000, just over 300 USD, to take the English entrance test.  They all have the will and the desire to take the test, but most just don’t have the resources while only making the equivalent of about 2 USD per hour. 

Not only was this process confusing to me, but their perceptions of Americans were as well.  I’m sure that monetarily, most Americans are rich compared to Botswana, but they assume we are all living such perfect lives.  It was surprising to them when they heard that many people are losing their jobs and can’t find any replacements.  Most are unaware of our economy, health care, and schooling systems.  I could continue for pages on the issues our country is facing.

Still, every country comes with its unjust issues, and each has its own triumphs.  In Botswana, workers are underpaid yet health care is free.  In the US, health care is remarkably expensive but people have the ability to succeed and advance in their fields.  In the US, education comes at a price but is unbounded.  In Botswana, college is paid for but limited.  The grass is always greener; with some advantages come even more difficulties. 

I’ve found so far that public health is such a complex field; it is impossible to serve and protect everyone. Where do you find the resources and political power to enforce public health policies?  With a topic that should be straight forward and simple, keep people safe and healthy, it is completely intertwined with politics, money, and limitations.  I think that no matter where you go, everyone is faced with similar public health issues at varying intensities.  Most health care systems are focused towards curing disease rather than preventing it. Patients come in when they are sick; why not before?  Most patients don’t follow the rules whether it’s concerning drug adherence or lifestyle choices; who is educating them?  Many hospitals and clinics are congested and most health care workers work too much.

So many issues…how do you fix them?

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Shawnda: Giving back to the Batswana

June 18, 2011

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. 

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Lindsey: Exploring London

June 18, 2011

This weekend started off early being I didn’t have to work Thursday or Friday. After class on Thursday, a friend and I finally went to Harrods! The department store is huge, and you can buy absolutely anything there like groceries or an elephant! Everything is so beautiful inside the store, the chocolate room was my favorite 🙂 Here’s a picture of the outside of the Harrods:

Afterwards, we went to a free curry dinner sponsored by our program. Curry is a very famous and popular dish in London so we thought we’d better try some. They served us SO much food there it was unbelievable. We had two plates of appetizers plus our dinner. It was very tasty!

Yesterday (Friday) we went on a tour of Fuller’s brewery in Chiswick. It is the only Brewery still operating in London! We went on a tour with a bunch of older men who were all excited to learn about the brewing process, so they thought it was pretty fun that we were there! The tour was pretty cool, they had a majority of their old machines and equipment they used in the 1800s still there, next to the new machines they use today. We even had a tasting at the end of the tour! We got some lunch at their pub, the Mawson Arms, and one of the guys working in the brewery gave us all free Fuller’s polos! It was a fun morning!

Later in the evening, we went to the Victoria and Albert Museum. The building was extravagant and so beautiful. The V&A is a museum of art and design. Everything was so pretty, and we are going back to see more another day this week! They have an outdoor courtyard that was so beautiful last night:

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