First, part one: the car has arrived! Not much more to say, but pictures are forthcoming...
Part two: this is actually Michelle writing for today, so I can assure you that it won't be nearly as clever as what you've read when Andy was in charge. However, a couple of people have asked me about details of what I'm doing at work, so I thought I would put up a little about my day today and some of the stuff I've seen.
The majority of my job is working in the Baylor-Botswana clinic, which is a really beautiful place that sits behind the main government referral hospital in Gabarone. Most months out of the year, I'll be here, seeing children with HIV and managing their treatment. However, because of the agreement between Baylor and the Ministry of Health in Botswana, Baylor has agreed to lend us to the hospital to run part of the inpatient pediatric service. So, three months out of this year, I'll be in the Princess Marina Hospital managing inpatient care, and October is one of those months. I'll come back to that in a minute.
During the time so far that I've been in clinic, that day starts, for me, at 8 am, when we begin seeing patients. For most of the families, though, the day starts far earlier. I have come into work at 6:15 and the lobby already has 10-15 people there. Often the kids fall asleep once they get back to the exam room, because they've left their home at 4:30 or 5:00 am to start their trip. Most live within a 60 km radius but because they're using public transportation the trip can take awhile. The other reason to get there early is: there are no appointment times. It is first come, first serve. We start at 8 and keep going until the last patient is seen. Today I was in clinic and that ended at 3 pm, although that's a little later than usual. Ostensibly someone could leave their house, come to clinic and arrive fairly early (because by 7:15 the lobby is packed), and still wait several hours to be seen. The contrast with our American system is striking at this point, because in Botswana, people know how to wait. There is no complaining - at least none that I've seen. I don't know if its a fair system for the patients, but it certainly makes it pleasant for the doctor when you know that you can give each patient the attention they need and rarely will the next one give you any trouble for it.
I should also include how the day starts: with prayer and song. There is one gentleman, Kopano, whose job is to open the doors and close the doors and then manage things in between. He has charged himself with the spiritual life of the patients. At around 7:15, there are Bible readings, some gentle preaching, prayer, and then song. The first time I walked up to the clinic at this time, I heard song coming through the door. I thought they were playing a CD of one of those Ladysmith Black Mambazo-type groups. I walked in the door and realized that it was a lobby full of patients and parents with some of the staff singing in that style. It was so overwhelming I immediately teared up (not a surprise), but every morning since, it still gives me chills. This is a random group of people who every morning sound PERFECT, singing in a call and respond style with multi-part harmony. I am still trying to devise a way to respectfully and confidentially record this to share it with you.
My impression the first time I walked into this waiting room was: I can't believe all of these kids have HIV. The lobby is teeming with babies, school age kids, teenagers - and generally, they all look great. Its inspiring and scary at the same time: they are living through this, their parents are going above and beyond to take care of them, but at the same time they are facing a lifetime with this disease and no one can tell them what that will really mean. I saw one child early on, the only child of a well-to-do family. HIV can do really horrible things to a young baby's brain and motor development, and this girl, although she was cognitively right on target for a 4 year old, still was not walking presumably because of her HIV infection. I walked into the room, introduced myself, and the dad smiled and said "When are you going to find a cure for this?" I explained to him that I was certainly not the one to do that, just here managing the damage (not in those words) until someone smarter than me can figure it out, but I got his point. The things this virus can do, especially when it is left to fester unchecked for many years, are astounding. One of the first kids I met, and who I have had the luck of seeing several times subsequently, is 2 months older than Jacob, but is the same weight and height as Kate. His mother died several years ago and he comes with his 19 year old sister who has assumed total responsibility for his care. When I asked her how he was doing in school, she said "Not well. I think this disease has done something to his brain." I agreed.
Today in particular was a difficult day. I saw another patient that I've now seen twice before. Also a child with stunted growth, this little girl will be 3 next month and is slightly larger than Jude. Last month I saw her with her mother. Her mom looked sick, and we started talking. She had been trying to check her CD4 count at the adult clinic (one of the markers of disease progression and one factor used to determine eligibility for antiretroviral medications) but the country was out of reagent and hadn't been able to run CD4's for several months. We were having the same problem with kids until the Clinton Foundation donated the reagent to be used for children only. In the interim, though, this mom had since developed belly pain and difficulty breathing. In Botswana, people carry their medical records with them, so she showed me an abdominal ultrasound that apparently showed some kind of tumor. At the end of the visit, we talked about who might be able to help her with her daughter if "she wasn't feeling well." It was a sobering conversation - I think we both knew that what we were really talking about was who was going to take over for her when she died. She left and we agreed she would bring her brother next time. Her husband worked and had difficulty coming to the clinic. The next day I called her and asked her to come back after one of the med/peds doctors in the clinic agreed to see her (we have some doctors seeing family members of our patients in select cases). He had her admitted to the hospital the following day. Today, the last patient of the day, at 2:30, was this little girl, accompanied by her father. I greeted them and immediately the father told me, "I'm sorry to say that her mother passed on the third of this month." He then produced the photocopied funeral program. It was incredibly sad. Suddenly, you're looking at a girl who lost her mother (only one week after that last visit), and the man who lost his wife, and the overwhelming thought is: no matter what you may think about any of this, whether you blame people for being sexually irresponsible or promiscuous (and I'm not convinced its any different here than the rest of the world), or whatever: nobody, anywhere, deserves this. Its really dreadful that these events that should be so happy in someone's life - dating, marriage, childbirth - in this country are marred forever by this disease. Sorry for the rant, that mom stayed with me a long time after I saw her last.
So, I was going to go on about the hospital, but suffice to say, the bad parts are just about as depressing as this entry, so I think I'll let Andy have his turn for a few more weeks then come back and sober it up again. I don't want anyone to think that there's a black cloud over the place - to the contrary, its quite uplifting work. But when days like this happen, they're hard to shake. I'm sure we'll all say an extra little thanks today for our health and good luck.
