Wednesday, June 20, 2012

You May be Wondering Why I am Even Here . . .

Well it has been over a week since I've last written - partly because I've been running around socializing and having a great time and partly because I've been running around town working on getting the translations of my research proposal finalized!

I'll start with an update about my research.  For a bit of background, I wound up here in Botswana thanks to to the recommendation of my faculty advisor at Yale, who has been here many times and previously worked with Holy Cross Hospice, the NGO that I am working with to complete my research.  Over the past year I worked hard on my literature review and research proposal, and this spring I was awarded funding for my project through the Wilbur G. Downs Global Health Fellowship (links with more info are at the end of this post).  The fellowship covers the expenses of my travel, research costs, and living expenses while I am here.  It is up to me to have everything in order and my data collected before I leave Botswana on August 20th!  The challenges of working on a research project independently (not to mention in a foreign country) are sure to present themselves.

The research itself is an investigation of hospice care/palliative care/end of life care needs here in Botswana.  My interest in hospice care, and my interest in health care in general, first arose after my personal experience of my father's death in 2007.  Seeing what a stark difference there is between good health care and bad health care, particularly the impact that an individual nurse can have on one's experience, either positive or negative, motivated me to apply to nursing school with the hope that I can contribute to making some of the most challenging moments in life a positive experience for my patients.  I decided to become a nurse practitioner (as opposed to an RN or a doctor) for many reasons, which I may go into when I have more time, but if you want some info on NPs in general see the link at the end of this post.

My dad (Ed Philips) reading to me and my brother in 1987
When I told people in the US what my research would be focusing on, I more often than not received responses such as "that's really intense" or "wow, that sounds kind of depressing . . ." when I wasn't speaking to a fellow health care professional.  I haven't yet received that response here in Botswana.  It has always seemed to me that death and dying are somewhat taboo topics in American culture, with our positive outlook and constant focus on moving forward and progress.  Although we have various individual religious traditions around death in the US, there really isn't a culture that allows for public mourning and there is very little discussion about death in general.  On the whole, I would say people in the US are uncomfortable talking about death or asking questions about loved ones who have passed away.  Perhaps the lack of a universal cultural background or religious belief system in the US has led to death being seen as more of a private individual or family matter and not one that should be discussed socially.  Here in Botswana I am still learning about the culture surrounding death, but there is certainly more discussion about the topic in general.  I'm sure that the intensity of illness and sheer volume of death that arrived with the HIV/AIDS epidemic changed the conversation about death here, but I am interested to see what the other differences are.

My study consists of interviews with family members of people who have died within the last year.  I will be asking questions related to the financial, emotional, and physical burdens of caring for someone who is terminally ill, health care services received prior to death, and what services or other types of assistance would have been the most helpful for the patient and the family.  I also will be administering a questionnaire that has been previously used in several studies in the US that assesses quality of death based on factors such as how much time the patient spent with their family, whether they were in pain at the time of death, and whether their wishes were fulfilled regarding where and how they wanted to die.

In order to administer my survey and complete the interviews here, everything needed to be translated into Setswana (the local language, also called Tswana) and then back-translated into English to check for consistency of meaning.  While I tried to get my translations completed prior to my arrival, it proved a difficult task from the other side of the planet and it is just yesterday that I received the near-final versions of my documents.  This afternoon I will be going over them with one of my local translators to resolve any last questions and if the stars align, I will be able to submit the documents to the Ministry of Health tomorrow morning.  Once the documents are submitted, it is a waiting game for final approval before I can start interviewing.  In the time when I will be waiting I hope to get to know Gaborone and the health care system here in Botswana better.  If possible I would like to shadow some NPs at the hospital here and see if I can tour the (very few) facilities that provide hospice/palliative care.

I don't want this post to go on forever so I will end here and write an update about some of the more fun social things I have been doing later this week.  In the meantime, here are a few photos of the things I've been seeing to keep you interested:

Interesting rock formations rising out of the bush - just outside of town

Blue Waxbills - Tons of these little guys near my apartment!

Giant Termite Mound - which the locals call "ant hills"
apparently when it rains all the termites run out and people flock to eat them

Kgale Hill (the highest peak in Gaborone) with Baboons in the Grass

Downs Fellowship:
Nurse Practitioner Fact Sheet:


  1. Good blog, Psyche! I hope all goes well with the Health Ministry!

  2. I found out I had to sign in with my Google Account FIRST to submit a comment! Love, Mom

    So what happened today?

  3. Here is a friendly suggestion. Some time before fielding your questionnaire, do a small "pre-test" with people much like your actual informants. The purpose of the pre-test is to see if the questions mean the same thing to the respondents as they do to you. The pre-test may save you much grief down the road allowing you to modify some of the questions, or the questionnaire length, or something you never thought about before you take it to the field.

    Jeff Grant

  4. I love reading your blog and loved the pics...and the one of you two and Ed. Happy Birthday--early--to us. And your Mom isn't the only one with a soft spot for Botswana after those gentle, lovely books about Precious, and the rest. I am glad the restaurant is there and the president was good and the people are kind.

  5. loving your blog! glad youre having a good time - love, Aliya