Monday, July 23, 2012

Research Update

It's been busy since my last post - I went up to Chobe national park last weekend for a wonderful safari/riverfront experience, and I have been working hard on my research.  This weekend I made Pakistani food for about 10 friends, after discovering that they sell Shan Masala (the best spice mixes) at Hyper Choppies!  I'll post some of the fantastic pictures of Chobe in my next update, but for now I wanted to write a bit more about the research I'm doing.

I have been going to people's homes along with staff from Holy Cross Hospice and interviewing the family members of people who have died.  As of today, I have completed 21 interviews.  Going to people's homes has been a really interesting experience, and has shown me once again how universal the human experience is regardless of geographic location.  The people I am interviewing are mostly in the lower income strata of Botswana, and most of them are in the Old Naledi neighborhood.  "Naledi" means star in Setswana, and Old Naledi is one of the oldest and poorest neighborhoods in Gaborone.  Most people live in one-room houses, often with an entire family living in one room.  Some of the houses have electricity, but most do not, and very few have running water.  Most of the houses are built from cement and cinder blocks with corrugated tin roofs and no insulation.

A nicer house - two one-room apartments next to one another
The neighborhood is expansive - I'm not sure how many people actually live there but it is extremely easy to get lost driving around on the winding maze of roads.  There are some cars driving through, but the streets are generally used more by people on foot, chickens, and stray dogs.  On any given block you will see people pushing wheelbarrows containing large containers of water to bring home from the pump, women with babies tied to their backs with blankets, children playing with soccer balls in the street, and groups of young men looking for entertainment or drinking Chibuku, the locally made sorghum beer/porridge.

Most of the interviews I have done have taken place outdoors, since it is winter and sitting in the sun is the best place to be in the chilly mornings.  Probably about 8 of the interviews I have done so far were indoors.  It is fascinating seeing how different people live - the houses in Old Naledi look very similar from the outside but I have seen a wide variety of interiors, from a tattered foam mattress on a dirty cement floor to a pristine pink room that could belong to an American teenage girl to a bachelor pad with a big TV and little else.  Most of the houses have small camping-style gas stoves for cooking, but some people cook over an open fire in their yard.

The majority of my interviews have been in Setswana with the help of a translator, but many people, especially the younger generation, speak English.  Doing these interviews has made it really clear to me how much richer information is when you hear it in your own language!  It is much easier to connect with the person I'm interviewing and ask follow up questions when the whole interview is in English.

I haven't yet tallied the results of my interviews, but from what I am hearing people are incredibly grateful for the hospice services they received.  My questions are aimed at finding out what their experience was like having a loved one who is ill and what (if anything) was helpful about the hospice services received.  One answer that I didn't anticipate that I have been getting very frequently is that transportation to and from the hospital or clinic is one of the most needed things, and is greatly appreciated when available.  I have yet to encounter a family that owed money for medical-related expenses after the loved one passed away.  Although the health care system is under much strain here in Botswana, health care IS free and accessible to all citizens.  People recognize the value of this and they do appreciate it, even when they have complaints about the conditions in the hospital or tell stories of misdiagnosis or improper treatment (which happens frequently in the U.S. as well).

Typical block in Old Naledi

Speaking of the hospital, yesterday afternoon I went with one of the hospice staff to check on a hospice client who had been hospitalized at Princess Marina - the main public hospital in Gaborone.  We went onto the ward where she was staying and found her in a bed along the walkway.  The ward was basically three or four big partitioned sections with a walkway connecting all of them.  There is no privacy for patients, since in each partitioned area there were about 15 or 20 women in hospital beds that were tucked in wherever they would fit, many of them surrounded by 4 or 5 family members visiting.  There looked to be about twice as many patients as the ward was designed to hold.  The wards are separate freestanding buildings on the ground floor, and all of the windows were open as were the doors on either end of the walkway, so air was freely circulating which was nice since it was a warm day, although the unmistakable scent of illness and bedridden patients was still present.  There are signs all around the hospital that say "Prevent TB: keep this window/door open."  We spoke to the patient for a few minutes and asked if she had eaten anything, she said no.  She also said that she didn't have any family to come visit her.  According to several people I've talked to, the hospital staff does not help patients to eat - they just bring the food and if the patient doesn't eat it eventually they take it away.  We were there around lunch time but I didn't see any food being served so I can't say whether that is true, but if the patients really do not get any help eating then that is a very sad state for the hospital to be in.  How is anyone supposed to recover from illness if they aren't getting any nutrition?  We left the patient and said we would continue to check on her and wished her a speedy recovery.  I think just having someone come and visit her to check in perked up her spirits a little, since it was clear she doesn't have any family who can come help her.

Last week I had the opportunity to shadow a friend, who is also a nurse practitioner student, at his internship at one of the local clinics.  The clinic was about 30 minutes drive outside of Gaborone, so it was in a slightly more rural area but not too far out.  My favorite part of the whole day was the sign welcoming us out front:

There has been new research in the past few years that males who are circumcised are less likely to contract HIV during sex.  Because of this research, the government here in Botswana has started a campaign to get the majority of men here circumcised over the course of the next few years.  I know many of you guys reading this are probably cringing, but circumcision is a straightforward outpatient procedure with minimal risk.  According to my friend who I was shadowing, people have been surprisingly accepting of it and the campaign seems to be going relatively well.

The clinic day was fascinating to see - as a family nurse practitioner, my friend sees patients of all ages and conditions.  One patient was pregnant, he saw a two year old with a possibly fractured forearm, a couple came in worried about STI symptoms, several people had dermatologic problems (mostly related to HIV), and a few people with constipation and stomach pain.  It was apparently a slow day at the clinic, but we saw 12 or 13 patients between 9am and noon.  Although the government funds the clinics sufficiently, there were problems with shortages of supplies and other essentials.  One patient said that she was supposed to have a chest x-ray for TB but the x-ray machine at Princess Marina was broken so they told her to come back later.  We could only find one clean speculum for the women's health appointments and the others were in the autoclave, so we could only do one pelvic exam.  We also took a long time finding a sterile cup to get a urine sample.  There was only one functioning blood pressure cuff, so not all of the patients had their blood pressure taken before coming in.  Apparently the issue is not funding but organization and logistics - the clinics that are outside of Gaborone have trouble staying on top of supplies and the distributors of the supplies are located in the city, so it is very time consuming to get more supplies when you run out.  I only saw the example of this one clinic but this could be a fantastic project for someone in healthcare management to take on. I'm sure each clinic is managed differently as well, so that must contribute to how well-stocked and organized a clinic is.

I could go on writing for a long time but I've got to get out and do some interviews today.  I'm heading to South Africa on Thursday to meet my husband (who FINALLY got his visa approved) but I will try to write an update about my trip to Chobe before then.

Wednesday, July 11, 2012

Namibia Part II - Walvis Bay, Dune 7, and the Return

On Monday morning we woke up bright and early for breakfast at our hotel, then drove down to Walvis Bay, about 30 minutes south of Swakopmund and also on the coast.  The drive between the two towns is fantastic - on our left there were golden sand dunes rising up into a eerily foggy sky, and on our right was a beach and the sea with grey water and pounding waves.  One of my favorite parts of driving through Namibia is that they have these huge signs with exclamation marks on them.  The first exclamatory signs we saw said "! No Lines" to indicate that the divided road was no longer divided.  We also passed a few that contained nothing but an exclamation mark, which I'm curious about - perhaps these signs are just a general warning?  I took them to mean "Get excited! You're in Namibia! !!!"  Here is one from the drive between Swakopmund and Walvis Bay:

Seems a little obvious when you're looking at sand dunes to your left and a beach on your right that there might be sand on the road, but hey, I'm not one to complain about excessive signage.

We got to Walvis Bay without incident and boarded a catamaran for our next adventure - a cruise and wildlife tour around the Bay.  We had no idea what to expect since we decided to take the boat ride on the recommendation of our hostess in Windhoek, and there was no mention in the guide book or from anyone we had talked to about taking a boat in Namibia.  We literally had written down the phone number and called the afternoon prior to see if there was space for us on the boat.  Thank goodness there was room for us, because this boat ride made the trip entirely worth it!

We walked down a long wooden dock to get to the catamaran, and one of the kids in the group noticed a jellyfish in the water off the dock.  I stopped to look and take a photo of the large jellyfish floating very close to the surface - a wildlife sighting already!  Little did I know that I would see more jellyfish than ever in my entire cumulative life experience on that boat ride - we sailed past pockets of them in the water so thick you could reach in and easily grab four or five in one scoop!  What a sight to see.

Jellyfish off the Dock
Once we got on a boat we were in for a real treat - our guide and our boat captain turned out to be fun-loving South Africans who loved to tell jokes.  Right after getting on the boat our guide picked up some chunks of fish from his cooler and called to two huge pelicans that were off in the distance.  He said "come! come on!" and they flew right up behind our boat!

Pelicans Looking for a Snack

Then the boat started moving at a faster pace, and we got a bit farther out into the bay.  Our guide proceeded to reach off the back of the boat and pick up a jellyfish WITH HIS BARE HANDS!  I couldn't believe he wasn't getting stung, but he explained that these jellies don't sting.  As you can see in the photo below, he had no problem touching its tentacles.  I was too nervous to touch anything other than its head, but it was very cool to see such a huge creature up close and personal.

Walvis Bay Jellyfish

We then sailed even farther out into the bay, and went past acres and acres of oyster beds.  We saw a crew of men hauling the oysters up into a small boat, which looked like incredibly hard work, and we also saw a huge old fishing boat sitting out in the middle of the oyster beds.  Our guide explained that that old boat has had the engine removed and there is one guy who lives on it and watches over the oyster farms to make sure nobody steals the oysters!  What a life.  He goes back and forth in a small boat to the coast, but apparently he lives out there for a week at a time and sometimes he invites friends to keep him company on the boat.

Before long we saw something splashing in the water a little ways away.  As we approached it became clear - dolphins!

There was another boat that looked very similar to ours out for a cruise as well, and the dolphins were following them.  Soon they began following us, and there were at least 15 dolphins in various locations around the boat.  At one point they were swimming right underneath the front of the boat, and we could look over and see them gracefully moving just below the surface of the water.  It was an incredible experience to see them so close!

Dolphins Swimming with our Boat
After hanging out with the dolphins for about 30 minutes we headed towards a large sand bar.  We saw more splashes in the distance and thought at first they were more dolphins, but they were seals!  There is a huge colony of seals that live in the bay, and they know that the boats provide fishy snacks for them so some of them got really excited when they saw us.  They were splashing around in the water and following the boat - one even came up right behind us to check out what was going on.  And then we saw the sand bar - SO many seals!  I felt like I was watching a National Geographic special on them - the sheer volume coming from so many animals was incredible.  We could see the huge bulls making loud, deep noises, and baby seals crying for their mothers, which sounds incredibly similar to "maa".  Some of the seals were fighting for territory, some playing and/or fighting in the water, and some swam up to say hello to our boat.  To top it all off, while we were standing there, a flock of flamingos flew overhead!

Seals - A small portion of the number we could see from the boat.  Wish I had a panorama!
 We started to head off after several minutes commenting on the dramatic plot lines that were unfolding in the seal colony and soaking in the grandness of the scene.  We thought our time with the seals was over, but suddenly our guide was yelling from the back of the boat.  "Come here, Pacho" he said.  As he came around the side of the boat, he said "I want you all to meet my dog, Pacho."  Following behind him ON THE BOAT was a seal!  I was a little intimidated at first, knowing that this was a wild animal and that seals have sharp teeth and massive body weight, but once a few others on the boat willingly reached out and pet him, I did the same.  Pacho turned out to be a very friendly and cooperative seal!  Anything for a free meal, I suppose . . . we even got to pose for photos with him!  Apparently he is the friendliest seal out there, and he knows our guide very well.  Because of that, we could get close to him and he was happy to allow us to pet him, and even seemed to enjoy being scratched on the head and neck like a dog!

Family Photo with Pacho
Apparently there is another seal that follows the boats around who is particularly unfriendly, and the guides have nicknamed him Saddam Hussein.  He barks loudly and has been agressive in the past, and a few weeks ago he bit one of the boat hands on the leg as he was making a repair on the boat!  I was glad not to have that information until after I had my photo op with Pacho!

Such a Friendly Guy!
 After everyone on the boat had their fill of photo ops and Pacho went on his way, they served us a nice lunch of cold sandwiches, fresh oysters, and champagne.  It was such a fantastic experience!  We kept saying to each other "I don't think this is Africa . . . " Feasting on oysters on a boat and hanging out with seals and pelicans were not exactly what we pictured living in Africa would entail :)

Just before we docked we passed a boat signal with a bunch of cormorants perched on it - as we went by, our captain pointed out the birds to us and made a comment about their character - as you can see, he said, they're hanging out in the red light district.

Seedy Cormorants in the Red Light District of Walvis Bay 
 We giddily stepped off the boat and on to dry land, still in disbelief that we had such an amazing experience.  We planned to head back to Windhoek that afternoon, but not before we saw one more sight - Dune Seven.

Ready to Go! (and representing with my Yale sweatshirt on)
Dune Seven is the tallest of a set of huge sand dunes which sit about 15 minutes drive west of where the boat took off.  As you can see from the picture above, it looks like we are about 1,000 miles away from the ocean.  It turns out that as soon as you drive inland the fog disappears and you are in the desert again (reminiscent of San Francisco yet again . . . minus the enormous sand dunes!).  The dune doesn't look so high in the picture above, but if you notice the tiny person climbing up in the background, you will see that it is a lot bigger than it looks!

The four of us started out with an optimistic attitude but by the time we were 1/3 of the way up we were already losing steam.  There were two teenage girls who started at about the same time we did, and one of them bolted up at twice the speed we did, while the other abandoned the cause less than halfway up.  By the time I was 2/3rds of the way up, the slope was so steep that I could only go about five or six steps before stopping to catch my breath.  Some of my companions began using their hands as well as their legs.  We questioned if we should have rented the 4x4 dune buggies they were touting at the base of the hill!  With a little faith and a lot of effort, we made it to the top!

Almost There!
 There was a nice cool breeze awaiting us at the top of the dune, and a wide open view that brought a sense of accomplishment with it.

 What a surreal experience to be shrouded in fog and feeling the chill of the ocean breeze just 45 minutes before we found ourselves on the top of this huge sand dune!

The Easy Part
 We walked along the crest of the dune for a while, and debated whether we should attempt to keep going until we reached the next dune over which appeared to be slightly higher than the one we were standing on  . . . but with a 4 hour drive ahead of us to get back to Windhoek we decided that climbing one gigantic sand dune was enough for one day.

The jaunt down took almost no time at all and felt like a moonwalk - a great reward for such effort climbing up!  by the time I got to the bottom, the cuffs of my rolled-up jeans had turned into sandbags - I actually had to stop halfway down to empty one of them because it felt like an ankle weight!

Driving Away from Dune Seven (on the left)
We drove back with exhausted grins on our faces, happy with an incredibly successful adventure on the coast.

The Almost-Full Moon Lighting the way Home
We spent one last night in Windhoek after an obligatory stop at Joe's Beerhouse again, and set out early the next morning for Gaborone.  I won't go into details about that journey, since it is not nearly as fun of a story, but suffice it to say our 11-hour drive turned into a 13-hour drive again thanks to my driving skills, a big white truck, and getting used to driving on the left hand side, which resulted in us switching out our rental car for another one.

Looking back on this trip, I feel incredibly blessed to have had the opportunities I have had.  I spoke to some of the hospice staff after returning from my trip and several of them said to me they have never seen the ocean.  It is so important to be able to put things in perspective, and to be thankful for all we are given in this life, big or small.

Until next time!

Sunday, July 8, 2012

Namibia Part I - Windhoek and Swakopmund

It has been a while since I posted because I have been super busy interviewing people for my research and I wanted to write a post about my trip to Namibia last weekend that would do it justice.  So here goes!  I was invited to join 3 others on an impromptu weekend road trip to Namibia - we left at 4am on Saturday morning and returned late Tuesday evening.  The drive from Gaborone to Windhoek (the capital of Namibia) is about 11 hours.  We stopped in Windhoek overnight and the next day drove another 4 hours to get to Swakopmund, which is a vacation town on the Atlantic coast.  My companions were a American pediatric resident, a PhD student in public health from Kenya, and a friend of the PhD student who is here on vacation.

Sunrise over the Botswana bush during our early morning drive

Driving along highways in the dark proved to be a risky undertaking - there are cows, donkeys, and who knows what other animals (I saw something that looked like a fox scurry across the road, and countless pairs of reflective eyes staring at us out of the bushes) hanging out in the middle of the road at ungodly hours.  It is incredibly dangerous to hit one of these animals, especially in a tiny car like the one we drove (a Kia Picanto), so we drove slowly and carefully during the night hours and were thankful when the sun came up.  We hit sunrise just as we were getting to Jwaneng, which is famous as a diamond mining town.  Underneath the "Welcome to Jwaneng" sign there is a sculpture of a huge diamond.  Most of the government's money in Botswana has come from its control of the diamond mining industry here, which has paid for the majority of the health care and other infrastructure from what I can tell.  Because the government has control over the diamond industry, there are no "blood diamonds" in Botswana, which is fantastic.

Amusing side note: there is a town in Botswana not too far outside of Gaborone called Kanye (pronounced like the American singer), and we saw a sign when driving through that pointed towards "Kanye West." Hmmmmm . . .

We managed to run out of gas about 15km from the town where we were planning to fill up before taking our turn west towards the Namibian border.  It turned out the gas gauge on our rented car was broken, so it looked like we had nearly half a tank left when we sputtered to a stop.  Fortunately some incredibly generous South Africans who were heading up north in a caravan with huge trucks and camper trailers stopped for us right away, and we were able to buy a fuel can that got us to the town.  Lesson learned, we began counting kilometers using the trip meter and filled up at EVERY gas station we saw after that, even if we just needed a few liters.  Once you are about 2 hours away from Gaborone, there is absolutely no civilization for hundreds of miles.  Occasionally you will come across a cattle post or there will be a few huts visible from the highway, but the Kalahari desert is not somewhere you want to run out of gas.  We were incredibly lucky to be so close to the nearest town when we got stuck.

During the drive we saw tons of ostriches (probably 40 in total), a variety of antelopes (definitely kudu and springbok, and possibly an oryx), and many warthogs.  We also saw a secretary bird, which was an impressive sight and looked to be about three feet tall.  I didn't get any pictures of the animals from the road since we were moving so fast, but it felt kind of like a fly-by game drive with fewer animals per square mile.
Crossing the Border
In Gobabis, the town where we stopped for gas after crossing the border into Namibia, we saw lots of women wearing super interesting outfits with pointed hats made out of the same sort of fabric as their dresses, which looked very 19th-Century to me.  I thought at first maybe this was some sort of religious wear or perhaps there was a wedding or other special event going on.  I didn't get any photos because I didn't want to be rude and gawk at them, but here is a good picture of what the clothing looks like.  We later found out they were from the Herero tribe, and the women wear this clothing every day, even in the heat of summer!  The hats are representative of cattle horns; cattle farming is the main source of income for the Herero.  The Herero people have a sad history of being forced from their lands by other African tribes and by European colonialists, and the majority of their remaining population now lives in Namibia. 

We arrived in Windhoek relatively unscathed but exhausted after our 13-hour drive, and we headed straight for the recommended watering hole, Joe's Beerhouse.  After drinking some Windhoek Lager (naturally one must drink Windhoek when in Windhoek), we were met by our gracious hostess, who is a friend from back home of the PhD student.  She is currently living in Windhoek doing public health work related to HIV/AIDS, but is originally from Kenya.  

We ordered dinner at Joe's, which proved to have an impressive assortment of game on the menu.  We decided to share so we could sample everything! We started with the Oryx carpaccio, which was really nicely seasoned and much less game-y than I would have expected.  Then we moved on to the Bushman Sosatie (on the menu below), and for the first time I tried zebra, crocodile, and kudu.  The kudu was my favorite, but all of the meat was incredibly delicious, perfectly seared with a smoky barbecue flavor.  I had tried ostrich before, which is similar to a lean steak, and it did not disappoint.  The crocodile was also surprisingly good, the texture lies somewhere in between the texture of fish and chicken and the meat had a very delicate flavor.  We also ordered a salad that had zebra steaks on top, and were soon ready for a good night's sleep after ending our meal with a glass of gluhwein (german hot spiced wine).

A small portion of Joe's menu

On Sunday morning we enjoyed a fantastic breakfast of scrambled eggs, toast, and Kenyan spiced tea before heading out early for the coast.  Before we left we took some pictures on our hostess's rooftop deck, which has stunning views of the city.

Looking towards downtown Windhoek
Road trip crew and our lovely hostess

We stopped to get gas in a town called Okahandja, and discovered a craft market and a biltong shop.  Biltong is the African version of beef jerky - and they make it out of all sorts of game, not just beef!  We bought a huge bag of springbok biltong for the equivalent of $10 USD (what a steal!) and snacked on it for the rest of the trip.

Biltong Shop in Okahandja

We drove westward and soon the landscape changed from dry bush to dry plains.  At one point we passed a whole herd of grazing springbok.  Before long the landscape changed once again to sand, dirt, and rocks with virtually no vegetation, and the fog of the coast was ominously getting closer.  Before we knew it we were out of the heat of the Kalahari desert sun and engulfed in a cold fog - it felt like San Francisco weather!  We arrived in Swakopmund and checked into our hotel, which was an old building with a beautiful garden.  It used to be a hospital and also houses a retirement home - and it was just 2 blocks from the beach.

Our Hotel in Swakopmund
We headed out to explore Swakopmund, which is clearly a resort town but was nearly deserted since it is winter here and thus the low season.  There were a few other tourists wandering the streets, most of whom appeared to be from South Africa.

The  Beach and the Jetty
 We wandered down to the beach, which had two brave surfers in the icy water and beautiful sand with shades of black and red blended into the earth tones.  We stopped at a restaurant for some refreshments and a sampling of fresh local oysters - something you don't get in Gabs!

Oysters on the Coast
Swakopmund turned out to be quiet and relaxing.  It is a very clean town with a clear German architectural and cultural influence from the colonial days.

Swakopmund Pedestrian Alley

Beautiful old building
We decided to have dinner at one of the nicer restaurants in town, aptly named The Lighthouse.  Ironically, we had a hard time finding it because it is hard to see the lighthouse from town (I suppose they placed it so that it is easier to see from the ocean, hmmm . . . ).

During our search for the restaurant we came across this shop:

Potatoes can cure most diseases? That's news to me!
Finally we found the lighthouse, which was beautifully lit up.  How did we miss it?  The restaurant is tiny and contained entirely in the small house at the base of the lighthouse.  We had a lovely dinner, although we were nearly the only people there, and then headed to the only bar that appeared to be open in town to watch Spain win the Euro cup alongside several other South African tourists - viva Espana!

The Lighthouse
After the game ended we headed back to the hotel for a good nights sleep. The next morning we woke up early to take a boat out on Walvis Bay and climb a huge sand dune - but that update will have to come later, since this post is growing far too long and it's time for me to go to bed so I can get some more interviews completed in the morning.

I am enjoying reading your comments, and I welcome feedback if there are things you would like to see/hear more of or less of.  Until next time!