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.