Quick update!

I don't have much time right now but wanted to update with a few quick things:

1) I added a new feature to my blog which is follow via email - that way you will receive an email whenever I post rather than having to check back all the time.  Check it out on the sidebar ------>

2) I'm going to Namibia for the weekend!  I am joining in with three other expats who are here studying/researching through Baylor and we're driving this weekend, since Monday is a national holiday (Sir Seretse Khama Day).  I don't have much time to write now but I'm hoping to come back with some great pictures!

3) I had a wonderful birthday on Wednesday with all of the people I know in Gaborone in attendance (which isn't very many but was quite impressive considering I've only been here 3 weeks).  I was also surprised this morning (Friday) with a birthday cake and beautiful Botswana-style rendition of "happy birthday" at the hospice - quite the sweet and unexpected surprise!  I will update when I get back from the weekend with pics.

4) I started interviewing! I got my first two interviews on Wednesday, what a great birthday present to finally get my research rolling!  To date I have completed 5 interviews, and they are going well.  I am already learning a ton and I look forward to sharing my recent insights soon.

5) I saw the monkeys!!!!!  They have wandered into our yard at least 3 times and I have seen them once around the neighborhood as well.  They are Vervet monkeys, and are very cute.  Their human-like mannerisms are fascinating to watch as they pick up objects and evaluate them or just scratch their behinds ;) There is a family of at least seven of them, including two babies, that rummages through our garbage on a fairly regular basis.  Here are two photos I took from my back porch (I can't have an entire blog post without photos!!):

Suspiciously creeping towards us

There are six monkeys in this picture can you find them all?

Apologies for the short update but I will write more soon.

Game Drive!

While I didn't manage to complete any interviews today (the hospice staff member who was supposed to come with me wasn't around), I thought I would post some pictures of my weekend and some more lighthearted things in the meantime.  My two flatmates and I set out on Saturday in search of good photo ops, since one of them is returning to the US in two weeks.  We were somewhat aimlessly driving around when we realized we were right next to the Mokolodi Game Reserve, a nature park on the outskirts of town that has lots of wild animals.  It is also a conservation and education center, and has a delicious restaurant where we ate lunch while we waited for our game drive to begin at 2pm.  We got a preview of what we would see on the game drive during our lunch on the terrace since there were two impalas and a couple of baboons lurking about in the adjacent bush!  There was also a tree right near the entrance to the park that was completely full of beautiful weaver bird nests - they almost look like something out of a sci-fi movie:

Weaver Bird Nests

I didn't see any birds near the nests, though, so these are either abandoned or it's not nesting season for the birds.  The nests are truly works of natural art.  There is actually one in the yard of my flat which I discovered the other day - here is a photo:

Weaver Nest in my Yard

On the 2-hour game drive we saw many different animals, some of which I attempted to photograph, although the pictures really don't do the experience justice.  It was a nice day, a little windy but warm in the afternoon sun.  The most abundant animals by far were impalas (or is impala the plural too?) - we spotted one right after leaving on the game drive and many, many more after that.  Most of them let us get pretty close and then would stare at our truck curiously for a moment before wandering off into the bush.  Others just bounced off into the distance without giving us a glance.  The have huge, beautiful black eyes, long eyelashes, and graceful, wide horns.

Impalas in the Afternoon Sun

Other animals we saw: Ostriches, baboons, vervet monkeys, warthogs, wildebeests, kudu, zebras, one giraffe head above the distant trees, and a ton of beautiful birds, including hornbills (which you may recognize as Zazu from The Lion King - my first thought when I saw one).  Unfortunately the pictures really don't do the experience justice, especially because by the time my camera was ready the animals were running away from the sound of the truck.  It made me really want to track animals on foot!

Male Ostrich

  

Red-billed Hornbill (aka Zazu)

Sidenote: Speaking of Lion King references, I have been noticing them everywhere (ok obviously it is ridiculous of me to think that these things are Lion King references, I am fully aware that these things existed in Southern Africa long before the Lion King was conceptualized, but I'm unable to dissociate.  Apologies in advance if I offend anyone).  Here are some examples: the word for "problem" in Setswana is "mathata".  That's right, like "hakuna matata".  It's also a very fun word to say!  I think every single animal that I saw on the game drive on Saturday appeared in the movie, and I couldn't help but be reminded of Pumba seeing the adorable warthogs plodding along near the muddy water hole.  Additionally, check out these awesome potato chips I bought a couple weeks back:

Simba Chutney Flavored "Crisps" - Delicious!

Okay, that is enough of  a side note!  I am planning to do an entire post about food soon enough, so stay tuned for that one.  In the meantime, here are some more pictures from the game drive at Mokolodi:

Kudu - These things are LARGE!  Quite impressive to see their size in person

I think the hoofed animals (categorically called "antelopes") don't get the respect they deserve from the safari-going masses.  From what I can tell everyone is so focused on seeing "the big five" that they forget how amazing the animals right in front of them are.  "The big five" is a term I learned after arriving here in Botswana, and it is more or less a checklist of the large animals you should see while game watching.  The big five are: lion, leopard, rhino, elephant, and cape buffalo.  I realize that once you have seen 50 impalas in one day it is easy to ignore them (or hope one of them becomes a meal for one of the local carnivorous species), but I just thought I would mention that all of the antelopes that I have seen are quite impressive animals, and worth appreciating.

Warthog and Family (Pumba?)

Zebras! Very shy and quick to run away, although not as difficult to spot as the well-camouflaged wildebeests.

Here is an interesting tidbit we learned from our guide about zebras - they have a symbiotic relationship with wildebeests.  Apparently, zebras have very good eyesight and a very bad sense of smell.  Wildebeests have a keen sense of smell and can easily track down the freshest grass, but they are easy targets for lions and other predators because of their poor eyesight.  By hanging out together, the zebras get to the best grasslands and the wildebeests get alerted when a predator approaches.  Added bonus: one animal likes taller grasses while the other prefers shorter grass, so they aren't even competing for a food source.  I am inspired by this natural collaboration and I think humans should strive to mimic the wildebeest/zebra relationship whenever possible :)

We didn't see either of these, but I did hear a hippo

Our wonderful guide with me and my two flatmates after the game drive

The bush - we saw some baboons creeping between groves of trees from this vantage point.  Hard to believe this is just 20 minutes out of town.

Approved!

Beautiful Modern Buildings Nestled Between Dirt Lots - this is right near the center of town

The Ministry of Health Complex

I went to the Ministry of Health first thing yesterday morning (after spending about an hour and more than $40 USD at the business center in Riverwalk Mall getting print outs and additional copies of my translations) to submit the Setswana translations and finalize my research proposal.  When I walked in to the office, the man working there recognized my research proposal immediately and said "oh, we already approved that one."  I was shocked, because when we checked in two weeks earlier (on my first day in Gaborone) they told us they were waiting for my translations before they would approve the study.  Not that I would have begun to interview people before I had the translations anyway, but the great news is that now I can go ahead and get started!  Yippee!  That means I've got 8 solid weeks in which to interview people.


Above are some photos of the ministry of health - one of the nicest buildings in Gaborone, and rightly so given that Botswana has been so affected by HIV/AIDS.  The office staff was very friendly and my visit was incredibly efficient - not exactly what I expected.  I had a much harder time figuring out how to navigate my initial administrative approval in the US.  On my victorious departure from the research department, I snapped this photo from the 7th floor (taken from inside the tall white building with all the balconies in the photos above):

Inside the Ministry of Health

To celebrate my approval (and being finished with long hours of fine-tuning my translated documents) I took a stroll down to the main mall.  On the way I passed the parliament building, which has a huge fountain along the front of it:

Botswana Parliament Building

The parliament faces a nice plaza which contains a statue of Botswana's first president, Sir Seretse Khama (see link at the end for more info on this sweet dude).  If you walk away from the parliament building, past Mr. Khama's statue, and cross the street, you will find yourself in the main mall.  While perusing the main mall, which is not a regular shopping mall but is a wide pedestrian area with lots of shops, banks, and street vendors, I saw the President Hotel.  I just finished reading the No. 1 Ladies' Detective Agency this week, so I decided to find out if there really is a terrace on the hotel where I could have a coffee like Mma Ramotswe does every weekend.  Well, not only does the hotel have a terrace, but they have actually named it after Mma Ramostwe!

The Mma Ramotswe Tea Corner at the Cresta President Hotel

 I did not see Mma Ramotswe there (sorry, mom), but there was one guy out there eating his lunch so I hope he didn't mind me snapping his picture!

Looking out on the Main Mall from the Mma Ramotswe Tea Corner

I decided to stay for a cup of coffee when I realized it was just about lunch time and they were about to serve a buffet lunch - so I went all out and had a delicious lunch, which seemed more like a Thanksgiving dinner to me!  Roast chicken, grilled beef, macaroni, beef (or was it goat?) curry, sweet potatoes, curried plantains, morogo (dark greens cut up small and cooked w/ other veggies), samp (cooked hominy), pap (white maize ground up and boiled), some kind of pickled carrot and cabbage thing, and maize with beans, and that doesn't include the dessert buffet.  It was delicious and well worth the $20 USD.

My Victory Feast!

After my massive meal I stopped by the tourist office to get a map and then decided to walk to the hospice - I'm not sure the exact distance but probably about 2 miles based on google maps and my personal estimate. It was a warm day, although rather windy, and it was fun to walk through the neighborhoods surrounding the hospice as I wound my way through the streets.  Here are some things I saw along the way:

I thought this sign was cool - the lot behind the fence was filled with
what looked like stolen cars which had been sitting outside for ages.
Is that a lion on the logo?

Well-trodden foot paths
These are EVERYWHERE and will get you from one end of the city to the other

Mother Hen With 10 Chicks - can they ALL be hers?

Everyone here is SO friendly - there is a certain amount of attention I get for being white (and they can probably also tell I'm foreign) - but really people here are very giving, warm, and honestly curious about other cultures.  On my walk I saw lots of kids who had just gotten out of school, and they always smile shyly and say "hello" to me while staring curiously.  Lots of adults sitting in their yards will wave and say hello or "dumela" as well, and occasionally they will stop me to ask where I am from and find out more about what I am doing in Botswana (this happened twice on my walk yesterday).  Sometimes the adults stare at me with suspicion and/or curiosity until I say hello first, but they always respond with a genuine smile and a wave.  Based on my experience in other countries I am instinctively wary of any stranger who tries to start a conversation with me - especially when I am alone - but the overall graciousness, politeness, and genuine curiosity of the Batswana has begun to break down my defensiveness.  This is a welcome change, and it is so nice to be in a place that feels so inviting.  It is hard to remain a cynic with so much positive energy around! Of course I will continue to be a cautious and conscientious traveler.  I keep an eye on my belongings at all times, and I still won't walk anywhere alone at night.


Today I returned to the hospice for the 7:30am staff meeting and then went along with some of the staff to pick up the patients who come to the hospice during the day.  It is interesting and incredibly informative seeing where patients live, regardless of what country I'm in.  Many of the hospice patients live in one-room cinder block apartments with a thin tin roof, no electricity, and an outdoor pit toilet shared with many family members and neighbors.  Despite their living situations, I am encouraged to see the patients well dressed in clean clothes and ready to go when the hospice van pulls up.  I should also mention that some of the places do have electricity, and I have seen many of these one-room apartments that house several people with satellite dishes attached (working or not I have yet to find out).  I am planning to start interviewing families on Monday, so I will get a closer look at their homes then.  I keep thinking it would be great to film a documentary or do a photo essay of people and their living situations here.  I will try to get some good photos of the neighborhoods while I'm out doing my research.

Seretse Khama, an awesome dude who, among other great things, refused to annul his interracial marriage back in the 1940s: http://en.wikipedia.org/wiki/Seretse_Khama
The No. 1 Ladies' Detective Agency: http://en.wikipedia.org/wiki/The_No._1_Ladies'_Detective_Agency

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: http://publichealth.yale.edu/downs/index.aspx
Nurse Practitioner Fact Sheet: http://www.aanp.org/all-about-nps/np-fact-sheet

The Gaborone Sun

I will keep this post short because our electricity was out last night for four hours and I wasn't able to write the post I was planning . . . so I will save that for later.  I will write an update in the next few days about what I have been up to and how things are going with the hospice.

In the meantime, I thought I would share a few photos.  The weather here reminds me of Albuquerque winter - nice and toasty so long as you are in the sun, but the second you step into the shade or the sun goes down the temperature plummets!  Generally the highs have been around 68 degrees F and the lows around freezing.  The most dramatic thing here about the weather, though, is the SUN.  And I am not kidding - I grew up in the desert and I love the sun, but I have never experienced a brighter or hotter sun than here in Gaborone - and it is early winter here!  Here is a photo taken yesterday evening from our back porch as the sun was getting ready to set:

Tswana Sun

Doesn't that make you just want to squint or look away?  No matter the time of day the sun has a blinding quality and seems to always be low in the sky.  It is the most amazing feeling to stand in the sun and warm up after a cold night in a poorly insulated flat, but I can't help but suspect that my retinas are frying!

Citrus Tree at the Hospice

Again, notice the quality of light in this photo - this one was taken around 9am this morning.  It is so bright here that in order to grow a vegetable garden (or pretty much any kind of non-desert greenery) you need to create a shade canopy.

Hipster Self-Shot in Shadow

In the picture above you can see the intensity of my shadow and the light reflecting off of the window next to me.  I'm amazed I haven't wound up with a sunburn yet!  Proof that I am not imagining the solar intensity: the most famous hotel here is called the Gaborone Sun.

I promise to write more soon but I thought I would share these photos in the meantime!

Go Zebras!

Today is Saturday – I was a bit at a loss about what to do with myself today since my advisor left yesterday afternoon to return to the US and I don’t have anything on my agenda until Monday morning when I will go to the hospice again.  I slept in until about 10am and then took a leisurely shower (as leisurely as it can get in our tub with no shower curtain and the shower head that you have to hold on to the entire time).  I needed to get out of the house, so I decided to walk down to the “other” shopping center (three blocks in the opposite direction from the River Walk mall where I have been going every day).  The other shopping center turned out to be a much cheaper supermarket called “Choppies” and a gas station.   Along the way I discovered a few interesting things, including a museum (I think it’s the natural history museum), a very modern looking gym called "Gym Active", and a cinema that didn’t look like it is in working order.  I love the names of things here - there is no avoiding the point: the cheap groceries are at Choppies and the gym is Gym Active.

On the walk back home I took a different route and saw the Holy Cross Hospice preschool and an art workshop/gallery.  I got back home with my bag of groceries and decided that I would go nuts if I spent the rest of the day indoors, so after a quick bite to eat I headed out again to River Walk.  I took my time and examined all of the shops this time, stopping in the Orange cell phone store to ask how to check my balance and see whether I would be able to use my US Android phone in Botswana (the answer being decidedly no).

After a stroll around the mall and poking around in some of the clothing stores to look for slippers (the one thing I really regret not bringing since the floors are cold and everything - including my feet - is covered in a fine layer of the red dust that makes up the landscape here) I headed to the bar/restaurant Linga Longo for a local St. Louis beer.  St. Louis turned out to be a pretty mediocre lager – it wasn’t terrible but I can see why they don’t export it to the US.  Nevertheless I ordered a second one and before I knew it the bar was filling up with football (soccer) fans – there was a Botswana (Zebras) vs. South Africa (Bafana Bafana) game on!

St. Louis - Botswana style

It was super fun to see people crowding around and watching, and the whole bar erupted into cheers followed by song when Botswana scored.  A little while after the Zebras scored I was having a hard time seeing the screen due to the overcrowding and I thought I should head home . . . but not before stopping at the liquor store I had just discovered!  I bought a small bottle of Amarula (cream-based liqueur made with Marula fruit) and a bottle of South African wine recommended by the guy working there.  I asked him what kind of wine he drinks and he pointed to a 42 Pula (~$6USD) bottle from South Africa, and dissuaded me from buying the 100 Pula bottle I was eyeing – way too expensive for him, he said!  I have yet to try either of my liquor store purchases but I will be sure to report on them when I do.

Watching the Zebras play @ Linga Longo

The soccer game ended after I got home, but the score was 1-1 in the end.  I'll have to make a note of when the Zebras play next so I can keep up on my local sports!

Creatures Great and Small

This afternoon we went to the hospice and met with three visiting American professors who are on a healthcare tour of the country and were curious about end-of-life care in Botswana.  It was very informative to hear my advisor and the hospice director answer their questions about the hospice and the availability/demand for end-of-life care in Botswana.

I am trying to learn the names of all of the hospice employees and volunteers but it is difficult!  Everyone at the hospice seems very nice but deferential, so I will have to work to break down the barriers created by me being foreign, white, and only here for a few weeks.  I hope that by spending enough time at the hospice and working closely with the staff there that I can make rapid progress in earning their trust.  I can see that there are frequent foreigners who come by briefly and either collect data or get a tour of the facilities without making much of a contribution (at least as far as the hospice staff can tell) so I plan to contribute as much as possible in my short time here.

My Neighborhood and the Botswana Blue Sky

When I got back to the apartment today my roommate told to be sure and shut the door if I see monkeys – I thought she was joking but apparently there are about 14 Rhesus monkeys who live in the neighborhood!  She said she saw a few of them this morning walking behind the apartment.  It is so funny to me because it really doesn’t feel like an exotic place for the most part, but I keep hearing stories about giant cockroaches (so big they wouldn't fit in a drinking glass), spiders the size of your palm, and now monkeys in the backyard.  I have yet to see any of the above, and I'm not exactly looking forward to encountering one of the roaches or spiders.  I suppose that it is all part of the charm/adventure of living in a new place – like seeing roadrunners in Albuquerque - except scarier!

Dumela, Gaborone!

On Wednesday I arrived around 1pm after many hours of flying (Boston to London to Johannesburg to Gaborone).  My academic advisor and the wife of the doctor I will be working with while I am here picked me up at the airport and brought me to the flat where I am staying.  The flat has two bedrooms and is currently occupied by three other American women.  It is kind of a motley crew in the apartment and everyone is very friendly but it is relatively tight quarters and pretty bare-bones in terms of decor and creature comforts.  The apartment is owned by the Anglican diocese and hosts aid workers, missionaries, students, etc. so it has a bit of a transient feel to it, although it is equipped with all the basic necessities so there really is nothing to complain about.  Fortunately everything was ready for me on arrival, including towels and a bed with clean sheets on it, which was very nice after such a long journey.

Home Sweet Home

Today was a whirlwind – we went to Holy Cross Hospice for a brief visit and I met the community organizer there who I will be working with this summer.  After the Hospice we went to the cathedral briefly, then on a thorough walk-through of the Princess Marina Hospital, Gaborone’s large public hospital facility.  It was pretty much as I would have expected, with lots of people looking ill and waiting around but nobody appearing to be in acute distress.  My impression of the health care system is that it is very good despite its limitations.  There is free health care for all - including free transport to Johannesburg for specialty surgeries that are not offered here in Gaborone!  It is clear, however, that there is a shortage of health care providers and the hospital facilities are much too small and not well enough equipped to handle the volume and acuity of needs of the population.  There were also some impressive facilities on the hospital campus with involvement from outside universities, including a pediatric outpatient clinic run by Baylor and an HIV/AIDS project with Harvard.  It would be amazing to see a nursing collaboration with Yale, particularly because there ARE nurse practitioners here in Botswana!

The sky here is the most vibrant color of blue, and on my first night here one of my roommates pointed out the “southern cross” constellation.  I had completely forgotten  that you can see different stars from the southern hemisphere!  I’m still getting used to the sun being in the North, but it definitely helps my sense of direction, especially since it is winter and the sun stays relatively low in the sky.

Oh, and "dumela" means "hello" in Setswana, hence the title of this post.