Chinese food!

I’ve been dying for Chinese food! So finally tonight, I forced everyone to come with me for Chinese food at J Ma Oriental at the Riverwalk Mall! They all ordered very American dishes (like beef with broccoli, chicken stir fried with vegetables, etc.) and I guess we were planning to eat everything individually. But they came out with all the dishes so irregularly that it became family style. I ordered eggplant and minced pork, which was by far the best dish, and everyone ate mine! But that’s okay – we all ate until we were ridiculously full. We also had these good dumplings in soup, that came with this straw fungus/mushroom thing (which my mom puts in Chinese jai) in the soup.

Prisoners as Patients

We were on call today and miraculously got no patients!!!! It’s the first time ever! I was pretty excited. :)

I’d like to mention a special subset of patients we have at Princess Marina – the prisoners. There is a prison near Gabs (which we actually saw on the way to the Kalahari) that often sends prisoners to us for medical treatment. There is a small clinic within the prison but I think they can only treat patients to a very limited degree – so for very sick prisoners, they send them to PMH, shackled at the ankles, along with at least one prison guard.

You never really find out what these prisoners were jailed for. Boipelo and Maggie (another MO) told us that it’s mostly small things, like theft, but occasionally there are murders (usually crimes of passion, or as they say, “passion killings”) and rapes. Sometimes if a prisoner comes with two prison guards, I think that they must have committed some more offensive crime. But we treat them all the same. They stay shackled with these old-fashioned metal chain shackles, and anywhere they go, a prison guard goes with them. Some of them are relatively healthy and walk around everywhere, while others are incredibly sick and stay in bed all the time – it’s interesting because they stay shackled no matter what, even if they’re too sick to move!

Most of the prisoners are pretty sick by the time by the time they come to PMH. I think the prison clinic does everything it can to help them and then sends them to the hospital only when absolutely necessary. There probably is a huge incentive to fake illness – PMH is like a vacation for these guys. They get mattresses, decent food, and they can even have visitors at PMH!

A high percentage of the prisoners are foreigners, especially Zimbabwean. It’s actually a big problem because foreigners don’t get the same medical treatment that Motswana prisoners do. Because they aren’t citizens, they can’t get CTs without paying (and it’s expensive!), and they can’t get free HIV or TB medications. One patient I had was diagnosed with HIV in prison a few months ago, and is starting to get these complications from AIDS. These are mostly due to opportunistic infections, like Cryptococcus, or TB, and if you get them, it’s a sign that your CD4 count is pretty low and you need to start HIV medications as soon as possible. If this patient could just start taking HIV medications, then it would be ok, his immune system would recover enough for him to fight off the infections on his own. But since he’s a foreigner, he can’t get the free medications from Botswana, and obviously he’s in jail, so he can’t make any money to pay for them. If he was out of jail, he might be able to make enough money, either here or in Zimbabwe, to pay for medications, but here he’s just out of luck. It’s a horrible situation – I don’t know how much jail time he has left to serve, but he might die in there just because he can’t get the HIV medications.

The San-people resettlement villages

On the way back from the CKGR (Central Kalahari Game Reserve), Jo took us to see a resettlement village of the San-people. The San-people were removed from the Kalahari Desert years ago – maybe not physically, but many of them were told to move and intimated out of the Kalahari and relocated to these settlements where the government provides them with free water and maize, education, roads, and a variety of other free services. So now, the San-people live on 3 main settlements in Botswana, but they really have nothing to do! The government tried to teach them to farm, but historically they are a nomadic group, and there wasn’t much motivation for them to learn farming or keep up with it once the government left. There are no jobs for them, but even if there were jobs, popular opinion is that they probably wouldn’t be interested in taking them. The government provides everything for them – food, water, shelter, so there’s not really a reason for them to work or go to school.

There even seems to be a degree of resentment among the other Motswana – they say that the government gives everything free to them, and if they want to go to college, they’ll pay for them and everything, but they don’t even take advantage of these things! Instead, they sit around all day, and they make this drink called Chibuku. The San-people get free water, sorghum and maize, so they use some of it to make this very strong alcoholic drink. They mix it together, dump in some termite mound for yeast (the more termite mound, the stronger the drink!) and it only takes a day or two to brew. They’re often drunk by noon or 1pm because they just sit around and drink all day and hang out. We visited one of these Chibuku establishments (a bar) and actually got a carton. It’s not bad – a little sour and mealy, but it’s ok. It was definitely very strong. Jo said that after you drink two cartons, you’re drunk. It was only about 11 am and many of them were well on their way to being drunk. It was a little sad.

So how did all this happen? The government made up some excuse about the roads not being good enough in the desert, so the San-people had to move (not that the San-people used roads anyways, or not that the government couldn’t have build the same roads that they built for the San-people’s resettlement out in the Kalahari). The rumor is that the real reason the government relocated the San-people is diamonds, which were discovered in the Kalahari. Some of the San-people have won the rights to move back to the Kalahari, but now the government is saying only those 200 or so whose names were on the legal suit are allowed to move back. So they had to sue again, saying (rightfully so) that they represented all of the San-people. They eventually won, but by that time, the government had been providing so much free stuff now to them that only the older people want to move back. The young ones just want to stay on the resettlement grounds and stay drunk. It’s a very sad story.

Camping in the Kalahari!

We went camping in the Kalahari this weekend! Joanne, Amy, Jeremy and I went with Johannes (Jo), a guide that works with Tim. It took us 3-4 hours to get there, we had lunch at the campsite, and set up our lion-proof tents. We were staying in Khutse game reserve, which is connected, or adjacent to, the huge Central Kalahari Game Reserve (CKGR) – the largest game reserve in Africa.

We had a huge lunch – quiche, salad, other things – and then went on our first game drive. We saw a few funny things, but no huge game. We did see this huge flock of vultures near the air strip – very impressive. Of course, we saw many springbok and steembok, some oryx gazelle, these cute ground squirrels that ran fast everywhere and use their tail to shade themselves. And we saw a ton of birds – the lilac-crested roller, hornbills, some weavers, and the kgori (or kori) bustard (which we were saying bastard the entire time) – apparently it’s largest flying bird in the world. We also collected some firewood and saw a beautiful sunset! Here are just a few pictures of the things we saw:

Vultures

Ground squirrel

hornbill

kgori bustard










After we got back, Jo made dinner. It’s funny – there were 3 Jo’s on this trip so it was very confusing when Jeremy or Amy tried to talk to one of us. They would say Jo, and three heads would turn. Dinner was delicious – we had steak, garlic bread, and green beans with pap. And we also had chocolate cake for dessert. We sat around the campfire for a while, and eventually crawled into our tents. I slept with Amy, Jeremy slept alone, and Jo(anne) slept with Jo(hannes). J We were a little afraid of lions – they often go right into the campsite at night although they stay away from humans for the most part. So I didn’t make it out to the drop toilets all night because I was so worried! I think that was a good decision because apparently campsite 5, which was right next to us, had a lion visit them!

We went on another relatively uneventful game drive the next morning after breakfast, and Jo took us to a relocated village of the San-people (they’re also called bushmen, which is derogative, or Basarwa, also derogative since it literally translates to “stick-people”). I thought it was the most interesting part of the trip, but it’s a pretty sad story. I’ll talk more about it in the next blog entry. After visiting the San-village, we stopped at the Khutse Lodge, which is right on the border of the Khutse Game Reserve, for a light lunch of sandwiches and salad. We were there for a couple of hourse, so we went swimming in their pool to cool off, and then drove home. Even though we didn’t see any big game, it was still a great experience, and I’m totally glad I went. It was so quiet and beautiful out there. I think it was a good preview of what our safari will be like…

My team at PMH

We were on call tonight and got a lot of patients. We have a new MO – Mpho Mpape. She’s not very good. But she’s pretty good at doing scut. She disappeared for like 3 hours in the middle of the day. But I guess then she stayed late (only until about 5) doing stuff.

There was a little tiff at the end of the night – Boipelo came on for call at 9pm and found a chart on the female side that said the patient was in the ward at 7:30pm and she got all mad because she had not been admitted yet. She got upset at Amy, the resident who was on call on the female side, and also at Shabnam, the Indian MO who is on call until 9pm. But both of them said they had not seen any new admissions! It’s interesting – the MO’s are very strict when it comes to whom new admissions are clocked by and which team new patients are assigned to. It makes sense – they don’t want to do any more work than absolutely necessary. In this case it turns out that Amy had already clocked this new admission but the nurses lost the admission note and so put the file back into the new patient box. So Amy was able to find the lost admission note and put it back in, but people were still aggravated at each other.

In general, I think my team is great, even though it’s the smallest one. We have as much work as every other team, but for some reason we don't get any new students, residents, or interns! At least so far it has been manageable. Boipelo (our MO) has always been there, although she’s taking the next two weeks off for vacation, starting Monday, and is being replaced by Mpape. She’s actually on call tonight. Not all the MO’s are that good, but she’s pretty good, even though she definitely has an attitude and is pretty cynical. She also works pretty hard. The work ethic is pretty interesting around here. Most of the Motswana MO’s and some of the doctors work relatively slowly, compared to the doctors in the U.S. It’s just a different pace – they tend to take 1 hour lunches (at least) and they don’t rush to try to get everything done. If by 4:00 pm there are some things that are left to do, they just leave anyways. They just try to get to the most important stuff early in the day. This I understand, but not necessarily agree with. There is just so much to do that sometimes one person just can’t get to it all. I do get frustrated on occasion, because there doesn’t seem to be a need for 1-2 hour lunches when you can be working on patients!

I think especially on the teams that have Penn people, the MO’s have a lot less work to do because the Penn people are “extra”. And on call nights when Penn people are on call, the MO’s tend to take off early or disappear, because we are also “extra” help on those nights. It can be really frustrating – often, an MO will just disappear for hours at a time because they feel there’s someone else there to do the work! Some of them are really starting to take advantage of us, and the MO’s are starting to fight to be on teams that have Penn people so they don’t have to work so hard. It’s annoying, because although we are there for patient care, Penn people rotate in and out, and we don’t always know the correct way to do something, or what resources are available to us. And more importantly, we can’t speak Setswana, so we need those Motswana doctors and MO’s to help us translate! It’ll be interesting to see how this plays out in the future because I don’t see it getting better unless there’s some kind of intervention.

Each team also has a specialist, who is equivalent to an attending in the states – they make the big decisions and do a lot of teaching. For my team, the specialist keeps on changing. The first two weeks it was Dr. Stefanski, the next two weeks it was Sarah, and now it’s Shanthi. They all do quite a bit of teaching, and are all very good (not all the specialists are good) but I think I liked Sarah the best because she knows how the hospital works and helps us out with the work after rounding. Shanthi will probably be like that too, but she’s relatively new, and is still learning the system.

Below is a picture of my most recent team – it’s Boipelo, Sarah, and I.

Decompressing

It was a busy day today and we barely had time for lunch because we had 10-11 admissions overnight that were done for us by the MO on call. There were 3 of us working though, so we made it through but were running around all day.

We needed to decompress, so a few of us (Sarah, Amy, Joanne, Jeremy and I) went to the Bull N Bush for dinner, which is a nice chain. It’s a pretty busy bar and club too on Friday nights, but I never went when it was really active. I had a great burger with mushroom sauce here, and we took these funny pictures with a cross-dressing cow statue. In general, I think I’m starting to get tired and worn down a bit – when we got home, Jeremy and I started Skyping each other even though we were in the same room and I thought it was the most hilarious thing ever. And we only had one beer at dinner! :)

Food at Princess Marina Hospital

My team was on call tonight and it was relatively busy – we got 4 patients, but all of them were handled well. There were some interesting cases, but instead of talking about medical stuff I think I’ll talk about food at the hospital a little bit.

The cafeteria is run by the restaurant Moghul, which is right down the street from our flats. The restaurant serves decent Indian food (so I’m told) but the cafeteria makes very affordable and excellent local (Botswana) food. It’s just one counter long, so there’s not much selection, but it’s always very good, and a full meal is about P14, which is only a little more than $2!

At the cafeteria, you choose from a selection of starches, such as rice, pap (maize meal), sometimes samp, sometimes dumplings (which I think are just these huge balls of steamed or boiled bread), and a one other thing I’m not familiar with – and they cover this with a little bit of sauce. Then you can either get chicken or red meat, and you get a hot vegetable. A common red meat dish is seschwa, which is sort of like pulled pork, but with beef and without the sauce. It looks pretty nondescript and boring, but it’s really really good. The often also have beef stew or oxtail stew. Being a red meat fan, I rarely get the chicken, but it’s often stewed, grilled or fried chicken with sauce. The hot vegetable can be cabbage, spinach (which is not exactly like our spinach), creamed spinach, carrots, and a few other possibilities, depending on the day. But there is just one vegetable made per day.

Further on down the counter, you then get 2 or sometimes 3 different salads – they make regular lettuce salad, sometimes there’s a potato salad, sometimes bean salad (which is basically cold baked beans), and sometimes there’s carrot or beet salad. All in all, it’s a huge amount of food, and I usually eat it all! As a result, my lunches have become the main meal of the day, and sometimes I barely eat any dinner at all because I’m so stuffed from lunch. The only thing is, you have to make sure you get there before 1:30 because the cafeteria starts to run out of food.

More recently, I’ve been going outside of the hospital to eat lunch. Right outside the hospital entrance there are many options for food. Some people have small tables set up where they have food in several pots and the food is very similar to what’s in the cafeteria, but cheaper and with much less selection. For example, for P10 you can get pap, seschwa, and spinach, but those are your only choices, and you get a little less food than you would at the cafeteria (which I actually welcome). There are also people in small huts selling food – there they have some pots too, and you can get a small little bowl of food (like chicken or beef stew or something) for like P4. They also have this pita-like thick bread called papata for P1 which is great to eat with the stew. Some of the huts also sell fresh-fried chips! They are so good. They come fresh out of the deep fryer into your little blue plastic bag, which you then take to the table to sprinkle on salt, vinegar, and hot pepper. It’s soooo good and it’s only P4! Lastly, my favorite is the sausage guy. He grills huge homemade sausages right there outside the hospital, puts them in a bun, and adds whatever toppings you want (mustard and tomato sauce – what they call ketchup here). It’s the most amazing sausage ever, and only for P6.

Another alternative is to walk the 10 minutes to the Main Mall, which is an outdoor mall. There are two pie places there (that sell meat and vegetarian pies) that are pretty good, a bunch of fast food, and again people selling food on the street. There are several sausage guys here, and they have small tables with women selling food in pots as well as grilling up big pieces of steak. They also have a few large groups of people who have set up long rows of tables with food in pots – the equivalent of the pot ladies, but super-supersized. They have even more choices than the cafeteria, and it’s only P12! And you can stuff as much as you can into your takeaway container – I’ve seen people pile it on incredibly high, with 3 or 4 different meats and tons of veggies. Also a 5 minute walk away is the museum - which serves similar food to the cafeteria at basically the same price, but there is a nice environment to eat it in. You eat at outdoor round tables, shaded by these grass roofs, and we often have our bi-weekly feedback sessions there.

Ironically, today, I was actually a little tired of stuffing myself every day and actually brought lunch – a salami and cheese sandwich. I think I just felt like eating something American for once, but it all worked out because when I got home, Lisa had made lasagna (sort of) and salad. So I ate a big dinner. :)