Family

Around this time of year I suppose tons of people are thinking about family, and usually with family. I'm really lucky to have a great one, and just as lucky to be marrying into another great one.

Here's my family back in Sacramento:


And here is the family I'm marrying into - with twins in the family it is pretty much impossible to get everyone together at the same time for a group shot, but here are a few pictures of them separately:















I am super lucky to have two such wonderful families... but sometimes I wish I could be close in distance to both at the same time. I'm on the east coast right now, and there's a good chance I will be staying here for quite a long time, and my mom, dad, brother and sister are all still in California - I definitely miss them.

And get this - this Christmas was the first time they met! Not everyone - that would have been pretty difficult, but Carol (Pete's mom) came over to California to meet my family. It went pretty much as expected, which was wonderfully.


Everyone got along very well, and we had a great Christmas. In fact, I'm still humming Christmas songs, much to Pete's chagrin, I'm sure. :)

The rest of Africa in one blog entry

So I never had time to blog about the safari Pete and I went on in Botswana (including Victoria Falls) and also my travels in Namibia with Bruce and his friend Mike, but here are some links to pics on kodakgallery.com:

3 albums (Joanne alone, Joanne and Pete on Safari, Namibia with Bruce and Michael)

As expected, it was an amazing experience. Our group consisted of Gunther, this 70ish year old German guy, Linda and Roger, Marcus and Lilian, and our guide Richard. The safari started out with a lot of safari drives in a huge 4x4 truck that held all of us - Richard, who's been doing this for 20+ years and is one of the best, was an amazing driver. Although there was a slight mixup and we were forgotten for the first half of the first day (and we missed Victoria Falls), we eventually caught up with the rest of the group and got taken to this awesome lodge. The next morning we set off! I'm not going to describe it in detail, but it was the same stuff I think everybody does on these safaris... game drives, river cruises, game walks, and mokoro canoe trips (people pole you around on traditional mokoro canoes). Highlights included an awesome game walk by a real San-person, almost getting chased by a huge bull elephant, coming scarily close to a hippo pod in the mokoro canoes, seeing two leopard sisters playing together, all the sunsets over the desert, the Okavango Delta, and everything else. With my brother in Namibia, we had an awesome game dinner, went on the most awesome hike I've ever been on in the Namib-Nauklauf park, climbed up the red sand dunes of Sossusvlei for a sunrise, and quadbiking and sandboarding near Swakopmund in the deserts of Namibia.

Amazing and unforgettable.

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.