So let me start by apologizing again on how little I've been blogging. In my defense, I have had a jam-packed schedule and there have been a few unannounced and announced power outages so technically it's not all my fault. Technically. We had one scheduled outage for 11 hours on Saturday. It's okay though because I had a chance to volunteer with adorable kids, which I will DEFINITELY post about soon enough!
I guess it's time to catch y'all up on all of the details! I'll go in order and try to keep it short but it has been a while so no promises!
I'll start with a daily routine: Firstly, I wake up around 6 AM and chat with my parents and some friends (their 11 PM) because it is the time that works best for both timezones considering I'd have to wake up soon anyway. After that I get ready for my internship and all. We leave around 7-7:15 depending on where the clinical rotation is for the week. Then we walk about 10 minutes to take a combi (16 seater public transport) to the combi/ bus station and catch another combi to the clinic. Last week, my group was at Julia Molefe clinic and this week we were at Old Naledi clinic. Below are some more images to get everyone familiar with the combis!
Getting to the clinic the first day of each week is process because we don't know exactly where we're stopping at and have to tell the driver to make sure to stop. It costs 3.50 P every ride which is about 0.43 cents. So after getting to the clinic we intern 8-12 AM Monday to Thursdays. Mondays are always the busiest day because we get a tour of the clinic and there are always a ton of patients waiting to be seen. A good amount of patients have nothing wrong with them but because the health care in Bots is free, they exaggerate symptoms or fake them to skip work/ school and go to the clinic. The doctor gives them a sick leave to prove they were at the clinic. This is a flaw of the system and of the mindset of people here. It is a shame because a doctor should see an average of 20 patients a day but ends up seeing up to 100 or so due to the amount of patients in the clinic and the lack of doctors available. There are about 25 doctors rotating in 15 or so clinics except 3 of the clinics are 24 hour and each of the 3 clinics need 3 doctors a day for each shift so between 12 clinics, there are 14 doctors. Most clinics get 1 maybe 2 doctors at a time. Some clinics don't have doctors at hand if the doctor doesn't show up or the shift schedule is miscommunicated.
Let me get into the more interesting and gory details...
So the first day I had at the clinical was alright, we just took vitals but I could already sense the difference in the worlds. When we entered the clinic, there was no clear way directing us where to go. We didn't even know where the office was because it was smack dab in the front. Once we found the right place to go, there was no one in the office either. Alright, fine so we get settled in and on my first day I'm taking temperatures of people by putting a thermometer in their armpit and recording their temperatures. Then I swab it with a spirited swab and onto the next. No gloves. No nothing. This may not sound that gross, but after a while, you just feel gross. It's even grosser because there's not really a place that I can wash my hands and well, some of these people are actually sick... so that helps.
Looking back, this was a piece of cake and it only gets worse from there. Day two was weighing babies. This sounds super adorable. Oh, the babies are too cute here. I'm talking deep brown beady innocent eyes adorable. I just want to take them all back. Alright, aside from all the cuteness, I didn't get to do much because mothers bring their own slings for their kids to be weighed in. It kind of reminds me of a grocery store but that's beside the point. They bring their own fabric slings to avoid cross contamination and to reduce spread of skin infection. This is an excellent measure taken place. However, the baby changing table wasn't cleaned once so that's screaming for transmission. Oh, and to top it off if babies peed in the sling onto the floor or table, the mothers had to clean it up with a paper napkin...the floor or table still weren't cleaned while I was there.
Day three. Oh day three. Day three, I watched people get screened for HIV by double rapid tests and the other half I shadowed a doctor. I'll get into the details of HIV culture in a later post but let's get back to this doctor. He was arrogant and more interested in his American interns than his patients. His bedside manner was virtually non-existant. He made a girl take off all of her clothes because she complained of abnormal vaginal discharge. This was upsetting because there was no reason for her to take off her clothes above her waist. Furthermore, another patient came in later that day and complained of vaginal discharge and wart around her body- the doctor only made her take off her pants. This doctor was speaking english the entire time so I know I didn't just miss a beat or something. Meanwhile, a baby came in who was diagnosed with Meningitis and the doctor (this part is common) tore off the end of his glove to tie on the baby's foot to search for a vein. This would be used to place the needle and then inject antibiotics. The doctor tried the vein on her foot three times, her wrist three times, and THEN he proceeded to try to find the vein in the head. Fine. But he also took the end of his glove and placed it on her head. Meanwhile, he was completely unaware of where the rubber string was on her head or how tight it was for her head. She was obviously crying in pain and the rubber string would fall over her eyes and her grandmother was the one pushing it up so that it wouldn't hurt her eyes. Moreover, the doctor kept moving the baby's head (not at all gently) to find the vein but one of the damn signs of meningitis (which the grandmother told the doctor) is stiffness of neck! After two unsuccessful attempts at securing the vein in the baby's head, he sent them away to the hospital. AFTER ALL THAT SUFFERING. Man, I'm not one to usually tear up, but I was fighting back tears as I could hear the pain of the one year old who was unable to express her pain other than crying.
Day four: Today, I shadowed another doctor and also shadowed pre-natal mothers' exams. This doctor was MUCH better at being a teacher and acting like a real person to his patients. Today was also interesting, I saw the doctor push back a piece of skin into a woman's anus because she was in the second stage of hemorrhoids- also, very painful. He also let us tell her prevention methods and how to improve her diet by eating high- fiber foods and drinking plenty of water. We also saw a lot of high blood pressure in people and it has shown to be a problematic issue here in Botswana. The doctor urged patients to lower BP when he had time to. He told them of the importance of eating more vegetables and not just meat and starch. A man came in who was in a car crash because he was avoiding a head on collision and then hit a tree with his car - the police brought him in because this was the closest clinic but it's not even an inpatient clinic! He has small wounds on his knees and arms, he complained of chest pain, and a headache. This guy was literally shaking and was almost in shock. They cleaned him up and ordered an x-ray of his chest. There was also other smaller injuries throughout the day because people use the clinic as an excuse to miss school/work.
When I was observing in maternity, let's be honest, it was adorable. I learned that the measurement (in cm) of a expectant mother's belly, so from the top of her abdomen to her pelvic bone- is a close guess to the weeks of gestation! It's pretty spot on as well expect for people who are very small or large in stature. Still, it's pretty accurate +/- 1-2 cm. Also, I heard a lot of heart beats and that's just something that is so cool and interesting to hear for the first time!
Alright, well this was all from the week of June 2-7, so I promise I'll be sure and update about that weekend and this past week soon! Also, I'll definitely try to post more often after the weekend! I saw some very interesting things this past week! Lot's of pus, blood, and TB- a teaser. I'd write more now but I'm actually about to take a weekend trip to Johannesburg, SA so I'll definitely post about that as well!
Safe travels and happy summer (or winter on this side of the world).
Komal
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