Austin to Africa. : Old Naledi Clinic makes do with limited resources.

Hello all,

Last week, I volunteered at Old Naledi clinic. There were many differences I observed from this clinic and Julia Molefe clinic. This clinic is larger in size and has two doctors at a time. One side of the clinic is dedicated to HIV positive patients- complete with intake, drawing blood, consultation, and dispensary. The other side of the clinic is the same except has an added weighing for under five years- babies get weighed every month (preferably on the same date) until their fifth birthday. The interesting part of baby weighing is that there are mostly mothers coming in for child weighings and it may occasionally be a couple and even less than that are fathers coming in for monthly child weighings alone.

Speaking of babies, the maternity ward at this clinic is respectable in size and in functionality. The Old Naledi area is rural in nature and is not as financially stable of an area as others in Gaborone. Due to this, the clinic observes power outages more often than not. This would be fine if the clinic had a generator but it does not. This would also be fine however, the maternity ward is harder to function without light and a proper heating system. Expectant mothers go into labor, give birth, and are observed here. It is one thing to give birth without proper lighting, but it is another thing for a mother to lay in a bed with a blanket with no heat during winter. The next ward that loses the most efficiency from electricity outages is family planning/ ante-natal care/ post-natal care. Women come in here to get full exams, vaginal exams, and pap smears done. If there is not proper lighting when conducting a vaginal exam, there is virtually no purpose in putting a speculum up a woman because there is no view of the cervix (There aren't even back-up flashlights for this purpose which is something I would highly recommend for these clinics to invest in).

Also, these woman aren't given the option of getting epidurals... So imagine that. There aren't even stirrups or lubricant for speculum. You spread your own legs apart during birth and other vaginal exams. Talk about discomfort. It's a wonder how so many women here still give birth willingly to multiple children. Imagine that.

Another thing I really liked about this clinic was how comprehensive the check up was to go back to using a form of birth control after delivering birth compared to the previous clinic I was at. A full exam must be completed. The materials to complete this exam are fully autoclaved and nurses double up their gloves when performing an exam. I also really enjoyed learning about the different types of family planning available and what is provided there. Most commonly, women were taking the three month injection as opposed to the standard combination pill. This was probably my favorite "learning moment" of the week but in family planning, the World Health Organization created a wheel with common problems such as hypertension or HIV/AIDS. This is a really helpful tactic because it promotes the idea that the same method of contraception isn't for everyone, which is very true. It was also interesting how family planning nurses told women of what they thought was best and rarely would a patient disagree.

Did I mention the TB cougher's area? Yeah, that's comforting. If you relapse on your TB meds, you have to get an injection (usually on your butt) for 60 days. Oh, and you're still contagious. TB just sucks all around.

As far as my experiences with the rest of the clinic, they were great. I saw a lot of abysses/ infection usually pus filled. They are very painful to squeeze out. There was a woman who had one the amount of pus that she had in her under arm- I don't even know how she was still functioning. Moreover, there was a man in dressings, where they clean and cover wounds as well as change dressings- daily until they heal. A man came in who recently got stitches out from a stab wound and there was so much dried blood when they un-stitched the wound. I'm not too sure if that much dried blood is normal but it made the wound elevated and painful for the patient.

Listed below are common medical services and the fees for them as dictated by the Ministry of Health. Note the 5 Pula flat rate- if only that was the case in the United States (5 pula= ~0.58 USD)!

From my observation, the doctors that work in public clinics here are mostly from the DRC who came in about 6 years ago. Their primary language is French- so they were forced to learn English and Setswana. They said the conditions of Botswana medicine and healthcare were much better back then and that it is unfortunate now. The doctors complained of a lack of medical personel- mainly a shortage of doctors, a major lack of medical equipment, and a shortage of medicines needed.

A woman came in complaining of painful and itching ears but there wasn't even an otoscope to look into her ears.

Doctors often complain of how little time they get to spend with their patients and that since healthcare to patients is completely free, most patients come in if they experience any symptoms. For the record, let me mention that over the counter medicines are a thing here too. People would just rather go to the clinic at any point of feeling sick and get a sick-leave from the clinic to avoid going to work.The power outages are so prevalent in this area and resources are limited so it's no wonder why a computer backup system seems like a waste of resources before obtaining a generator...or flashlights.

I think the worst part about this week was that we experienced a few sad cases -an expectant mother in her first trimester's baby wasn't found when the mother got a check up, a person who had been on antiretroviral drugs for ten years was diagnosed with Tuberculosis and the x-ray showed it was intensive and one of my colleagues reported a case of HIV that was so far gone that virtually nothing could be done at this point because he had been off his medication and waited too long to seek treatment. Although this is Africa, this should not happen anywhere.

To leave off on a relatively happy note, the community here, although not wealthy, makes do with the resources available. People stay warm and still smile. This says a lot considering I was working in a rural clinic, in the winter, and around people who generally aren't feeling well. Also, people on our way out to the combi stop urged us to take pictures of the community. Enjoy!

Until next time,

Komal