Experiences and Reflections from Serowe Healthcare

       
  There were eight students who traveled to Serowe to learn about the healthcare of Botswana in a village setting. We split up into 3 groups, each group assigned to a certain clinic in the village. I and two other students were assigned to Serowe clinic, which was a mere ten-minute walk from the neighborhood in which we were staying. We arrived at the clinic early Monday morning and were introduced to the head nurse. The nurse showed us around the clinic and then told us to allocate ourselves to different areas of the clinic. The three of us began by working in the child welfare clinic, which is run very similarly to the one in Gaborone. Mothers bring in their children up to five years of age to be weighed and to measure their heights. This is done each month and the results are recorded on a graph in the patient chart. The height and weight data is compared with each other; if a child is underweight, a third test is done to clarify the results. They use a tape-measure armband to measure the circumference of the upper arm. If the distance does not meet the marked ‘green-zone’ then the child is considered to be malnourished. In this situation the mother will be counseled on proper care of her child, and appropriate amounts of food will be distributed to the family.

Although English is the official language of the Botswana, it is not the first language of any of the locals. We faced the inevitable barrier in trying to inquire about the effectiveness of these tests. In the child welfare clinic height and weight are recorded in different charts and did not seem to be correlated. In addition, the confirmatory armband test did not have any dependency on the age of the child. From one month to five years the same band is used to confirm malnutrition, which seemed counterintuitive to us. When we asked the nurse about its effectiveness across this wide age range, she went on to explain to us how they check for malnutrition, a process we mostly understood at this point. Later in the week, we put the question to another doctor who explained to us that the height and weight are combined in diagnosing malnutrition in a child. The uncertainty of the armband, however, was an issue that was never resolved for us.

Mondays and Fridays are ARV (anti-retroviral) days in Serowe Clinic. On these days, patients come in to begin or continue ARV treatment. Patients also come for general consultation as well. There were two doctors seeing patients in the consultation rooms. In the afternoon I shadowed a young doctor named Paul. On this afternoon, Paul saw various cases including: HIV, cysts, various skin irritations, and possible tuberculosis. TB is an illness that has become a major issue in Botswana, and across most of the developing world, especially where HIV is prevalent. I asked the doctor if patients suspected of TB are ever asked to wear masks to protect the workers. He said they do not do this unless this patient has multi-drug resistant (MDR) TB. He explained that nearly everyone who works in health in Botswana would test positive for TB. Apprehension for my own health aside, this did not seem like the best public health policy. After all, MDR-TB is born out of non-MDR-TB and control of the latter should lead to control of the former; or at least reduce its proliferation. In addition, if health workers are not properly protecting themselves from TB, they also put at risk patients who are negative for TB; a risk multiplied in a nation that carries the second highest HIV prevalence in the world.

Working in the clinics has been an indispensably informative experience in learning about healthcare delivery in Botswana, however there has been a nagging tendency to get the idea that HIV is not as a big of a problem as it has been made out to be. In the clinics, patients have rarely reached a stage of the disease that is devastating, and most seem healthy. On our last day in Serowe, we were taken to the Sekgoma Hospital, to have our doubts stripped away. It was Friday, ARV day, and we walked in to an excessively bustling clinic. We pushed our way through the crowd of people surrounding the two consultation rooms, and made our way in to talk to one of the doctors. There was a new, more senior doctor in today to see patients. He told us that with the amount of people needing to be seen, he would not have time to talk to us about the patients, and didn’t feel that our experience with him on this day would be worthwhile. Instead, he called the hospital and arranged for us to shadow some doctors at Sekgoma. We caught a cab outside the clinic, and within minutes found ourselves in the accidents and emergencies ward, searching for the doctor. Upon fulfilling our search, the doctor showed us to the patient he was currently seeing: a man with Stevens Johnson syndrome, which is an allergic reaction to the sulfur-based ARV medication. This is a life-threatening skin condition in which cell death causes the dermis to separate from the epidermis. When we first saw the patient, I thought that he had been victim to a serious burn. However, the burns were found in patches all over his body. The doctor then explained to us the cause of this patient’s pain. After this, the doctor decided to take us to the general ward of the hospital. As we walked through the halls of this large hospital, the most noticeable feature of the building was its desolation. The halls were empty. However, when we reached our destination, we found a busy ward. We were introduced to a doctor from Cuba, who was seeing patients of all sorts of ailments. There were two cases, however, that have been fixed in my memory. The first was an HIV-positive patient suffering from cancer of the throat. We were allowed to view this for ourselves, and we saw a large tumor at base of the tongue of a young woman. The woman had come in due to complications, but was about to be released from the hospital. She was waiting on biopsy results to return from Gaborone, and the doctors could not operate until their arrival. We were informed that biopsy results could take up to 2 months to make it back to Sekgoma hospital in Serowe. The second patient we saw was a young woman in her mid-20s suffering from AIDS related wasting syndrome. The woman had failed to properly take her ARV medication, and the disease was now consuming her body. At home, she lived alone, and lacked any familial support in her burden. Now she was laying in the hospital bed at Sekgoma, staring blankly into the wall, as the doctor examined her and moved onto the next patient. This was our first true exposure to a patient whose life has been devastated by HIV, and she is not alone. Later in the pediatrics ward, we were shown a baby who had contracted HIV at birth, and now was suffering from TB and malnutrition. Botswana has implemented a very successful program called Preventing Mother-to-Child Transmission of HIV (PMTCT), which has greatly reduced the number of babies contracting HIV at birth. Unfortunately, however, not every mother follows the program, and the program itself is not 100% successful. On rare occasions, babies such as this one are unfortunate to contract the disease at birth. While the reduction of this has been a success for Public Health in Botswana, hopefully soon it will become a total victory.

Our experience at Sekgoma hospital has been the most invaluable one of our stay in Botswana thus far. Here, we were exposed to the true impact of HIV on the lives of people of Botswana. We also were able to talk to many different doctors about practicing in Botswana, and further explore the dynamics of the healthcare system and the relationship of doctor and patient in this country.

                                             
                                              (Note: all photos in this post taken by Dina Fico)

Weighing babies

The armband used to check for malnutrition 

Karata -- The patient's chart

The pharmacy

Reflections

In the clinic in Gaborone most patients speak English well, however many prefer to communicate in Setswana. This is because most patients are most comfortable expressing themselves in Setswana and are able to understand instructions from caregivers more accurately. Still, English is a viable option when caregivers are unable to speak Setswana, as is the case with most doctors in Botswana. However, in the Serowe clinic, very few patients spoke English. This is a major problem for the country, as most of the doctor positions are filled by expatriates. The main reason for this problem is the lack of a proper medical school in the country. As I mentioned before, the University of Botswana has recently created a medical school, however, it has yet to gain accreditation or respect in the medical field. Until the School of Medicine establishes itself, the government of Botswana will continue to send medical students abroad to receive education. Because of this, the vast majority of students fail to return to Botswana to practice.

           One of the most interesting things about shadowing healthcare workers on the ground is to hear the varying opinions about the system and its future. So much about the jobs of these workers is dependent on policies put in place by the government. This is not unique to Botswana either. I remember shadowing various doctors after the passage of the new Healthcare law in the U.S. last year. Opinions I received ranged anywhere from passionate enthusiasm to gloomy uncertainty about the future. Perhaps it is a testament to the nature of healthcare work that providers are able to continue their jobs effectively even in the face of so much uncertainty and confusion. It is well known that hospitals anywhere in the world are a hub for human suffering, and the attitudes of those who work in these places are undoubtedly affected and shaped by this fact. Then again, perhaps I am merely romanticizing the profession to which I plan to dedicate my life. Either way, these professionals all have serious opinions about the systems in which they work. In Serowe, I heard doctors and nurses cursing the system under which they work; complaining about lack of supplies and personnel. ‘Botswana is a disaster!’ One nurse said this to me speaking about the healthcare system of Botswana. On this particular day, no doctor had shown up to the clinic, so this nurse was put in charge of consultations for the day. This means she performs all the duties of a doctor, including prescription of drugs, with the exception of interpreting lab results. This particular nurse was very young and was only 6 months out of school. I asked if this was a common occurrence, and she explained that on her first day out of school, she was asked to perform consultations; answer: very common. Another doctor explained his discontent with the system after being unable to find examination gloves in the consultation room. In addition, the water supply to the clinic had been mysteriously halted, a problem, which was not resolved for several days. He told me that a major problem in Botswana is the allocation of funds within the system. ‘Those in the Ministry of Health who are creating policies are not doctors, they are politicians.’ This doctor was a Motswana, and although his consultations were mostly in Setswana, it was clear to me that he was able to relate to his patients much more effectively than other doctors I have shadowed. Unfortunately, his dismay with the system was enough for him to desire to practice in a different country. It was clear that these practitioners had serious quarrels with the system of care and were not simply venting frustration.

            Still, others we talked to were very confident in the system implemented in Botswana. There is no doubt that the delivery of free ARVs to citizens of Botswana has been extremely effective. When ARV treatment was initially discovered, treatment was virtually unavailable for the general population of Africa that had been the hardest hit in the world. This was due, in part, to monopolization by pharmaceutical companies, preventing affordable treatment to areas of greatest need. Today, the price of ARV treatment has been massively reduced, and the government of Botswana has managed to provide free treatment to every citizen in the country. This success has been an inspiration of hope to sub-Saharan Africa in the fight against the HIV pandemic. Unfortunately, many countries still do not have access to the life saving treatment that can dramatically extend and improve the quality of life for people suffering from HIV infection. Botswana, however, offers treatment to all citizens of its country, allowing those living with HIV to have a much-improved quality of life when compared to neighboring countries, such as Zimbabwe or Zambia. Dr. James Orbinski, former president of Médecins Sans Frontières (Doctors Without Borders), said in his 2008 book, “AIDS is a fully treatable disease – as treatable as diabetes. Yet today, worldwide, 30 million people have died of the disease, 33 million live with HIV infection, and upwards of 100 million may be infected by 2020.” There is no doubt that Botswana is at the forefront of the fight to make ARV treatment available to all areas afflicted by HIV/AIDS.

            When comparing healthcare in Serowe to that in Gaborone, the biggest noticeable difference is the lack of proper personnel in the clinics. The Gaborone clinic in which we have been involved with is actually very well staffed, and the organization of each ward runs smoothly together. Apart from this, many of the same problems with lack of supplies and barriers in communication are still felt.

            Hopefully you now have some idea of the various things I have been doing relating to healthcare, and of my experiences in Serowe. Many of the thoughts provided in these reflections are applicable both to Serowe and Gaborone. As the semester moves along, I am beginning to gain an understanding of the dynamics of the diseases around which the system of healthcare in this country are based. 

Children after a public health discussion on Safe Male Circumcision

Vaccinations at a school

The public health group

Village Homestay in Serowe

          Recently, the CIEE Public Health students spent the week in the nearby village of Serowe, which is about 300km (180mi) North of Gaborone. We took the public bus from Gaborone to get there, which took around 4 hours. We arrived in the evening, and were greeted by the families, which would be housing our group for the entire week. The host-parents were preparing a welcome meal for our group at the host-home of one of the CIEE girls. At this dinner, I met Sebeo, Zwabo, and Tjango (prounced Chango). Sebeo is a 96-year old grandfather to Zwabo, who is 30 (ish?); and Tjango is Zwabo’s 4 year old son. After a short period of visiting, the food was ready, and we ate our fill of traditional Setswana food, very similar to what has been described previously. It consisted of porridge, papa, chicken, beef, Mopani worms, and a couple other traditional dishes (the names of which have escaped me). After dinner, we were welcomed with a ceremony put on by the families. During this ceremony, the local pastor said a prayer for our well-being, several of the Moms, as well as my grandfather stood up and welcomed us in different ways. Everything that was said was spoken in Setswana with another person translating to English or vice versa. Between each speaker they would sing a song, the only word of which I could make out was ‘Modimo,’ which in Setswana means ‘God.’ Finally, we all split up to go home and be introduced to the rest of our families.

The house where I was staying is only a short walk from where our dinner took place, so Zwabo guided me through the dark dirt roads of the village to our destination. At the house, I met Morwadi, Korraba, and Thaboga. Morwadi is the wife to Zwabo, Korraba is their 6 year old daughter, and Thaboga is their two month old newborn. I also met Oduetse (OD), a cousin to Zwabo who is staying in their home. I was also given the Kalanga name ‘Zwango,’ which means ‘mine.’ Kalanga is the tribe, which Zwabo and his family come from. It is one of the biggest tribes in Botswana. At first, I wasn’t exactly sure of my place in the family. Was I the son of Sebeo, making me the uncle to Zwabo? Or the son of Zwabo, making me the great-grandson to Sebeo? Everyone else in the group would talk about their host-Mom and brothers and sisters, while I was left somewhat confused as to what to call my family. Fortunately, this gave me all the more reason to learn their names quickly. Even though Zwabo assumed more of a fatherly position, in showing me around the house and village, Morwadi eventually called me her brother giving me certainty of my place in the family.

On our first morning together, OD showed me how to do some of the daily chores, including wood splitting, chopping down tree branches, cooking porridge, and hand-washing clothes. That night, everyone gathered around the TV to watch Ghana and Mali play in the consolation match of the Africa Cup of Nations. Mali upset Ghana in a 2-0 victory. The next night, Zambia would win the Cup on penalty kicks in a 0-0 game. Unfortunately, I fell asleep during half-time of this game, which is basically the Super Bowl of Africa, and as far as the quality of game goes, it was as good if not better than our own Super Bowl. Side note: I stayed up until 7 in the morning to watch the American Super Bowl, which didn’t start until 2am in Botswana…

Throughout the week, OD would continue to show me various chores around the house, and Zwabo showed me some interesting things in the village. On one of the days, he wanted to show me how a destitute Motswana lives. He took me to see his friend who has several kids, and is sustaining his family by selling Chubuku beer. This is a local beer that is very popular. Unfortunately, however the government has now issued a law saying that it will no longer be legal to sell alcohol from a residential home. People who sell this beer, will now have to rent a business plot to continue their sales. For the person we talked to, this was simply impossible. We talked for a long time about how he had ended up in this business and what his future looks like. He is very concerned, because when the law takes effect, he will no longer be able to sustain his business. He is living day-to-day trying to figure out what to do next. We also went into the main mall in town, where we saw a bustling local market. This one was much more authentic to Africa as compared to what we have seen in Gaborone. Small tents were set up on either side of a long alley, between the larger stores. The merchants were selling everything from dried Mopani worms, to various nuts, fruits, and vegetables. One of the girls I was with, who for some bizarre reason actually enjoys Mopani worms tried these dried worms and was not satisfied. Aside from that, we did not buy anything else as we have been warned against consuming food sold from street vendors especially when it is uncooked.

One night, one of the host-mothers took us to her brother’s local farm, which took about an hour to drive to on very rough dirt roads. When we got there, her brother showed us around his farm, where he has cattle, goats, sheep, and chickens. When we arrived, they had just milked one of the cows, and we were able to taste some fresh milk, straight from the utter! As the sun was setting, we had the privilege of experiencing one of the most colorful sunsets I have ever seen. I watched the sky as the clouds shifted from blue to yellow to pink to orange and faded back to blue as the day turned into night. I will post a picture at the end of this post, because no words could do it justice. The picture is not my own, but taken by another student.

The homestay in Serowe was without doubt one of the highlights of my experience so far. In the next post I will talk about our experiences in the health field of the village, however learning about the culture through my family, as well as that of other students, and simply talking to local people gave me a multitude of knowledge in itself. There is no doubt in my mind that while the village of Serowe is one of the largest in the country, and would be more accurately described as a town, it seemed to be more authentically ‘African’ than Gaborone. It was easy to see here that much of the lifestyle remains unaffected by the modernization of the country.

I am currently running behind on my posts, with school and travels it has been hard to find the necessary time to put together the right words to help you to share in my experience. Next, I will be talking about the healthcare in Serowe, and perhaps dig a little deeper into some of the problems and advantages of the current system in Botswana. Last week I traveled to the country of Namibia for our vacation, which was an amazing experience. I will do a post about that when I have time as well. I also hope to post more pictures, however uploading them to blogger takes a lot of time, for more pictures you can see my facebook profile here:

http://www.facebook.com/profile.php?id=1315470053&ref=tn_tnmn

Until our next digital rendezvous..

Take care!

                                     (photo by Shilin Zhou)

TCM

Quick Update

Hi everyone,

Sorry, I don't have time to leave a through post here. As I said, last week I was in the village of Serowe, which is about a 4 hour bus ride to the north of Gaborone. I stayed with a family for the entire week, and spent my days mostly working in a local clinic. I also was able to see a Health awareness day at a local primary school and then we visited several traditional healers. We also were able to shadow several doctors in the hospital and got to see many interesting things.

Unfortunately I have had several tests and projects due this week, and have not been able to write up a discussion about the week. Next week is our 'Spring Break' and I am leaving early tomorrow morning to spend the week in Namibia. I will work on several posts while I am away and will have plenty of material for you to read when I get back.


Thomas

Urban Medicine in Botswana -- first post

I have been promising a post about this for some time now, and since the title of this blog is Community Public Health -- I feel obligated to provide you with some information about my medical experiences thus far. Unfortunately, I am currently preparing to depart for a week long home-stay in the village of Serowe. The following is a reflection that I wrote for one of my Public Health classes. It is by no means complete, and altogether inadequate by way of my reflections on some issues. Still, here is a taste of my first experiences in a clinic of Botswana.

It is now the beginning of February, and I have visited one of the local clinics on the city of Gaborone three times. In the following lines, I will describe these experiences, as well as provide my own reflections and recommendations of the experiences described.

            Coming into my clinical experience, I wanted to be as open-minded as possible, in order to suppress any preconceptions, and allow for my learning to be solely based on my experience. Still, it was not possible to totally remove the ideas, which I had about healthcare in Africa. Coming into this experience, I expected the health system to be more sophisticated than what is generally depicted for the whole of Africa. I understood that Botswana, while still a developing country, has had great successes, especially in the field of health. Still I know that certain communicable diseases like HIV and TB have not been properly controlled, and I wondered what the reasons for this might be. Knowing this I expected some sophistication in the system, with identifiable flaws, which I would have to be on the look out for.

            When I entered the clinic for the first time, I honestly was not sure if I was in the right place. I saw a lobby that was crowded with people who, at least did not look particularly sick. By this I simply mean that it was not blatantly apparent that these people were here for medical assistance, while it did not seem improbable. In addition, I did not see anyone who looked like a medical professional, or even an area for reception. Assuming we were in the right place, my colleagues and I searched the building for someone who looked seemed to be in charge. Eventually we found a nurse, and were directed to the office of the Matron. The Matron greeted us warmly, and as the conversation progressed, our doubts were quickly eased. The Matron discussed with us the nature of the clinic, and its goals and mission, and then proceeded to ask us about our own goals for our experience. We made it clear that we were not medical students and did not have license to provide direct care to patients. However, our main goal was to learn about the healthcare delivery of Botswana from a perspective on the ground, and then be able to apply our experiences to public health issues facing the country. Once satisfied, the Matron proceeded to introduce us to the head nurse, Cecilia, who then gave us a tour of the clinic. After we were shown the basics of the clinic, we were directed to specific wards to spend the rest of our day. I was appointed to the maternal health clinic. Here I was able to participate in weighing of pregnant women, who come in to make sure the pregnancy is advancing healthily. I also observed as the nurses questioned women about their behaviors, problems, and histories to make sure that they were not doing anything improperly.

            The next week I began in the child welfare clinic, where mothers bring in their children to be weighed, in order to ensure that they are growing properly and healthily. I was able to help the women weigh their babies, and watch as the nurses recorded the information onto the patient charts and made sure the children were healthy. Once the traffic in this clinic began to slow down, I moved to consultation. This is the first area where patients check in, have their vital signs recorded, and then are directed to their appropriate clinics. Here I was able to assist the nurse in taking patient vitals, and recording biographical information onto the patient charts. Here, I was able to observe the various types of people who come into the clinic. It was, however, frustrating that I was not able to see the reason for their visit. Knowing this would have helped me get a more clear view of the reasons for seeking the help of this clinic.

            My initial idea of what healthcare might be like in Botswana was actually very accurate. While there are many serious problems, the set-up of the clinic was relatively sophisticated. I was impressed with the organization and well staffed personnel. While there is only one long-term doctor and one rotational doctor, there are many nurses who are able to handle a great deal of the patient influx. Still, there were many perceivable problems. Firstly, as we were taken around the clinic, there did not seem to be much care taken to protect the privacy of the patients. The nurse took us into various rooms where patients were being seen currently, and talked to us as if the patient was not there. We also were not given any explicit instructions about protecting patient’s privacy during our day-to-day shadowing. This situation is one that should be addressed in this clinic. Another problem that I have observed is the seeming insensitivity of caregivers in the clinic. This is one of the hardest issues to address, since the problem is in large part due to the massive number of patients that need to be seen in a day. Still, it seemed to me that there was no attempt to treat the emotions and fears of the patient. This last issue is one that I will be sure to comment on further as the semester progresses and I learn more and more about the delivery of healthcare in Botswana. 

Take care,

Thomas

Protests and Pastimes

Greetings Everyone,

            Sorry for the delay in updating the blog, things have been rather hectic here, and I wanted to make sure this post was well thought out and complete.

            At this point, I would like to begin to discuss some of the more serious issues I have encountered thus far in Botswana. As I continue to travel and see various things, I will display more of the beautiful land. But the meeting of the mind with the unknown is perhaps more intriguing, if only harder to express.          

            What is a country if not for its people? In the short time that I have been in Botswana, I am beginning to understand some things about the people of Botswana. There are three groups that I would like to discuss here: the sports fan, the student, and the sick.

            Over the past couple of weeks some interesting events have taken place right here on the campus of the University of Botswana. In summary, the students began a protest that resulted in the cancellation of classes for one week as the administration determined how best to move forward and resolve the issues of unrest. But do students really have the power to cause a university-wide shut down? Let me take you back to my first discovery of the possibility of a strike.

            Within the first week of my stay in the dorms, I had an interesting conversation with a local student. After a brief discussion about many things including politics in Botswana and the U.S., we parted ways for the night. Soon our paths crossed again and we began hanging out more frequently. He began to tell me about his anger with the new Vice Chancellor and all of the offenses he had committed against the students of the university. Despite my inherent skepticism, he proceeded to show me the ‘Memorandum’ or simply the ‘Memo’ that was released by the president of the Student Representative Council (SRC). These memos are posted around campus whenever there is any announcement to be made by an organization of the school, the topics are widely variable. This particular memo was one of the most impassioned letters I have ever read, addressed to the student body and spelling out the injustices of the Vice Chancellor, and calling the students to stand up and fight! After I had read the letter, my friend pressed me further, asking my opinion and if I agreed with the SRC president. I did my best to explain to him that it was hard for me to form an opinion based on such an emotional letter. At the time, I assumed this was an issue that would simply blow over with time. I did however find out that protests are not uncommon to this school, and sometimes can even result in violence. Only two years ago there were also campus-wide strikes where students were forced to participate under threat of violence.

            One night, as some fellow students and I were returning to the dorms, we began to hear many voices singing and yelling. Soon a large group of students were convening at the pavilion in the center of the dormitory courtyard. Soon they were all singing a Setswana song in unison and waving branches adorned with bright green leaves. The group continued to sing and dance for several minutes, until finally the SRC president was raised above the crowd (on the shoulders of the student who had shown me the memo) and made a brief announcement. As he was lowered the group of students raced out of the courtyard and continued their march as quickly as they had come. The protests had officially begun!

            Soon the protesters had recruited enough students to their cause to force classes to be disrupted. As soon as this happened, the university quickly decided to cancel classes in order to ensure the safety of all the students. In the meantime, the administration began to address the issues that caused the strike. Here is a summary of the problems addressed:

·      The School of Medicine, which was only established in 2005 has yet to be accredited, and many faculty members were recently fired due to a lack of funding. The students are very upset with the administrations operation of this department.

·      Supplementary examinations. The University of Botswana used to run on a year long system, and recently switched to semester based classes. The effects of this are still being felt. Particular classes are only held during one semester, this means that if a student fails a course that is necessary to move on in a degree track, the student must wait until the next year to retake the course. One possible relief of this problem is the introduction of supplementary exams. This would allow a student who fails to take a second test in order to try to raise his or her grade to passing. Supplementary exams were introduced last year, but were not sustained, and as a result there were record numbers of failing students last semester.

·      411 student bar. Currently the University has a student bar that is run on campus, where alcohol is sold legally. Because of the high prevalence of fights, sometimes resulting in serious injuries, the closure of this bar was up for consideration.

·      Intervarsity games. Recently a partnership was formed between UB and the University of Lesotho and the University of Swaziland, in order to facilitate sporting activities known as intervarsity games. This allowed students to participate in competitions between these three schools. This was discontinued this semester due to the inability of the University of Lesotho or Swaziland to host the games.

After some of the protests resulted in property damage to the university, consisting mostly of broken windows, the members of the SRC were suspended from school, and several of the leaders of the protests were arrested. With a lack of leadership, and the fear of ruining their education, the protests have now subsided and students are returning to school. The administration, however, did promise to address the issues that caused the strike. While the fruits of these protests did not lead to immediate results, they no doubt opened the eyes of officials to the passion of the students to have a successful school.

In the midst of all this excitement on campus, the country of Botswana was also participating, for the first time in the Africa Cup of Nations. It was amazing to see the students and people of Botswana come together and support their team through dancing and singing, and by sporting the blue and black colors of the Zebras! Although, Botswana was eliminated in the first round of the tournament, watching the games in the midst of crowds of Batswana, with the wild cheering and the blasting of vuvuzelas, is an experience I will not soon forget. I find it interesting how sports have the power to bring a people together, even amidst dispute. The Botswana national team accomplished a feat this year that had not been done in its history. The exited atmosphere of the games and the demoralized spirits after the losses reminded me of the roller coaster of emotions one gets from being a Husker football fan. It is comforting to know that sports are one thing that are a nearly universal human experience.

I know I promised to talk about healthcare, but this post has gotten rather long, so I will continue into that discussion in my next post.

Cultural excursion of Southern Botswana

            Last weekend, the University of Botswana took the international students on a cultural excursion to the surrounding area of Gaborone. On this excursion we were introduced to the practices of the traditional Kgotla in Botswana. We also spent the night at a cultural lodge, and took a ride around the Mokolodi game reserve. This trip exposed us to some of the traditional practices of Botswana that have helped shape the culture and society here. We also got to see the landscape and wildlife that make the country the beautiful attraction that it is.

            First things first, when you go to see a Kgotla, proper dress is required. It is seen as a sign of disrespect to dress immodestly when visiting a Kgotla. Now, apparently I mistook the ‘modest’ request for ‘dress up’ because I seemed to be the only person, especially male that decided to dress up for this event. But no matter, better to be too respectful than not enough I suppose; and I sported my shiny black shoes with pride.

We boarded the bus at 8:00am, and set out for the village of Kanye, which is about 90km southwest of Gaborone. While most of the students were fast asleep for most of the ride, I couldn’t help but seize another opportunity to take in the land of Botswana. A good conversation with my seatmate also worked wonders in the effort to remain awake on this early morning drive. The skepticism that had grown in me about the beauty of Botswana as a country as I researched the country prior to my departure has all but been obliterated after only a few excursions around the Gaborone area. The land of Botswana in the Gaborone area is that of large rolling hills, which could almost be referred to as ‘little mountains.’ In addition they are covered in richly green trees and grass. We did, however, learn that many of the vegetation here have evolved painful defense mechanisms, including thorns and fiber glass-like material which causes painful rashes.  

Upon our arrival to the Kgotla in Kanye, we were directed toward the area where meetings and trials are held. We were all seated, with a stern warning not to enter the elevated stage area, as this was reserved only for a select few. Our host then explained to us some of the more traditional practices both historically and contemporary that involve the kgotla. The term kgotla can refer both to the meeting place, as well as the meeting itself. Basically a kgotla is a public meeting, where, traditionally, a tribe or village would gather to discuss issues. It is headed by a kgosi, or chief, but discourse between all those present is allowed and encouraged. Because this represents the traditional form of governing in Botswana, it is said that the transition to a contemporary democracy was very smooth due to the history of acceptable discourse. Although they are traditional, the kgotlas still exist in practically every village and work in concurrence with the government of Botswana. Many minor disputes that arise in a community are still resolved through a kgotla. The interaction between the two forms of governing is something that is still not completely clear to me, and which I hope to learn more about throughout my time here.

Our next major stop on this trip was a visitation to a pottery workshop. Here a small group of Batswana create hand-made pottery, which they sell both in a local shop, as well as on a larger scale to the government of Botswana. It was interesting to watch as they explained the process of creating this art, and then demonstrated to us several of the steps, including forming the pot on the pottery wheel. While in general, there was not much here that is truly unique to Africa, the touch and smell of clay always reminds me of home so I especially enjoyed this visit. Thanks Mom J

Next, we visited a site in the country where rock paintings that are estimated to be around 2000 years old have been discovered. Our tour guide walked us around this cliff and pointed out the shapes to us. At first glance, I could not see the shapes and was starting to think that the ‘paintings’ may be nothing more than natural coloration of the rocks. However, once I got close, the shapes became clear and animals could be seen in several locations around this cliff. After the tour, several of us climbed to the top of the cliff and were able to catch a beautiful view of the Bots countryside.

The day culminated with an overnight stay at a cultural lodge, where tents and huts were prepared for us to stay. In addition, the lodge was set up as a traditional village, where we were introduced to some Botwana dances, games, and traditions. One game which was particularly interesting was some sort of hybrid between tick tack toe and chess. Played on a sheet of metal with a board chalked in and rocks used as game pieces. My first and only attempt at this game was a success as I beat a local Motswana, although two of the older men played more of the game than I did, so I can’t really claim the victory. As the evening wore on, the rain came and sent us scrambling for cover. We were able to wait out the rain under a pavilion and stay relatively dry. The rest of the night was spent socializing with local and international students, making new friends and getting to know others more.

The next day we visited the Mokolodi animal reserve. Upon our arrival we were served with champagne and orange juice, with a choice of mixing our having the drinks separate. It was an interesting welcome to an animal reserve in the middle of a country area. After introductions and drinks, we loaded onto the tour trucks, and began our drive around the park. We saw many interesting animals on this drive. The most common animal of the park is the impala, of which we got many great views. We also saw kudus, zebras, and wart hogs. The lone cheetah of the park is kept inside a fenced area, so a good view is rare unless a special tour is given. We were lucky enough to spot the cheetah, however he was laying in the grass and our view was far from clear. In my research of this country prior to departure, I read about the danger of kudus in driving at night. I read that sometimes kudus will jump into your car, causing an accident. By this description, I was under the impression that these were some kind of small rodent-like animal. To the contrary, kudus are large moose-like animals that have massive vertical leap abilities for an animal of this size. The tour-guide told us that these animals can jump 3 meters high, and are attracted to headlights of cars, which they try to jump over at night, hence the danger. Obviously this is a much greater risk than was conveyed in my guidebook. It also makes the danger of deer in Nebraska seem almost trivial

After the tour of the park, lunch was provided to us near a lake in the park. Unfortunately, the rain came again, and this time our only cover was the tour trucks. Fortunately the trucks were equipped with water-proof tarps, however the rain still soaked the edges, forcing us to huddle toward the center in vain attempts to stay dry. Once the rain had finally slowed to a drizzle, the drivers decided it was okay to head back to the welcome area of the park. This was quite an interesting drive, as the driver had to keep a good speed so as not to get stuck. Trying to take pictures of the after effects of the rain on the park was also quite the challenge, as major bumps jolted me quite severely on this high speed exit of the park. Despite the grungy feeling of being partially soaked from the rain and then getting on a bus with 50 other rain-soaked students, the experience of seeing the exotic animals as well as simply enjoying the rain and its affects on the park was well worth it.

Once we left the park, we finally returned to Gabs, where we were free to shower, sleep and recover from a long and exciting weekend.

I hope all is well back in the States, as well as in other parts of the world that may be tuning in. I experienced my first clinic visit today, so my next post will finally enter into the issues of healthcare in Botswana well as my personal observations.

Stay well!

Tom

Our welcome drinks at the Mokolodi reserve

The Kgotla, with some international students checking it out

A view of the 'village' of Kanye

The international group trekking a forest

'Joe' shaping a pot

The finished product

The Kgosi of our cultural lodge performing a dance

This is the game I was talking about

Can you see the giraffes?

The countryside of Botswana

This is a kudu 

Zebras!

Impala posing for the camera

The beginning of the rain

A 'puddle' on the exiting drive. This was not here 2 hours ago