Lesedi

I have now put in about 18 hours in two days at Bontleng clinic. The clinics in Gaborone are named for the district (for lack of a better translation) they are located in. My purpose at the clinic is to observe and take part where I can, but I am lost in a fog right now.

Hours begin at 7:30am, but I have quickly come to realize this means closer to 8am according the staff. Every morning Bontleng begins its day with song and prayer by volunteer. I wish I had a recorder. I simply cannot express the feeling that came over me while listening to the patients and staff join together. Upon entering the clinic I felt uncomfortable and out of place, but after this song I felt part of something magnificent. No sheet music needed to harmonize and echo each other perfectly. Music has only had this significant impact on me twice before: once while listening to the AcoUstiKats sing Ave Maria (live) and the second while watching Dispatch perform Elias with Zimbabwe children at MSG (on DVD). I closed my eyes, let a truly genuine smile light up my face, and welcomed the chills the spread over my arms. Little did I know this was going to be the highlight of my first day.

I have been looking forward to working in the clinics in Botswana since I first found this Public Health program. Tired of learning from a classroom, working with TB and HIV/AIDS in the field is something I have been dreaming about. However, I failed to fully understand just what I was getting myself into. Integrating myself into this clinic is proving to be quite a challenge.

Simply put, Bontleng clinic is struggling. Not only is it coming across the common issues of lack of supplies and sanitation, it has also taken a blow due to the workers strike. Bontleng currently only has 3 nurses on staff – there is not a full time doctor, the ARV department is not running, and the pharmacy is also not operating. Sad shape. The majority of our patients are expecting mothers, children, youth with STI’s, and adults with various minor problems. There are four of us assigned to this clinic, and we are struggling to find things to do with ourselves. I spent the entire first day sitting and watching an assistant take BP and weight of expecting mothers with no one talking to me when I tried to ask questions. The entire 5 hours of my morning was spent in frustration. Basically, I had to learn quickly who was going to be helpful and who was going to ignore me. The head nurse ended up falling into the “ignore me” category. She provides zero guidance as far as my learning experience goes and, instead, likes to quiz me about useless information about the States. I spent the afternoon with the midwife seeing patients, and the experience was much more interactive. I aided in diagnosing and discussed treatments in comparison with medicine in the USA, but things are still tedious. Other things I have done: checked patients in at the front desk, took BP and pulse, and learned how TB was handled at Bontleng specifically. The following are some notes I have taken:

Unorganized: I do not know if this is all of the time or just recently due to the lack of staff, but there is a definite problem. No one person is in the same place at one time. One nurse will be consulting and then mid-consultation another nurse will take over. The staff will also wander aimlessly throughout the clinic before finally walking into a room to consult a patient.

Privacy: There is none. Some doors do not even shut all of the way. Staff will barge in while another staff member is with a patient. The head nurse did this multiple times to one of the other nurses. She would walk in yell something to the nurse in Setswana then storm out leaving the door wide open behind her. At one point, a staff member was eating a fat cake (fried bread in the shape of a ball) in the room where we were seeing expecting mothers. I did notice, however, that when the doctor was with patients on Thursday, no one disrupted him.

Respect/Professionalism: None of the staff (nurse, janitor, doctor) have respect for the patients. Cellphones are used whenever, wherever. SMSing while a patient is trying to describe their problem. Stopping a patient mid-sentence to take a call. One of the other girls witnessed a doctor take a phone call in the middle of a vaginal exam. This is all common throughout the day. It takes every ounce of control I contain my two cents about this. Bite your tongue, Shelby. Bite your tongue.

Patient Care: Lacking. I may not know a lot of Setswana, but like my parents always tell me “It’s all in your tone of voice.” The dismissive manner in which the patients are treated irks me like no other. I cannot stand it! The midwife asked the four of us to design some signs with slogans geared toward youth with STIs. He wants us to convey that the clinic will help them providing physical and emotional care. I am having a really hard time promoting something that has clearly NOT been demonstrated. I sat in on many consultations with patients that had contracted STIs, and not one of them showed the slightest hint of even listening. No wonder these kids are scared. Write a prescription and send them out the door. Am I missing something here?! I am anxiously waiting for the appropriate time to ask patients if they are happy with the care they receive.

Cleanliness: Vaccines are kept in a mini cooler (looks like something you would take to the beach to keep your beer in). Let’s just say your beer would be nasty after a few hours top, because there is no ice in it! The examination tables are covered in a white sheet. On top of that is a piece of plastic the reads “hazardous” that is the length from the belly button to mid-thigh. This plastic is kept there all day – it is never changed. Another thing – I witnessed the head nurse use a needle as a tooth pick. I could keep going.

It is important to note that Gaborone is well developed in comparison to other African countries. While I note some unclear issues, Gaborone is far better off than other places. Facilities are sound structures that if fully staffed have great potential to aid the city well. Healthcare is pretty much free here – paid for by the government. At most some have to pay P5 (less than US1). I’m still working out the logistics, because I know there are some that have to pay but loopholes for others.

The title of this entry is my Setswana name given to me by my Taxis Driver. It means “light.” I find it fitting for my current situation at Bontleng. I am lighting my way through a heavy fog right now. Everyone around town is so very friendly and helpful. If I ever need help figuring out which combi to take I will have a handful of people jump at the opportunity to help. I am frequently greeted every day. I know that being white woman has much to do with this especially the stares that never leave me until I am shut in my room. However, I walk into the clinic and this attitude leaves. People are not providing me help to receive the knowledge I want. I instead mindlessly wander trying to assist but repeatedly fail. I have to fight my way to get what I want. Never thrown off by a challenge no matter how many times it smacks me in the face, I refuse to give up. I cannot rely on others to be my light through the fog, so I will continue to be a bright, smiling face in the clinic, and I will learn what I came to learn.