Tuesday, February 28, 2012

Top 10 Things I Love about Botswana

1) Working and talking with the Ministry of Health convinces me I’m in Harry Potter.


2) Our study nurse Mma Molapisi greets me each day by stroking either my breasts or butt.


3) It’s assumed I will eat everything with my hands.


4) The Dingo drives like a dream even after potholes and speed bumps knock off at least one clanky thing per week.


5) The movie theater has a popcorn condiment stand with 4 different gallon-sized shaker bottles of monosodium glutamate: 1) Salt and Vinegar 2) Chicken flavor 3) Beef flavor and 4) Original.


6) A full plate of lunch in the hospital cafeteria is $4, but a full plate without the two small cubes of beef is $0.25


7) Batswana men in caps and goggles exercise in the pool by sitting on the wall for an hour and then hitting the steam room.


8) The phrase: “There are no crocs” translates to: “There are many small crocs.”


9) If medicine doesn’t work out, I can strike gold teaching 3-yr-olds to blow bubbles underwater.


10) There is not a single place in the city or in the bush where it’s inappropriate to get drunk and dance on tables.

Sunday, February 26, 2012

Wednesday, February 22, 2012

BFF with the President

Finding those before-and-after pictures of the trailer too good not to share, I emailed them to a couple colleagues in our office. This morning I was informed that I shouldn't freak out, but the former hospital administrator had received them, and he forwarded them to the President of Botswana. Apparently the administrator had been instrumental in getting the trailers donated, and he found the state of things unacceptable.


I guess Ian Khama and I are just destined to be in each other's lives.

Tuesday, February 21, 2012

SOOO PAINFUL

"Sooo painful." This is my mentor's favorite line to use when the Botswana medical system makes things interesting. Whether it's the radiology department misplacing the codebook that identifies all x-rays ever taken at Princess Marina Hospital, the electronic medical records system crashing for a week due to a leak in the roof that damaged the server, or 85% of all medical charts mysteriously disappearing before they reach the medical records department, we simply say, "So painful."



I had my ultimate painful moment yesterday. I returned to the trailer of emergency department records to start documenting more cases of pneumonia. Remember the trailer/dumpster of records? I'll refresh your memory:

And here's what I found when I opened the door yesterday:
My jaw dropped. "SO PAINFUL." Those are not emergency department records forming that barricade between me and my research. Those are thousands of "old hospital charts" with the word "CONFIDENTIAL" across the front.


I picked up one box to try to clear a trail to the back, and it immediately collapsed into a mush of flimsy cardboard, and the confidential records spewed all over the place. I wiped my sweaty forehead and trudged back into the ED. Head nurse Mma Malatsi was in the middle of computer training, and she was livid to hear that all her boxes were hidden behind a monstrosity.

Apparently, she told medical records they could use the extra space as long as the ED records were placed off to the side. As you can see, that did not happen.



My next stop was to the medical records department, where I had to take several deep breaths before opening the door, because I get at least one marriage proposal per day from either the director or one of his interns (By the way, if anyone asks, my husband lives in New York City). Here's how our conversation went:

"Hi Josiah! How are you?"

"Emly! You never come to see us anymore. How are you doing in A&E (ED)?"

"I'm fine. I was just trying to get some of the A&E boxes, but they are all blocked in! Do you think it will be possible to get to my records?"

"No, I don't think it will be possible."

"Well, I can move them myself, but is there someone who can help me?"

"No, there is no one."

"Okay, thank you, well then I can move them myself?"

"Yes, you can take all the medical records out and then put them back in."

"Tanki rra. Gosiame."

"Okay, Emly! Come say hi to us again soon! You never come anymore!"


After asking around the office about how best to handle this situation, it was decided that tomorrow, Miseki, gardener-slash-poolboy, and I will be sharing in the manual labor of taking out the new medical records, switching them with the ED records, and then putting them all back in. Poor Miseki is about 5'5" and has no idea what is in store for him.


On the bright side, look what just got fixed in the ED office! Now I will be able to see all the medical records...that I can no longer access. So. Painful.

Sunday, February 19, 2012

Gabs hold out of the century!

Lame (pronounced La-may) was right--the Beef Baron was a palace. As we drove towards the Grand Palm Hotel, past manicured lawns with spotlights, I knew I wasn't in Kansas, Botswana anymore. Two valets met us at the front drive and ushered us into the front lobby, which could have been mistaken for any Hilton. I leapt for joy when I saw multiple vases of quality fake flowers and heard background jazz music that didn't involve the more popular "nn-tsss, nn-tsss" beat you'd typically expect to hear in a drug den but instead hear in restaurants, gyms, offices, bathrooms, etc. Lame and I brought along buddy Dagan, an internal medicine attending working in Botswana for Harvard's new education program. He works in Molepolole, which is about an hour outside of Gabs, and he oversees anywhere from 1 to 6 Beth Israel residents visiting at a time. Dages takes great care of his residents, driving them to and from Molepolole and showing them the Gabs activities and nightlife (which basically means he goes to the yacht club a lot). I don't know what they'd do without him...or wait, I do, because while he was still attending in the US in January to keep his academic title, my phone inherited the blessing of residents calling with flat tires and bad direction sense.

Anyway, after many many meals of gristley, overcooked beef, this steak was perfect. When I stated that, Lame responded, "I know. I can't believe someone thought I was taking you to the Cattle Baron." Apparently, the Beef Baron should never be confused with the Cattle Baron, which is a "dingy place" in Lame's opinion.
The rest of bachelorette weekend was relaxing and fun. I taught a swim lesson to a Penn ID doc's 3-yr-old son, and despite the tummy ache and sob-fest at the end of the lesson, I don't think I failed completely. All I have to say is thank God for Finding Nemo and noodle horsies.

Dages, Lame, and Marlow have been doing a great job keeping me company, but I gotta say, "Sarah come back to meeeeeeeeee!!" I miss my roomie! What am I going to do when I have to let her go back to Baltimore!? I may have to schedule my electives next year based on this newfound co-dependency.

...If you've made it to the end of this blog, and you're asking yourself why an entire narrative was just devoted to a cheesy hotel, please refer to posts: "Bots loves its meat" and "Momfari Part:1" for some perspective.

Friday, February 17, 2012

Bachelorette pad weekend

World AIDS conference submission success! Such a great feeling! We show that the percentage of adult pneumonia patients presenting to the emergency department with HIV is just as high as in TB, which is pretty shocking.

My sad news is that last week my hip started hurting after running, and I've diagnosed myself with trochanteric bursitis. I haven't run in a week, so I'm getting pretty stir crazy and worried about the ultramarathon. However, I've yet again proved how versatile spandex can be after turning my birthday outfit into a series of dynabands for muscle training.

Another bummer is that I was planning on running the Mafikeng marathon in South Africa this weekend with my French running buddy Renaud, but I backed out so I wouldn't kill my bursa. I didn't back out in time to make it onto the road trip my friends are taking to Mozambique this weekend, so instead, I'm sleeping, dog sitting, and going on a ladies night with my friend Lame to the Beef Baron, which is apparently the nicest restaurant in town according to her. I'm thinking this might require some photo documentation.

Back to the dog-sitting. Marlow is insane. We just went for our first walk using her choke collar, which is supposed to encourage her not to yank my arm off. Instead, she just choked herself every time she wanted to eat fire-starter or bottle shards. Don't worry Ryan--no glass in her stomach, but I can't make any promises about the mysterious animal fur.

On the other hand, walking down the street with a giant, crazy dog was the most empowered I have ever felt in Botswana. People here are TERRIFIED of dogs, and for good reason. Anyone with anything inside their house to protect always has a giant, viscious dog in the front yard ready to bite any stranger's face off. The most popular guard dog is the Boerboel, which can shift from a giant teddy bear to the embodiment of a nightmare in miliseconds. I just googled "Boerboel" and found this: http://www.isdog.net/3002/Boerboel-300x298-Boerboel.html

Anyway, when I walk towards people on the street with Marlow, they unfailingly make a quarter-mile arc around us while staring at Marlow in terror. For me, it's a far cry from constantly worrying about being mugged.

Aside from occasionally trying to bite my face off and chasing her own tail, Marlow is pretty good at getting what she wants. I was sitting on the Ryans' high bar stools today, and Marlow kept coming up and resting her chin on my leg and looking up at me pleadingly. When I indulged her, she tried to bite my face off. I'll get the hang of it soon I hope...

Monday, February 13, 2012

Title of word document I just received:

Pneumonia-HIV-Severity of Illness Abstract - meeting draft-haas Emily comments_more haas comments-moreEmily-AHFcomments.docx.

This is getting fun!

Sunday, February 12, 2012

Email subject lines I never thought I would be instructed to send

"URGENT: When is the latest possible time we can send you this draft?"

Research is nuts...

And...one more Shake Shake shout-out!

Friday, February 10, 2012

Crunch Time and a Chibuku-full Aftermath

Research is insane. I apparently never understood the meaning of the term "crunch time" until now. When it's crunch time for a med school exam, at least you know that the exam will happen, and that whatever work you did or did not put in will be reflected. Not true with research! My crunch time means collecting lab values from 800 charts, cleaning my database, running the statistics, putting this into an abstract, and then driving around Botswana asking co-authors to review it, ALL WITHIN THE NEXT 3 DAYS! And if that doesn't happen, well shoot, we're out of luck and a lot of sleep.

The toughest part for me is that I'm so bogged down in the actual data collection process, that I don't have the kind of time I need to be asking the bigger questions and running the statistics. I am worried a career in research would always feel like a race to the finish line without the necessary time to process everything. However, it's pretty funny to say that after spending my first 4 months complaining about the system being so slow and having nothing to do. Now with data and a deadline, I'm losing my mind and desperate for things to slow down.

Anyway, I really hope I can pull this off this weekend. Wish me luck and send some encouragement as I sit alone swearing at my computer and possibly architecting some new curse words involving STATA code.

Here's what I'll be doing Wednesday night at 2am after my abstract gets submitted.
Chibuku, also known as Shake-Shake, is the traditional brew in Botswana. It's fermented Sorghum, and you know you have a good carton when it's nearly exploding with gas. It has the consistency of milk that's gone bad to the point of having chewy particles, but it tastes more like a mixture of yogurt and vomit. I was told once that it's the perfect snack because it's both food and drink.



This particular night, Matt and Tessa were having a homeless party due to their short-lived homelessness, so rest assured, my look was only an attempt to be loony tunes homelesss lady with a wand and lots of cats.

Monday, February 6, 2012

A Day in the Life...

So basically my life according to this blog is one long sunny vacation full of moms and lions. I feel the need to prove to you otherwise.

Welcome to the Office of Emergency Department Medical Records at Princess Marina Hospital!
If you're thinking, "Oh, that's a nice building behind that giant dumpster," perhaps you're right. It is a nice building. Too bad the medical records are in the dumpster. Let's take a look inside! That was easy. You might expect a lock or code or something, right? Wrong again. When chief nurse Mma Malatsi showed me the trailer, we had such a hard time opening the door with its complicated double lever contraption that had to be twisted at precisely the same angle at the same time, that she decided no one would bother trying to get in, and a lock was therefore unnecessary. That was great news for me, since I was going to be opening that contraption at least twice a day. I cannot tell you how many nurses have cracked up at the sight of me in a dress dripping in sweat as I try to pull both levers with all my might. They are probably thinking the same thing I was the first time: Why is she trying to open that dumpster?

I do have to admit, while each box supposedly containing one month of carbon copied ED admission sheets is mixed with food wrappers and bodily fluids, this 1000 degree trailer is still more organized than my room ever was in high school. I can almost always find what I'm looking for, but unfortunately for the carbon, I'm covered in sweat by the time I do.

Ever since my study was approved a couple months ago, I have spent each day carrying one box at a time across the hospital to this ED office, which has been my second home. However, it's not at all my space. In fact, it is the primary office of about 6 ER attendings, 6 residents, and 1000 nurses wanting to check facebook on the one functional computer in that wing of the hospital. Yeah, I have definitely been kicked off the electronic medical records system by a nurse wanting to chat on facebook.
Another great part about the space is that whenever it's cloudy or past 5pm, the room goes completely dark, and the single overhead light has not worked in a year. At first I used a headlamp, but now I straight up bring in my bedside lamp each day.
Here's the best part. Lunch! This is called a "fat cake." It's a ball of sweet dough deep fried in oil. All it's really missing is powdered sugar. There are hundreds of carts that sell these on the street everyday. Lucky for me, there's one right outside the ED.

Okay, so even though the routine is a little ridiculous, I have to say I am incredibly happy with how things have gone so far. I've collected most of the data we'll ultimately need, and we're already synthesizing it into interesting stories about HIV care in Botswana. My mentor Michelle was just visiting for the week, and it was so much fun troubleshooting and brainstorming with her. She got so into it that she actually spent a good amount of her week looking through raw data with me in the tiny office and getting really excited when she saw that doctors were following her pneumonia protocol. Luckily I had brought the lamp AND the headlamp those days.