Friday, September 14, 2007

Adjusting


8/21/07

A week has now passed since arriving in Africa. Since that last communication, life in Lesotho, the Kingdom In The Sky, continues to be good and bring interesting little adventures. Here is a re-cap of what’s been going on.

The Living Situation
Anu (friend from med school, recent Oakland pediatrics grad) and I have moved out of the “Baylor cottage” located on the clinic grounds. We miss getting the free wi-fi internet access from the clinic but enjoy being closer to the center of town and having our own place. We finally were able to unpack that first night after leaving the cottage, mostly to keep warm by constantly moving; the 3 space heaters we had enjoyed in the cottage (including Big Bertha, which is more like a super nova than a space heater) didn’t come with us, and our new house had none. The beauty of 30 degree evenings quickly wanes with no central heating and no space heaters. We did manage to collect some brush and build a fire in the fireplace (I know, why am I complaining?), and that did warm up the place. Our 3rd roomie, Kara Dubray (recent Oakland pedi grad), didn’t make it in that night as expected, and with no phone, we weren’t so sure as to why. Early next morning I had a vague sense of someone repeatedly leaning on their car horn. After I cleaned out the icicles and tundra moss that had grown in my ears during the evening chill, I realized that Kara had simply missed her connection and arrived the next morning instead. The house has a “guard”, Isaac, who is a tall Basuto young man of 29 yrs. It’s mandatory that we keep him, per BIPAI, and I suppose it’s a good thing to help give another local a living. His official watch is from 6 pm to 6 am. He speaks a little English, we speak a little Sesotho; basically we have no idea what the other person is saying. The best we can figure out, his routine involves talking over the fence to the next door neighbor’s guard in the early evening, then around 730 pm he retires to a side room, wraps up in his customary Basotho blanket, turns on the heater, and falls asleep. Usually, when a guest honks their horn outside, we are able to beat him to the gate (“Yay, I won again”). He does enjoy the food we bring him (Anu is impressed how he is able to wake up with just a tap on his door when you have a plate of food in your hand). The house is pimpin’, if you will, with a great stoop (porch) for stoopin’, which involves sitting on the stoop and drinking beer and or wine. There is a eucalyptus tree, sans koala, a fenced off “garden” that currently resembles two elephant-sized graves, a walk in vault (some previous owners “sold jewelry” we’re told) but currently is just a closet (safest shirts and underwear in all of Lesotho), and all the amenities that you’d expect in a house in the US. No hot tub, but I’ll work on that. Our kitchen is stocked with good foods (peanuts, cereal, cheese, beans, and beer – mostly unchanged from my kitchen in Santa Rosa). Anu likes to cook, so we have chutney, pasta…even veggie burgers. We found out the hard way, tonight no less, that the box on the wall with digital numbers (that count down, though we hadn’t noticed this small but important detail before tonight) tells us how much electricity we have left. Much like a calling card, you add minutes to it at the electricity shop. We came home tonight from soccer to find that we were out of minutes (we were really out this morning; we just thought it was a power outage). Bummer. Thankfully the food in the fridge doesn’t spoil in arctic weather, so the goods were, well, still good. As the Basuto government realizes that most foreigners are ignorant to buying electricity minutes, the store is open 24 hrs for just such occurrences. So with help from the clinic sub-director (after she stopped laughing), we figured out what went wrong and were back in business.

The Gym
So some of you might have already heard about The Gym in Maseru. Nicer than most private gyms in the States, and certainly nicer than the government hospital across the way from it, the Gym looks like it was built on another planet and landed by mistake in this small African country. We signed up for the Gold Membership the other day. For a whopping 19 US dollars a month, you get weights, heated pools, treadmills, bikes, elliptical machines, rowing, squash courts, ping-pong (YES!! - oops, no nets), etc. We passed up the Executive Membership which adds the dry sauna and steam room. As much as I enjoy these normally, we decided that in a country with one of the highest rates of tuberculosis and enough extensively drug resistant TB to attract Paul Farmer’s Partners in Health group to start a project here, it’s best to avoid cramped, small, damp, enclosed spaces filled with near-naked Basuto men coughing into your alveoli. We also saved 5 dollars a month with that decision. Learned to play squash (like racquetball but with a ball that looks like it should bounce but doesn’t; the game is named after the noise that’s made as you run into the plexiglass wall at the back of the court). The Basuto male members are all large. That is, the men that go to the gym are built like tug boats. I doubt that any of them are traditional sheep herders; if they are they must carry their sheep from town to town.

Work
Most of the days this week have been spent filling out paper work. Proof that I am a doctor, proof that I haven’t been arrested, questions about my plans for work in Lesotho, questions about how many wives I am bringing into the country (I need special permission from the government for more than one!). We’re getting to know the ropes around the clinic through lectures and a little shadowing. The clinic is new and nice. Yes, the rumors are true – the medical records are electronic, typed during the clinic visit on these box-machines called “computers”, for my friends at the Santa Rosa Family Practice Clinic. Believe it or not, we have social workers, in-clinic pharmacist and pharm techs (that can compound meds, do pill counts, alert us if they think there are adherence issues), nurses that go into the community to find patients that have missed appointments, real, live, translators whose job is to translate (instead of also be a nurse or clerk, and no freaking AT&T translator phones), a classroom for lectures (with built in computer and projector hardware), wireless internet (fast), dial up internet (slow), a small library, local artwork, a lunch room, etc. Clinic starts around 830 am. The day begins with the staff and some patients singing harmonized hymns (they’re amazing; I’m making some recordings on my iPod and will send some soon). Some of the kids come in very sick and have to be coded in the treatment room. Most look and are relatively healthy. Many of the kids around this clinic that need to be on antiretroviral medications are on them. The waiting room is crowded but not pandemonium. The patients come en mass in the early morning without individual appointment times and are seen in the order they are registered, except for those discovered on triage that are very sick. There is “Family Clinic” which means adults, 90% of which are women, lots that are pregnant. We provide the prevention of mother to child transmission care to the pregnant women, prescribing and managing their meds, etc. They continue with their midwives/obstetricians for routine antenatal care and deliver either at home or at the hospital with those same providers. Perhaps unsurprising to some of you, I’ve started to see what opportunities there are to get involved with actually catching the little wet willies when they’re born. We’ll see. Otherwise, work looks like it will be divided between the main Baylor Center of Excellence (COE) in Maseru, the run down government hospital wards at Queen Elizabeth 2 (aka QE2, or Queen 2), QE2’s own pediatric HIV clinic, and then work outside of the city. This community work sounds great - road trips or small plane trips to the mountains, past mesas and waterfalls, to set up pediatric HIV clinics in hard to reach areas around the country. Teaching opportunities abound, from training med students and residents from the US that rotate through Maseru, to lecturing to doctors and nurses in India about pedi HIV care, and lots in between. Of note, I haven’t yet found a group, whether government or a non-governmental agency (NGO), that is actively working with the sex workers in HIV prevention and treatment. With the successes seen in places like Thailand and India, I would be surprised if a program has not been implemented to help with this marginalized and stigmatized group. More on this as it develops.

That’s all for now. Hope you are well. Keep those emails coming.

2 comments:

Della said...

jeff,
we're wondering about the photo of your house. why is the driveway into the garage so steep? and the height of the wall next to the garage? is this because of the possibility of flood, or is the house built on a hill?
what are the bathing accomodations like? how did you all bathe without heat?

Cathy said...

jeff,
this has been some of the most amazing reading. you are truly blessed to be doing the work you have been called upon to do and in such an incredible area of need. i have received updates from my sister and your mom for years regarding your life adventures! it's great to get to hear straight from you! Keep up the incredible work that is so desperately needed. just think, i used to take care of you as a patient w/dr. rhodes! ha!