Back in the months of September and October in Botswana, all the nurses were on something called a “go slow” very similar to a labor strike in the States. It means that they were refusing to do anything more than what duties are listed in their job descriptions. This was apparently a country wide strike, and the reasons they were given for it were that nurses were not compensated well enough, and that they were doing jobs that should be done by doctors or pharmacy technicians.
There is a shortage of health professionals as a whole in Botswana, many nurses and nearly all the doctors come from neighboring countries (which also contributes to the communication barrier and mistrust between villagers and medical professionals). I’ve been told there is a medical school being built in Gabs which will hopefully help with this shortage. Right now the government supports students who want to pursue a medical degree in other countries that have medical schools, but I’m uncertain if there is a provision for them to return to their home country to practice medicine.
One of the first problems with a strike in a developing country like Botswana lies in the fact that all nurses are employed by the government, and thus there is little opportunity for any productive negotiation. The nurses were demanding something like a 60% increase in their salaries, and it makes for a sticky situation when the government cannot intervene on behalf of the people who are experiencing interrupted services. The effects of such a strike might be felt a bit less in communities that are large enough to have a hospital, where doctors could step in and help with the overflow of patients not being completely treated by nurses. But in a community like Seronga it was a nightmare.
The nurses in Seronga, (who were incidentally running short staffed with only 2 or 3 nurses –we are considered fully staffed when we have five- for the duration of the go slow, which is thankfully over now) weren’t prescribing any pills other than those deemed absolutely necessary, like malaria drugs. They would triage serious wounds and injuries, but referred a huge number of people to the doctors at the hospital in Gumare, a 300 k one way trip around the delta with very few boats and ambulances going through rather than around… (and now might be the time to mention the lack of public transport for the first 100 or so kilometers on this side on the dirt road, a pretty unpleasant journey if you are healthy, much less injured or sick in the back of an open truck with dust and dirt or worse yet rain flying at you). The clinic’s biweekly boat/ambulance trips to deliver the blood to the hospital in Gumare for analysis were extremely full of patients trying to get to the doctor to be seen for conditions the nurses were refusing to treat. The go slow also had a domino effect of causing all the health education workers and clinic cleaning staff to reevaluate their duties and there were many smaller yet important cleaning and educational functions that were not being performed at the same time. It was a very difficult time for the morale of everyone.
HIV testing, which is usually done by the lay counselor, with back-up from the nurses, was not being done when Pulane was out (and he was out quite a lot, they get an amazing amount of off days in Botswana). There were a few instances where I was near tears of frustration and calling in every favor, and using every begging, pleading and threatening method I could muster with the nurses to get them to test. Admittedly, they were between a rock and a hard place (in Batswana culture I have found that there is a great emphasis on obedience and following directions very specifically, with little thought towards if the command given makes sense for the situation at hand, or if there might be a more effective or efficient way of getting things done.) but could usually be convinced if for no other reason than to shut me up. I found that the nurses at the health posts and mobile stops had run out of testing kits a while back and although they weren’t refusing to test, they were refusing to order more tests, as this was not supposed to be their job. The DBS (dried blood spot) tests that were supposed to be done on babies were occasionally getting done, but not submitted to be analyzed.
Don’t get me wrong, I understand where the nurses are coming from, maybe not on the pay dispute (in relation to other Southern African countries nurses in Botswana are very well compensated, in fact we have many nurses from Zambia and Zimbabwe who have come here to earn money to send home to their families, and I know they are making a hell of a lot more than me right now) but certainly on the job duties. Although nurses trained in Botswana are given a short course on pharmacology, (having spoken with them about the issue they emphatically state that they do not feel qualified to dispense drugs in the manner they are, especially not when the drug interactions with local methods of traditional healing methods are taken into consideration) there should definitely be a pharmacy tech as well as a doctor on site. There is, in fact a doctor and pharmacy tech living in Shakawe who are specifically assigned to Seronga. They make the trip down the dirt road from Shakawe to Seronga two Mondays per month. The doctor and phamracy tech get patients started on ARV’s when the patient’s CD4 count drops below 250 (ie they start to get real sick). The doctor will monitor the patients at appointments on these two Mondays per month for three months. After that the patients are expected to follow up and get their medications from Shakawe. Right. The inability to make their way to Shakawe for whatever reason has caused many people to default on their ARV’s, or to develop immunity to the effectiveness of their ARV’s, after which they should probably be referred to Gabs for a third or fourth line drug. This doesn’t happen, as if they can’t get to Shakawe 100 k’s away how on Earth will they make a three day’s journey to Gabs? It’s not difficult to understand why villagers resort to the local roots and pseudo-medicines of the traditional healers. With respect to traditional healers, I understand and admire their attempts to heal and cure the people through age old methods, and am willing to bet that for common ailments they have the ability to provide a great deal of comfort and help. However with AIDS they really don’t stand a chance. I’ve seen many people who consult traditional healers get very ill very quickly, and many have died.
In Seronga we have a big, beautiful, red brick ARV building that stands locked, empty and unused. Currently we don’t have adequate housing on the clinic compound for the nurses who work at the clinic (It is part of government employees’ contracts that they are provided government housing in the village they are sent to. This is normally where Peace Corps volunteers are housed as well) and so we don’t have housing for a doctor, either. It’s shocking to me that the government would have gone through the trouble of building such a beautiful building without plans to provide the housing for the doctor and pharmacy tech as well, but that is apparently what has happened. I suspect that like most services promised to Seronga, the government rushed to put up the building to placate the people, to quiet their demands and complaints, without the necessary follow through to make it functional. While I understand how difficult and expensive it is to get building materials and laborers this side, that’s not really a good enough excuse for me.
Although there are open houses on the police compound I’ve been told the doctor refuses to come to live in an area where he cannot be supplied with 24 hours a day electricity. In some ways I can’t blame him; this is a less than desirable life for someone who went to medical school to improve themselves and their career and lifestyle opportunities. There was a Spanish woman with the British Skillshare program who had been working as a volunteer at the Okavango Poler’s Trust to try to improve their marketing. She lasted about 6 weeks. Many of the professional employees (teachers, police, nurses, ect) have expressed dismay and depression at being placed in Seronga, and have recently requested both hazard pay and a rural placement bonus from the government. It’s the bush and it’s not easy and it’s frustrating and I get that. I certainly spend enough time wanting to get out of here, at least for a while. I understand that a life like this isn’t for everyone, but I am still nevertheless distraught at the lack of services being provided to the villagers in Seronga.
Although the strike is over, the level of health care provided in Seronga is still discouragingly under par, despite the increased efforts of the nursing staff at the clinic. As someone who has been sent here to build the capacity of aforementioned entity, it is frustrating to feel that you don’t have the complete support and commitment of the government that has requested you be here. It's frustrating to stand by and witness these problems that are amongst the many I have nothing feasible I can do about them. It is during these times of tear inducing frustration that I am reminded again that change takes time. I search for the things this village has going for it, the people who do care, the ones who are doing things, and dream of the place Seronga can be. I still have hope.
Showing posts with label Seronga clinic. Show all posts
Showing posts with label Seronga clinic. Show all posts
Thursday, November 20, 2008
Thursday, October 30, 2008
An Unintentional Rehab... An Unexpected Sentence... Where do I go from here?
28 days. I will be on Combivir for 28 days. For the length of a first timer’s stay in rehab, the length of time of an average menstrual cycle, I will be on this drug. Post Exposure Prophylaxis. It makes me nauseous, tired, and I struggle to keep my bowels about me. And yet, because of the events of a split second of my life, I will not cease it’s ingestion for 28 days.
It’s like the beginning of a pregnancy, I suppose, but opposite. The fluids of two bodies were exchanged, and I hope and pray to all that is holy that there is only one line on that test I will take in 28 days, and that it’s negative. I’m nauseas as hell, and usually in the morning, and should not drink alcohol due to its effects on my liver. I must remember to take it at the same time every day morning and night, and plan my day’s activities around my water intake and nearness of bathroom facilities. All this fun and I didn’t even get to have sex.
I will live through a month of uncertainty, in some ways better than the other uncertainties in my life here, as it has an end date. This makes it a bit more bearable, but still, the not knowing. Despite all the facts and figures being thrown at me, all the information available, and my dear friend in the States spending an hour on the phone with the CDC, the statistics of less than 1% chance doesn’t reassure me completely, as there are more than a few variables in my particular situation. I have nothing tangible to do but hope. The odds are good but not completely 100% and so there still remains an element of uncertainty. And nothing left to do but hope and pray against everything I know that after this month of not knowing I will remain HIV negative.
How did this happen? Quite simply, quickly, ordinarily as most moments do, even those which have the potential to change your life.
I was at the clinic. It was Friday, nearing lunch time, and one of the nurses was trying to finish up with the last patients that were in the waiting room prior to lunch. It was a mother and her child; they had traveled to the clinic from Gunitsoga, about a thirty minute drive down the horrible dirt road out of Seronga, towards Gudikwa. It would be difficult to catch a lift out that way regardless, but I shuddered to think of the mother and baby trying to hike in the midday heat. If they didn’t get finished before the lunch break (the only thing that ever happens promptly on time in Botswana) they would have to wait and leave after 2. In the interest of everyone involved but myself, in order to help everyone get where they were going in a timely manner, I agreed to perform the small task that would change my life.
The mother needed a consultation and the baby needed a vaccination. As our injection area at the clinic is incredibly cramped and small, there is no room for a proper table on which to sit a baby who is getting a shot. Usually the mother just holds their child, while the nurse gives the child the injection in their upper thigh. As the mother was in the consultation room, I agreed to hold the baby for the procedure.
I propped the baby on my lap, speaking in my strange language to the back of his little 4 month old head, murmuring something about how in just one quick second he was not going to be very happy, but not to worry as it would only last a moment. The nurse swabbed the area and prepared the syringe. He pressed the needle into the baby’s thigh. The baby predictably cried and squirmed. The nurse removed the needle and went to wipe away the tiny bit of fluid that seeped out of the baby’s thigh.
And accidentally plunged the needle into my own thigh.
He recoiled immediately.
I looked up at him in surprise, unwilling to completely believe what had just happened, but unable to deny it as a droplet of my own blood appeared on my skirt.
I look down at the crying child in my arms, the tiny possible carrier of such a deadly disease. I stammer, “What is the baby’s, is the baby, the mother,” I want to hand the child off to someone, to get away from it, and immediately feel guilty, judgmental, but my fear quickly overrules these emotions. The nurse, just as shocked as I am, quickly says “It’s ok, this baby is negative.” I look at the baby, fat, and healthy looking, it seems right that this is true. “The mother? The DBS? (Dried blood spot.- the test in which blood is taken from a baby’s heel and blotted onto a paper, sent to a laboratory in Gabs, and analyzed and returned to the clinic via the mail. It is the way to determine the HIV status of a baby.) Where is the baby’s DBS?” The baby is still in my arms and squirms and cries and I want to be away from him, far, away. I am nearing panic and am trying to remain calm so as not to drop this child, this innocent child, and trying to remind myself that he is just that, and innocent child.
The next few minutes pass in a blur, phoning the PCMO, panicking, trying not to panic, rationalizing. I go into the defensive mode of denial for a while, and eat lunch. I walk through the blazing heat to try to make a copy of the baby’s DBS report to fax to the PCMO, as I am thinking this is essential information for her to have, and of course no fax or copy machines in Seronga are working and I am pissed off.
I try not to think "Why me" because why not me? I'm human, no different from anyone else, just as susceptible to this disease as the next person. But I think it anyways. And I'm slightly mortified by my previous and lasting sense of invincibilty. I'm indignant.
I wish for the strength to bear this uncertainty alone, willing myself to remain calm and not to burden anyone else with this worry but I lack that particular strength. It seems unfair to bring anyone that cannot feasibly do anything into this surreal terror but as is her tendency, no matter where I am on Earth it seems my mother can sense my turmoil as only a mother can and chose that exact moment to text me. I ask her to call. She does and I try to downplay the situation, trying my damndest to convince myself and her that this is no big deal and all will be fine. I speak sharply and try to speak factually, playing up the things in my favor and downplaying the ones that suggest the true risk. I hear the tears in her voice and I demand that she not worry herself with this, that I will be fine.
She asks me if I’m scared.
I blink back tears.... And I lie to my mother.
“No,” I snap, only realizing as I say it how frightened I really am.
I chase away these fears and thoughts by conjuring up the blameless denial that has gotten me this far in Africa. “This is not happening to me, I will not allow it,” just as sternly as any parent admonishes their child.
And in response, a small, small voice inside me, one that I haven’t heard for quite some time wonders, “Maybe Africa just doesn’t want me here anymore.”
As long as I’ve contemplated coming to Africa, and joining the Peace Corps, there has been many, many times in which the sheer force of my will has prevented me from even entertaining the possibility of leaving. When people have asked me what I want to accomplish with my two years in the Botswana, they are often uncomfortable at the forcefulness with which I pronounce that my accomplishment will be to stay the whole time. I’m generally quite venomous when people gently remind me that it’s ok if I want to come home. It’s telling that it took another event completely outside of me to push the question into my mind- maybe more than whether I want to stay in Africa, I need to question the other side of the equation, whether Africa wants me here. Through the thefts, the sickness, the difficulty, the adjustments, the homesickness, the disappointments, and the relationship that has crumbled at least partially due to my decision to come here, I have rarely, if ever, considered if I should leave. As anyone who has ever been in a relationship with me can attest, I never did know when to give in, or how to quit while I was ahead.
In my darkest moments here, I’ve trusted that the stuff that has been happening has all been for a reason, to teach me something, with the really hard things maybe a lesson I’m not yet ready to understand the meaning of. I swallow the lump in my throat and rack my mind for the bright side, something to make this fear and uncertainty productive. All I’ve found at this juncture is that I now know intimately the feeling of anyone coming in to be tested and having any doubts about what will be revealed to them.
Today it’s a week since the moment that upset the balance of my life. Other than remembering to take my medication, I’ve found I don’t want to think about it. I don’t want to talk about it. I can usually forget about the dark cloud looming over my future, and ignore the flattened plum-like bruise on the back of my right hand that indicates where they took my blood for the first round of liver function tests. I decline the wine at dinner and go to bed early. I reason that this is just like a completely irrational pregnancy scare and that in a month, and three months, and six months the tests I take will turn out just the way they always have, negative. Tomorrow I will return to my life in Seronga, where I left in a hurry one week earlier. I will continue my life as normally as possible. I will try to make it through the remaining three weeks of my sentence; I will try to adjust to the slightly off-ness of my new normal.
I will hope that by the sheer force of my will, I will be fine. I will repeat it like a mantra whenever I need to white knuckle way through this, even if my fingernails pierce the skin of my palms. I will breathe deeply and I will continue on in the only direction I know how to go, which is foward...
It’s like the beginning of a pregnancy, I suppose, but opposite. The fluids of two bodies were exchanged, and I hope and pray to all that is holy that there is only one line on that test I will take in 28 days, and that it’s negative. I’m nauseas as hell, and usually in the morning, and should not drink alcohol due to its effects on my liver. I must remember to take it at the same time every day morning and night, and plan my day’s activities around my water intake and nearness of bathroom facilities. All this fun and I didn’t even get to have sex.
I will live through a month of uncertainty, in some ways better than the other uncertainties in my life here, as it has an end date. This makes it a bit more bearable, but still, the not knowing. Despite all the facts and figures being thrown at me, all the information available, and my dear friend in the States spending an hour on the phone with the CDC, the statistics of less than 1% chance doesn’t reassure me completely, as there are more than a few variables in my particular situation. I have nothing tangible to do but hope. The odds are good but not completely 100% and so there still remains an element of uncertainty. And nothing left to do but hope and pray against everything I know that after this month of not knowing I will remain HIV negative.
How did this happen? Quite simply, quickly, ordinarily as most moments do, even those which have the potential to change your life.
I was at the clinic. It was Friday, nearing lunch time, and one of the nurses was trying to finish up with the last patients that were in the waiting room prior to lunch. It was a mother and her child; they had traveled to the clinic from Gunitsoga, about a thirty minute drive down the horrible dirt road out of Seronga, towards Gudikwa. It would be difficult to catch a lift out that way regardless, but I shuddered to think of the mother and baby trying to hike in the midday heat. If they didn’t get finished before the lunch break (the only thing that ever happens promptly on time in Botswana) they would have to wait and leave after 2. In the interest of everyone involved but myself, in order to help everyone get where they were going in a timely manner, I agreed to perform the small task that would change my life.
The mother needed a consultation and the baby needed a vaccination. As our injection area at the clinic is incredibly cramped and small, there is no room for a proper table on which to sit a baby who is getting a shot. Usually the mother just holds their child, while the nurse gives the child the injection in their upper thigh. As the mother was in the consultation room, I agreed to hold the baby for the procedure.
I propped the baby on my lap, speaking in my strange language to the back of his little 4 month old head, murmuring something about how in just one quick second he was not going to be very happy, but not to worry as it would only last a moment. The nurse swabbed the area and prepared the syringe. He pressed the needle into the baby’s thigh. The baby predictably cried and squirmed. The nurse removed the needle and went to wipe away the tiny bit of fluid that seeped out of the baby’s thigh.
And accidentally plunged the needle into my own thigh.
He recoiled immediately.
I looked up at him in surprise, unwilling to completely believe what had just happened, but unable to deny it as a droplet of my own blood appeared on my skirt.
I look down at the crying child in my arms, the tiny possible carrier of such a deadly disease. I stammer, “What is the baby’s, is the baby, the mother,” I want to hand the child off to someone, to get away from it, and immediately feel guilty, judgmental, but my fear quickly overrules these emotions. The nurse, just as shocked as I am, quickly says “It’s ok, this baby is negative.” I look at the baby, fat, and healthy looking, it seems right that this is true. “The mother? The DBS? (Dried blood spot.- the test in which blood is taken from a baby’s heel and blotted onto a paper, sent to a laboratory in Gabs, and analyzed and returned to the clinic via the mail. It is the way to determine the HIV status of a baby.) Where is the baby’s DBS?” The baby is still in my arms and squirms and cries and I want to be away from him, far, away. I am nearing panic and am trying to remain calm so as not to drop this child, this innocent child, and trying to remind myself that he is just that, and innocent child.
The next few minutes pass in a blur, phoning the PCMO, panicking, trying not to panic, rationalizing. I go into the defensive mode of denial for a while, and eat lunch. I walk through the blazing heat to try to make a copy of the baby’s DBS report to fax to the PCMO, as I am thinking this is essential information for her to have, and of course no fax or copy machines in Seronga are working and I am pissed off.
I try not to think "Why me" because why not me? I'm human, no different from anyone else, just as susceptible to this disease as the next person. But I think it anyways. And I'm slightly mortified by my previous and lasting sense of invincibilty. I'm indignant.
I wish for the strength to bear this uncertainty alone, willing myself to remain calm and not to burden anyone else with this worry but I lack that particular strength. It seems unfair to bring anyone that cannot feasibly do anything into this surreal terror but as is her tendency, no matter where I am on Earth it seems my mother can sense my turmoil as only a mother can and chose that exact moment to text me. I ask her to call. She does and I try to downplay the situation, trying my damndest to convince myself and her that this is no big deal and all will be fine. I speak sharply and try to speak factually, playing up the things in my favor and downplaying the ones that suggest the true risk. I hear the tears in her voice and I demand that she not worry herself with this, that I will be fine.
She asks me if I’m scared.
I blink back tears.... And I lie to my mother.
“No,” I snap, only realizing as I say it how frightened I really am.
I chase away these fears and thoughts by conjuring up the blameless denial that has gotten me this far in Africa. “This is not happening to me, I will not allow it,” just as sternly as any parent admonishes their child.
And in response, a small, small voice inside me, one that I haven’t heard for quite some time wonders, “Maybe Africa just doesn’t want me here anymore.”
As long as I’ve contemplated coming to Africa, and joining the Peace Corps, there has been many, many times in which the sheer force of my will has prevented me from even entertaining the possibility of leaving. When people have asked me what I want to accomplish with my two years in the Botswana, they are often uncomfortable at the forcefulness with which I pronounce that my accomplishment will be to stay the whole time. I’m generally quite venomous when people gently remind me that it’s ok if I want to come home. It’s telling that it took another event completely outside of me to push the question into my mind- maybe more than whether I want to stay in Africa, I need to question the other side of the equation, whether Africa wants me here. Through the thefts, the sickness, the difficulty, the adjustments, the homesickness, the disappointments, and the relationship that has crumbled at least partially due to my decision to come here, I have rarely, if ever, considered if I should leave. As anyone who has ever been in a relationship with me can attest, I never did know when to give in, or how to quit while I was ahead.
In my darkest moments here, I’ve trusted that the stuff that has been happening has all been for a reason, to teach me something, with the really hard things maybe a lesson I’m not yet ready to understand the meaning of. I swallow the lump in my throat and rack my mind for the bright side, something to make this fear and uncertainty productive. All I’ve found at this juncture is that I now know intimately the feeling of anyone coming in to be tested and having any doubts about what will be revealed to them.
Today it’s a week since the moment that upset the balance of my life. Other than remembering to take my medication, I’ve found I don’t want to think about it. I don’t want to talk about it. I can usually forget about the dark cloud looming over my future, and ignore the flattened plum-like bruise on the back of my right hand that indicates where they took my blood for the first round of liver function tests. I decline the wine at dinner and go to bed early. I reason that this is just like a completely irrational pregnancy scare and that in a month, and three months, and six months the tests I take will turn out just the way they always have, negative. Tomorrow I will return to my life in Seronga, where I left in a hurry one week earlier. I will continue my life as normally as possible. I will try to make it through the remaining three weeks of my sentence; I will try to adjust to the slightly off-ness of my new normal.
I will hope that by the sheer force of my will, I will be fine. I will repeat it like a mantra whenever I need to white knuckle way through this, even if my fingernails pierce the skin of my palms. I will breathe deeply and I will continue on in the only direction I know how to go, which is foward...
Life at Seronga Clinic
I sit perched upon a broken stool as I stare out through the square space that comprises the dispensary window, and watch all the people on the other side. They wait patiently for their medications, drugs that will relieve some of their suffering, that will be their salvation, and that I sit amongst, unable to dispense. I again feel useless in a questionable mission. They chat amongst themselves, speaking of what I am unsure, as somewhere between my ears and my mind the rhyme and reason of this language is lost. I absorb but do not comprehend this musical speaking. They stare back at me, a fish in a fishbowl, and animal in a cage, a creature more exotic (and possibly more dangerous, based on the look in their eyes) than any animal that stalks their village at night.
At the other end of the benches where they sit babies dangle from a scale one by one, their weight measurement noted in their ragged charts by a disinterested nursing assistant. Some are used to dangling from this hook (which disturbingly appears to be the same sort of scale that is used to measure the weight of meat for sale at the butchery…) half naked in what looks like a large grocery bag with holes for their legs, and hang like sacks of potatoes. The younger ones seem surprised by their unexpected defiance of gravity, and startled by the lack of ground under their feet extend all of their limbs like little stars. Their look of complete surprise is priceless.
The nurse arrives, the words to effectively communicate with these patients spilling off his tongue like the rain shower we all so desperately crave. He distributes the small bags of medicines like Halloween candies to the hands of the waiting patients. In the next room bodiless voices in the same mysterious language float in, some urgent, others joking, all bathed in the static of the roger roger radio.
It goes on like this, day in and day out, each day like the one before and yet with an infinite significance to the ever changing cast of characters. Life will go on in the same way in Seronga, and I doubt I will find, despite my desperate searching, the switch to flip to change any of it. I wonder if I would want to, what difference it would make, if I would have the sensitivity to understand if it were for the better or worse.
At the other end of the benches where they sit babies dangle from a scale one by one, their weight measurement noted in their ragged charts by a disinterested nursing assistant. Some are used to dangling from this hook (which disturbingly appears to be the same sort of scale that is used to measure the weight of meat for sale at the butchery…) half naked in what looks like a large grocery bag with holes for their legs, and hang like sacks of potatoes. The younger ones seem surprised by their unexpected defiance of gravity, and startled by the lack of ground under their feet extend all of their limbs like little stars. Their look of complete surprise is priceless.
The nurse arrives, the words to effectively communicate with these patients spilling off his tongue like the rain shower we all so desperately crave. He distributes the small bags of medicines like Halloween candies to the hands of the waiting patients. In the next room bodiless voices in the same mysterious language float in, some urgent, others joking, all bathed in the static of the roger roger radio.
It goes on like this, day in and day out, each day like the one before and yet with an infinite significance to the ever changing cast of characters. Life will go on in the same way in Seronga, and I doubt I will find, despite my desperate searching, the switch to flip to change any of it. I wonder if I would want to, what difference it would make, if I would have the sensitivity to understand if it were for the better or worse.
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