World AIDS Day

Today is World AIDS day. I spent this particular Monday the way I will spend two Mondays a month for the next two years: working in the clinic on ARV day. With a room packed full of HIV patients waiting to see the nurses, the importance of having World AIDS day could not be more clear. I spend these days filling up charts and looking for patient folders. I will spend hours later inputting the results of CD4 counts and viral load blood work once it’s all processed by the lab. And I will occasionally help the clinic’s pharmacist organize the huge piles of pill bottles that keep people alive.

I haven’t been here long enough to know everything about how the process works, but I can write about what I do know. Botswana has one of the highest HIV infection rates in the world. In 2002, the government purchased the three-drug combinations of ARV knows as HAART (highly active antiretroviral treatment) and started training physicians and nurses to treat HIV patients. Today, Botswana provides free testing and treatment to all of its citizens.

When I talk to people about what it was like in Botswana in the 1990s, I am always told the same thing – terrible. People don’t like to talk about it much, since virtually everyone lost friends and family to AIDS, but when they do, you get a window into the sense of the fear, uncertainty, and loss that was experienced at the time. People talk about the overwhelming number of funerals the most.

To commemorate this day, I started reading Saturday is for Funerals by Unity Dow and Max Essex. The book is made up of short stories of the lives of people who were affected by HIV in Botswana. Each story is then accompanied by a scientific explanation of different facets of the epidemic. The back cover of the book reads, “In the year 2000, the World Health Organization (WHO) estimated that 85% of fifteen-year olds in Botswana would eventually die of AIDS. In Saturday is for Funerals we learn why that won’t happen”. That statistic is devastating and terrifying, but it also makes the progress Botswana has made even more astounding. People can now have healthy, full lives while living with HIV. That fact was unimaginable in the 90s.

There are still countless challenges to dealing with HIV. There are issues with adherence, side effects to medication, non-concurrent partners, and convincing people to get tested and use condoms, to name a few. At the clinic I also see some of the pressing logistical issues that come with treatment. People show up at 7:30 in the morning at the clinic, and then wait for hours and hours until they can see a doctor. The doctor for our clinic can only come twice a month for ARV day since he works at many clinics in the region, but sometimes he gets pulled away for conference, and the nurses are left with frustrated patients. Despite all the progress that has been made, there is still stigma and shame associated with acquiring HIV.  Furthermore, Botswana has an indirect culture when it comes to addressing sexuality, which can make it more difficult or awkward to discuss health issues like STIs or safe male circumcision. For example, the word for condom in Setswana is sekausu, which means sock and the phrase used for sexual intercourse translates to ‘sharing a blanket with someone’. Finally, many parents simply do not feel comfortable discussing safe sex with their children.

Anyway, this morning I read an article on al-jazeera stating that the world may have reached a turning point in the fight against AIDS. According to the article, “the number of people newly infected with HIV over the last year was lower than the number of HIV-positive people who joined those getting access to the medicines they need to take for life to keep AIDS at bay”. I felt like my heart was going to burst with joy. The article went on to state that back in 2010 only 5 million people were receiving treatment globally. This year 13.6 million people are getting their pills.

But the fight is nowhere near over, and the global response needs to stay aggressive and fully funded. I was reading some speeches by Paul Farmer the other day and he strongly criticized the lack of imagination exhibited when it comes fighting global epidemics. He also consistently fights back against arguments of cost-effectiveness that are used as excuses not to support global health initiatives. When treatments for HIV were just starting to be produced, a study found that it would be ‘28 times more cost-effect to prevent new HIV infections than to treat people who already have AIDS’.  Despite the horrifying implications of that sentence, dedicated public health practitioners fought and won to have HIV treatment more available around the world. And it turns out that AIDS medication costs have decreased to a fraction of their original prices. Not only are they affordable, but it also turns out that ARV reduces transmission to other people by 96 percent. Proper treatment is part of today’s prevention and it would not have been possible without the rollout of generic ARV drugs. The world is facing a new health crisis as well with the ebola outbreak in West Africa that has already killed over 7,000 people. The international response and support has been slow to say the least.  I can only hope that dedicated organizations like Doctors Without Borders get the support they need to help get the outbreak under control.

I never know how to end my blog posts, but I’ll say thank you to anyone who stuck with it and read to the end and I do hope that anyone who reads this chooses to stay informed and supports global health initiatives. That’s all for now!

Sources:

Saturday is for Funerals by United Dow and Max Essex

To Repair the World: Paul Farmer Speaks to the Next Generation by Paul Farmer

Al-jazeera news online

Happy Thanksgiving!!!

Happy late-Thanksgiving from a group of happy, completely stuffed volunteers~! 

Standing in the Limpopo River

Two weeks ago, Dr. Mashini gave two Peace Corps volunteers a wonderful gift: he invited Megan and me to join him on a Sunday to do malaria testing in the Tuli Block! For those of you who don’t know, the Tuli Block has a game reserve in the very east of the country with some of the most incredible and diverse wildlife in Botswana. Since it is not nearly as well known or visited as Chobe National Park or the Okavango delta, Tuli is often referred to as the hidden jewel of Botswana. Nonetheless, quite a few people live and work in the Tuli Block, especially monitoring the borders with Zimbabwe and South Africa, so Dr. Mashini wanted to make sure they also had access to malaria testing and treatment. As you can imagine, Megan and I were practically giddy at the thought of going.

Early that Sunday morning, we clambered into the back of an ambulance and held on for dear life while we trundled along the bumpy terrain in the Tuli Block. On our way to the testing sites, we peered through the tiny side windows of the ambulance to try to spot some wildlife. Suddenly, the ambulance lurched to stop and Dr. Mashini started frantically pointing out the window. It took me a couple of minutes to figure out what was going on, and then I saw them, five gigantic elephants casually picking leaves off of a tree. They were beautiful and gigantic and terrifying. We took pictures as quickly as possible, but sadly my crummy ipod camera does not do well with zoom and they didn’t come out to well. Nonetheless, we kept zipping around the Tuli block for the next hour or so until we reached the border post where the malaria testing would take place.

Once Dr. Mashini was well set up, he told us we could go explore a bit while he tested patients. A guide graciously walked us down to the riverbed where we had seen a crocodile. Across the way we saw a gigantic family of baboons and some elephants all watching us from the other riverbed.  I couldn’t believe I was standing in a riverbed, staring at all these incredible animals.

The big rains haven’t come to Botswana yet, so the river was almost completely dry. In a few months it will be full again and there will be hippos happily floating about. After the malaria tests were finished, we were lucky enough to have a tour guide drive us around in one of their game cars. We saw ostriches, kudu, impala, springboks, giraffes, baboons, warthogs, wildebeests, and of course, more elephants. At one point we were quickly veering through the bush, the car took a quick right, and suddenly, right in front of us was a huge elephant running along. Before the elephant could turn around and see us and decide to charge, the driver picked up his speed to scare the elephant into running away from us. After a heart-stopping minute, the elephant ran off the trail and into the bush. Elephants can be extremely dangerous when they feel threatened, so our guide took no chances and got us out of there.

Finally, another highlight from the trip was when we stood in the middle of the connecting point where the Limpopo and Shashe Rivers meet.  This point had us standing right at the edge of where Botswana, Zimbabwe, and South Africa meet. I climbed to the top of some big rocks, and took in the view.

This volunteer is home

Hello internet world! Please excuse the long absence in updates. I needed to take a little time to settle in to my new home and once I did that it took even longer to figure out how to get the internet necessary to post, but I can now proudly say that this volunteer is officially moved in!

I should start with the swearing in ceremony. On Wednesday the 16^th of October, Peace Corps Botswana welcomed 72 new volunteers to the Peace Corps family. The ceremony was lovely, many dignitaries were present, and the US Embassy’s Deputy Chief of Mission led us in taking our oath. My friend Isaac gave a speech that moved us to tears, and then my friend John gave a Setswana translation of that speech with such gusto that he had all of us shaking with laughter. This day was a particularly proud one for all of us; some volunteers have literally been waiting for this moment since they first started their applications years ago. I was reminded of my college graduation a few months ago and how happy I was on that day too. I really wish my friends and family could have been there, but I know I’ve got a wonderful support system cheering me on from a distance. After the ceremony ended there was nothing left to do but celebrate with my friends and internalize that we were all about to venture off on our own at last.

Fast forward a couple of weeks and I am now happily settling into my new home village. Any move requires adjustment, but I think it’s fair to say that this one requires quite a bit more than usual. My house is lovely and perfect for one; I am lucky enough to have both water and electricity, although both sometimes go out from time to time. So far I have met many of my neighbors and they are all warm and welcoming people. Since I mostly lived in big cities before moving to Botswana, being a part of a community is very new to me. Some highlights of my community life include: a neighbor came over on my first night with a plate of food to welcome me, one of my neighbor’s kids came over one night just to drop off some handmade Setswana flash cards to help me learn the language, and my personal favorite, once the neighborhood kids found out I had never been in a donkey cart and wanted to try it out, they showed up one afternoon with one and took me for a ride around the block.

I also started working at the clinic three weeks ago and am trying to learn the ins and outs of how things are run. Gobojango Clinic is actually more of a health post. The regional doctor, Dr. Mashini, comes twice a month for ARV (anti-retroviral) day to check up on HIV patients and do general consults. Dr. Mashini is from the Democratic Republic of the Congo and speaks fluent French, so I get to have someone to speak French with! Anyway, it’s fair to say that those two days are easily our busiest each month. When the doctor isn’t around, things get very quiet by lunchtime and I end up with ample time to read or try to practice Setswana. I was invited to join the student PACT club at the junior secondary school as well, so twice a week I walk over to the school and help the kids plan their projects. PACT club provides peer counseling and support to other students and tries to raise student awareness about various health issues that affect young adults.

Now that I’ve settled into a bit of a routine and have submitted my security forms to Peace Corps, I will begin work on my Community Assessment. Over the next few weeks I will interview members of the community and try my best to learn as much as possible about Gobojango.

I still feel like I have a long way to go in adjusting to being here. It’s hard to find my balance between wanting to integrate and form bonds as soon as possible and taking time for myself to recharge and be alone. It’s also quite an adjustment to go from being around American volunteers constantly to being the only American in a village of 2,200. Furthermore, since there is no guide book for what to do and there’s no one around me to compare with, I spend a lot of time wondering if I’m doing what I’m supposed to be doing and puzzling over what kind of projects I can work on next year. For now, I just keep telling myself to trust the process, to stay present, and to stop worrying about what will happen months from now. A quick shout out to my friends and family: thank you for all the love and support, for all the emails and phone calls, and for your patience in waiting for me to update this blog! I couldn’t do it without all of you.

Peace Corps Thoughts

With swearing in just around the corner, I started reflecting on why I joined the Peace Corps, what I’ll be doing for the next two years, and why this is the right choice for me. I started my application in September of 2013, so I’ve been thinking about the moment I would swear in for over a year now. I first thought about joining the Peace Corps when I was in middle school, before I even really knew what it was. Then, in high school I decided there was no way I could ever join the Peace Corps. Two years was way too long and impossible, that was a big chunk of my young life to commit to something!

It wasn’t until the summer after my junior year of college that I really gave it some serious thought. That summer I did a humanitarian training course in Toronto complete with an intense simulation in the woods and a healthy dose fear. This course opened my eyes to the importance of global health and how connected it is to international relations. Most importantly, I was introduced to an incredible group of people from all over the world who were passionate and dedicated to humanitarianism. Many of them had experience working in the field in remote corners of the world. I even met an American who said he wished he had joined the Peace Corps when he was younger (Now that I know what I do, I just want to say that it’s never too late! Bots 15 has some kickass older people who have a wealth of experience to share while they’re here).

Anyway, that fall I sat down with a professor at my university who had done the Peace Corps in China to talk about his experience. He told me that Peace Corps is the only organization he could think of that gives you the chance to really be a part of a bottom-up development approach where you get to live and be with a community, and that’s exactly what I want to be a part of. I want to work and live with my community in Gobojango and learn everything I can about Botswana. Peace Corps calls it ‘peer-to-peer development focused on capacity building and sustainability’ and that’s what I’m going to strive for. So after all that thought, this Wednesday I’ll take my oath and swear in as a health volunteer for Botswana.

 

For my first three months at site I will be on lockdown, or as Peace Corps would prefer we refer to it as ‘community integration’. During that time, all I’m supposed to be doing is getting to know my community. I need to learn the ins and outs of my clinic, learn about the available resources in the village, and complete my community assessment. They don’t want us starting on projects until we actually know what’s going on in our villages. It will be very strange going from being around 70 other Americans constantly with a busy schedule to being alone in my new house with a fairly relaxed schedule. Most of me cannot wait, but a small part of me is worried about how I’ll handle the isolation. I know I’ll form bonds with people in my community, but that will also take some time. I just need to be patient and trust the process.

I was planning on buying a dongle yesterday so that I could have internet at my site, but when I went to the store they said they were out! There’s a chance they may have some next week, but if not, it may be a long while before I can post again. So until then, thank you for reading my blog and wish me luck with the big move! (I have no idea how I’m going to drag all my stuff to Gobojango)

Here are a few more pictures from my day to day life:

Some kids at culture day ran up to show us their awesome moves

These purple trees are in bloom all over Serowe right now and it's beautiful

This is my favourite dog in Serowe, we've named her Ladybug and she is the cutest

Week 7 and 8

Well, I tried to update my blog last week, but the power kept going in and out so I eventually gave up. It’s probably a good thing anyway, because week 7 turned out to be pretty rough. When we got here we were told week 7 is one of the hardest weeks of PST, and now I understand why. It’s difficult to explain, but I basically think we were all burnt out. After all the excitement of site announcements, I think we lost all of our energy and drive. Anyway, week 8 was hard too, but now we’re getting much closer to the countdown for site and we’re all just trying to push through and finish strong. We also got a bit of a break because Botswana’s independence day was this week! September 30^th marked 48 years of independence for the country and we were graciously invited to the kgotla to see some of the festivities. Then I hopped into a combi (little van) and went to my host family’s independence day gathering. For this holiday, people tend to return home and have big parties, so I got to meet my host mom’s entire family! It was a pretty wonderful experience. Some of her younger nieces and nephews speak perfect English so I got to ask them all about Botswana culture. Some of the best times I’ve had here involve just sitting under trees, enjoying the breeze, and talking about Botswana.

This Saturday was our host-family appreciation party. We had to plan and provide food and entertainment for 250 people on our own. It got pretty stressful sometimes, but our group was amazing and really well organized. The night before the party was probably one of my favorite moments of PST so far. We finally managed to buy our supplies and bring them to the school. Someone put on some music and everything fell into place. Everyone had their assigned jobs and we were all working together and it made me really happy. I was on the decorations committee and we managed to put together some pretty great things with our limited resources. One volunteer, Laura, managed to draw a giant map of America and we all got to add our names for the places we’re from. It was really cool to have our host families walk up to it and see how diverse our group is and how we literally come from all over America.

Overall, I think the party was a big success. We had great food and music and even a Jell-O eating contest! Some of the younger kids learned to do the Macarena and the electric slide with us, and at one point we had a big circle going so people could jump in the middle and show off their moves (including some awesome old ladies).

Only 10 more days until I swear in as an official Peace Corps volunteer!

Me and my host niece Sadie at the party