Sunday, July 31, 2011

Sunday: Misadventures on Kgale Hill

The team: , Armageddon (Kari) Kung Fu Panda (Liam, owing to the fact that he is a blackbelt in karate and captain of the Cambridge University karate team) and Bush Baby (me).

The mission: Climb Kgale hill.

As we pulled up to the car park of our confidence had already swelled: this hike won’t take more than an hour total! We started on our hike full of vim and vigor. Panda took the lead, scrambling up the rocks like a nimble tree frog (and yes, I’m aware that tree frogs don’t scramble up rocks but cut me some slack). 

We made it up the totally unmarked path (which consisted of huge boulders) with only a few hiccups and were treated to some breathtaking views of Gaborone. 
Why are we outside the fenced path?
Gleeful from our successful summit we started on our way back down. And this time we found a trail of green arrows! Smug, we practically skipped down the mountain and stopped to take the odd picture or two. 

All was rosy and well in out world until we discovered that we were outside the fenced, concrete path we were meant to be going down. Hmmm. We were still following the green path so we continued on our merry way. Who needs a path? We were hearty Botswana trail warriors! 

We continued with our green path for quite some time until we realized…approximately 1 hour later…that perchance we were veering slightly off course. How did we know? For one thing, we could barely even see the hill from which we had descended and for another, we heard the sounds of a quarry…the same quarry that we saw in the distance from the top of the hill. 

And still we didn’t worry. We were following a clearly(ish) marked path. But then we came to a 3-way split in the path and none of the 3 ways seemed to be correct. OK, so now we’d lost the clearly marked path and we couldn’t see where we came from but this path had to lead somewhere, right? 

But morale flagged for a brief second as the path looked less path-y and we battled copious thorn trees. We considered turning around until Panda ran ahead and shouted that he could see a road! We were overjoyed until we realized that we had wandered into a blasting zone that was basically nowhere near where we needed to be. Oops. 
We wandered down the road until we came to a quarry worker (I would have loved to have been able to read his thoughts as he saw 3 white people emerge from the bush) who vaguely pointed us in the direction of game city (a mall that is a few km from the car park). Luckily, we were able to hitch a ride with a kindly gent and made it back to civilization with nothing more to show than bruised egos and a few thorn-induced flesh wounds. Maybe they will get infected with sporotrichosis and we can write up the case! (Kidding! Sort of). We ended the adventure with a giant muffin and bottomless ginger beer at Mug and Bean where we toasted to our stupidity, lack of directional sense and all-around buffoon-ery. Go team!
See that huge quarry way in the distance? Yah. We ended up on the other side of that.

Saturday: Bye bye Dougie Fresh and Hello Gaborone Game Park

Went to Fresh Cafe in the AM in honor of Dougie Fresh's last day. We saw him off and then, through the fog of our tears, Kari, Liam and I decided to deal with the lost of the Fresh-ster by going to the Gaborone Game Reserve. Our expectations were low - this "game park" is like 10 minutes from our flat and by Botswana standards, is more like a playground than Disneyworld if you will.

We needed a car to get around so we called our favorite cab driver, Tendai. Despite our low expectations we had the best time- it was awesome! We saw warthogs, ostrich, rock dassies, impala, kudu and so many monkeys. We would spot something in the distance and Tendai would gun the engine and chase it down while yelling "capture it! snatch it!" (he meant take a picture).


Toward the end of the day we came upon a cadre of monkeys who eagerly approached the car. At first I was simply charmed by the little imps but I started getting nervous as they jumped on the hood and got closer to the window. Kari and Liam were making fun of my jumpiness but I waved them off- "I'm not scared!" We drove up a bit to another group of monkeys and I had my head of the window when BAM a monkey popped up out of nowhere right near my head. I screamed and literally flung myself across the car onto Liam's lap. Keep in mind that these are vervet monkeys which are not aggressive and all of 1ft tall. Needless to say my little "episode" was the source of much amusement for my compatriots. Hmmpph. 
Trying to regain composure after I launched myself at Liam. Note the monkey in the background. Cheeky lil' bugger.      

Moderately less frightened. At least enough to throw the 'ol double thumbs up.
 The other highlight of the game park was a small unlabled building/tent/shanty near the entrance. Intrigued, we stopped in and discovered several very dirty fish tanks with a few random fish swimming in the murk. One simply held a large, dead fish. Why was there an "aquarium" randomly in this totally dry game park? These are questions I don't trouble myself with.

The star exhibit at the "aquarium:" a huge dead fish in a tiny tank.

Tendai checks out the rest of the aquatic exhibit.

Friday, July 29, 2011


One of the coolest things I get to observe is the use of the robotic microscope in the National Lab. When a skin biopsy is done (by Doug or Didi, PMH's full time dermatologist), we take it to the national lab (across the street) and Doug gives it a preliminary read (i.e. what he thinks is going on based on the microscopic appearance of the skin and the clinical data that we write down). If it's clear cut, he writes down his read and that's that. For the other cases, we load it onto the wells of the Zeiss Mirax Live RT microscope and the computer scans it. The images are sent via the internet to Carrie Kovarik in Philadelphia (who is the head of the study I am working on). She can even control the microscope remotely! She emails her reads to Doug and we write them down in the records. Simple as that.

This robotic telepathology technology is truly amazing and, at least to me, seems like the future of medicine. Especially in a developing country, it fosters a level of collaboration that would be impossible without the aid of tools like this.

If anyone is interested, there is a more in-depth article about this program (authored in part by Dr. Kovarik) in the latest issue of JAAD (the Journal of American Academy of Dermatology): May 2011 Volume 64, Number 5.

Wednesday, July 27, 2011

Happy Birthday Dougie Fresh + other inappropriate things

Doug's birthday was yesterday. The big 50 35. We had an excellent day in clinic, went to Fresh Cafe (how appropriate for Dougie Fresh) and then out to dinner. Doug had a hankering for some General Tso's chicken so we braved a place called "Chinese Restaurant." 10 points for simplicity. 

They wisely seated us in our own room and, because our collective maturity level hovers somewhere around 6 years old, we wasted no time playing with the lazy Susan (all of us) and sticking chopsticks up our nose (Doug). At least he doesn't act 35 :)

My menu was crumbled, stained and otherwise very difficult to read. Luckily I was able to read the first dish on this page loud and clear: 

Yes, that's right. Seafood with ass mushroom. I would make a pithy speculation about what an "ass mushroom" would be but a) this is a family friendly blog and b) after three weeks of dermatology (which frequently includes seeing sexually transmitted diseases) I might have too vivid an idea of what an ass mushroom might entail.

We ordered a melange of food and it was actually delicious. As they heaped it on the table we looked at one another in alarm: did we really order that much? We comforted ourselves with the notion that we'd have leftovers. Yah right. 30 min of solid feeding frenzy later we had fully dispelled that delusion. Not even a lone grain of rice escaped the carnage. 

We went home and had some delicious cake and Doug enjoyed his 2 birthday presents from me: a facebook account and some Jack Daniels. Just what every 35 year old needs. 

I feel it worth mentioning that despite all the good natured ribbing from me, I can't even tell you how much I appreciate Doug. I literally spent every waking moment with him these past few weeks and I mean every waking moment. We not only work together in clinic, on the wards and in the lab but we also live and play together. That is a lot of time to spend with someone who you just met. 

I know that there are time that he wanted to strangle me (like when I asked him the 101546th derm question of the day when he was "off the clock") but to say that he put up with me would be an egregious understatement. He taught me so much, kept me laughing pretty much 24/7 and basically shaped my entire Botswana experience. It was a pleasure to watch him settle into the routine here and really hit his stride. I'm sad that he's leaving on Saturday- I'm so lucky to have been able to work with him and I can't wait to bother him er....shadow him.... when we get back to Philadelphia. 

Happy birthday, buddy! We'll miss you so much when you leave :(

Tuesday, July 26, 2011

Madikwe (aka obligatory pictures of animals)

You thought you'd be able to escape it. You weren't sure. But as time wore on and I blathered on about dermatology and the hospital, you grew hopeful. "Perhaps," you thought. "perchance I might be able to read a blog about a foreigner in Africa without looking at a picture of a godforsaken elephant." 

Well, friends, I am sorry to disappoint. But I am, after all, only human. This past weekend Doug and I scooped Kari up from the airport and headed an hour or so over the border to South Africa. We spent the evening in Madikwe Game reserve. 

I really couldn't help myself even though I know that millions of more qualified photographers have captured the flora and fauna of Botswana in far better fashion than I. It's like a compulsion. I'd be sitting in the safari jeep, see an animal and I'd start getting that itch. "Stop it, Hayley. Don't even think about taking out your cheapy point and shoot and getting a blurry picture of that elephant." But I lack the necessary self control and out would come the camera and I'd end up with 40 pictures of the same pachyderm. Sigh. 

Well... now you'll all have to suffer. Hah! 

Jackal eating a dead elephant

In all seriousness, it was an amazing weekend. And after three straight weeks of begging- I even managed to drag Dougie on safari with us! What a coup! 

Monday, July 25, 2011

Best. Team. Ever.

Kari came bearing gifts (I told you she rocked). She and Jen have made me an honorary (very very junior) member of "team derm" and sent me this sweet glow in the dark shirt (from a race ran by some residents and attendings I guess). Derm AND glow-in-the dark? It appeals to both my inner nerd and my inner 8 year boy so I'm pretty much in heaven.

THANK YOU JEN (and good luck on your boards- you're going to kill them!).

Kari is here!!!!!!

This weekend marked the arrival of Kari, the next derm resident who I will be working with. She and Doug will overlap a week and then it's just me and Kari. I actually knew Kari before coming here and I LOVE her. She is Wisconsin friendly at it's best.

Back in Philly I had the opportunity to shadow at the STD clinic and Kari was working that day. She was so welcoming and I learned so much from her and Dr. Intracaso (the attending). I couldn't believe how nice they were.

A month or so later I was invited to a dinner for residents in the global health track. Knowing no one except Dr. Kovarik (the head of the vulvar cancer study) and being a lowly medical student (and a first year to boot...the peons of the peons), I was pretty terrified. And sure enough, the resident sitting next to me pretty much lost interest right away when I disclosed my lowly status (I should have been wearing a scarlet S on my head for student). When Dr. Kovarik had to get up, the resident turned his back and started a conversation with someone else so I was stuck with no one to talk to.

When I grew tired of cursing the back of his head, I couldn't decide whether I should take out my phone (and risk looking rude and disinterested) or to stare into space with a dumb smile plastered on my face (and make it patently obvious that I had no one to talk to).

All of a sudden I heard a friendly midwestern accent: "Hayley! Come sit here!" I have never been so relieved to hear my name. It could have been Jack the Ripper and I'd have heeded the call- anything to ameliorate my loser-dom on display. Luckily it wasn't a 19th century serial killer- it was Kari and she remembered me from STD clinic (tangent- I hope no one is skimming this and reads just this paragraph because "she remembered me from STD clinic" isn't a phrase you want taken out of context). Even though she's a 3rd year resident (and chief resident at that) and I am merely a peon, she was amazingly friendly and introduced me to all the residents she was sitting with and included me in the conversation.

I saw her a few more times since then and I was psyched that she was coming to Botswana. When she arrived (sans luggage...ugh) Dougie and I scooped her up and took her to Madikwe game reserve in South Africa. I'll show the pictures in the next post. Bottom line...Kari is here and I'm so psyched. Everything I've suggested she's like "Sure! I'll do that!" And she said that she'll fully indulge my nerd-ery...we've already looked up the whole Porphyrin cascade so we could understand Porphyria cutanea tarda. It's gonna be a great few weeks.

Team Derm at Madikwe!

Sunday, July 24, 2011


I am so unbelievably happy right now. I have had one of the best weeks of my life and I can’t wait for the rest of the summer. I think that the reason for my happiness is multifold. Being a compulsive medical student (you should see how many highlighters I use in my notes), I tried to break it down into each individual factor: 

1. Taking a break from the grind
As I mentioned in a previous post, I think that medical school is awesome. I feel so privileged to be able to learn about the body and spend time with my awesome classmates (PennMed 2014 for the win!). But as any medical student will tell you- the pre-clinical years of medical school can be kind of a grind. You are basically binging on information day in and day out. And although Penn makes a valiant effort to get us in small groups and foster discussions, it can be kind of isolating and frantic trying to memorize all the various microbial pathogens for example. But having some time off has allowed me to get excited about what I’ve learned/am learning. After my last exam, my friend Nick was asking me questions about the gastrointestinal system and as I attempted to answer him, I felt myself getting really excited while explaining how fiber is digested. I think that a little space is a good thing in this case.

2. Being in Botswana
One of the residents I am working with mentioned that I seemed so at ease and comfortable navigating my life here, almost as if I were “coming home.” That sort of resonated with me- I do feel like I’m coming home in a way. Not that spending time in Malawi last year makes me African or that I think I’m super authentic. It’s just that I really enjoy being here. I’ll join in when everyone complains about not finding Heinz ketchup or about the inefficiencies at the hospital but the truth is that I adore being here. Really and truly love it.

3. Doing dermatology*************
I can’t remember the last time that I have been this intellectually stimulated. I am fascinated by the skin conditions we’ve seen and I literally pepper Doug with questions whenever I get the opportunity. I scribble down whatever I can during clinic and then I come home and look up what we’ve seen. I’ve already filled an entire notebook. Without sounding braggy- I am very proud of how much I’ve learned. I went from not knowing anything (not an exaggeration- we’ve not had any derm yet) to being able to describe a rash and even having some ideas about a differential diagnosis. I’ve already annoyed my roommates by talking incessantly about dermatology but I can’t help it- I really love this stuff. 

I have always been"that kid" who loves things that other people consider gross. Pus, absesses, flaky skin, warts, blisters...I love 'em all. My mom once left me a JAMA article (about a derm case) with a note: "because you like gross things." Most of my classmates don't share my enthusiasm so I've tried to keep it under wraps so it's been amazing being around derm residents who share my fascination. 

On Jenny's last night (a Friday night) my friends literally had to drag me out of the apartment because I wanted to stay in an do practice questions with Jenny. I was so sad to see her go but she was kind enough to bequeath me a stack of her old dermatology books so I plan to continue the nerd-ery when I return to Philly.

Gratuitous picture from my trip this weekend. Consider it a preview. 

Thursday, July 21, 2011

Staying fit

One of my priorities on this trip was not to let myself get out of shape. I'd been running and doing pilates in Philadelphia so I wanted to keep it up as best as I could.

Our walk to the hospital each morning is 30ish minutes each way so that's not a bad start. On top of that, I've gone on a few runs (I don't want to run alone after dark so it's hard to find time. But I'm getting in a rhythm and hoping to make running a more regular part of my exercise regime. My favorite activity, however, is pilates/abs/pushups with Nathalie. We look absurd but we have a great time.

Wednesday, July 20, 2011

Typical day

Again, the unwashed masses are getting restless. Enough with the salt pans and meerkats. They (OK, OK it's just my grandmother again) want to know more about what my typical day is like here in Gaborone. Given that today was fairly typical, I thought I'd share my agenda in excruciating detail

7:00 am - Leave our apartment and walk to the hospital
7:30 am- Check on a patient who is being enrolled in my study and has an appointment today
7:45 am - Morning report (internal medicine doctors present cases)
8:30 am- Check on the inpatient consults. Today we are re-visiting a woman with a very swollen leg and a bullous (like huge blisters) rash. It seems like no one else is checking on her so we are compressing the leg and dressing it each day.
Writing a note for an inpatient
9:00 am- Dermatology clinic begins. We saw quite a few complicated cases today.
1:00pm- End of clinic. Time to clean up, bring our biopsy instruments to get sterilized and take stock of what we'll need tomorrow (because tomorrow we have outreach clinic).
1:15pm-  Go to the main hospital lab and then the microbiology lab to drop off our bacterial cultures and mycobacterial stains
1:30-3:30pm- Go across the street to the national lab. Agenda for today- drop off fungal cultures, find missing slides (we got 'em all!), load new slides on robotic microscope and then Doug does preliminary reads of the slides (he looks at them before they go on the robotic microscope and get read by Dr. Kovarik in the US) while I double check on the retrospective samples (they are finally ready!).
3:30pm- Quick stop by gynecology clinic to see if I can find out anything about my study patient
4:00pm- Walk home (jump across the ditch again)
4:30pm-7:00pm- Scarf some food (lunch slipped through the cracks today), restock biopsy bag, arrange a ride to the bus station for tomorrow morning (for outreach clinic), look up anything I didn't understand in clinic today, write up an instruction sheet for VisualDx (the computer program I installed in the library here), update the blog.
Biopsy bag madness. I am always petrified that I will have forgotten something. I literally woke up from sleep last night muttering about 3cc syringes, 15 blades and IL kenalog.

7:00pm- dinner for Aileen (a 4th year med student at Penn) because she is leaving tomorrow :(

Then wash, rinse and repeat!

Tuesday, July 19, 2011

Makgatigati salt pans: last and final part I swear!

We ATVed off the pans but before we got back to the hotel we made a pitstop to meet some meerkats! They were just as adorable as they look in the pictures. 
I love how prim they are with their tiny little paws poised delicately over their tummies

Yes. I touched a meerkat. In fact, I touched several meerkats.
  We got back to the hotel and were all pretty nervous about our trip home. We needed to flag down a bus before 1pm if we had any hope of being in Francistown before dark. We were told that the buses “usually” come by every hour and would “probably” stop for us. After scarfing down some food (and the term “scarfing” is way more ladylike than what we were doing), we started to settle our bill and discuss our return trip. “Excuse me ladies, do you need a lift?” said a man sitting near us. “That’s very kind of you, but actually there are 6 of us so unless you had a bus, we need to stick together” we explained. “I actually do happen to have an empty bus” he responded. Can you believe our luck? He was a tour operator and a friend of Marya (who was on the pans with us) and he did indeed have an empty passenger van. So we arrived in Francistown in style. 
Our saviors and our chariot.
This time around we were more than prepared to do battle with the bus rank. I led the charge, marching resolutely toward the buses and politely but firmly waving off everyone who tried to “help” us by trying to show us the bus to Gaborone (they generally expect recompense).  I may even have whipped out the tried and true “talk to the hand” sign when trying to shake a particularly persistent gentleman. I hate being rude but in this case all we wanted to do was get ourselves (and our possessions) safely on the bus. We were able to do so without a single incident and we arrived home in Gabs by 8:30pm.

All in all, despite the hassles in Francistown and a total of 32 of hours traveling, I have to say that this was an incredible experience and I would do it again in a second. 

Makgatigati salt pans part 3: waking up on the pans

We woke up just in time to see the sun rise over the pans. I have to confess a nerdy secret: when I first woke up I sleepily rolled over to Julia and said, “wow, the pans really look like sebhorrheic dermatitis (an inflammatory condition that causes flaky, scaly skin).”
Seb Derm anyone?
Our bedroom
Camp in the morning

I should probably explain that the Makgatigati salt flats (one of the largest salt flats in the world) are actually several flats connected by sandy desert. They are the remnant of what used to be a lake bigger than Switzerland. During the wet season they will be covered with water and grass but during the winter season they are dry and flaky (cough, cough seb derm). We stayed on the Nwetwe pan. 

Brief pictoral interlude

Salt pan bandits. I'm the one in the middle.
I am a compulsive cartwheeler

P.S. Any/all photo credits from the pans go to my lovely roommate/friend Julia Beamesderfer. She's a pro with the SLR, eh?

Makgatigati salt pans: part 2- trekking onto the pans

We woke up (after sleeping 12 hours) feeling much refreshed and decided that we couldn’t ignore the siren call of the beautiful pool at the hotel. I know it’s hard to conceptualize, but it’s winter here and it gets really cold! Like pants/sweater during the day and fleece/gloves at night cold. But PennMed-ers are a hearty bunch so we stripped down to our skivvies and jumped in. Freezing but totally worth it.

 Finally we set off toward the salt pans with an amazing drive:

We made a quick stop at Chapman’s baobab: an enormous tree that is more than 4,500 years old.

Next we donned some headscarves (for dust control) and hopped on ATVs to make the trek onto the actual salt pans. Despite an injunction from Doug aka the “man of the house” (the derm resident I work with) not to use the ATVs, we had a great time and were very careful. 
Roommate love.

I love how little liability there is in Africa. Here was our intro/safety talk: "These are the quad bikes. Turn on like this. Down for neutral. Up for shifting- 1, 2, 3, 4, 5. Don't forget to downshift when stopping." That was it. No wavers, no demonstration, nothing. Several girls in our group had never driven a manual car so they were like "umm...shift?" But the whole "throw you in the pool to learn to swim" technique worked like a charm because within 5 minutes we were all ATV-ing champs.

We arrived at camp in time just as the sun had dipped below the horizon. We ate dinner and stayed by the fire telling riddles with the guides and the other guests: an American women named Marya, 2 young British boys who were biking across Southern Africa, a Japanese diplomat couple and a German family.

At around 10pm we crawled into our sleeping bags. We slept without tents, with nothing between us and the stars. The moon, however, was so bright that you could have read a book without a headlamp. Keep in mind that the temperature was hovering somewhere around freezing so I was wearing, no joke, 6 layers. Closing my eyes that night I felt obnoxiously, deliriously happy.  I kind of can't believe that I am here in Botswana, doing something I love while having the most amazing experiences. It's an incredible feeling.

Makgadigadi pans: Part 1- Getting there

(I am going to split my description of my long weekend into several parts in the hope that it's less overwhelming. I already received some "feedback" that my account was confusing (*cough* my grandmother *cough*)  so just as a brief overview here was our itinerary:

Sat: Took a bus from Gaborone --> Francistown --> Gweta (the location of our hotel). Spent the night at the hotel
Sun: Spent the morning at the hotel and then headed out to the salt pans that afternoon (got there by a combo of driving/ATVing). Slept on the salt pans.
Mon: Woke up on the salt pans and headed back to the hotel. Did the reverse of our previous bus journey (Gweta --> Francistown --> Gaborone) back to our regularly scheduled programming ....

Getting to the salt pans was a less than pleasant experience. Let me preface this story by saying that most of the interactions I’ve had in Botswana have been unbelievably friendly and pleasant. But, as any traveler knows, the laws of probability favor at least a few unsavory experiences as you traverse the world. And a personal note to my Nana- don't read this.

We got up at 5am and got a ride to the bus rank where we boarded a public bus to Francistown with little issue. Two hours into this 6-hour leg, however, the bus pulled over and everyone started to get up. We looked around confusedly until an elderly woman took pity on us and explained that the bus had a leak. 15 minutes later and they apparently fixed the leak…or so we thought. 20 minutes after that, the bus pulled over again. This time they didn’t let us off. There was a general rumbling amongst the populace and people were shouting things in Setswana but of course, we had very little idea what was going on. Christina, another med student traveling with us, leaned over to me “I saw someone earlier chewing on a match.” Grrrreeeatttt. The bus finally started moving again and we made it, without bursting into flames (which is always a bonus)

Once in Francistown we all piled off and decided to use the bathroom before boarding our next 4 hour bus. Once we arrived at the bathroom, however, our friend Amy realized that her wallet hadn’t exactly made the trip with her. Pissed off and a bit frantic (being pickpocketed stinks), she was escorted back to the bus by Julia to make sure she didn’t leave it on the seat. On the way back to the bus, two men grabbed them and tried to search through their pockets. The worst part was that they were yelling for help and not a single person in the crowded bus rank did anything to stop the men. Luckily, they were able to pull away and rejoin the group. At this point we were all super rattled and simply sat on the bus until it left. The rest of our trip was uneventful and we made it to the hostel without incident. 
Got off the bus at Gweta after 12 hours of bus travel.
Fear not, dear reader- put away your hankies...the rest of out odyssey was far happier. When we got to the hostel we found out that the tents we had reserved were unavailable so we were upgraded to the most adorable little huts for the night (only 110 Pula a night each which is like $17!!) Our hotel, by the way, was called "Planet Baobab" after the amazing baobab trees scattered around the property. I challenge any of you to say "we are staying at Planet Baobab" without a trace of irony. Impossible. I’ll save the rest of the story for my next post but here are some pictures.

Bar at the hotel