Thursday, September 8, 2011

Wrapping things up: Part I- Botswana Survival Guide

Ever since I’ve been back, I’ve been trying to synthesize my Botswana experience and decode what it meant to me, what I learned and how I wanted to grow as a result of my time there. Sheesh. Talk about biting off more than you can chew.   This sort of experience, unsurprisingly, doesn’t take kindly to attempts to categorize, contain or label it in a consise way but as per usual, I’m going to try my best. Also per usual, I was feeling verbose and thus am going to split up my thoughts into 3 posts.

Patience, perseverance and the delicate combo thereof: my experience in Malawi gave me a leg up on this one: it can be so incredibly frustrating to work in a developing country. Most people think that is because of a lack of resources: “it must be hard to want to treat someone with a medicine or procedure that you don’t have.” I suppose that is true, but I think that most people who do this kind of work are prepared to make the best of what is available. What people are less prepared for is dealing with what people like to term “cultural differences” or “inefficiencies” (I find these somewhat euphemistic).

Hard to get frustrated when you get to see babies in clinic
I told Kari of the metaphor I like to use for my interactions at the hospital: one of the those dolls that you punch but they keep springing back up. Whenever I wanted to accomplish something (fix a microscope, check on a patient, get a photocopy, install software etc), I would get rebuffed or redirected almost instantly: “why don’t you talk to Mr. So and So, come back later, we don’t do that here etc etc.” I'd call it getting PMH-ed. The trick was not to get annoyed by that or respond by being pushy. I would simply write down the information I needed and say “What is Mr. So and So’s phone number? I will be here tomorrow at 8:00 and I hope to find him here.” Do this enough and people realize that you are serious and they will help you. Remarkably effective actually. 

When all else fails, use junk food: It is important to remember that you are a guest. While you should never compromise when it comes to an issue of patient care, it’s still important to be polite and respectful. Bringing offerings of food never hurts. 
Behold the transformative power of cake! Saying thank you to all my lab buddies.
Let go of your elitism: it would be really easy to leave Botswana disgusted by way some things are handled. And it’s true- there is no excuse for letting patient care fall by the wayside. It was hard to stomach sometimes: I met doctors who seemed not to care about their patients, nurses who would routinely use facebook during clinic etc etc. One time I tried to bring a very ill patient into the dermatology clinic room but the nurses insisted I find somewhere else because they wanted to go home. Patients weren’t generally handled with deference and I saw some things that really horrified me. It would be easy to emerge from this experience smug in the knowledge that many of these issue would be better handled in the US….BUT let’s remember that the US fails on patient care in other ways: we order unnecessary tests, practice defensive medicine, don’t spend enough time with our patients and we are participating in a healthcare system that is unsustainable. So coming from a place of judgment not only limits what you can learn from a place, it also is sort of hypocritical.

Going above and beyond: a nurse at Kanye
Try not to generalize: Many of the physicians I met did not take initiative at all, many would try to shunt responsibility whenever possible. In some ways, this colored my experience at the start of my trip especially because the nurses I worked with in Malawi were dedicated almost to a fault. However, for every lazy lab tech, sullen nurse and irresponsible doctor- there were 3 other people who would go above and beyond for patients, their colleagues etc. I was blown away by the microbiology lab worker who let us look at crfptococcuc under the microscope just so we could learn or Bonnie, the nurse who looked up a patient’s phone number (I still have no idea how she did that) so we could ask if they got treatment for a DVT.

Most the door to your room on safari: or a monkey will come in and steal your coffee...duh!

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