Christmas Potpourri

School is out for the summer holidays (BTW it's summer here) and people are gearing up for the festive season. The normal bumper to bumper traffic from 0645-0745 and 1630-1830 has been replaced by bumper to bumper lines leading into the retail establishments of the 'big city' (Gaborone). I am eagerly anticipating the arrival of my sister and mom who will spend Christmas with me here in Africa!

This first picture is of a painted fabric table runner (that I am using as a decorative hanging) that was gifted to me by the women in my Bible study. Isn't it beautiful?



Here is a picture of the post-office where I receive my mail.



These are the birds that are enjoying a lay-over on their journey north in our pool. This is not a natural migration. One of my housemates has a delivery service and he recently has been doing business with poultry farmers... or something like that. Let's just say I haven't been spending much time in or near the pool recently.



This is the Christmas tree at my house!

The fruits of the Spirit

But the Holy Spirit produces this kind of fruit in our lives: love, joy, peace, patience, kindness, goodness, faithfulness, gentleness and self-control. There is no law against these things! (Galatians 5:22-23 New Living Translation)

A wise person once advised me to be very cautious about praying, "God, please produce the fruit of the Spirit within me." This person suggested that I may not really WANT God to teach me, for example, patience.

I thought this was very sage advice, but I have prayed this prayer anyway... and God is definitely teaching me patience. He has evidently selected a few individuals and circumstances to be my primary lessons, but on the whole, I can say that living and working in Botswana has been somewhat of an immersion program in this area. You may have heard of language immersion programs where you go live in, say, South America and learn Spanish, but you likely have not heard of a patience immersion program. That is what I am enrolled in- a patience immersion program. I am learning to wait on the Lord- as well as my fellow man.

Thankfully, this immersion program is also helping me develop the other fruits of the Spirit- love, joy, peace, kindness, goodness, faithfulness, gentleness and self-control. May God bless each of us with opportunities to develop each of these fruits.

Bokamoso Private Hospital

Last week I visited the Labor, Delivery, Recovery & Postpartum (LDRP) unit at Bokamoso Private Hospital (not as a patient, don't worry). I met one of the nurses who works on the unit through a friend at church and she generously offered to show me the unit. I had read about the hospital in the newspaper because it is apparently a very ambitious venture for Botswana and it has had its share of financial and technological challenges. Let me just say, that I was impressed.

As you can see from the pictures, the patient rooms are beautiful and well-equipped. I had read in the newspaper that the hospital was 'the first paper-less hospital in Botswana.' However, it sounded like the integration of technology has been difficult and this 'paper-less-ness' isn't quite true.

Regardless, Bokamoso is a beautiful facility and the nurses I met seemed very professional and dedicated to their work.

Mochudi Clinic

Here are two pictures of the Botswana Harvard Partnership clinic on the campus of the Deborah Retief Memorial Hospital in Mochudi. We use the clinic to see patients who are participating in any one of several research projects. Obviously, I cannot take pictures of the important work with patients and participants that goes on at the clinic. But, hopefully you can get an idea of where we work.

Mail call, mail call!

Sending and receiving mail is a funny thing here in Botswana- or at least it seems so to me. Botswana Post, the official national postal service, does not provide home delivery. So, if you want to have a place to receive mail, you either rent a postal box or depend on your place of work to receive your mail at a corporate postal bag (pictured above).

I receive mail at the postal bag that my office has. This bag has to be picked up at a post office that is quite a ways off the beaten path of Gaborone Central. The Botswana-Harvard drivers only retrieve it a couple times per week. Our bag is apparently only for envelopes. If a package has arrived addressed to me, the bag will contain a slip that can be redeemed for the package. However, we don't find out that there is a package slip until the bag has been unlocked and opened-- back at the office. This means that the package won't be picked up until the NEXT time a driver goes to the post office, which can add days to the amount of time it takes to receive a package.

On average, it has taken letters 10 days to get here from the USA and packages 30 days. I mailed my Christmas cards on Monday, so hopefully they will arrive soon. If you are interested in stamps of Botswana, I posted some pictures under an entry called "Botswana Philatelic Society" in August.

World AIDS Day

Today is World AIDS Day 2010.

The national annual events to commemorate World AIDS Day in Botswana rotate around the country and this year they are taking place in Palapye (a long way from Gaborone). The theme for this year highlights universal access to care and human rights. Botswana has a lot to celebrate this year. The country has made tremendous progress from the early years of the HIV/ AIDS scourge. However, they have a ways to go in order to achieve their vision of zero new infections by 2016 (which is also their 50th anniversary of independence).

Please check out this article from The Independent. It highlights the Mochudi Prevention Project!

http://www.independent.co.uk/life-style/health-and-families/health-news/plan-to-treat-supercarriers-offers-new-hope-2148091.html

image downloaded from google images

'Black Friday' Botswana Style

The last Thursday in November may not be formally recognized as 'Thanksgiving' in Botswana, but the last weekend in November has definitely caught on for the biggest shopping event of the year.



The Annual Craft Fair is the place to be for Christmas shopping, fund-raising, socializing, and eating.

I attended with my roommate, Amy and ran into people from work, church, nature outings, and pretty much every group I have been a part of since my arrival in Botswana.



I had a very successful day of shopping, but I can't disclose what I bought because the people I shopped for are likely reading this blog. But take a look at that blue sky-- This may be the first year on record that I came home from shopping with my Christmas shopping done AND a sunburn.

HAPPY THANKSGIVING!

Psalm 100:4 (NIV) Enter his gates with thanksgiving and his courts with praise; give thanks to him and praise his name.

The holiday of Thanksgiving is not officially recognized in Botswana, (note to turkeys, this may be a good refuge to consider for next year). When I asked one of my colleagues if there were other holidays set aside for reflecting on our blessings and giving thanks, he responded that Independence Day and Presidents Day were their official days for these practices. Several of my ex-pat friends who have lived in Botswana for many years commented that the weather in November is simply too hot to do a traditional spread of turkey, pumpkin pie, green bean casserole, etc. so they have had to modify their thanksgiving feast to include dishes that don't require them to leave the oven on all day.

I hope you all enjoyed a wonderful Thanksgiving!

HIV Prevention Messages

This week I visited all (eight) of the junior and senior secondary schools in Mochudi and took pictures of the HIV prevention messages that were displayed on the campuses. I have decided not to provide any commentary about the messages and instead let you interpret for yourself...

Ah, to read for pleasure! (and other musing)

The pace of living here has given me the opportunity to read literature other than scientific journals and text books. My recent reading list has included The Girl With the Dragon Tattoo (purchased as my major indulgence during my recent trip to Australia), The Poisonwood Bible (borrowed from a house-mate) and now I am reading The Guernsey Literary and Potato Peel Pie Society (sent to me, along with a few other enticing titles, by my dear friends in the USA). Oh, and I am finishing up reading through the Bible in a year--- which I started out listening to on the Daily Audio Bible Podcast, but have had trouble downloading it since being in Botswana, so I've resorted to just reading it the old fashioned way.

Other musings:

I have decided that, given the choice between having no electricity or no water, I will always choose having no electricity. However, I get grumpy when both services are cut off at the same time.

Today my friend, Rachel, took me to her church which holds its Sunday morning service at a local (private) primary school. These giraffes (pictured) are an example of the beautiful, whimsical artwork that adorns the campus.

Also today, when I responded to a Matswana woman's question about where I was from, she responded with enthusiasm, "Oh! You are one of Obama's children!" I've never really considered the US President (Obama or any other) to be my parent, but I guess some people do.

This coming week, I will be visiting all of the schools in Mochudi collecting examples of behavioral messages targeted at HIV/ AIDS prevention. One of the controversial messages that is prominent in the schools is "HIV KILLS." I'll blog more about that next time.

Happy Days!

Sunday, Monday, Happy Days.
Tuesday, Wednesday, Happy Days.
Thursday, Friday, Happy Days.
Saturday, What a day,
Groovin' all week with you…

One of the most challenging ‘mental shifts’ I have made during my time in Botswana has been accepting the fact that, unlike in the US, where I can plan and organize my social and professional calendars weeks in advance, here I cannot even anticipate what I will be doing from one day to the next. Two very common questions I get from people (both expats in Botswana and friends/ family in the USA) are, ‘so what does a typical day/ week look like?’ and ‘what are you up to tomorrow/ in the weeks ahead?’ My typical response is, ‘I have no idea, but if you hear anything, please let me know.’ So, I thought I would provide a few snapshots of each day THIS week:


This Sunday, like most Sundays, my friend Wemmie picked me up and we went to church. Here is a picture of me standing outside the sanctuary. After church, I usually go home or do errands. On Sunday afternoons I also like to Skype with friends and family back in the US. Since Gaborone is nine hours ahead of Pacific Standard Time, my Sunday afternoons are their Sunday mornings—I usually Skype my Grandpa Joe in Nebraska first because I am only seven hours ahead of him (and he wakes up early anyway).














This is me on Monday sitting at the desk I usually use at BHP. I don’t actually have an assigned spot at the office, but Onalenna, our administrative assistant- extraordinaire, usually lets me sit here in her office. When Onalenna took this picture, the power in the building had gone out, so I was only using my laptop. Usually I use both the desktop and my laptop at the same time. Having two computers going helps me cope with the slow internet.

















On Tuesday, I met with one of the Mochudi Prevention Project collaborators at his office on the University of Botswana campus in Gaborone. This is me outside the Faculty of Health Sciences office ‘port-a-camps’ (which are what we call ‘modular’ or ‘portable’ buildings). Later that day we had our weekly Mochudi Prevention Project conference call with Boston. I wanted to take a picture of this meeting because it is one thing I actually DO attend every week, but we were cramped so tightly in a small office around the speaker phone, I didn’t dare ask someone to come in to take our picture.











This is me working from home on Wednesday afternoon. I am working on an ‘inventory of prevention messages’ as part of the Mochudi Prevention Project and earlier in the day, I had had two very successful meetings at the Ministry of Health collecting data for the inventory. Later that afternoon was our first Fogarty Scholars meeting via Elluminate Live!























I look forward to Thursdays because I am in a ladies’ Bible study that meets on Thursday mornings. The women in the study are from all over Africa, Asia, Europe, Australia and the US. It is amazing to listen to their stories about what brought them to Botswana. In addition to wonderful fellowship, the Bible study and discussions have been a source of spiritual enrichment and inspiration for me. This Thursday (before and after Bible study) I worked on administrative ‘stuff’ related to the Mochudi Prevention Project. After work, I made the mistake of trying to go grocery shopping during the afternoon rush. I got so frustrated that I was near tears when I left the store (without everything I needed and having been charged for a case of mixed vegetables when I only bought one can).




















On Friday we were having our work-load analysis done at the Mochudi site as part of the continuous process improvement effort going on at BHP. These are some pictures of the home-based counselors picking up their supply bags before heading out on home visits in Mochudi. When I came home from work on Friday we were without power and it was not restored until well after my bedtime- more about this in a future blog.




Saturday, what a day! As I work on this posting, I am doing laundry and just finished baking a tuna-noodle casserole (like tuna-helper from scratch).

I am sure next week will be slightly (or completely) different from this week just as this week was different from last week. But, at least this gives you an idea of ‘what a day/ week in the life of Katie in Botswana looks like.’ Thank you for 'groovin' all week with me!'

"Happy Days" by Norman Gimbel and Charles Fox accessed at: http://www.sitcomsonline.com/themesonglyrics.html

The rainy season has begun

The rainy season (generally regarded as October-April) is upon us. Most days, the temperatures are in the mid 30's Celsius and the skys are blue. However, during the evenings, the winds and clouds come bringing AMAZING electrical storms. Some days, however, the rain comes during the day... like this day when we hadn't quite gotten our laundry off the line (oops).

Potpourri

If this blog entry were a Jeopardy category, Alex would refer to it as 'Potpourri' because potpourri pretty well sums up how this week has been.

First, I ran into a bit of a SNAFU with immigration upon my arrival back in Botswana after my trip to Australia, so I have spent much of my week sorting that out. Next, the Mochudi Prevention Project has been moving full-steam ahead, so I spent some of my time getting updated on the progress and plans for the future. Finally, our CFO introduced me to the Executive Secretary of the Nurses Association of Botswana and I am now working on a project for the Southern African Network of Nurses and Midwives General Assembly Meeting. So, here are the ingredients in this week's potpourri 1, 2, 3.

1) When I landed in Gaborone last week, after spending time in Sydney, the immigration officer at the airport informed me that I did NOT have the proper documentation for my extended stay in Botswana. I showed her my exemption certificate that allowed me to work in Botswana until June 2011 and explained that I thought this was all that I needed. However, it seems that I was supposed to have obtained an exemption certificate for residency in addition to the one for work. Thankfully, the immigration officer gave me an 8-day stamp in my passport which gave me time to spend this week getting the proper documentation. Any 'foreigner' who has spent any time in the immigration office in Gaborone can empathize with the experiences I have had this week- getting conflicting information, waiting in lines when there seems to be an abundance of personnel wondering around behind the counter, and the sense of relief when someone finally helps you with your 'problem'. So, at this point, I have a temporary permit to wait for my official exemption certificate to be ready in 14 business days. By mid-November, I'll either be a legitimate worker and resident, or I'll be home in time for Thanksgiving.

2) In between trips to the immigration office, I had time to get updated on the progress of the Mochudi Prevention Project. We had our weekly conference call with the Boston constituency on Tuesday, and things are really moving forward. The clinic is still pretty slow because participants don't come to the clinic until after they have been visited in their homes by the home-based counselors. Two of the major challenges we are facing right now is a lack of space for our growing team to function and inadequate transportation to allow the home-based counselors to do their work as efficiently as possible. In most of my previous work experiences, I have known in advance EXACTLY how things were supposed to roll out and had all the resources available to ensure that things went according to 'the plan.' This project has been a little different in that we are continuing to make minor (and major) adjustments as we go along.

3) The final ingredient in this week's potpourri was a fortunate connection to the Executive Secretary for the Nurses Association of Botswana. Apparently my name came up in a social conversation and she thought I might be interested in helping with a few projects that are underway. She was right! I am working on one project for the Southern African Assembly of Nurses and Midwives, and with my supervisor at BHP's permission, I am hoping to work on a few other projects she has-- including analyzing survey data... my FAVORITE!

So, this has been a bit long-winded and I don't even have a good picture to go along with it! If you need an image, just close your eyes and imagine yourself getting passport-sized photos taken by a friendly, entrepreneurial Motswana who has set up shop outside the immigration office and before he takes the picture, he reaches out and helps you adjust your bra strap.

You're Invited to Gaborone

I am feeling settled in and ready to entertain visitors. Here is one of Gaborone's older residents (you can tell a giraffe's relative age by his markings- young giraffes are light-colored and older giraffes are dark-colored. We would be happy to see you. Just shoot me an e-mail.

G'day and goodbye to Australia

I am back in Botswana after an amazing trip to Sydney, Australia. The trip was successful on all fronts: I attended the Australiasian Sexual Health and HIV/ AIDS Conferences, did some memorable sight-seeing, and took care of some 'practical matters' in-country.

My main objective for the trip was to attend two conferences: The Australasian Sexual Health and HIV/AIDS conferences. The first one completely surpassed my expectations. I was very impressed with the quality and diversity of the topics and I think Africa and North America could greatly benefit from adopting some of the forward-thinking strategies discussed related to sexual health. The HIV/ AIDS conference was also very good, but the epidemic in Australasia is quite different than it is in Africa, so some of the information was less relevant to my work here in Botswana. For example, the prevalence of HIV/ AIDS is less and it largely affects gay men rather than heterosexuals.

During my time in Sydney, I also had time to explore the city. It reminded me a lot of Seattle- but everyone spoke like Crocodile Dundee and they sold Veggiemite in the grocery store (for veggiemite sandwiches). In short, I LOVED Sydney. Above is a picture of me on a cruise of the harbor with the Australian flag behind me.

Finally, my trip to Sydney offered me an opportunity to take care of some practical matters such as getting a hair cut. I also enjoyed seeing the deep turquoise ocean again (Botswana is a land-locked country), having high-speed internet, going to the grocery store without having to be searched by a security guard and having soap and paper towels in the public restrooms.

All in all, it was a great trip and I am looking forward to continuing to digest the voluminous materials I brought home from the conferences-- just as soon as I get my luggage, which has not arrived back in Gaborone, yet.

Katie in Botswana?

Enjoying a bit of the city after a day at the Australasian Sexual Health/ HIV/ AIDS Conference in Sydney

My changing frame of reference

This week I had the privilege of taking a break from my normal work routine to attend the 3rd Botswana International HIV/ AIDS Conference in Gaborone. It was a fantastic conference with many international speakers-- coincidentaly, several of them were from my alma mater, the U of W. I met people from all over the world and even got to know some of my co-workers, who were also attending the conference, a little better. However, one of the most striking things about my experience at the conference was realizing how much my frame of reference has changed since my arrival in Botswana.

The conference was held at the conference center associated with the hotel I stayed at my first night in Botswana. This was the first time I had returned since my arrival in July. Before I came to Botswana, I decided that, in order to ease my transition, I would make reservations at an 'upscale' hotel for my first couple of nights. The hotel looked wonderful on the website and I was excited to arrive. However, when I got to the hotel, I was sadly disappointed. Having just come from 3 weeks of living in the Hyatt in Bethesda while attending Global Heath Seminars at NIH and tearing up the town with Mom and Jessie at some of Boston's finest restaurants, it is safe to say that I was tough customer. So, when I was at the conference hotel in July I found it lacking in many ways. In fact, after the first night, I canceled the remainder of my reservation in hopes of finding better accommodations.

Now, fast-forward 10 weeks to my more recent experience at that same conference center/ hotel in Gaborone. When we drove onto the conference grounds, I recognized the place, but at the same time, it was completely new. I noticed the manicured trees and the shined furniture. It was the same place I had been before, but my expectations and frame of reference had completely changed. My gut feeling is that this shift is a good thing- being easier to please. So, that's my story of my changing frame of reference- from chagrin to charmed... in 10 weeks.

Princess Marina Hospital

Botswana Harvard Partnership's (BHP) main offices and reference labs are
located on the campus of Princess Marina Hospital near the central
business district of Gaborone. Despite their close proximity, the
relationship between the two entities seems rather distant.

When I first arrived at BHP, I asked if I could tour the nursing wards at
the hospital-- I was especially interested in the maternity wards because
this is the area of the hospital that I am most familiar with. I expected
that one of the doctors from BHP would be able to show me around the
hospital or introduce me to a professional colleague who could do me this
favor.

This expectation was in-congruent with reality. Lacking an informal
opportunity for a tour, the CEO of BHP graciously wrote a letter to the
Superintendent of the hospital describing my credentials and interest in
seeing the hospital wards. (This letter was dated August 13, 2010). Making
a long story short, today, October 12, 2010, I got my tour of the
hospital.

Each of the matrons who showed me around the various wards was extremely
gracious-- and crazily busy. When I arrived in the ante-natal ward, the
head nurse was preparing for the monthly clinical conference where
clinicians discuss maternal deaths-- so I got a chance to see a bit of
their record-keeping and vital statistics systems. The ante-natal ward was
full past capacity, but rather mellow with women resting, eating and
talking on their cell phones in beds and mattresses on the floor.

The delivery ward was quiet, except for one wailing infant under a warmer
in one of the rooms- his mother was in an adjacent room and I couldn't
quite figure out why they were separated. The delivery ward matron
reported to me that the hospital does about 650 deliveries each month-
but the serenity of the delivery ward made me question this estimate. So,
she showed me the delivery book, and sure enough they deliver A LOT of
babies. However, the mothers and babies don't spend much time in the
delivery ward. Women labor in the ante-natal ward and about an hour after delivery, they are transferred with their infants to the post-partum ward.

All of my skepticism about the 650 deliveries per month vanished when I
saw the post-partum ward. There were women and babies and doctors, nurses,
orderlies, everywhere. Beds and mattresses were lined up along the walls
of the ward, on the floor, and in every little nook and cranny-- there was scarcely room to walk. It seemed like total chaos to me. The matron told me that they receive about 20-30 new couplets each day (from the delivery ward) and about 5-6 of those are status post cesarean section. I learned that women have the option of delivering at clinics, but most choose to come to the hospital-- she didn't know why.

One of the most interesting aspects of my hospital experience-- aside from
simply arranging my visit in the first place, was meeting several people
along the way who were asked to wait with me or guide me along from place
to place in the hospital. People are often curious about life in the USA and my impressions of Botswana and the HIV/ AIDS 'situation.'

Pula!

Pula refers to money and water- two very precious resources in Botswana. Here is a picture of the different denominations and examples of how much things cost.

Dinner for two at a restaurant comparable to "Outback Steak House":
P250.00 = $38.00

T-bone steak on special at the grocery store:
P55.00/ kg = $8.31/ kg = $3.78/ lb

Apples:
P16.00/ 1.5 kg = $2.42/ 1.5 kg = $1.09/ lb

Bananas:
P6.96/ kg = $1.05/kg = $0.47/ lb

Small bottle of shampoo:
P25.00 = $3.78

Butter:
P22.00/ 250g = $3.32/ 250g = $5.98/ lb

Milk:
P15.00/ 1 L = $2.27/ L = $8.60/ gal

Petrol:
P6.05/ L = $0.91/ L = $3.45/ gal

Letter to the U.S.A.:
P6.10-P8.00 = $.90 - $1.19

Biscuits!

Baking in Botswana intimidated me enough that it took me almost 2 months to try it out. However, I feared unnecessarily. Above is a tray of my most recent creations- no-bakes and peanut butter biscuits (here, no one says "cookie"). They may not be gourmet, but they have gotten rave reviews from friends, co-workers, house-mates, etc. I made the batches pictured here for the Missions Conference at my church, but when I arrived to help with the Face the Nation brunch (for 150 people), we realized we needed more baked goods, so they were served early.

So what was so intimidating about baking in Botswana? Well, the ingredients are all a bit different- white and brown sugars are coarsely ground (moist, packable brown sugar does not exist, as far as I can tell), good coconut, chocolate chips, and baking soda are hard to find, quantities and temperatures are in metric/ Celsius, and it is SO dry here that things get 'crispy' in a jiffy. Thankfully, the internet had the answers I needed to overcome some of these barriers including tricks like allowing your moist ingredients to soak with the sugars until it dissolves and using AllRecipes.com which converts any recipe to metric with the click of a button. Hooray!

Somehow, I thought it would be more romantic...

Growing up, I fantasized about having a canopy bed where I would sleep under a cascade of beautiful pink fabric. I didn't have any clue what the purpose of sleeping under a canopy of fabric might be, but is seemed very romantic-- and most princesses did it.

Later in life I learned that this cascade of fabric that I had seen floating above people's beds in pictures and movies was actually a mosquito net and it was used for keeping mosquitoes off the person sleeping under it. In fact, Jessie, mom and I used mosquito nets while we were in Costa Rica. This revelation and experience took some of the romanticism away from the whole idea, but they still seemed pretty exotic.

Well, yesterday I got my very own mosquito net-- treated with 'long-lasting insecticide'! For the record, needing a mosquito net is not romantic at all and having one isn't very fun either. I know I should not complain about having a mosquito net-- there are people dying of malaria because they don't have mosquito nets. But, I have to lament that my mosquito net is NOT pink, and it is a bit frightening to wake up and find that you are trapped under a net. Thankfully we don't have malaria in Gaborone, but we DO have mosquitoes-- and the rainy season hasn't even started. (yikes)

While my insecticide-treated net cost P315, you can purchase one for someone in need for only $6. The following link is to World Vision's Operation Safety Net:

http://www.worldvision.org/worldvision/eappeal.nsf/donation-item?open&amt=18&num=360&%3FOpen&go=item&item=1849059

Sugar daddies and small houses

This is the second installment in my series on HIV/ AIDS prevention strategies. This time, I am writing about messages targeting multiple concurrent partnerships and a few miss-steps in messaging about this sensitive topic. Part of the Mochudi Prevention Project is to support existing, effective prevention messages.

Media messages play an essential role in educating the public. Accordingly, health and social organizations in Botswana have employed multiple media resources including radio, television, billboards and pamphlets to get messages about HIV/ AIDS to the masses. One of the greatest challenges to effective 'messaging' is articulating and disseminating the right message to the right people at the right time.

There is currently a media campaign targeting multiple concurrent partnerships (MCP's). It is common for people in Botswana to have multiple concurrent sexual partnerships (NACA defines this as having two or more sexual partners at the same time) and this has contributed to the high rates of HIV/ AIDS in the country. Hopefully, this campaign will get the right message, to the right people at the right time and promote safer sexual practices.

Media messages need to be delivered using appropriate and relevant language. This can often be difficult to achieve- especially in a country where there are two common languages (Setswana and English).

However, not all messages are interpreted as they were intended. Here is an example of a misinterpretation of slang and an example of a seemingly universally accepted slang term:

An example of a miss-step in messaging in Botswana was the use of the slang term 'small house.' There was an HIV prevention message saying something like, "Small houses contribute to HIV transmission"

In the local culture, a 'small house' is where a man goes outside of his primary household/ partnership for sex. Logically, these multiple concurrent partnerships increased HIV and other STI transmissions. However, 'small house' also refers to a literally 'small' house. This difference in meanings lead some to miss-interpret the message to meaning that having or living in a small house increased HIV transmission.

An example of the use of a slang term that seems to cross cultural lines is the term 'sugar daddy.' Sometimes a woman will have different sexual partners to meet different needs- sometimes those needs are financial. The term 'sugar daddy' for someone who you have sex with who in turn supports you financially or buys you gifts seems to be a universal term.

Botswana's Vision 2016 & the Mochudi Prevention Project

The year 2016 will mark the 50th anniversary of Botswana's independence.
In anticipation of this milestone, various stakeholders came together in
the 1990's and developed the Vision 2016 Strategic Goals. These Goals
cover everything from health and education to security, morality, and
culture.

The Mochudi Prevention Project addresses the HIV/ AIDS section of Vision
Pillar 6: A Compassionate, Just and Caring Nation that reads, “By the year
2016, the spread of the HIV virus that causes AIDS will have been stopped,
so that there will be no new infections by the virus in that year.”
(http://www.vision2016.co.bw/index.html)

Since the establishment of the Vision 2016 Strategic Goals, researchers
and policy makers have made great strides in HIV/ AIDS treatment; however,
the prevalence of HIV in Botswana has continued to climb. Currently
available treatments have been very successful in Botswana, but treatment
alone is not a sustainable model. In order for Botswana to realize the
goal of zero new infections by 2016, new and effective prevention
strategies are essential.

This is what I think is so exciting about the work we are doing in the Mochudi Prevention Project-- we are using a comprehensive approach to transmission prevention. I am specifically interested in interventions that target behavioral change including: promoting the ABC's (abstinence, being faithful and condom use), encouraging people to get tested and emphasizing the importance of infant and adult (for HIV negative males) getting circumcised.

So, I thought I would highlight a few of the prevention strategies that
are currently underway in Botswana (and at BHP). This week's highlighted prevention
strategy is infant circumcision.

As you likely know, circumcision can help prevent an HIV negative male
from becoming HIV positive. In response to this evidence, several of my
colleagues have been involved in acceptability and implementation studies
about infant circumcision in Botswana. This week I had the opportunity to
observe a newborn circumcision in their clinic. The procedure they used
was like nothing I had ever seen (and I've seen a lot of infant
circumcisions). The Accu-Circ is really amazing- and apparently it holds
great promise for scaling up the infant circumcision efforts in Botswana-
which is a very good thing.

Coming soon, I will blog about media messages including abstinence, condom
use and discouraging multiple concurrent sexual partnerships (such as
sugar daddies and 'small houses.')

In closing, next weekend, the nation will be celebrating Independence Day and her 44th birthday (complete with a 4-day weekend). That leaves six
years for her to realize the Vision 2016 Goals. The team at BHP are certainly doing their part to give Botswana her best shot at realizing the HIV-related Vision 2016 goals. Oorah!

p.s. the image included in this posting is from the US Embassy- Botswana Facebook page

Morning at Mokolodi

This morning I went to the Mokolodi Nature Reserve- which is just south of Gaborone. I caught a ride to the Reserve with a friend who was attending a meeting there. While he and many of our colleagues were attending a strategic planning meeting at the Mokolodi Conference Center, I went on a game drive and enjoyed the education center, gift shop and grounds. When I arrived for my 0730 drive, the woman at the registration desk informed me that I was the only person who had signed up for the drive and they needed a minimum of 2 people. So, I was going to have to pay for 2 people if I wanted to go… unless, I wanted to go on the ‘game drive + cheetah visit.’ There wasn’t anyone signed up for the ‘game drive + cheetah visit’ either, but at 295 Pula, they didn’t make ‘solos’ pay double. So, I fell for the up-sell and went on the ‘game drive + cheetah visit.’

The Mokoldi Nature Reserve is essentially just some protected property that has rudimentary dirt roads through it (think a lot of bouncing in the back of a truck) and it is home to several types of truly wild animals… that is, except for a pair of tame cheetahs who were abandoned early in life and now live in a large fenced area within the Reserve. There are also some young spotted hyenas who are in a large enclosure who were abandoned, but they are not tame.

My 2+ hour, solo drive through the Reserve, accompanied by two guides, was very successful. I saw impalas, white rhinos, giraffes (my favorite), roans (the largest antelope in Africa), ostriches, monkeys, and lots of beautiful birds. I also learned about ecology and conservation in Botswana and Africa.

But, the best part of all, was visiting the cheetahs! We found Duma (the darker one)
and Letotse (the lighter one) around 0945 lounging in the shade purring audibly. As the only guest on the visit, I got to pet them and ask questions while my photographer-guides snapped pictures of us.

So, the moral of the story is that when things don’t work out as planned, they sometimes work out even better. And, while I was trying to experience Africa’s wilderness in the ‘born-free, live free’ spirit, I really enjoyed meeting these ‘captive’ cheetahs. I think their life at Mokolodi is pretty sweet.
After my adventure, I went to another co-worker's house briefly (and met his dogs, which was interesting given that I had just petted cheetahs). And then we went to work. Such is the life of a working woman in Botswana.

Language acquisition

After about six weeks in a new place, one might expect to have learned
some of the language, customs and social norms that dictate daily
life. Indeed, I am learning to walk on the left side of the path,
greet people with dumela mma/ raa, and I have even mastered the
customary handshake that involves three distinct hand grasps. One of my
colleagues has taken me under her wing and is teaching me phrases in Setswana;
but I have all but given up on really learning to communicate
effectively in the language.

I am, however, learning a completely different language.. the language
of Botswana-Harvard Partnership's (BHP) Standard Operating Procedures
(SOP's) and Standard Forms (SF's). I have spent the past few weeks
working on the SOP's for research participant clinic visits. Every
research study has a code (ours is BHP041). Because the research we
are doing is on such a large scale, everything has to be standardized
so that data keyers can easily enter information from the standardized
forms into computer databases. A few weeks ago, when I started this
process, I was confused by all of the codes. What does it mean that we
need to complete an HR210, HR201, HR 101 and HR401 during the
post-survey follow-up visit? Now I know that each of these are the
codes for the forms that go along with the DBS & Rapid HIV, HIV ELISA,
CD4 and VL tests respectively. (DBS = dried blood spot; VL = viral
load). What is CN001 and how is it different from a CN002? These are
different versions the consent form that are filled out during
different stages of participation.

This new language, along with some of the tools we are using to store
and share information have been keys to my success at BHP. One of the
most useful tools has been the wiki. All of the SOP's and SF's are on
BHP's wiki and many of the SOP's and SF's are undergoing revisions. (Making these revisions requires a separate set of computer language skills). As
we update SF's and SOP's it is important to ensure that everyone is
working with the most up-to-date versions. With investigators
collaborating from across thousands of miles, this gets to be
confusing-- but somehow it all seems to work out in the end.

So, while I may not be becoming a fluent Setswana-speaker , I am
learning a new language. In fact, when I was learning Spanish in
junior high and high school, my teacher told me that I would know I
have mastered the language (which I never did) when I started dreaming
in Spanish. Well, I haven't had any dreams in Setswana, but I did wake
up one morning wondering about an ST002-PNL (the partner notification
form that we give to participants to invite their partners to
participate in the study).

Go Siame (goodbye).

Botswana Power Company

Oh BPC, my BPC
Botswana Power Company

You’re there for me in so many ways
You make life better most all the days

You keep my computer humming along
You power the radio that sings me a song

You help keep me warm when nights are cold
You power the air con when you’re told

We pay our bill and you light up our house
You don’t complain, you’re quite as a mouse

I know I often take you for granted
And when you’ve failed I’ve raved and ranted

I know the rolling blackouts are needed,
But I’d like to know my plea was heeded.

So, BPC, my BPC
Botswana Power Company:

I wish I may I wish I might,
Have power when it gets dark tonight

But just in case, I've bought a lamp
And I'll pretend I'm at summer camp

And when the power IS on for me
I'll consider it a delicacy

Cause after all, there is more to life
than creature comforts and an easy ride.

2001 to 2010

As I was going to sleep last night, I reflected on the contrasts
between my experiences in South Africa in 2001 and my current
experiences in Botswana in 2010-- specifically related to HIV/ AIDS. During my
time in South Africa in 2001, I worked at an orphanage for children
who had HIV/ AIDS. The children had all presumably contracted HIV in
utero or early in infancy through mother to child transmission. None of the
children in the orphanage were expected to live past the age of 7-- at that
time, kids with HIV progressed to AIDS and died very young. The
primary 'care' we provided to the children was good hygiene, nutrition and
a lot of love (the idea being to shine as much love into their short
lives as possible). I distinctly remember getting news that a set of
twins, whose mother was HIV positive (and the babies were presumed to
be HIV positive) were scheduled to arrive at the orphanage. We
anxiously awaited their HIV test results. When we learned that they
were HIV negative, we were surprised but overjoyed and the twins ended up being
placed in alternative care-- as the orphanage was specifically for
children with HIV/ AIDS.

Fast forward to 2010

This year I am slightly more removed from the physical labor of caring
for people with HIV/ AIDS, and my work focuses on scientific research to
prevent the spread of HIV. I recently had the privilege of visiting
the Baylor Pediatric HIV/ AIDS clinic adjacent to where I work in
Gaborone. Like the children at the orphanage in South Africa, most of the patients at the clinic contracted HIV from their mothers early in life. However, the care available at the clinic offers an inspiring contrast
to the situation I was confronted with in South Africa nine years ago.
The staff at the clinic showed me a graph displaying the average age
of the patients-- which is now extending to 20 years and beyond
(presenting new challenges of transitioning patients to adult-focused
care). Where the bell curve used to be heavily skewed toward high
numbers of infants and young children, those kids are now growing older
which is really changing the make-up of the clinic's patient population.
The prevention of mother to child transmission (PMTCT) through the use of
anti-retroviral therapies has been so successful that, with
appropriate peri-natal care it can be nearly eliminated. I am
astounded by the progress that has been made in nine short years- from
providing nutrition, hygiene and love to support children through
their short lives and early deaths, to nearly eliminating mother to child transmission and having the anti-retroviral drugs available to help children, and all who are infected with HIV/ AIDS live longer, more productive lives.

Human Resources

This week we have been busy reviewing applications and conducting interviews for several key positions within the Mochudi Prevention Project: home-based HIV counselors, a driver and an administrative assistant. I understand that the unemployment situation in Botswana is rather bleak and this was confirmed by the humongous pile of applications we received.

I was very impressed with the professionalism of the BHP human resources department and the precision with which they executed posting of the positions, collection/ review of applications and interviews. The Ministry of Labor must have some pretty tight regulations because they took great care in documenting each applicants' performance within the interview.

My role during the interview process was to run each interviewee through an exercise to demonstrate his/ her competency with technology. This was a very eye-opening experience for me. We had a brief (or so I thought) exercise that involved typing and data entry in a word processing program and a simple spreadsheet computation. I cannot express how fortunate I feel for the fact that I am a digital native and have been around computers (and Nintendo) since I was in Kindergarten. Thank you Granddaddy for those early Apple computers where I made digital doodles and played Webster's Revenge.

The picture above is a typical example of the PILES of paper that surround me each day. The piles are, surprisingly, very dynamic- data-entry specialists and clinicians are continually going through them and shuffling them from place to place. I have been stationed in the Data Management Center (DMC) for most of my time here-- I actually don't have a specific space to sit, but this is where I usually find a seat when I am at BHP Gaborone.

Oh, and I have been getting informal Setswana lessons. Here are a few of my phrases:

Dumela Mma: Hello to a woman
Dumela Rra: Hello to a man

Go siame: goodbye

Umbrellas

This is my limerick about umbrellas- many people carry umbrellas to protect them from the sun.

What can one do with an old umbrella
in the sunny country where they greet you 'dumela'?
Carry it with you when it's hot
and you'll always have a shady spot
It will make you a cool and smart fella

No. 1 Ladies'

Okay, this one is for all you fans of Mma Ramotswe, Mr. JLB Matekoni and the No. 1 Ladies' Detective Agency series of books by Alexader McCall Smith. Today a friend picked me up and took me out to the No. 1 Ladies Opera House wwhich is just south of the Gaborone CBD. The Opera House is a re-fitted garage that hosts events and live performances. We were there for the monthly food and farmers' market- a lovely event with live music and good company. The top picture is the sign outside the gate and the bottom picture is where you order your drinks- I am taking the picture while standing on the stairs that lead up to the seating area for viewing performances.




On a sad note- during the drive to the Opera House we saw a group of monkeys and one of them got hit by a car in front of us. Traffic stopped and another monkey retrieved the monkey who had been hit (and was very badly injured) from the road and carried him (or her) away. I am telling you all this 2nd hand from my friend who was driving because all I saw were the group of monkeys playing and then one going under the car- from then on, I shut my eyes.

They tried to warn me that this would happen...

Thank you to all of my friends and colleagues who have done international work- for your words of wisdom and for correctly cautioning me against potential pitfalls. One of the phenomenons I was correctly cautioned against might be referred to as the 'one-month blues.' It is the point about one month into an international experience when the honeymoon period is over and some of the tough realities set in. Well, I have been here for a month and I think I have the one-month blues. While I am still enjoying the delights of my work and life here, I am feeling anxiety related to home-sickness, daily annoyances, inconveniences, and generally feeling like a cultural (and linguistic) outsider. So, to counteract this malaise, I am going to share a list of things I am very much enjoying about Botswana: In no particular order, other than the order they occurred to me.

Fruit! Lots of it and at really cheap prices.
Hanging clothes on the line for drying-- and the clothes drying really fast in the sun
Purposeful work and the respect of the community for the work BHP does
Wonderful friends and colleagues from all over the world doing amazing work here
Birds- beautiful little birds everywhere, (especially the brightly colored ones)
National pride for Botswana and its potential as a young nation
Sun, all day, everyday
Curious people asking me all sorts of interesting questions- where am I from, do I know of someone who can help them with this or that
Church and the fervor and enthusiasm with which my church family worships
And last, but not least, knowing that you are all thinking and praying for me!

Mochudi Prevention Project

I am coming up for air after an intense week of presentations, meetings, discussions, brainstorming sessions, decision making, and planning. We are preparing to kick-off the scaled-up Mochudi Prevention Project and there is a great deal of work to be done. It has all been very exciting. The pictures above: 1) a view of the village from the Museum (where the meetings were held) and 2: the sign in front of the museum. The village symbol is the monkey.

Keep reading- the next post is hot off the press...

Bojale

It must be universal- being initiated into a group involves staying up all nights and listening to long speeches from your elders (whether those “elders” are one year ahead of you in school, outrank you by a pay grade in the military, or are the cultural leaders of your community). This eventful week ended with the privilege of observing the coming of age ceremony for young women in the village of Mochudi. The Bojale commences with the young women, who have spent the previous weeks learning lessons about what it means to be a woman in the community and the previous night preparing down by the river, entering the Kgotla (village meeting area) around 0800. Here, the entire community, along with a few Anglo guests, await their arrival. All of the women cover their heads and wear skirts and the men who have been initiated wear impala skins on their backs (sometimes over modern sweat-suits or jeans). There are speeches by leaders including the Kgosi (Chief) and village leaders. After the ceremony, the new initiates file off to their respective wards singing chants lead by the elder women.
I did not attend the entire Bojale, but arrived to see the finale procession and enjoy a post- Bojale luncheon that our group had been invited to in one of the wards. The picture above represents these festivities.