Today, Kelley and Yin leave for America; tomorrow, a larger group of our group go home. It is unreal to think that after 5 weeks of being here it is time to return to America, Philadelphia, and most importantly, our final semester at Penn.
This final week, many of us travelled before we headed back. Yin, Tiffany, Kelley and I went up to Kasane and then Zambia for Victoria Falls. The most amazing night was sleeping in the Salt Pans, a seemingly endless expanse of nothing but beautiful blue sky and the most amazing stars any of us had ever seen. When the sun set, the sky was filled with stars and constellations from top to bottom, and we ran around without a care in the world. It was an amazing experience, and future Botswana nursing students, please make a visit to the Salt Pans a priority.
Another of our best memories was sitting at a laptop looking at our senior clinical placements- the internet for an hour cost us about 3,000 kwacha and was very well spent!
Finally, during the week of August 22nd-28th, Kaitlyn and I participated as student nurses on the Journey of Hope, a breast cancer awareness campaign through northwestern Botswana. We went with our clinical instructor Lucille, and it really was a true learning experience- our little group performed 870 breast exams total, and I can say that I think we will be very confident doing breast exams through the rest of our nursing career. We also got to see so much of Botswana- we gave talks and exams in Kayne, Jwaneng, Kang, Ghanzi, Toteng, and Maun. A very unique experience.
We are a group of 10 Penn Nursing students who will be spending 4 weeks doing clinical work and learning in Botswana for our community nursing clinical!
Sunday, September 4, 2011
Tuesday, August 30, 2011
The Donations
Yesterday, Erin and I made sure that your donations were used as the group saw fit. We traveled around to various malls collecting items for Holy Cross Hospice and Preschool. To the hospice we donated a radio for patients to listen to, gardening materials and seeds for those patients wishing to grow their own food, toothbrushes, and medical supplies such as gloves, hand sanitizer, blood pressure cuff and stethoscope, and N95 masks. To the preschool we donated toothbrushes and toothpaste. Also included for Holy Cross Hospice was the remainder of the donations, a total of P3,300, which can be used as Holy Cross desires but will most likely go to gas money for patient transport to and from the facility. Holy Cross was extremely grateful for the donations. We knew as a group that these particular gifts would go a long way with Holy Cross. Once again we would like to thank all those who donated for your generosity and allowing us the opportunity to give back to an organization that so graciously hosted us for our clinical weeks. -Jaclyn Koucoi
Friday, August 19, 2011
Wrapping up and Kamogelo
We're finishing up our clinical tasks here in Gaborone, which includes spending and distrubiting the money that has come in throughout our stay. A portion of the money will be going to the Kamogelo preschool, which has instruction, meals, supervision, a garden, playground, etc for orphans and vulnerable children in a village outside of Gabs. "Orphans or vulnerable children" means that they have lost caregivers due to AIDS, and generally they are living with grandparents or extended family, and don't have as many resources at home to stay healthy.
We did physical assessments on all of the children and found lots of skin infections, runny noses, dental problems and a few more serious issues. This was also a repeat assessment so we were able to do growth charting and identify kids who need more nutritional support. There are local medical and dental clinics so we were able to refer all of those children and the staff at the preschool will be helping with follow-up.
In addition to the assessments we also were asked by the staff to teach them first aid on topics that they see often. We also invited the parents for this 2 hour session and had about 30 people attend. We covered oral health, skin infections, and communicable diseases based on what we saw in our assessments. We also covered seizures, head injuries, poisoning, cuts and burns, and fractures at the request of the staff. We used a lot of demonstration and the nun who runs the orphanage (Sister Margaret) did a great job translating for us. (Or so we assume. How does one translate the concept of losing "electrolytes" when a child has diarrhea?) The learners seemed very engaged, asking a number of great questions and taking notes. We are following up on this session with handouts that illustrate the key points for each topic. Our hope is that much of the information will spread throughout the community as teachers and parents teach each other when they notice a problem.
The donation money will primarily go to our third task requested by the day care, which is to restock their first aid kit. This kit is used for the bumps and scrapes of preschool life, but also to support care for longer-term problems. While we were there, one child had an infected cut in his heel from stepping on a thorn, and he had not received any care at home. The teachers were the ones who noticed the limp, assessed the wound, and performed hot soaks and dressing changes with the first aid kit supplies (and some instruction from us.) They had a rudimentary kit, but are missing many essential supplies, such as band-aids (called "plasters" here), antibiotic ointment, skin creams, and bandage tape.
Another portion of the money will be used to provide toothbrushes for the children at this preschool and another preschool for OVCs that we have been working with. Our fabulous dental student Saveet, was able to assess each child and teach them how to brush their teeth correctly. Of course, in order to do that they will need a brush which runs at least 20 pula (equivalent of a buffet lunch or 6 rides on the combi).
We will post another final update when all of our projects are complete. The Journey of Hope has already left town and will be sending updates when they get back on Monday. Many of the rest of us are leaving this weekend for a week of travel before we fly home. We are grateful for all of the various forms of support we have received and are excited to share more in person!
We did physical assessments on all of the children and found lots of skin infections, runny noses, dental problems and a few more serious issues. This was also a repeat assessment so we were able to do growth charting and identify kids who need more nutritional support. There are local medical and dental clinics so we were able to refer all of those children and the staff at the preschool will be helping with follow-up.
In addition to the assessments we also were asked by the staff to teach them first aid on topics that they see often. We also invited the parents for this 2 hour session and had about 30 people attend. We covered oral health, skin infections, and communicable diseases based on what we saw in our assessments. We also covered seizures, head injuries, poisoning, cuts and burns, and fractures at the request of the staff. We used a lot of demonstration and the nun who runs the orphanage (Sister Margaret) did a great job translating for us. (Or so we assume. How does one translate the concept of losing "electrolytes" when a child has diarrhea?) The learners seemed very engaged, asking a number of great questions and taking notes. We are following up on this session with handouts that illustrate the key points for each topic. Our hope is that much of the information will spread throughout the community as teachers and parents teach each other when they notice a problem.
The donation money will primarily go to our third task requested by the day care, which is to restock their first aid kit. This kit is used for the bumps and scrapes of preschool life, but also to support care for longer-term problems. While we were there, one child had an infected cut in his heel from stepping on a thorn, and he had not received any care at home. The teachers were the ones who noticed the limp, assessed the wound, and performed hot soaks and dressing changes with the first aid kit supplies (and some instruction from us.) They had a rudimentary kit, but are missing many essential supplies, such as band-aids (called "plasters" here), antibiotic ointment, skin creams, and bandage tape.
Another portion of the money will be used to provide toothbrushes for the children at this preschool and another preschool for OVCs that we have been working with. Our fabulous dental student Saveet, was able to assess each child and teach them how to brush their teeth correctly. Of course, in order to do that they will need a brush which runs at least 20 pula (equivalent of a buffet lunch or 6 rides on the combi).
We will post another final update when all of our projects are complete. The Journey of Hope has already left town and will be sending updates when they get back on Monday. Many of the rest of us are leaving this weekend for a week of travel before we fly home. We are grateful for all of the various forms of support we have received and are excited to share more in person!
Sunday, August 14, 2011
Home Health with Holy Cross Hospice
This week I have visited two home health care organizations as well as spent one day in the medical clinic at Princess Marina Hospital. The first home based health care org works in Otse, Ramotswa, and Mogobane, three villages located just out of Gaborone to the south. The second, Holy Cross Hospice, works in Gaborone, and it is at this one that I have spent the most time. I have been performing health assessments on patients in their homes while two other students have done assessments on patients who come in to the facility. My patients have been located mostly in Old Naledi, what is considered the most impoverished neighborhood in Gaborone (though they are currently paving roads there very efficiently, and the government built houses and outhouses for all the residents some time ago - some very positive aspects). The patients I saw are living with TB, HIV, or cancer. Because Holy Cross Hospice is on the brink of losing its funding, as many orgs here seem to be, our underlying goal is to assess patients and screen for who is ready to be discharged from the program and who may need to be referred to another similar program.
The patients who come in to Holy Cross for assessments enjoy the company with other patients as well as two delicious meals during the day. They often work on crafts or even help out by sweeping around the property. Holy Cross has been a highlight of my time here because of the opportunity to perform home health assessments and tailor patient education and needs to life circumstances such as access to water, household cleanliness, and nutrition. -Jaclyn Koucoi
The patients who come in to Holy Cross for assessments enjoy the company with other patients as well as two delicious meals during the day. They often work on crafts or even help out by sweeping around the property. Holy Cross has been a highlight of my time here because of the opportunity to perform home health assessments and tailor patient education and needs to life circumstances such as access to water, household cleanliness, and nutrition. -Jaclyn Koucoi
Holy Cross Hospice
Kelley helping wash vegetables to cook at Holy Cross.
Tiffany with "the heartbeat of the hospice" -- Anna, who works in the kitchen every day
Yin working in the office at the hospice after some assessments
Friday, August 12, 2011
Women's Health Week
A big part of the Botswana UPenn Partnership is the work in women's health that has been going on here with cervical cancer prevention. Several of us spent from 2-5 days at the clinic working with VIA (visual inspection with acetic acid) and with LEEP (loop electrical excision procedure) clinic. Since the procedures are very complicated, the nurses and doctors at the clinic preferred that we spend multiple days there in a row so that we could learn at first and then be helpful the rest of the time.
I've spent 5 days this week in the women's health clinic, and I've learned so much there from assisting with procedures and shadowing nurses! Doreen Masire pretty much runs the show there and is clearly the clinical leader. (Bio here: http://www.med.upenn.edu/botswana/LeadershipBios.shtml) We also worked closely with another doctor, Mimi, as well as other nurses and staff there who were all extremely helpful and inspiring.
The clinic focuses on treating pre-cancerous lesions with cauterization and LEEP when women are referred from either the main hospital through abnormal paps or from a community clinic post-VIA. This week, I spent Monday and Wednesday in the community clinic observing and assisting with VIA. VIA is a procedure where acetic acid (vinegar) is placed on the cervix so that any abnormal cells turn a white color (acetowhite lesions). VIA is especially good in low resource settings where labs to process pap smears may not be available. VIA relies on the expertise of the nurse (or other clinician) to determine when a lesion is present and to take action. (The "See and Treat" method.)
At the clinic here, they start by doing the VIA with the naked eye, but they then do "EDI" (enhanced digital imaging). They usually have a big screen so be able to see a truly enhanced view. The screen is currently not working, but they are able to zoom on the camera and make a determination. I'll get to what they do with the images later. But then, for the patient, if they have a lesion that meets certain criteria (i.e. not extending into the os, not covering more than 75%, etc), then they do cryotherapy there on the spot. ("See and Treat") If it does not meet those criteria, then they are referred to the main clinic.
I was at the main clinic Tuesday and Thursday. At the main clinic, there is a colposcope, and the patients get another VIA done, which can be compared with the images from the community clinic's exam. (And they are pulled up right then and compared to see why the patient was referred and what the nurse saw in the previous exam that was concerning.) After the VIA, the doctor does VILI (visual inspection with Lugol's Iodine), which is really interesting to see. It is the same process as with the acetic acid but with a special iodine that turns any abnormal areas a mustard yellow color. Then, from that, they determine whether to do LEEP, cautery, etc.
At the end of the week, every Friday, they do quality assurance with the whole team. They review all the images and determinations to see if there is consistency and accuracy in the decision-making of the examiners. If they see anything that was missed, they recall that patient for follow-up. This step is crucial, since as I said, VIA and the follow-up procedures all rely on the clinical judgment of the nurses or clinicians doing the work.
What I was able to do with them all week:
Below are some images of posters from the clinic showing VIA and VILI findings.
And below is the clinic area and some of us working in the clinics:
I've spent 5 days this week in the women's health clinic, and I've learned so much there from assisting with procedures and shadowing nurses! Doreen Masire pretty much runs the show there and is clearly the clinical leader. (Bio here: http://www.med.upenn.edu/botswana/LeadershipBios.shtml) We also worked closely with another doctor, Mimi, as well as other nurses and staff there who were all extremely helpful and inspiring.
The clinic focuses on treating pre-cancerous lesions with cauterization and LEEP when women are referred from either the main hospital through abnormal paps or from a community clinic post-VIA. This week, I spent Monday and Wednesday in the community clinic observing and assisting with VIA. VIA is a procedure where acetic acid (vinegar) is placed on the cervix so that any abnormal cells turn a white color (acetowhite lesions). VIA is especially good in low resource settings where labs to process pap smears may not be available. VIA relies on the expertise of the nurse (or other clinician) to determine when a lesion is present and to take action. (The "See and Treat" method.)
At the clinic here, they start by doing the VIA with the naked eye, but they then do "EDI" (enhanced digital imaging). They usually have a big screen so be able to see a truly enhanced view. The screen is currently not working, but they are able to zoom on the camera and make a determination. I'll get to what they do with the images later. But then, for the patient, if they have a lesion that meets certain criteria (i.e. not extending into the os, not covering more than 75%, etc), then they do cryotherapy there on the spot. ("See and Treat") If it does not meet those criteria, then they are referred to the main clinic.
I was at the main clinic Tuesday and Thursday. At the main clinic, there is a colposcope, and the patients get another VIA done, which can be compared with the images from the community clinic's exam. (And they are pulled up right then and compared to see why the patient was referred and what the nurse saw in the previous exam that was concerning.) After the VIA, the doctor does VILI (visual inspection with Lugol's Iodine), which is really interesting to see. It is the same process as with the acetic acid but with a special iodine that turns any abnormal areas a mustard yellow color. Then, from that, they determine whether to do LEEP, cautery, etc.
At the end of the week, every Friday, they do quality assurance with the whole team. They review all the images and determinations to see if there is consistency and accuracy in the decision-making of the examiners. If they see anything that was missed, they recall that patient for follow-up. This step is crucial, since as I said, VIA and the follow-up procedures all rely on the clinical judgment of the nurses or clinicians doing the work.
What I was able to do with them all week:
- At the community clinic, I did a lot of close observation, since there are certain clinical skills we can't do here even if we are trained in the US to do them (and the exam is short anyway). However, I was able to assist in actually taking the digital images of the cervix -- trying to avoid the speculum, shadows, get the lighting right, etc. Then, after all the images are done, they choose 3 per patient to pass on to the main clinic. I helped choose the 3 images with the best quality and then helped to renumber all of the images in the folder at the end of the day with patient IDs and what sort of visit they had.
- At the main clinic, I was a full assistant in all the procedures, and they taught us how the whole process worked, when to get what ready, etc. We were setting up exams, pouring acetic acid and iodine, providing LEEP equipment, preparing the camera settings for images, and more. Dr. Doreen Masire is also an amazing teacher who expects you to know a lot but also is very encouraging throughout the learning process. She let us look through the colposcope in order to point out certain things, which was really nice as students.
Below are some images of posters from the clinic showing VIA and VILI findings.
And below is the clinic area and some of us working in the clinics:
The exam room at the LEEP clinic
Me (Tiffany Holder) standing with the cryo tank at the VIA clinic.
Erin Reynolds at the VIA clinic ready to help with supplies
Wednesday, August 10, 2011
STEPPING STONES...
Last week, Lucille, Erin, Kelley, Yin and I traveled to Stepping Stones International, an innovative after school program in Mochudi dedicated to youth ages 12-18 left orphaned or vulnerable by the HIV/AIDS epidemic in Botswana. The program seeks to support, nurture and motivate these adolescents and empower them to become successful leaders. Through job and life skills training, study skills building, psychosocial support, income generating projects, and arts activities Stepping Stones sure keeps their adolescents busy!
After receiving an informative tour by the Peace Corps Volunteer, Tish, we spent some time chatting with the youth and helping with homework assignments. Later, we joined the group for some of the most energetic and heartfelt cheering I had ever experienced. With the captivating and entertaining Teen Program Leader's direction, it would be hard for anyone to lose interest!
Next, the youth were split into several groups for a special gardening project led by Tish. Effortlessly, the youth embraced us, and together we planted rape (a delicious green vegetable similar to swiss chard), carrots, radish and other vegetables. In previous weeks, Tish provided education on agriculture and growing produce, and helped the students prepare their new garden. This garden project was initiated through the generous donation of Barclays Bank of Botswana with the intention to teach the youth how to plant, grow and market organic vegetables in the community.
MOCHUDI TEEN CLUB
A couple of days later, Kaitlyn, Roberta (a fabulous nutrition student from the University of British Columbia) and I returned to Stepping Stones for their monthly Saturday Teen Club. Teen Club is a peer support group intervention for HIV-positive adolescents operating in Mochudi as well as a number of other sites throughout Botswana. In Botswana, the number of adolescents on Anti-Retroviral Therapy (ARVs) is rapidly increasing. Records indicate that more than 1,400 teens are currently enrolled in the Botswana government's ARV program. As the population ages, the number of Batswana teenagers on ARVs will significantly increase, which is related to the increasing number of infants who are born with HIV. Although the focus of some day care centers and orphanages in Botswana is on pre-school aged orphaned and vulnerable children, resources for teenagers are seemingly scarce. HIV-positive teenagers need the social support, education and care from a program specifically targeting the needs of this population in order to promote successful transitions into adulthood. Thus, the Teen Clubs in Botswana were developed to provide a welcoming and nurturing environment for HIV-positive adolescents where they can build strong relationships, improve self-esteem and learn positive habits.
After just a few moments standing among the large circle of teens at the Mochudi Teen Club, it became clear that this was much more than simply a support group or typical Saturday afternoon activity. During the initial ice-breaker, the teen leaders instructed each of the teens and volunteers to introduce themselves and to describe one thing that made them happy that day. From the teens' responses it was evident that the group members treasure this monthly event and have developed deep bonds with their Teen Club peers. Research indicates that for adolescents, interacting with others in similar situations may assuage their sense of alienation and resentment; thus, the social aspect of the Teen Club alone must be immensely beneficial.
The joy and energy exuding from the teens during the activities throughout the morning permeated the entire room and I felt chills throughout my body. The faces of the teens were ebullient as they cheered and danced together following the lead of two incredibly charismatic, energetic and vocal teen leaders. To me, the cheers represented positivity, hopefulness and unity in fighting for a better future.
Following the physical activities and cheers, the teens were divided into four large groups in order to engage in a brainstorming session. Throughout the morning they were asked to develop and share ideas to improve their Teen Club; to discuss how to handle difficult emotions in a beneficial manner; and to determine what educational topics to address in future Teen Club meetings. My participation in one of the groups was quite eye-opening. Firstly, it was clear how instrumental the Teen Club has been for many of the teens. One teen, for example, described her traumatic past and credited the Teen Club as having changed her life. Secondly, I was also struck by the teens' degree of seriousness and commitment. Rather than prioritize leisure or entertainment topics, the teens described their need for information on ARV medications as well as their desire to discuss issues related to romantic relationships.
After the morning of brainstorming and planning, Tish led an outstanding nutrition education activity for the teens which was innovative, interactive and fun. Roberta, Kaitlyn and I integrated a bit of education on food groups, vitamins, and digestion which we hope was informative. We thank the teen leaders who translated for us so patiently!
Overall, I was incredibly impressed by the Stepping Stones organization and the Teen Center. I feel so fortunate to have had the opportunity to participate in such unique activities and to connect to both the teenagers and staff members. I was deeply touched my experiences and will always remember the room full of energetic cheering and the fortitude of the teens who shared their stories with us.
-Leigh
Monday, August 8, 2011
HIV and Botswana
Today, Mma Mogowe, from the University of Botswana, came to speak to us about HIV and Botswana. She is a faculty member who teaches a course on human sexuality and HIV, and we have been invited to sit in on the class if we have time. She created a nice powerpoint that I wish I could import here now, but I only have the text on hand at the moment. Some of the main points that I noted were:
- 33 million cases of HIV worldwide
- 22.5 million cases in Sub-Saharan Africa
- 75% of hospital admissions in Botswana are related to HIV
- In 2001, a program called Masa (which means :dawn") was begun, and it provided free ARVs to all
- The main focus is on Intervention, Education, and Communication (IEC model)
- The general age for sexual debut in males is 17, while it is 14-15 for females
An old billboard in Serowe, Botswana -- 4 hours outside of Gaborone. Yes, those ae condoms as letters, and the coloring used to be better.
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