Friday, October 21, 2011

One month down, 25 to go

I’ve been in country for a little over one month now! It’s gone by so fast! This past week I was in Semolale, a small village near the eastern border of Botswana with a current PCV for shadowing. The purpose of shadowing is to give us a chance to see what current PCVs are doing in daily life, how they’ve integrated into their communities, etc. It was really an eye-opening experience for me and I enjoyed it a lot. We left early on Monday morning and were dropped off at the bus stop in Gaborone, and then were left to our own devices (finally!) to get on the correct bus and all that. My first bus ride was about 6 hours which wasn’t so bad except that for some reason Batswana like to keep the windows shut on the bus and the woman next to me kept making me close my window! With no AC, this makes for a VERY hot bus ride! Anyway, it was nice to see some more of the country and just actually be doing something on my own. The emptiness of the country struck me again as we would drive for miles without seeing any people or houses, just goats and donkeys! I switched buses in a village called Bobonong and then had about an hour ride from there to Semolale. 
My host, Jen, met me at the General Dealer which is the only store in the village and is about a five minute walk from her house. Jen is in the CCB (Community Capacity Building) program which is not the program that I’m in which is life skills, so some of the things that she does I won’t be doing, but it was all still cool to see. She works mainly in the clinic whereas I’ll be working mainly in the schools, but she also does some work with the primary school in the village. On Tuesday it was ARV day at the clinic which is when HIV-positive people who are on treatment come to get examined by the doctor and get a new set of medication. Jen sits with the doctor during all the appointments and fills out paperwork for ordering blood and other lab tests as well as scheduling patients for their next appointments. Patients who are having adherence issues are only given two weeks supply of medicine at a time so that the doctor can keep closer track of them to make sure they are adhering to their medication.  Adherence is a big issue because if patients don’t take their medicine or take it only sporadically, the virus will build up tolerance making the first-line drugs ineffective. This makes them more infectious to other people and causes them to have to switch to second-line treatment which is more expensive. The Government of Botswana provides free ARV treatment (with the help of PEPFAR which is a US program that provides monetary aid to African countries which makes ARVs more affordable) to HIV-positive people who qualify. In order to qualify patients have to wait for their CD4 count to drop to a certain level since there are too many HIV-positive people to put everyone on ARV treatment immediately. Anyway, when we got to the clinic on Tuesday morning there were a lot of people ranging in ages from 2 to 65 and everything in between waiting for their turn to see the doctor. Not everyone on treatment comes every Tuesday; patients are staggered so that the clinic isn’t overwhelmed on a given Tuesday. If a patient is adhering well they will be given a six-month supply of medication and only have to come in to the clinic twice a year. Some are given a three month supply, some one month, etc. Patients have to come to the clinic the week before they are scheduled to get medication to get blood drawn so tests can be done to track their CD4 count. This process can be inconvenient and time consuming for adult patients since they may have to travel far (the Semolale clinic serves 2 other surrounding villages as well) and might have to take off a full day of work. However, it’s especially harrowing for babies on treatment. When I was there, there was a 2-year-old who was just starting treatment and had to have blood drawn, but babies’ veins are too small to take blood from their arm so the doctor has to use the femoral artery which is in the upper thigh. The nurses had to hold the baby down so that the doctor could get enough blood. It was really painful to watch because the baby was screaming and crying and it really struck me how devastating HIV is. I had to walk away from the situation because I couldn’t fight the tears. It was so hard to see a child in pain like that and know that they have to go through something so terrible at no fault of their own.  It’s especially sad and frustrating because with the correct treatment mother to child transmission is highly preventable. PMTCT (prevention of mother to child transmission) therapy is also free for all HIV-positive pregnant women and is very effective if followed correctly in preventing the baby from being born HIV-positive. Yet, there are still babies being born with HIV. There are various reasons for this, but I think I would like to work on PMTCT as a secondary project when I get to site. Anyway, the rest of the day was spent with patients and was very interesting. I won’t be working daily at a clinic since I’m Life Skills, but I would like to at least spend some time at my local clinic.  
That night we ate tacos, yum! (If anyone is wondering what they can mail me, tortillas and taco seasoning are highly appreciated!)Other meals throughout the week included homemade Pizza, soya burgers, and pasta! The next day we spent some time at the clinic and that afternoon we went to the primary school and I sat in on a life skills lesson that Jen gave about transmission of HIV. It was helpful to see a lesson in an actual classroom of children since that’s what I will be doing. The lesson went well, although it is sometimes hard to tell whether they are absorbing the information or not. At the end of the week we conducted a focus group about youth opinions on the government and economy and about the US government which was part of my assignment for the shadowing week. It was hard to find people to attend because the required age ranges were either from 13-18 or 19-25 and since there is no secondary school in Semolale there aren’t many youth around. We managed to get together a group of 19-25 year olds, mostly special constables from the police station. We discussed their attitudes towards the government and what they saw as the biggest issues facing their community. We also talked about what they thought about the US which was really interesting because some words that came up were “heaven”, “everything”, “peace”, and “better life”. They were really shocked to find out that there are people living in the US that are homeless and that there are US citizens who are HIV-positive but can’t get on treatment because they can’t afford it.
Overall, it was a really interesting week and I could go on and on about all of the things that I learned, but I don’t want to bore you all! We only have three weeks left of training and I have a feeling it’s going to go by fast! This Friday we get our site assignments which is very exciting and on Saturday we get to go to Gaborone for a party that the Peace Corps is throwing to celebrate Peace Corps’ 50th anniversary! Should be a good week.

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