Out of Africa...with a BANG!

After our internships ended, David, Tamar, and I decided to stay in Africa for a few extra days to travel. We left on Friday and flew up to Kasane, which is in the Northeastern corner of Botswana. We got in around noon and had arranged to be picked up at the airport and after a buffet lunch at a gorgeous lodge we were immediately taken on safari in Chobe National Park. It was by far the best game drive I've been on since being here. Chobe has the highest concentration of elephants in the world, and we saw many of them along with huge herd of antelope, giraffe, and other animals that got incredibly close to the car! The Chobe River also runs through the park so we saw huge pods of hippos, which are actually the most dangerous animals in Africa.

After the game drive we were driven to the Kazungula ferry to cross the border into Zambia. Kazungula is a cool place geographically because it's the place where Botswana, Namibia, Zambia, and Zimbabwe all meet. In reality, the "ferry" they use to get people across the Zambezi river which makes the border could generously be called a barge. Its dirty, old, smelly, and practically falling apart. They first load a few tracter trailers or cars on and then let on the people, who just stand there next to the cars. We got our passports stamped in Zambia and then got picked up by the driver from the hostel we would be staying at and headed out. After a longer than anticipated car ride (the van broke down, typical) we reached the Jollyboy's Hostel, which is a great hostel in Livingstone, the home of Victoria Falls.

White Water Rafting
The next morning we got up early and were picked up at 7 AM to go white water rafting on the Zambezi river, which is a Class 5 (highest) river. It was a great time! After going to the boat company to hear the safety talk, grab breakfast, and gear up we headed out on a half hour drive through mud-hut villages to the gorge. We then had to climb almost vertical down this treacherous boulder/stick ladder path into the gorge. It was probably the scariest part of the trip!


We got acclimated in our boat and no sooner had we taken off then we were capsized by the first rapid, aptly named the "Gnashing Jaws of Death". The water was pretty cold and I was not a fan of swimming in white water holding on to the overturned boat for dear life. We unflipped the boat and thankfully that was the only time we fully flipped. Going over the rest of the rapids was really fun once it stopped being terrifying! It was definitely a roller coaster ride and my entire body was sore (and a little bruised/cut up) afterwards! It as definitely a great workout though and the Zambezi was a beautiful and intense place to have my first white water rafting adventure!

Livingstone Island
The next morning, I got up early again and went with two girls from Cornell that I met in the hostel to go have breakfast on Livingstone Island. This is the Island at the very edge of the falls where Livingstone was first taken to see the falls. The tours are opperated by the most posh lodge in the area: the Royal Livingstone. So we got to the lodge and they speedboated us out to the island, then they gave us raincoats and took us on a tour of the island. When I heard "tour" I had no idea that they meant they would take us to the VERY EDGE of the falls. We could sit on the rocks and everything. It was incredible to be that close to such power and the spray created a rainbow so you felt like you were at the end of the end of it. After that, since this tour is operated by a 5 star lodge, we were served with tea and a gourmet breakfast. It was a magical morning!

"My sister, me I like to trade, I give you good price" - Marketplace Adventures
This is a quick not about the bartering process in Zambia. Zambia is a lot poorer than Botswana, which really doesn't have much of a bartering culture. Usually if you just stand there long enough in Bots people will lower the price a little but for the most part the price doesn't move much. By contrast, in Zambia they're allll about trading. I'm used to this from China and Ecuador, but I have to say I like it better in Africa. The traders are a lot more personal when they make their sales pitch and it feels more like a friendly negotiation than a fight like it feels in China.

Another thing that makes trading different here is that they LOVE to trade you for items you think are totally insignificant so they can take it back and give it to their family in the village. One guy asked me what I wanted for the hair tie that was on my wrist. Other requested items were socks and pens. A lot of people, like me, also trade old t-shirts, which they LOVE. The result is a lot of Zambians walking around with t-shirts that bear the names of random American towns or Universities. It was an interesting, and sometimes exhausting, afternoon of shopping. I'm horrible at bargaining because everyone tries to push you into their shop and tries their best to keep you there til you've bought something. It's also so clear that they really need the money and I always feel really guilty. But in the end, I got some cool things so I was happy!

Sunset Cruise
That night we also went on a sunset cruise. There's not much to say here, but it was nice and fun. We got to see crocodiles, hippos, and the always gorgeous African sunset over the Zambezi.
Leap of Faith and the Smoke that Thunders
The last day of our adventures started in the morning. We went down to Victoria Falls and immediately went to the bridge over the gorge that connects Zambia and Zimbabwe to get our adrenaline rush. We made a pact that we would all do the bunji combo, which includes a bunji jump, a gorge swing, and a zipline. We decided to get the worst overwith first so we did the bunji. I've never been so scared in my life. I was shaking. The bridge is 111 meters (364 feet) high and the prospect of jumping off of it headfirst is terrifying when you're actually there staring out into the gorge. We were also the first jumpers of the morning, so we didn't get to see anyone do it before us.

The one great thing was that all the other tourists on the bridge are really supportive. I met one Texan lady who must've been like 60 who said she was going to do it after us and she had just done the one in Cape Town which is 170 meters. So if she could do it so could I. I went last, and as I was getting strapped in a group of Zambian priests and nuns were waving to me on the bridge. I asked the priest to pray for me because to be honest I'd been praying all morning (you would too if you were about to jump off a bridge!) He said it seemed he'd come at the perfect time and came over and blessed me. Then I turned around strapped to the harness and chord and after the man yelled "5, 4, 3, 2, 1, BUNJI" I took the leap of faith and swan dived off.

It really was the most unreal feeling in the world. It's pure nothingness and wind rushing around. One the chord caught me the first time and I bounced up I realized it was nowhere near the horrible experience I though it would be. By the 3rd bounce I was having a blast! It was also incredible because the spray from the falls made a rainbow and you felt like you were diving into it.

After that I did the gorge swing, which I didn't like as much and I think is scarier then the bunji because you just fall straight down feet first and then start swinging across the gorge. The swinging part is cool because the view is beautiful, but the initial drop is horrible. I ended the morning with a really tame zipline across from the gorge to the bridge, which helped bring down my levels of adrenaline.

After our thrill seeking, we crossed the border into Zimbabwe to see their side of the falls. Victoria Falls is the largest sheet of falling water in the world and it's absolutely spectacular. You can see why it's one of the It really takes your breath away. The native name for it means "The smoke that thunders" and you can see where that comes from because you get SOAKED at the park from all the spray.

All in all, it was an amazing vacation. I pushed myself to do a lot of things I would have never done. Carpe dium! It was a perfect way to conclude my trip!

The Final Project

So this week concluded my internship at Botswana's Ministry of Health. I've learned a ton here and it's been an amazing experience. Very few American students have the opportunity to work for the government of a developing country, but it really is the best way to gain perspective about issues of development and global health. Every day I was coming into work with Botswana's best and brightest and seeing the challenges they faced. Moreover, I spent most of this internship working for the Office of the Health Inspectorate, which means I got to go with them on inspections and read accreditation reports and help pinpoint and identify all the problems within the health system and the barriers that they face in improving the health care of the citizens of this country.


About 3 weeks ago, Vernon and I had finished our project reading through the accreditation reports of 4 clinics in Botswana and identifying the critical criteria they needed to work on to get accredited. When we went to our boss to get a new project he just gave us some tedious spreadsheet work to do and told us that he would be going on holiday before he retired at the end of the month. We had just come back from an amazing week helping with the accreditation baseline assessment at the mental hospital, so we were frustrated at being stuck in from of Excel again. However, after expressing this frustration to Gill and Nicki, the amazing English mother-daughter pair who run the Botswana-Upenn partnership office in Gabs, the end of our internship took a different turn.

It turns out Gill's husband works for the Minister of Health as the Advisor for Public Private Partnerships. So she had us meet with him to see if he could give us a real substantial project for us to work on. When we went to go see him, he said that this was perfect timing, because he had just been asked to write two grant proposals for PEPFAR and it would be tremendous help to have two Americans working on the project. So that's what we were assigned to do.


PEPFAR stands for the President's Emergency Plan For AIDS Relief. It's hailed by some as the best thing Geroge W. Bush ever did in office, and I'm inclined to agree with that. It provides a huge amount of aid money to the 14 countries most effected by the AIDS epidemic and is a major reason why most HIV+ people in Botswana have access to the anti-retroviral drugs that can save their lives. Anyway, since Obama took office PEPFAR has been looking to expand it's impact beyond just supplying drugs and testing under something called the GHI (Global Health Initiative). This program works on creating sustainable health care systems within the countries PEPFAR is active in so that in the future they will be stronger on their own and eventually not need aid money, which is truely the only solution.


The two grant proposals I wrote last week were directly related to that. Both were about strengthening Botswana's healthcare system overall, rather than just providing quick fixes. The first grant I wrote was for a Healthcare Management and Leadership Training Program. This program will train the management staff of the healthcare facilities, especially hospitals, with leadership and management skills, because right now most of the people in these positions aren't trained; their just doctors who got placed there and have to try to manage the hospital on top of seeing patients. In hospitals where there are only a few doctors, this is really a challenge. In the past, all of the management positions were filled by the British left over from colonization, but they all left a few decades ago, leaving a lot of untrained people filling the void. The hope is that this will be a great way to build capacity within the healthcare system so it has trained people who can both handle the technicalities of health facility management as well as provide visionary leadership to take Botswana's healthcare standards much higher than they are now.

The other grant I wrote these pas two weeks was a grant for a pilot Care Management System at the Princess Marina Hospital in Gaborone. Princess Marina is where a lot of the other Penn interns work and it's the best/biggest public hospital in Botswana. That being said, the standard of care there is still pretty appalling. The wards are opperating at about 120% capacity and patients sometimes wait 7 days before being seen by the appropriate specialist. This is because a lot of the time the Batswana doctors aren't good about filling out the patients files and don't seem to realize how bad it is to have such long waiting times. But when you're in a country where about 1/4 of the population has HIV, this can be really deadly. An AIDS patient who has an opportunistic infection of pneumonia or meningitis will die if they're not seen quickly. So the grant I wrote is to establish a team of care management experts who will audit patient files and hold hospital staff accountable, to make sure that patients are being seen by necessary specialists as quickly as possible and that doctors are providing both a high quality of care and documenting everything correctly in the patients' files.


This project was AMAZING to work on. I'm possibly going to be writing my thesis on PEPFAR and how it's changed US-African relations in the past 2 administrations, so this was a once-in-a-lifetime chance to actually submit a grant proposal to the US government program I'm going to be studying. I also learned a lot from the project. It was a nice way to come full circle, because both of the grants I wrote address deficiencies in the healthcare system that I'd identified during my inspections. It was great to both have a chance to be part of the team pointing out the problem and the team working towards a solution. It was also awesome to be able to apply a lot of what I've learned about the need to build stronger health infrastructure in developing countries and not just try to put a band-aid on the issue. If I ever have a job at the US Agency for International Development or the World Health Organization, this will be a learning experience I will certainly draw on, since most Americans are only ever used to reviewing grant proposals from the governments of developing countries, not actually writing them from their perspective. I'm so greatful for this opportunity and it was an amazing way to end my internship :)

Good Morning Teacha!

So on Friday I took the day off of work and went to visit Jing and David who work at the Kamogelo Orphans and Vulnerable Children Project in the nearby village of Mogaditshane. Orphans and vulnerable children are a large population in Botswana because the AIDS epidemic has hit this country so hard (about 25% of adults are infected and 60-80 thousand children are orphans because of it). Kamogelo is run by the Catholic diocese here and is headed by Sister Margaret, a Motswana nun.


It's not a stereotypical orphanage, in that none of the children stay there over night. It's more like a daycare/preschool. The culture of the Batswana has very strong emphasis on extended family, and there is very much the "it takes a village to raise a child" mentality. It's not uncommon for children to be brought up by grandparents or aunts/uncles. So if a child's parents die of AIDS, most often a family member offers to take in the child. Also, a lot of the kids that go to Kamogelo aren't orphans at all. They're what the global health community calls "vulnerable children", meaning their parents have HIV/AIDS which makes the kids more at risk for HIV and a lot of other social problems. The kids come to Kamogelo in the morning, where they get breakfast, then have lessons, have lunch, play, and then go home. It serves kids ages 3-6 with a class for each age that has about 15-20 kids in it.


It was such a great day! We went to work and went to the staff morning prayer/Bible reflection. You have never heard such moving singing in your life until you've heard a hymn sung by a group of Batswana. One person kind of appoints themselves canter and sings the first line and then everyone joins in with the most perfect harmony I've ever heard. It's amazing and they sound like they've rehearse for months but they do it just on the spot.

After that all the kids came. As soon as they see a new adult, especially a foreigner, they scream TEACHAAAAAAA!!!!!!!!!! and cling to you because they're desperate for attention. I was literally dripping children. Kids in my arms, on my back, on my legs. But they are the cutest kids ever. However, "Good morning teacha" is pretty much the extent of most of their English. They do sing English songs, like "Jesus loves the little children", "Good morning Mr. Teddy Bear", and "Welcome to Kamogelo". I taught them the Hokie Pokie, which was hilarious.

The lesson that day was short and consisted of writing their name, writing the word "apple" and then coloring in the apple. Friday's aren't heavy on lessons because the teacher's clean the classrooms, so they just let the kids loose on the playground after. So I got to go run around outside, push kids on the swings, play catch, and carry them around. It was a blast! But I also had to sometime break up kids fighting and make sure they didn't kill themselves on the playground. I took a few pictures and it's funny that one word the kids know very well is "camera" because other volunteers have taken pictures too. They cannot get enough of seeing their pictures on the screen.

Kamogelo is a great place, but it's extremely sad to see these kids who have to go through so much and are living in real poverty. At least here they get 2 hot meals (with a lot of carbs and starchy food to help them gain weight), most have a uniform of some kind, and they get a start at an education even if the curriculum isn't very organized.

Saturday I went with Cat to the orphanage she works at called SOS Children's Village for the graduation party. SOS is very different. A lot of the children stay there overnight, divided into little houses with 2 house "mothers" and about 12 kids of all ages (so if a sibling group comes they can all be together). You can tell SOS is a lot better funded and it's a lot more colorful, with bright murals on the walls and things. The kids there were great too and also very happy to see us!

Both of them were great places to see. They have different approaches but are still dedicated to solving the same problem faced by children here. I hope that with they help them have a better future.

Okavango Safari to Enter my "Roaring 20s"

So this weekend was a long weekend for the Penn interns, because Thursday was a Botswana national holiday (President's Day) and we all used one of our allowed personal days on Friday. We all went different places in small groups. Others went to Cape Town, Durban, Chobe/Victoria Falls, and villages not far from Gabs. Tamar, Alex, and I decided to use this long weekend to see "The Jewel of Africa" and Botswana's most famous tourist attraction: the Okavango Delta. It's a really unique place because it's the only inland delta in the whole world, so it has a really unique landscape and ecosystem.

Because of that, the Delta is really difficult to see when you're a poor college student on a budget. Botswana has perfected low-impact ecotourism, which is a good thing. This means that they have pretty few tourist lodges/places within the region and they are all commited to environmentally friendly practices that sustain the amazing wildlife tourists come to see. That being said, the vast majority of the lodges in the Delta are extremely, almost excessively expensive and this part of Botswana has the international reputation among safari-goers for being uber-exclusive.

So we decided to book our trip to the Delta through "The Old Bridge" Backpackers. We got to Maun, which is the "Gateway to the Delta" on Friday, and were immediately picked up in an open air safari truck and driven our place. Once we got there we were immediately put on a motor boat and boated 45 minutes to a village in the southern part of the inner delta. We had book a 2 day Mokoro Camping Safari. A mokoro is a traditional dugout canoe used in Botswana, particularly by the tribes in the Delta. From the village, we met our guides and the other polers (it took 4 mokoros to get us and our stuff out there) and embarked on a 2 hour long mokoro trip. The Delta swamps are like nothing I've ever seen. Huge waterways of tall grasses, huge patches of water lilies, all types of birds flying overhead, and dotted with islands covered in palm trees. There were also some unpleasant parts of the longgg mokoro ride, mostly the fact that mokoros go right through the reeds and tall grasses coming out of the water, leaving the passengers inside covered in gnats, mosquitos, and cobwebs (with spiders in sometimes in the boat). Good thing I was wearing long pants/sleeves and took my malaria medicine!

We got to the island, set up camp, relaxed, and went on a game walk. We didn't see much the first night, just birds and a few steenbok. BUT there was a bull elephant that decided he wanted to eat some palm nuts about a hundred yards behind our tents. He kept getting closer and closer and we were hoping he wouldn't come crashing through! But by nightfall he went away. Our cook, Monk, cooked us an amazing dinner of beef stew, rice, salad, butternut squash, and this cool apples-and-bananas-boiled-in-milk desert that I have to try, then we went to bed in the warmest tents ever in very comfortable bedrolls listening to bird calls that sounded ten times cooler than those tapes rich Americans use to fall asleep ...sweet!

The next morning we got up at sunrise and mokoro'd out to another island for a early morning 3-hour game walk. As we were getting to the island we could see an elephant get our of the water up onto the island, which was amazing to watch! Then as we pulled up to the island we saw its whole family, about 4 elephants eating and chilling. On the game walk we also saw a herd of zebra (with a really cute baby they were trying to protect!), hyena tracks, more beautiful birds, a herd of impalla, and wildabeast. One the mokoro ride back we saw some monkeys and we heard (but couldn't spot) a leopard. Exciting!


When we got back to camp around mid-day, Monk made us the Botswana version of French toast (toast dipped in beat eggs and then deep-fried, he had also never even heard of syrup before as there are no maple trees here) and other assorted breakfast foods. We stuffed ourselves and relaxed for a little bit before breaking camp and heading back on the Mokoros for the 2 hour journey home. The bugs weren't bad for the first half and the weather was warm, mostly sunny, and amazng so it was actually really relaxing to be in such a beautiful place, so close to nature, and enjoying creation.

When we got back to the hostel, we each dropped our stuff in our private rooms, which were pretty cute, and then went to watch some World Cup soccer with the collection of white/Asian characters that collect at a Backpackers hostel in the middle of nowhere in Africa. After eating dinner and watching the games we were so tired we passed out.

Today, I had the most chill birthday ever. After eating breakfast we checked out of the hostel and then we did a whole lot of nothing in Maun. But, for doing nothing, it was pretty awesome. The weather was clear blue skies and pretty hot (by my American standards) so we changed into shorts and walked around the town of Maun, which has almost nothing in it. Its extremely sad to see the state of Maun, which is extremely poor despite the fact that so much money is spent on tourism there. I also know from reports I've read at work that the Okavango district has some of the worst health indicators in Botswana. The mix in Maun is really interesting and kind of sad. though the industry provides some local Batswana with employment, but most of the managers of the safari companies are British expats or white Africans who've been here for generations, so its a weird dynamic. Anyway, I then had an amazing 2 hour long lunch at a French restaurant that caters to tourists outside of the Airport, complete with a dessert crepe filled with bananas, almonds, and Tia Maria chocolate syrup - YUM! Then we walked around Maun more and bought some cool souvenirs, which I haven't bought almost any of so far.

After a short flight back to Gabs I took an incredibly refreshing shower, but as soon as I walked out of it the rest of the interns surprised me, in cute animal masks with a cake, candles, and a birthday glass of wine. They made me blow out my candles in my towel, while taking what I'm sure are mortifying pictures. Then I got changes and we celebrated/ relaxed for the rest of the night.

It was, overall, an amazing and relaxing weekend and a great way to spend my last few days as a teenager, reflect on the years I've had so far, and bring in an exciting new year of life ☺

Kamping in the Kalahari!

This weekend I went adventuring on a camping trip into the Kalahari desert. Our guide picked us up on Saturday morning and we drove about 3 hours north to the Khutse Game Reserve.

The landscape changes dramatically when you get farther towards the Kalahari. While it is not the spectacular sand mountains that you see in the Namibian parts of the desert, the entire place is fine white sand with tall grasses and scattered trees. Everything is a light tan/yellow/ or pale green color and the place looks quite barren and desolate. On the ride up I also saw more of traditional pastoral life of the Batswana. This area is where one of the women at work has her "Cattle post", which is where the family's cattle are kept and graze. It is a very poor and remote area and herds of goat and cattle, along with boys riding donkeys bareback were some of the things we saw out the window.

When we got there we quickly set up our lion-proof tents and made camp. After a quick lunch we went on a game drive. We drove down to the water hole and on the way we saw many different types of birds, sprinkbok, other types of antellope, and ostriches. When we got to the water hole we saw a pride of lions that had just killed a giraffe that morning. The lionesses were lounging under a tree - completely stuffed from eating there kill. We couldn't get as good of a look at the male lion because he was still in the grass guarding the dead giraffe. The family of giraffes was still there too! Apparently they thought it was safe because the lions already ate and wouldn't hunt them too. There was even a baby and we got very close, it was amazing!

That night, after watching a beautiful sunset, we had a very filling dinner/dessert and stayed close to the fire. The Kalahari is FREEZING at night because its a desert and when the sun goes down the heat disappears. (temperature - about 35! ah!) Actually sleeping wasn't as bad as I thought it would be (outward bound was much worse). We had bedrolls, comforters, and extra blankets, in addition to the sweatshirt, fleece, sweatpants, and scarf I was wearing so I was actually quite toasty.

This morning we woke up early to watch the sunrise, which was amazing. Then we went on an early morning game drive. It was slightly anti-climatic at first. It seems as though most of the animals were doing what we wanted to be - sleeping! But then we ened up seeing more ostriches & springbok, some pretty cute ground squirrels, leopard tracks, a big golden eagle, and another giraffe family. This time there were 8 of them and we got even closer because they were standing right in the middle of the road. It felt kind of like being in Jurassic Part because they're such huge, bizarre but beautiful animals!


After a huge breakfast back at camp we embarked, covered in dust and sand, on the 3 hour drive back to Gabs, half of which was on a rather bumpy dirt/sand road. I got a lot of reading done!

Now I'm finally clean and ready to sleep in a real bed, but it was a great weekend!

Making Meghan a Motswana

Some people might be wondering what I do after work on weeknights, since most of my blogs thus far have been about my weekend adventures.

Many nights are spent chilling out, since we all have to be up at the crack of dawn. Previously, this was a lot of time in the common room chatting, playing cards/boggle, and reading. We still do that, but now we have the World Cup games to go watch at bars or in the TV room, not to mention internet access which has cut down our need to be social with each other.

However, my favorite weeknights are hanging out with Carol, who I've talked about a lot because she's my Botswana buddy.

Last week Carol offered to cook my suite a traditional meal including pap, seasoned greens, beef, and fat cakes. Fat cakes are basically like donuts except not as sweet, but still very good and extremely filling. I actually like traditional food here a lot, though getting used to eating it with my hands, which people don't do when they buy it from street vendors but they do at home, took some getting used to.

Also, on a different night last week Carol showed me how to tie my scarf around my head the traditional way Batswana women do (meaning she tied it for me because we all know I lack the coordination to do it myself). It doesn't look right on me because my hair is "too slippery" so I don't think I'll be adopting this fashion when I return to the States, but I really like how it looks on women here!

Sbrana Psychiatric Hospital

So this week was an interesting one at work. On Monday when Vernon and I got to work Moseweu, one of the health inspectorate officers was late, "Great, you're here! Let's go!" Apparently it was planned that we'd be going on the official accreditation baseline assessment visit to the Sbrana Psychiatric Hospital, which took place all this week. No one bothered to tell us that, but it was a great surprise; we love any chance to take a break from office work and see how what we're working on translates in the actual hospitals and affects real people.

Sbrana is the only psychiatric hospital in the country. It's located in the town of Lobatse, which is about an hour southwest of Gaborone. This week was different than the previous inspections I went on. Instead of the HI officers conducting they're own inspection, we were accompanying a team of 4 doctors/nurses/public health specialists from an organization called COHSASA (Council on Health Service Accreditation in Southern Africa). Its an organization that measures health facilities against a set of standards and accredits them, just like any accreditation process with schools, etc. The Ministry of Health has been using COHSASA as an outside accreditor for some of its hospitals/clinics because its a good way of improving and ensuring certain standards of care. I learned a ton this week about the importance of policy and standards in terms of health, but a lot of what I saw this week also made me very upset and angry.

Sbrana is a brand new facility that hasn't even had the official ribbon cutting yet. From the street it looks beautiful, and you can see from the photos that it's far from the stereotypical third-world hospital stereotype. However, there are major problems within it, starting with the fact that this facility has some horrible flaws with its design and the Chinese firm contracted to build/furnish it obviously did no consulting with anyone who works in psychiatry, or in a hospital for that matter. Major design flaws include but are not limited to:

• These bizzare patient verandas so they can get sunlight. They have glass on top and open bars on the bottom.
• Open flower beds within the hospital. You'll just be walking and then there's a big square open dirt pit, some empty and some filled with a few plants. Not only is this a safety hazzard when it's located in a forensic ward (which holds criminals pleading insane) because they can bury weapons there, but also its dangerous because some of the plants are poisonous and the hospital has some intellectually disabled patients who will eat them (I'm thinking now of Erin eating all of my mom's merigolds).
• Fire exits/escapes that lead to nowhere or to chained doors which only the hospital manager has a key to
• To many reception areas, about half of them are unnecessary and therefore empty
• Glass walls/doors everywhere. In a psychiatric hospital, many of these are smashed
• Burgler bars/curtain rods in the rooms - a perfect place for psychotic patients to hang themselves.

They also have a lot of expensive equipment that either they don't really need or doesn't work, yet are missing vital items such as working suction machines, a defribrulator, and even rubber gloves, and beds (yes beds). There are only beds in 2 of the wards. They're still "waiting for the rest to be assembled" so the patients have been sleeping on matresses on the floor for 8 month. Did I mention the temperature control doesn't work? This is bad when patients are in little track suits/bathrobes and Lobatse is one of the coldest cities in Botswana (it gets down to around 30 at night). The wards are also way overcrowded. For example, Male Acute Ward 2 is supposed to have a bed capacity of 36, but currently has 70 patients. Yet, the hospital has a playground and no kids to play on it, and a lot of other things it doesn't need.

This makes me very mad, because the government just spend millions of dollars on this new facility which, according to the South Africans we were with, can't be accredited as it is now. A lot of money was wasted: money that the government doesn't have and which might have come from foreign aid. The South African accreditors were also talking to me a lot about the importance of policy development and how crucial it is to improving the quality of care in hospitals, especially in developing countries. Most of the hospitals haven't developed guidelines that answer questions like, "How do we get a patient's consent?" and things like that. That can lead to problems I saw this week, such as a patient being sent to seclusion for almost a month and non-authorized staff delivering drugs. Documentation, or lack thereof, is also a really big problem, and the accreditors are real sticklers about it, because a lot of these hospitals don't keep very good records so its hard to tell who is an isn't following the rules. Unlike in the US, hospitals haven't been monitored for things like this up until now and patients don't have the resources to sue if they're not being treated right. Take aways for the week as an IR major: when development projects are done irresponsibly by contractors who feel like they can get take advantage of poor countries and get away with it, real people suffer. Also, policy can be a very effective tool to make progress in the quality of care because if you create standards and then work with facilities to identify where they're failing and monitor them to help them reach those goals it will help foster a collective movement to improving a sustainable healthcare infrastructure.

World Cup Fever!!!!!

So I just had what definitely could be counted as one of the craziest weekends ever. Since the kickoff game, all of the world seems to have caught soccer fever! We've watched the games at several bars and in the graduate village's TV room and its so much fun. I didn't think I was going to get to go, which was sad because its SO close and a once in a lifetime chance to go to an international sporting event. Talk about being in the right place at the right time. So at the last minute Linda and I were able to get tickets and join a group going to the Ghana vs. Australia match this past Saturday.

It was amazing! The atmosphere is absolutely insane! I went with 5 other girls from Penn and we were driven there by these guys who run Choppies, which is a grocery store chain here. The guy who owns the company is this indian guy whose son is going to Penn next year so he's had all the penn interns over for dinner and offered to drive us since they were going to that game too and buses in south africa right now are nuts and not particularly safe. So not only did we get free transportation and not have to pay for housing, but they also gave us a bunch of fried food/cookies/water/other beverages on the way down. And they took a divergence on the way there to go to a lion park that the guy's friend owns. So we got to see cheetahs, 2 types of lions, tigers, and even lion cubs and a baby white tiger! It was a pretty sweet deal.

Anyway, we finally got there though only like 1.5 hours before the game (they say to get there at least 3 hours before) and picked up our tickets from the ticket collection point at the mall, which surprisingly took no time at all, and then sat in what was hands down the most crazy traffic jam of my entire life. and what made it even crazier is that south africans (and people in botswana for that matter) cannot drive. i mean it, like take the craziest driver you know in the US and multiply that by 10. plus people were screaming and blowing vuvuzelas (which i couldn't find to buy! so sad!) So we finally park at the parking lot and take the shuttle bus over.

We ended up being like 5 minutes late to the match, but once we got in it was absolutely incredible. Total sensory overload. SO MANY PEOPLE! The australian fans are absolute fanatics; they call themselves "socceroos" and come out in droves to support their team. The ghanians were just a lot of fun. But there were so many different nationalities and languages and people dressed ridiculously. and the match was really good too! Even though it was a tie, bot teams were great to watch (but especially Ghana because they have amazing footwork and the most impressive goalie who made some spectacular saves!) i've come to the conclusion I should start watching soccer, because I played it until sophomore year of high school so i actually understand it and like watching it.

Anyway, after the match is was complete chaos. There was a flood of fans, TV cameras, vuvuzela's blowing, drums going, people screaming: quite a scene. But not only trying to find everyone since we weren't all sitting together and our cell phones didn't work because we left the country, but then trying to get on the buses to get to the parking lot was a nightmare. It was like herding cattle, picture like tens of thousands of people squished together. But at least it kept us warm (its FREEZING here at night!!!) and we met some cool Australians and talked to them while waiting. We also got separated from our driver, but luckily he was waiting for us when we got to the parking lot. We had a very long, traffic filled drive home and didn't get back until about midnight.

I had a blast! It was a total rush and definitely a once in a lifetime experience!

Motswana for a Day

So I had a very relaxed Sunday getting to know everyday life in Gaborone better.

I started out by going to the Catholic church here for the first time. I really liked the service and the priest was very good and had an insightful homily. Most of the things were the same, except some of the wording of a few of the prayers are different, and everyone’s accent makes everything sound different! Plus they had all the little kids from Sunday school walk down the aisle during the collection singing “Jesus loves me this I know, for the Bible tells me so”. It was adorable!

After church I went for a run and then went to go see Carol upstairs. She wasn’t doing anything and I wasn’t doing anything, so we decided to do something.

She took me to BBS mall, which is where she goes when she goes shopping. Its very very different from the westernized and “modern” malls of Riverwalk and Game City. It has a lot of stalls outside, discount clothing shops mostly run by Chinese people, and other stores. I bought a scarf for $2, the same plaid scarf could run me like $20 in the US.

After that we were still deciding what to do and it was such a nice day so she decided to take me to one of the townships (like a slum) on the outskirts of Gabs. It is shocking here to see the disparity between the pretty and quiet Gaborone that I’ve spent most of my time in and the poverty of the slum. One tiny room in what would generously be called a house can hold a mother and all her children, with no electricity or running water. Most people are unemployed or have basic jobs like gardening or cleaning.

The whole afternoon Carol and I talked about life in Botswana and the culture there and I told her things about the US. I love Carol because not only is she a great friend but she’s really helpful in showing me what life is really like for the Batswana.

She was explaining how there’s a very different attitude towards raising children and extended families. Its not uncommon for children to live with a grandparent or aunt/uncle. There’s also a very high rate of teen pregnancy, because not as many people talk about birth control in high school. But also the proportion is high because Botswana just has a tiny population overall (1.6 million in the whole country…around the population of Philly), so just like with AIDS, there’s a higher rate even if the total number is smaller than many countries.

She was also telling me about schooling and employment here. Primary education and sending kids to kindergarten is difficult it is because you have to pay school fees. But also even for the students that make it through UB (the only university in the country) or who go abroad for education and come back, employment prospects are limited because there just aren’t a lot of opportunities in the country. For example, if a student graduates as a chemistry major or anything in science, one of the only things that he/she can do really is be a high school science teacher, or maybe a university professor if they have a graduate degree. There aren’t really any science research companies based here, which is why a lot of people end up doing something else or going abroad. That’s sad because there’s a lot of potential that’s not being utilized, and if there’s one thing that would help countries develop it would be science.

She also told me about her cousin who has Downs Syndrome because I was telling her about Erin and how I was sad I was missing Special Olympics this weekend. There are basically no resources at all for people with special needs here. There is 1 school in the whole country and its in Ramotswa, which is about an hour out of Gabs and she says its too crowded. Carol’s cousin didn’t really go to school because they live in a rural village but her family did the best they could and taught her life skills like cooking and things. It was hard to hear because I think of Erin and all the disabled people I know and know that as much as they struggle everyday, they would have a much harder life with a less hopeful future if they lived in a different country.

It was a great day and it was good to see the other side of Gaborone. The longer I stay the more I feel at home here and I love it!

Choppies Dinner

On Saturday all the Penn interns went to dinner at the house of the owner of Choppies. Choppies is a chain of discount grocery stores in Botswana and South Africa. The owner is really good friends with the director of the UPenn-Botswana Partnership and his son is going to be a freshman at Penn (Wharton) next year. So he invited all the interns over for a dinner at his BEAUTIFUL house in Mokolodi, which is a village outside of Gaborone with beautiful large houses and a game park.
To get to the house Zein (the director of BUP) drove us in his pickup truck. Obviously there wasn’t room for all of us to sit in the cab of the truck, so some of us rode in the bed of the truck. I felt kind of rebellious doing that, since my dad’s had pickup trucks all my life and I’ve never been allowed to. Though totally illegal in the states, I have to say it was the most amazing way to drive out of the city. It wasn’t too cold that night and we were sitting back and when we got to the pitch black road outside of Gabs I saw the most amazing stars I’ve ever seen. There were so many and you could even see part of the Milky Way – it felt like being in a planetarium.
When we got there we met the whole family and saw they’re beautiful house. The owner of Choppies is Indian. There’s actually a pretty sizable Indian population here and it reminded me of Aashna. They fed us SO much food! First we had little appetizers, then they started to bring out TRAYS of meat like chicken, sausages, pork, and lamb, from the Braai, which is a South African style bbq. I thought that was the meal so I ate a lot. However, after I was already stuffed we learned that this was just the warm-up for the actual dinner, which was amazing Indian food. I ate so much I could barely move.
We told the owner’s son all about Penn and gave him all the ins and outs on what to do and not to do as a freshman. We also watched the US/England game. Though it got off to a rough start (we almost cried when England scored in the first 3 MINUTES) we were satisfied that we at least tied.
It was a great night!

See if for Yourself

Its safe to say that I learned more about global health this week than I have in 2 years of studying it at Penn.

This week Vernon and I got to go on official inspections. We were supposed to leave on Monday, but there was a logistical issue with our transport. So we arrived at 7 am like we were supposed to, then we heard our combi was in the shop & wouldn't be ready until 10. 10 came and we heard it wouldn't come until 12. At 12 we were told we couldn't go that day so we could just go home. Yet another TIA moment. The lady leading our team, who was very flustered, said, "This is Africa, yes? You are learning! We're in a first world building but there is still a third world mentality. " We just rolled with it.

It was cool to really get out of Gaborone, which is reasonably modern, though not very big. When you get out of the city you can see the real Botswana, which is incredibly rural and very sparsely populated. There are donkeys, cows, and goats, all on the side of the road and you can go forever between seeing houses. We got to see a lot of it on the road to Good Hope, which is a town about 2 hours southwest of Gabs. Its a very small town in a pretty remote area. I think a description of it can best be described by our team leader: "Why would they name this place Good Hope? Look around, the conditions are not good and there isn't really much hope."

We were going on inspections of the Goodhope Primary Hospital and the Digawana Clinic. The purpose of the inspections is to go through the hospital/clinic and see if they are providing care which is up to the standards that the Ministry is trying to establish. The goal is to use them to improve the quality of healthcare being delivered to Batswana. On these inspections the officials from the Ministry meet with the hospital management to discuss all types of issues and then each individual department/aspect of the facility is evaluated.

Vernon and I weren't really sure what our role was going to be in these inspections, but it was an incredible experience because not only did we get to sit in on the meetings with the management and hear what they had to say and go with some of the health inspectorate officials, we actually got to evaluate some of the departments as inspectors and our evaluations are being used in the official report. "This is where I throw you in the ocean and you learn how to swim," is what the team leader said to me. So at the primary hospital I was responsible for evaluating the maternity ward, the operating theatre, and the central supplies and sterilization unit. At the clinic I did the consultation room and the resuscitation trolley.

Things I observed absolutely blew my mind and I learned so much. Its different seeing pictures of hospitals in developing countries and reading about them and actually being there. The lack of resources is appalling and so much is just improvised. They're also incredibly understaffed (the primary hospital only has 2 doctors). We got to talk to a lot of the nurses and hospital management, and it was clear that the staff is trying their best and is extremely dedicated, but they're constrained because there's not a lot of space in the hospital and they don't have a lot of the supplies they need. For example, there's only 1 suction machine in the whole hospital and its shared by the Operating Theatre and the Maternity ward. So God forbid a newly delivered baby needs suction while someone's in surgery.

I was also able to see and hear some really interesting things about "Global Health" as its experienced here. Global health programs are very evident in the health facilities: there's UNAIDS posters on the wall about "The 5 D's of Pallative Care" and things of that sort as well as handouts made by USAID and WHO. We also visited the AIDS center at the hospital, which was in a trailer and was markedly nicer than the facilities in the rest of the hospital. I'm told that its because the center, like so many others here, are built by Americans with PEPFAR money. It makes me wonder more about how programs that are meant to help people are spending their resources and if all the money spent producing these posters (paying the graphic designers, printing costs, shipping costs, etc.) couldn't be better spent on something else the facilities need for primary health care, which would help more of the citizens. They also talked a lot about ways to raise funds, because the only way to address a lot of the issues at the hospital is to expand and relocate it since the facility is inadequate in itself. Also, a lot of the equipment they need is expensive and the Ministry has a limited budget. They're talking a lot about looking for private donors to help boost that. Its not within my job capacity at the Ministry to help with that, but its interesting to see how people are looking for solutions.

Needless to say, I had a lot to reflect on on the 2 hour drive home each day. This week was an emotional roller coaster: from shocking when I first entered the hospital and started to my inspections, to inspiring because of the dedication of the Batswana staff working there and the fact that I think this knowledge will make me better able to help improve the situation in my work in the future. It was a great experience!

The Legit Khale Hill

We spent Sunday afternoon taking advantage of the gorgeous sunshine and climbed the LEGIT Khale Hill.

Linda and Cat joined our group this time, making for a grand total of 5 people, so we called Tim, the best cabby in the world.

I will pause here for a second to describe how taxi's work in Botswana. They're a major source of transportation for us poor Americans who can't drive here. There are some actual cab companies, and some of them are labeled with a small sign that says "taxi" on the top of the car, but most cabbies are just guys with cars who decide to be taxi drivers. When taking one back from the mall you tell them where you want to go and they tell you the price (usually about 25 pula) and then you go. To go anywhere from UB we have to call one, which means that when you find a good one you like with good prices you get his number and call them when you need to go anywhere. It can be chaotic calling one if the guy you want is busy and sometimes they can take a while to show up.

Tim is my new favorite cab driver. He's a great guy that Alex found through some of the docs he works with at the Baylor Clinic. His prices are great and the best thing is he has a mini van. He took us to Khale Hill, and since the actual path still has a pretty ambiguous entrance, he decided to walk with us to make sure is was the right path. He ended up hiking the WHOLE thing with us and leading us to the top, practically running even though he was in sandals. Tim's the man.

It was a strenuous but awesome hike, very steep but there was no vegetation cutting my legs and there was a defined path (even a road!). I definitely got my exercise! The sunshine was beautiful but it got hot. Thankfully I was wearing my SPF 50! I can't believe its winter here.

The view from the top was breathtaking! I went out on the very edge because I have a death wish, but when you do that you really feel like you're on top of the world. You can see just how much development has been done in Gabs and how vast it is, but you can also see all the hills around and how they and the clear blue sky reflect in the reservoir. Gorgeous!

Child-Like Faith

"Now faith is the substance of things hoped for, the evidence of things not seen." Hebrews 11:1

This Bible passage, apart from being one of my all time favorites, was the starting point for the sermon I heard on Sunday.

Alex and I decided to go to church with Carol. She goes to a Pentecostal church in the village of Mogoditshane which is about 45 minutes outside of Gabs. It wouldn't take that long, except that we were taking combis. We had to take one combi from UB to the combi station and then transfer to another one to take us to the village.

Maybe this would be a good time to explain what combi's are. They're these little minibuses that are used for transportation here. They have about 4 rows and people are packed in like sardines. I can’t imagine taking them during the summer, when the temperature can be about 40 degrees Celsius! They always cost 2.70P (about 40 cents). It was great to get out of Gabs and see some of village life and how many Batswana live.

It was an amazing experience and a really moving (though admittedly very long) service. Religion is a huge part of life for most Batswana. Almost nothing is open on Sundays, because everyone is in church. Christianity is the dominant religion, though many denominations are present, ranging from African to the more traditional Protestant denominations to Roman Catholic. The service was in English. Well sort of. The preacher would speak and immediately the interpreter would follow it with a Setswana translation. It was chaotic at first but fine when we got used to it. The praise and worship was great, with some amazing gospel music. I've never been to an actual Pentecostal service though, and my Catholic upbringing still leaves me unfamiliar with speaking in tongues and the type of charismatic worship that was there, some of which was uniquely African (the types of crying out for example), but it's extremely inspiring to be around so much faith and you definitely feel moved by the Spirit.

The sermon was extremely long, but very good and gave me some material for spiritual meditation this weekend. The theme was "child-like faith": humbling oneself and trusting in God. It was about doing what he is calling you to do with utmost faith and not allowing for our adult minds to worry or doubt, but to put trust in the fact that, ultimately, His plan will be put in place and everything will work out for the best. This spoke a lot to me, since worrying is something I tend to do a lot. I've seen way too many miracles in my life not to have faith, and its the reason I still have my religion as a big part of my life. I know it's always important to turn to God and trust Him to take care of it and place me where I'm meant to be, with the people that are meant to be in my life, and doing what I'm meant to do. J

Horseback Safari!

Saturday was a lot of fun! The weather was gorgeous, so after a nice run around the border of UB's campus and a relaxing lunch at Nando's (Peri-Peri Chicken!!!) Alex, Michelle, and I went to the Mokolodi Game reserve for a horseback safari.

My horse's name was Melody and she was pretty awesome. Alex had a really old horse named Savannah though and she was less than awesome, meaning she ran him into a bush of thorns and made his lip bleed. Poor guy. We didn't see too too many animals, but we were able to get really close to the ones we did see (wildebeest, warthog, impala, ostrich, and khudu) because we could just follow them off the trail. We also saw an absolutely amazin

g sunset and the Mokolodi game reserve is a beautiful place for a trail ride! Overall, it was a great way to spend a Saturday afternoon and $20.

Intercultural Girl Talk

So on Thursday night when the guys went out, the girls in my suite ended up having some girl talk, which was made so much more fun because Carol, our student guide from UB was hanging out with us. Carol just graduated from UB studying law. She is awesome and hanging out with her really helps me learn more about regular life in Botswana and give us insight that we might not get just hanging out with other ex-pats and foreign students.

She was able to explain some things to us and we had a fun time sharing stories about the guys who hit on us American students because she says they see us and they think money and the stereotypes of American girls they see on TV. She also was able to tell us more about how HIV has affected dating here, since Botswana has one of the highest HIV infection rates in the world. One of the Penn girls had a guy show her his HIV test booklet when he was hitting on her to show her that he was negative. Carol says that lots of guys do that now, and when they hit on you sometimes they ask you what you're status is, meaning HIV not whether you're single. But you still have to be extremely careful, since unless the test was done that day, you don't really know.

She also makes me feel really bad for complaining about internet, since she says she sometimes checks her e-mail only about once month. That's a complete shock to us American internet addicts. She says she doesn't really need it since everyone she wants to talk to is local and she can just call or text. We made her a Facebook last night though so she can talk to us when after we leave :) We also had fun showing her our favorite ridiculous Youtube videos, since she had never seen them before.

She's also never seen snow or the ocean. She thinks snow is cold but she's scared of how cold it is, since she thinks its unbearable when it gets down to 45 F at night during the winter. I wish she could come visit us in America, which she wants to. But its so expensive; I mean I wouldn't be able to afford to travel that far without Penn providing a stipend for my flight and lodging. UB is only able to help a couple students every year go abroad, and its very competitive and difficult.

Anyway, Carol is definitely one of my new favorite people. It's my goal to be able to say her last name correctly, because her tribe uses clicks in their language and its very hard for my American mouth to say!

Frustrations and Why They're OK

So I’m not going to lie, I was feeling pretty frustrated yesterday.

At work we started creating a health facility database. This is really important since it counts how many hospitals, clinics, and rural health posts are in each district and how many specialists/doctors/nurses/hospital beds they have. This will allow the inspectorate to look more closely at issues of access and manpower.

The document Dr. Moffatt gave us that was supposed to contain the data was an absolute cryptic mess. Even after we deciphered what was a town/city and what was a district and which of the facilities were clinics we realized that we needed more information. Dr. Moffatt wrote up a great little memo for the Health Statistics Office detailing what information we needed.

We went up there and met with the head of that department, a great woman who gave us a whole background on the procedures of health statistics gathering and dissemination. However, the information they gave us was still missing a lot of what we needed. There were no breakdowns by clinic or village and most of the statistics were from 2006 and districts have been remapped since then. You also can’t just e-mail a rural health post and ask them how many nurses work there, especially when you still don’t have internet access.

Which brings me to my next frustration: internet or lack thereof. My internet clearance at work still hasn’t come through and they say it probably won’t until the end of next week at the earliest. Keep in mind I work at the Ministry of Health, one of the nicest government buildings in the country. You would think I could get internet there. Also, despite her best attempts, Carol still hasn’t been able to get us internet in our rooms and I still can’t even get it in the library. Worse is that the IT office closes at 4:30, which is when I get out of work, as does the Botswana-UPenn Partnership office which has free Wi-Fi. Its frustrating to still not have it when we are told we’re supposed to and I keep having to spend my money on internet cafes which are far away and pretty slow.

But these frustrations are all ok. Actually I think they’re kind of good in a way. Internet is a luxury that I should not be whining about. I think it’s the fact that the program gave us the assurance that we would have it that irks me; if I had come in expecting not to have it I think I’d be fine. I mean I had no internet for the first 2 weeks of summer last year and at the time I also had no bed, and was not in Botswana, so I think I’m moving up in the world. As inconvenient as it is, it’s a little liberating not to check it 24/7, and I’m doing much more reading.

As for work, we’re just going ahead working with what we have and writing up a report to go along with the database, noting the discrepancies and missing information and making recommendations for further investigation. Working in policy of any kind means dealing with bureaucracy, and even when everyone’s trying their best, sometimes the numbers just aren’t there. When we analyze the data that we do have it puts a lot of things into perspective.

For example:

· Most rural health posts in Botswana have only 1 or 2 people on staff, both nurses. They also have no beds and can only provide most basic care and send people home/somewhere else.

· Clinics are usually just 4-8 nurses and maybe 1 MD. Some have beds (meaning babies can be delivered there) but many don’t.

· Primary hospitals often only have about 3-6 MDs on staff total

· There are only 2 "referral hospitals", which offer the highest standard of care: one in Gaborone and in the other city of Francistown.

Herein lies the difficulty of delivering healthcare in rural areas of a developing country. People are very spread out except around the cities and that makes it hard to reach them. I just let the fact that the assignment is a challenge motivate me more and we finished today having done the best we could J